The VA Clarifies Requirements for Aid and Attendance When in Independent

The VA rules and regulations are oftentimes unclear and ambiguous. So it is helpful when there is clarification from the horse’s mouth as to how to handle  certain situations. On October 26, 2012, the Department of Veterans Affairs issues a letter to the pension management centers to clarify the medical necessity requirement for those veterans living in independent living.

Independent living communities (ILs) are generally the large facilities with common eating areas, separate apartments, and availability of additional services to manage one’s Activities of Daily Living (ADLs). The residents are “independent” but can be cared for with more acute needs.

In the past, ILs were treated like assisted living but now there is some clear lines of demarcation that must be observed to qualify for the aid and attendance pension.

This is also very important for those already receiving the pension as each year the Eligibility Verification Report (EVR) must be submitted and this submission may cause ineligibility. Please contact the person that filed your claim to assure continued eligibility with regard to this new policy from the VA.

As now defined by the VA, custodial care assists individuals with ADLs which are “basic self-care and includes bathing or showering, dressing, eating, getting in and out of bed or a chair, and using the toilet.” The VA considers a facility to provide custodial care if it assists with at least 2 ADLs. Management of a person’s medications was previously used as an ADL but this has now been eliminated from consideration.

The bottom line is that the cost of a room and board at an IL will be considered a medical expense if the facility provides custodial care to the individual, OR the individual’s physician states in writing that in order for the claimant to reside in the facility he/she must have a separate contract for custodial care with a third party covering the required assistance with at least 2 ADLs. In the absence of one of the two options, the cost of the room and board will not be considered.

Anyone desiring a copy of the October 26, 2012 letter can contact me via email and I will forward a copy.

This entry was posted on Thursday, December 6th, 2012 at 5:11 am and is filed under Veterans.