Executive Order Expands Mental Health Benefits to Combat Veteran Suicide

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mental healthy

By Debbie Gregory.

“Supporting our Veterans during their Transition from Uniformed Service to Civilian Life” is an executive order that aims to reduce veteran suicides.

Focusing on soon-to-be former service members, all recently separated veterans (except those with a bad paper, less than honorable discharges) will be entitled to one year of mental health screening. The VA launched a separate program offering emergency mental health services for veterans with bad paper discharges.

Beginning March 9th, transitioning veterans will receive one year of mental health care through the Veterans Health Administration, either at a VA facility or at a private facility, based on wait times where you live.

“As service members transition to Veteran status, they face higher risk of suicide and mental health difficulties,” said Secretary of Veterans Affairs David Shulkin. “During this critical phase, many transitioning service members may not qualify for enrollment in health care.”

This means that VA mental health care will now be available to the 60% of transitioning veterans who are currently ineligible for long-term VA medical benefits, usually because they didn’t serve in a combat zone or don’t have a verified service-connected disability.

Signed by President Trump, the order requires that within 60 days of the January 9th signing, “the Secretary of Defense, the Secretary of Veterans Affairs, and the Secretary of Homeland Security shall submit to the President, through the Assistant to the President for Domestic Policy, a Joint Action Plan that describes concrete actions…” that will address access and resources to address the suicide issue.

Within 180 days, a status update on the Joint Action Plan must be submitted to the president.

Military Connection salutes and proudly serves veterans and service members in the Army, Navy, Air Force, Marines, Coast Guard, Guard and Reserve,  and their families.

IRRRL Facts for Veterans

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homeowner

By Debbie Gregory.

The Department of Veterans Affairs (VA) is often praised for the education benefits given to those who have served. But just as important, the VA strives to help servicemembers, veterans, and eligible surviving spouses obtain veteran home loans so that they may become homeowners.

An Interest Rate Reduction Refinancing Loan (IRRRL), often referred to as a “Streamline” or a “VA to VA” loan is a great option for providing veteran home loans.

A VA veteran loan provides a home loan guaranty benefit and other housing related programs to help buy, build, repair, retain, or adapt a home for personal occupancy. These loans are obtained through private lenders such as banks and mortgage companies. The VA guarantees a portion of the loan, enabling the lender to provide more favorable terms.

Except when refinancing an existing VA guaranteed adjustable rate mortgage to a fixed rate, it must result in a lower interest rate. When refinancing from an existing adjustable veteran home loan to a fixed rate, the interest rate may increase.

To decide whether it is beneficial to refinance your veteran home loan, the general rule of thumb is that if you can refinance and reduce your interest rate by 1% then it is something worth considering. However, it’s important to consider other factors, such as closing costs and how long you plan on living in the property.

An IRRRL may be done with “no money out of pocket” by including all costs in the new loan or by making the new loan at an interest rate high enough to enable the lender to pay the costs, but you must NOT receive any cash from the loan proceeds.

The occupancy requirement for an IRRRL is different from other VA veteran home loans. When you originally got your VA loan, you certified that you occupied or intended to occupy the home. For an IRRRL you need only certify that you previously occupied it. The loan may not exceed the sum of the outstanding balance on the existing VA loan, plus allowable fees and closing costs, including funding fee and up to two discount points.  You may also add up to $6,000 of energy efficiency improvements into the loan.

One more thing to keep in mind is that an IRRRL can only be made to refinance a property on which you have already used your VA loan eligibility. It must be a VA to VA refinance, and it will reuse the entitlement you originally used.

Lenders are not required to make you an IRRRL, however, the lender of your choice may process your application for an IRRRL, and you do not have to go to the lender you make your payments to now or to the lender from whom you originally obtained your VA Loan.

Also keep in mind that the ability to reduce the term of your loan from 30 years to 15 years can save you a lot of money in interest over the life of the loan, if the reduction in the interest rate is at least one percent lower. But this will more than likely result in a large increase in your monthly payment.

Veterans are strongly urged to contact several lenders. There may be big differences in the terms offered by the various lenders you contact.

Military Connection salutes and proudly serves veterans and service members in the Army, Navy, Air Force, Marines, Coast Guard, Guard and Reserve,  and their families.

VA Faces Challenges to Implement “Forever” GI Bill

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forever gi bill snip

By Debbie Gregory.

The Department of Veterans Affairs has said it is facing problems implementing some parts of the Harry J Colmery GI Bill, better known as the “Forever GI Bill”.

Recently separated veterans may be getting inaccurate information about their education benefits in the mail, potentially causing “mass confusion” among veterans about their eligibility due to outdated IT systems, Veterans Affairs officials admitted.

The Forever GI Bill, which was signed into law in August, not only removes the 15 year time limitation that newer veterans have to use their GI Bill, but it also gives back GI Bill entitlement to some veterans who were in schools that closed mid-term. The new regulation gives back any GI Bill that was used to take classes that resulted in no academic credit due to no fault of the veteran. This part of the law is retroactive to 2015 and affects over 8,000 veterans.

Although the VA has reached out to veterans eligible for this benefit, only about 250 of the affected veterans have applied for the restoration of their GI Bill.

Additionally, it extends benefit eligibility to more guard and reserve members, and it creates a new program for STEM students in addition to 30 other changes.

To meet the goals of launching the program, the VA will and spend some $70 million and hire 200 temporary workers to manually process claims until they can get their software changes implemented.

The VA is trying to avoid encountering problems like those that occurred back when the Post-9/11 GI Bill began in 2009. At that time, the VA got so backlogged in making payments they were forced to issue emergency checks of up to $3,000 to veterans who had waited months for their GI Bill payments.

The Forever GI Bill contains the most sweeping expansion of veterans education benefits in a decade. Most of the bill’s provisions go into effect Aug. 1, 2018.

Military Connection salutes and proudly serves veterans and service members in the Army, Navy, Air Force, Marines, Coast Guard, Guard and Reserve,  and their families.

Merger of VA and DoD Health Systems Being Considered

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vatricare

By Debbie Gregory.

The Department of Veterans Affairs (VA) provides healthcare to veterans through medical centers and clinics owned and run by the federal government, although veterans can also see private doctors through the Choice if VA wait times are too long. The Department of Defense provides healthcare to current servicemembers, retirees and their families through TRICARE,  insurance that is paid for by the government and uses private doctors and hospitals.  But soon, the two may be one and the same.

The VA generally serves older, sicker veterans, while TRICARE’s patients are generally healthier.

VA Secretary David Shulkin has been exploring the option of integrating VA and Pentagon health care. This follows the VA’s planned adoption of utilizing a similar electronic health record (EHR) platform as the Defense Department’s MHS GENESIS.

“VA’s adoption of the same EHR system as DoD will ultimately result in all patient data residing in one common system and enable seamless care between the Departments without the manual and electronic exchange and reconciliation of data between two separate systems,” said Shulkin.

Since an overhaul of VA’s EHR won’t be completed for another seven to eight years, a TRICARE merger would more than likely take at least as long.

News of the plan is worrying various veterans groups. The American Legion, Veterans of Foreign Wars, AMVETS and Disabled American Veterans have expressed that a TRICARE merger is likely to be a “non-starter” if the goal is to transform VA care into an insurance plan.

Louis Celli, director of veterans’ affairs and rehabilitation for The American Legion, said outsourcing services away from the current VA system via its medical centers and clinics would be financially unsustainable.

Bob Wallace, the executive director of VFW’s Washington office  said that his organization  would oppose any effort to reduce the VA’s role of providing care for veterans.

What do you think?

Military Connection salutes and proudly serves veterans and service members in the Army, Navy, Air Force, Marines, Coast Guard, Guard and Reserve,  and their families.

Colorado VA Used Forbidden Lists of Patients Wanting Mental Health Car

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Denver VA

By Debbie Gregory.

A Veterans Administration (VA) investigation has revealed that VA facilities in Denver, Golden and Colorado Springs failed to follow proper protocol when keeping tabs on patients who sought referrals for treatment of mental health conditions such as post-traumatic stress disorder.

The “off-book” lists did not always contain complete information or request dates, calling into question whether veterans requesting care received it and how long they had to wait for it.

Unofficial wait lists have been used by VA health care facilities elsewhere. The discovery of the lists created a nationwide scandal in 2014 when 40 veterans died while waiting for appointments at a Phoenix VA hospital.

Whistleblower Brian Smothers said the problems found in Colorado reach across the VA system. He worked on the VA’s PTSD support team in Denver and said he resigned in November 2016 after he was retaliated against for speaking up.

Smothers alleges that Colorado VA facilities in Denver and suburban Golden used unauthorized wait lists for mental health services from 2012 until last September. He said the longer that veterans have to wait for mental healthcare, the less likely they are to use it when it becomes available.

“It was totally unacceptable to me,” he said.

Smothers estimated the lists contained 3,500 entries but did not know how many individual veterans were on them because some names appeared multiple times. It was not immediately clear how long veterans on the lists had to wait for care.

Unofficial wait lists have been used by VA health care facilities elsewhere. The discovery of the lists created a nationwide scandal in 2014 when 40 veterans died while waiting for appointments at a Phoenix VA hospital.

According to Smothers, “VA management knew that these wait lists were absolutely forbidden.”  “But they directed the use of these wait lists anyway.”

Military Connection salutes and proudly serves veterans and service members in the Army, Navy, Air Force, Marines, Coast Guard, Guard and Reserve,  and their families.

Allegations of Skimming Impacts VA’s Private Healthcare Providers

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By Debbie Gregory.

TriWest Healthcare Alliance and Health Net Federal Services, the companies charged with administering private health care options for veterans, are both under investigation for over-billing the government by tens of millions of dollars.

The Veterans Access, Choice and Accountability Act, expected to cost taxpayers $10 billion has come in closer to $12 billion to date, and that between the two companies, they have collected at least $89 million more than what they were supposed to.

The VA Choice program was launched during a very rough time for the VA Health System, when allegations of misuse, misconduct, claim backlogs and long wait times for veterans seeking treatment at its facilities were every day occurrences. It was created as an emergency stopgap to serve patients who were waiting weeks or months to see doctors in a backlogged VA healthcare system.

To alleviate part of the problem,  if the VA is unable to schedule an appointment for a veteran within a month, or if a veteran lives more than 40 miles from one of its clinics, they can access a network of private clinicians and hospitals managed by TriWest and Health Net.

An audit revealed that both companies billed the VA for more than what they paid medical providers, charged different rates other than what was contractually set up, submitted duplicate bills for the same services, and billed for medical services already covered by private health insurance.

TriWest maintains they have done no wrong, blaming the VA’s billing system for the overpayments. But this isn’t the first time TriWest has been investigated for mismanaging government funds. In 2011, the company paid the Justice Department $10 million to settle a lawsuit that the company systematically defrauded the government.

Inspector General Michael Missal estimated that, in duplicate payments alone, Health Net and TriWest overbilled taxpayers by $89.7 million.

Health Net was instructed to reimburse $50.8 million; TriWest allegedly owed $38.9 million.

Both TriWest and Health Net’s current contracts will run for the next 10 months.

Military Connection salutes and proudly serves veterans and service members in the Army, Navy, Air Force, Marines, Coast Guard, Guard and Reserve,  and their families.

$2.3 Million Settlement in Marine Veteran’s Death

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jason and heather

By Debbie Gregory.

Former Marine Jason Simcakoski was 35 when he died in 2014 at the Tomah VA facility. His death uncovered a reality of overprescribed opioid painkillers at the facility.

From 2006 to 2014, Simcakoski had been treated for a variety of conditions. He was admitted to the Tomah VA’s psychiatric unit on Aug. 10, 2014. Less than three weeks later, he was found unresponsive. It took 10 minutes for life-saving CPR to begin, but by then, it was too late.

An autopsy revealed that Simcakoski died from mixed-drug toxicity.

The government reached a $2.3 million settlement with Simcakoski’s survivors , namely his widow Heather and daughter Anaya.

Simcakoski’s death led to the passage of the Jason Simcakoski Memorial and Promise Act, a law aimed at improving the way opioid medications are used in treating veterans, improving patient advocacy by the VA Secretary, and expanding the availability of complementary and integrative health.

An inspector general’s report in 2015 found that Tomah VA doctors commonly over-prescribed opioid painkillers, earning the facility the nickname “Candy Land.” Tomah VA’s chief of staff, Dr. David Houlihan, was fired and permanently surrendered his medical license.

Simcakoski was never advised of the risks associated with the medications he was given.  Additionally, the delays in the start of CPR and the lack of medication at the Tomah VA to reverse drug overdoses contributed to his death.

Heather Simcakoski, who is also a Marine Corps veteran, says there was a point when she didn’t know it was possible to move forward. But now she is ready to dedicate a significant amount of her time to the new project she and daughter Anaya are getting ready to launch that will give back to veterans and their families.

Military Connection salutes and proudly serves veterans and service members in the Army, Navy, Air Force, Marines, Coast Guard, Guard and Reserve,  and their families.

Lawmakers Want to Reduce the Number of VA Facilities

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By Debbie Gregory.

The Department of Veterans Affairs and the House Committee on Veterans’ Affairs are taking a hard look at VA facilities across the country to determine which ones have been outlived their usefulness. Many aging and underused facilities could be subject to closure.

Department of Veterans Affairs Secretary David Shulkin said that the agency is considering a plan to close more than 1,100 facilities across the country, given that the VA continues to allow a larger number of veterans access to private sector health care.

Shulkin told a House hearing that the department has identified 735 underused facilities. There are also 430 empty buildings, most of which were constructed around 90 years ago.

Committee Chairman Rep. Phil Roe, R-Tenn., and Rep. Tim Walz, D-Minn., the ranking Democrat, want to create a paid commission to recommend which facilities should be closed.  Their bill, the Asset Infrastructure Review Act (AIR) is in its early stages. As it is currently written, the bill would require Shulkin publish the criteria to be used in choosing which facilities to close, modernize or realign in the Federal Register by January 15, which is less than two months away.

Shulkin said the VA and Congress would work together to review buildings for possible closure, possibly using a process like Base Realignment and Closure (BRAC), which the Pentagon has used in the past to determine which underutilized military bases should be closed.

But the BRAC process has been controversial, raising concerns among members of Congress about the negative financial impact of closing military bases in their districts.

Military Connection salutes and proudly serves veterans and service members in the Army, Navy, Air Force, Marines, Coast Guard, Guard and Reserve,  and their families.

Higher Disability Ratings for Service-Connected Injuries

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sharp

By Debbie Gregory.

Sharp v. Shulkin may be a game-changing decision for many disabled veterans who suffer from injuries to the back, neck, and joints.

Many veterans file claims for disabilities that, while chronic, are worse on some days than on others. So, while on a typical day a veteran with a disability may experience pain in the 3 or 4 out of 10 range, on another day when the veteran experiences a flare-up of his condition, he may experience 10/10 pain. Not observing the impact of a flare-up on the veteran’s functionality could result in a drastically lower rating for the veteran’s disability.

Bobby P. Sharp, a Korean War veteran who suffers from numerous musculoskeletal injuries, argued in his lawsuit that the VA medical examinations he received were inadequate because he was never asked about the frequency, duration, characteristics, severity, or functional loss when he was having a flare up that resulted in 10 out of 10 pain.

The court agreed that the system was inadequate, and now the VA must now ensure that Compensation and Pension (C&P) examiners do not overlook flare-ups and pain when assessing a disabled veteran.

The ruling also specified that the VA must try, whenever possible, to schedule the C&P examination when the veteran is experiencing a flare-up.

If that is not possible, the veteran can submit evidence for consideration, such as their own description of the flare-ups and pain they experience, or they can submit a “buddy statements” from a person who knows the veteran and can testify to the extent of their suffering.

Hopefully, this decision will make it easier for veterans to receive a higher disability rating for injuries sustained while in the military. This gives precedent for other veterans who want to challenge their disability ratings.

Military Connection salutes and proudly serves veterans and service members in the Army, Navy, Air Force, Marines, Coast Guard, Guard and Reserve,  and their families.

Is TRICARE Fee Restructuring a Good Thing?

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tricare

By Debbie Gregory.

The three region TRICARE system will soon be history as TRICARE divides into two regions: Tricare East and West, with East being managed by Humana Military and West falling under Health Net Federal Service. But there are other, bigger changes in store for the new year.

The Defense Health Agency (DHA) has announced a fee restructuring in 2018 that will impact all plans except Tricare for Life, the military’s supplemental insurance to Medicare for those over 65 or disabled retirees.

TRICARE Standard, the fee-for-service insurance option, and TRICARE Extra, the preferred provider option, are being replaced with TRICARE Select. Select is supposed to combine features of both. Meanwhile, the managed care option, TRICARE Prime, will not change.

The size of the new fixed fees unveiled for TRICARE Select did come as a bit of a surprise, as they are higher than appointment fees planned for new enrollees.

Last year when the DHA proposed new TRICARE copayments, Congress voted to insert a grandfather provision for existing TRICARE participants, and a separate fee schedule for new entrants in 2018 and after. Defense health officials urged the repeal of the grandfather provision so that TRICARE wouldn’t have two sets of fees, as well as an inequity in the cost. Further complicating the situation, the new method of calculating appointment fees has resulted in the copayments for the grandfathered group coming in higher than for the non-grandfathered group.

This means that many new entrants who join after Jan. 1, 2018, will be paying less than current beneficiaries, who should be paying less. For example, a grandfathered active duty family member’s cost for an in-network primary care physician visit will be $27, and a specialist visit will cost $34, while a new entrant family member will pay $15 for the primary care visit, and $25 for the specialist.

Since this is having the opposite affect than was intended, it seems as though someone needs to go back over the plan and make adjustment so that those who are already relying on their health benefits aren’t penalized.

Military Connection salutes and proudly serves veterans and service members in the Army, Navy, Air Force, Marines, Coast Guard, Guard and Reserve,  and their families.