Chapter 690-1 FEE FOR RESIDENCY IN A FACILITY OF THE GEORGIA STATE WAR VETERANS HOME
|(1)||The purpose of this rule is to implement O.C.G.A § 38-4-56, for the Veterans Service Board to provide for a reasonable fee for residency in and services provided by a facility of the Georgia State War Veterans' Home (SVH); to provide for a full or partial waiver of such fee based on economic need; such fee waivers shall be established on a sliding scale based on established criteria, including, without limitation, consideration of assets, income and other resources.|
|(2)||The philosophy of the Veterans Service Board for establishing a reasonable fee to be charged to veteran patients by the SVHs is the fee shall be directly related to and will not exceed the maximum value of the U.S. Department of Veterans Affairs (VA) Aid and Attendance (A&A) benefit for single veterans with no income, as established and periodically adjusted by the VA under the rules of Title 38 of the United States Code (USC).|
|(3)||O.C.G.A. § 38-4-56(b)indicates a primary focus for collection of any fees under this Code Section is the VA's A&A benefit as the primary example of an assignment source. Accordingly, the purpose of this rule is to establish and collect a reasonable fee based on the value of the VA's A&A benefit, as defined elsewhere in this rule.|
|(4)||The funds collected in accordance with this Chapter will be used to provide a place of residency for and services to the veteran patients of the SVHs, maintenance and operations of the SVHs, and to augment the funding of operations of the SVHs, which are primarily supported through state appropriations and VA per diem payments.|
|(5)||The purpose of the VA's A&A benefit is to assist veterans in paying the direct costs of their medical care. By federal law under Title 38 USC, the VA's A&A benefit is paid to the veterans and the veterans are responsible to pay the provider(s) of medical care for the care and services received.|
|(6)||In accordance with VA rules and regulations veteran patients of SVHs receiving VA pension benefits are able to file claims with the VA to obtain the A&A benefit. As part of those claims, the income verifications contain information on the amount of moneys paid for medical care by the veterans, regardless of providers, to include fees paid to SVHs. Thus, depending on the VA rules and regulations and approval by the VA, eligible veteran patients may get all or part of the fees paid to SVHs refunded back to them by the VA.|
For purposes of this rule (Chapter 690-1-1) the following terms and words shall have the meanings provided in this chapter.
|(1)||VA's A&A Benefit: All veteran patients of SVHs are eligible to receive the VA's A&A benefit ( 690-1-1-.01(2) ) because they are patients in skilled nursing homes/SVHs. The VA's A&A benefit is income based and is dependent upon the amount of income veteran patients have. This determines how much the value of the benefit is to be received by the veteran patients. In other words, veteran patients eligible to receive the benefit may not receive a cash payment of the benefit because they are "over income," up to the full amount of the benefit for which they qualify based on their income levels.|
|(2)||Admission Eligibility for Georgia's SVHs: Admission to and residency in Georgia's SVHs is available for the use and care of disabled war veterans discharged under other than dishonorable conditions. The term "war veterans" means any veterans who were discharged under other than dishonorable conditions and who served on active duty in the armed forces of the United States, or on active duty in a reserve component of the armed forces of the United States, including the National Guard, during wartime or during the period beginning January 31, 1955, and ending on May 7, 1975 (O.C.G.A § 38-4-50). However, a war veteran shall not be eligible for admission to Georgia's SVHs unless such war veteran has been a resident of this state for a period of at least five years immediately prior to application for admission (O.C.G.A. § 38-4-55). While payment of approved fees by veteran patients is a requirement to be and to remain residents of SVHs, O.C.G.A § 38-4-56 does not create a new criterion for admission to SVHs.|
|(3)||Daily Fee: The Daily Fee is based on the value of the VA's A&A benefit for a single veteran with no income, as determined by the annual VA schedule. For purposes of this rule the daily value of the VA's Pension with A&A benefit provided to a single veteran with no income, minus the daily value of the pension for a single veteran with no income, times 12 months, divided by 365 days will equal the Daily Fee. Example: X = ((Y - Z) x 12) / 365), where X is the Daily Fee, Y is the value of the VA's pension with A&A monthly benefit for a single veteran with no (zero) income, and Z is the value of the VA's monthly pension for a single veteran with no (zero) income.|
|(4)||Federal Poverty Guidelines: The U.S. Department of Health and Human Services Poverty Guidelines for the 48 Contiguous States and the District of Columbia is published periodically for use for various purposes. In this Chapter these guidelines will serve as a basis for determining eligibility to request a waiver from payment of the Daily Fee provided for in this Chapter. As used in this Chapter, these guidelines reflect gross income before deductions, taxes and other adjustments.|
|(5)||Residency: Veterans who reside at or live in SVHs as patients and receive medical care and services provided by the SVHs are considered residents of the SVHs and are subject to the payment of the Daily Fee, as provided for in this chapter. Residency begins on the days of admission of veterans to veteran patient status at the SVHs and ends when the veteran patients are permanently discharged from the SVHs or their death at the SVHs. Temporary discharges from the SVHs for medical or non-medical (leave) reasons will not terminate the residency of the veteran patients.|
|(6)||70% Service Connected Disabled Veteran Patients: Under current federal law, these are veterans who have been rated by the VA as 70% Service Connected Disabled, or higher, who are admitted as veteran patients of SVHs. Under current federal law, the VA per-diem payments to SVHs for the residency and care of these veteran patients in SVHs is payment in full; thus, based on this status Daily Fees cannot be charged to these veteran patients.|
|(7)||State Veterans' Home (SVH): This encompassing term is used in this Chapter and includes other similar terms, such as, State War Veterans Home, a facility of the State War Veterans Home, Georgia State War Veterans Home, etc.|
|(8)||Substantial Hardship: For purposes of this rule substantial hardship means a significant, unique, considerable in degree and large demonstrable economic suffering, adversity or misfortune to the veteran patients requesting waivers and/or their families, which impair the ability of the veteran patients and/or their families to provide for their economic viability.|
|(9)||U.S. Department of Veterans Affairs (VA): As used in this Chapter, the VA is the agency of the federal government that administers federal benefits for veterans, as provided for in federal law and rules and regulations. The federal benefits include, but are not limited to, the Aid and Attendance (A&A) benefit, compensation for service connected veterans, pensions for certain other veterans and per diem payments for a portion of the operating costs of SVHs.|
|(10)||Veteran Patient: As used in this Chapter, a veteran patient is a veteran who is a patient residing in and receiving medical services from a SVH.|
|(11)||Veterans Field Service Offices and Veterans Field Service Officers (VFSO): The Department of Veterans Service operates field service offices located at each of the SVHs, as well as other locations throughout the State of Georgia. Each of the field service offices is staffed with one or more field service officers. As used in this Chapter, the abbreviation "VFSO" may indicate either the field service offices or field service officers and the context of the sentence or paragraph will determine which usage of the abbreviation is being observed.|
|(12)||Waiver: Waiver means a decision by an the SVHs, or the Department of Veterans Service, based on substantial hardship, not to charge all or part of the Daily Fee to a veteran patient who is subject to this rule.|
|(1)||Fee Purpose. The purpose of the fee for residency in and services provided by SVHs to be collected from veteran patients of SVHs is to augment funding for the operation of the SVHs in addition to the funding provided by state appropriations and VA per diem payments. Funds collected from the Daily Fees will be used for the maintenance and operations of the SVHs, to include the operations of the VFSOs located at the SVHs that are directly related to the administration of this Chapter, and will not be used to support other programs of the Department of Veterans Service, or the State of Georgia.|
Veterans Service Board Authority.
|(3)||Daily Fee. Beginning on or after January 1, 2013, the Daily Fee will be charged to all veteran patients of SVHs. This Daily Fee will be charged to all current and future veteran patients of the SVHs because there is no provision in the O.C.G.A. § 38-4-56 to waive collection of the fee based on reasons or criteria other than economic need. To treat veteran patients differently based only on the date of admission to the SVHs would be a violation of the Equal Protection Clause of the 14th Amendment to the Constitution of the United States because there is no rational basis for treating the similarly situated veteran patients differently.|
|(4)||The value of this
|(5)||Monthly Fee. The amount of the monthly fee to
be billed to the veteran patients will be the Daily Fee times the number of
days in the month the veteran patients resided in the SVHs, to include the days
the veteran patients are discharged for medical leave or non-medical leave, as
the veteran patients' beds are held for their return.
Benefit. In accordance with federal law, VA rules and
regulations veteran patients of SVHs who are receiving VA pension benefits are
eligible to receive the VA's A&A benefit and must file claims with the VA
in order to receive these A&A benefits.
|(7)||Agreements. The current veteran patients
residing at the SVHs at the time of implementation of this Chapter and/or their
immediate family members (responsible parties), and new veteran patient
admissions and their immediate family members (responsible parties) will
finalize and sign financial agreements at the time of implementation of this
Chapter or admission to the homes. Failure of these individuals to sign these
agreements will result in the initiation of actions to permanently discharge
current veteran patients, or the cessation of the admission process for new
applicants. The agreements shall be enforceable for the entire time of veteran
patients' residencies at the SVHs.
|(9)||Waivers to payment of
the Daily Fee.
invoicing and payment and actions to require payment.
of veteran patients for non-payment of the Daily Fee.
|(13)||70% Service Connected Disabled Veteran
|(2)||Commissioner of Veterans Service.
|(3)||Veterans Field Service Offices at SVHs.
|(4)||State Veterans' Homes
of Veterans Service Accounting and Budgeting Functions.
|(6)||Veteran Patients at the SVHs and Immediate Family