Introduction to VA Health Care Biggest health care organization in the nation 54 hospitals in 1930, 168 medical centers and 1,053 outpatient sites today At least one in each of the 48 contiguous states, Puerto Rico and the District of Columbia. Roughly 60% of all medical residents receive a portion of their training at VA hospitals Using electronic patient records since before 1985.

Where do our region’s veterans go for care? CommunityBased Outpatient Clinics Alamogordo Northwest Metro Artesia Raton Durango, CO Santa Fe Espanola Silver City Farmington Taos Gallup Truth or Consequences Las Vegas

Eligibility for VA Health Care To be eligible VA health care you must have: 1. Been discharged from active military service under conditions other than dishonorable. 2. If you were a National Guardsman or Reservist, you must have served the entire period for which you were ordered to active duty. It can’t be just for training purposes. 3. Served a minimum of 2 years if you enlisted after Sept. 7, 1980 or entered active duty after Oct. 16, 1981.

Priority Groups VA set up Priority Groups to serve Veterans who need care the most before serving other Veterans. Priority Groups determine co-pay status, access to some specialty services, financial test status. Under the medical benefits package, the same services are generally available to all enrolled Veterans.

Priority Groups Major factors considered for group assignment: Service-connected disabilities Military honors/medals earned Receipt of VA pension benefits Medicaid eligibility Combat operations involvement Exposure to hazardous environments Income

Income Limits All Veterans with a compensable service-connected disability are eligible for basic health care services, regardless of income. Income is based on prior calendar year. Veterans may apply for hardship consideration if income changes within past year. Income thresholds change yearly. “Geographic” thresholds by state and county.

Annual Income Limits (2017) Above numbers reflect Eligible for reduced inpatient copays (80% reduction) and Cost Free Medical Care. 10% above require copayments County Veteran Only +1 Dependent +2 Dependents +3 Dependents Bernalillo $34,550 $39,450 $44,400 $49,300 Lincoln $29,100 $33,250 $37,400 $41,550 Santa Fe $36,200 $41,400 $46,550 $51,700 Socorro $28,400 $32,450 $36,500 $40,550

Core Skills Integration: J/K student Guide How to Apply for Care Complete VA form 10-10EZ. Get form by visiting, calling, or writing any VA health care facility or Veterans’ benefits office. Can also call toll-free 1-877-222-VETS (1-877-222-8387) or get online at http://www.va.gov/1010ez.htm VETERANS MUST BE ENROLLED TO USE VA HEALTH CARE BENEFITS Mention they may have a co-pay and reference benefits book page 6 Did NOT address priority groups (book page 12)

VA Medical Services Outpatient and Inpatient medical, surgical / specialty and mental healthcare. Prescription drugs, including over-the-counter drugs. Bereavement counseling for immediate family members.

VA Medical Services Comprehensive rehabilitative care. Durable medical equipment and prosthetic and orthotic devices. Optometry exam and hearing exam Pregnancy and delivery care Decedent benefits, including memorial flags, headstones, burial allowance, etc.

Extra Qualifications or Authorization Services Requiring Extra Qualifications or Authorization Home health care services. Respite, hospice, and palliative care. Payment of travel and travel expenses for Veterans. Emergency care in non-VA facilities, if authorized. Hearing aids, visual aids/eye glasses Dental care (to eligible Veterans)

Copayments apply unless: Veteran is 50 % or more SC Treatment is for a service-connected condition Veteran’s income is less than the VA pension rate/annual household income thresholds established by Congress

Copayments for Medications Medication Copayments changed to a tiered system effective February 27, 2017. Tier 1 drugs (preferred generics) $5 Tier 2 drugs (non-preferred generics) $8 Tier 3 drugs (brand name drugs) $11 (Veterans in Priority Groups 2 through 8 are limited to $700 annual cap)

Copayments for Outpatient Services Basic Care Services (PCP) $15 / visit Specialty Care Services $50 / visit Copayment amount is limited to a single charge per visit regardless of the number of health care providers seen in a single day. The copayment amount is based on the highest level of service received.

Copayments for Inpatient Services Priority Group 8 Inpatient Copay for first 90 days of care during a 365-day period $1,316 / each additional 90 days of care during a 365-day period $658 / Per Diem Charge $10/day

Copayments for Inpatient Services Priority Group 7 Inpatient Copay for first 90 days of care during a 365-day period $263.20 each additional / 90 days of care during a 365-day period $131.60 / Per Diem Charge $2/day

VA Care and Other Health Plans VA is required by law to bill any health insurance company that provides coverage for Veterans, except for service-connected issues, including policies held by a spouse. Money recovered is a necessary part of the New Mexico VA operating budget. VA does NOT make the Veteran pay more than what is collected from the insurance company.

Authorized Non-VA Care 38 U.S.C. 1703 Available to Veterans under specific circumstances. (after clinical and administrative review) Must be pre-approved (except for emergencies, notice of hospitalization must be given to the VA with in 72 hours). May include inpatient or outpatient care. Consult VA’s Non-VA Care department to determine specific eligibility.

Who Qualifies for Choice Program You are eligible if any of these situations apply to you: You have been (or will be) waiting more than 30 days for VA medical care CID You live more than 40 miles away from a VA medical care facility or face one of several id excessive travel burdens. The VA can not provide the care. (Non-VA)

Authorizations for Choice Must be pre-authorized by VA based on eligibility and clinical criteria Care must be considered medically necessary, and within the scope of VA medical services Veterans must call the Choice Program Call Center to “Opt-In” for care and arrange non-VA appointments Treatment includes any follow-up appointments, as well as any ancillary and specialty services Emergency care and urgent care not included.

Important VA Numbers toll-free: (800) 465-8262 New Mexico VA (505) 265-1711 or toll-free: (800) 465-8262 Enrollment Office Ext: 2741 Enrollment Fax (505) 256-2808 Non-VA Care Ext. 2707 Caregiver Hotline 1-855-260-3274 Veterans Crisis Line 1-800-273-8255 Homeless Veterans Call Center 1-877-424-3838 Veterans Benefits 1-800-827-1000 Choice Program Call Center 866-606-8198

Additional Information VA Healthcare Benefits: 1-877-222-VETS (8387) www.va.gov/healthbenefits/ Burial & Memorial Benefits: www.cem.va.gov New Mexico VA Healthcare System: (800) 465-8262 (Enrollment: ext. 2741)