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. |
| (2) |
The
Veterans Service Board Authority.
| (a) |
Retained Authority. The Veterans Service
Board retains authority for approval of fee amount adjustments not related to
the value of the VA's A&A benefit. |
| (b) |
The Veterans Service Board authorizes the
Commissioner of Veterans Service, or designee, to periodically adjust the value
of the Daily Fee to be charged to the veteran patients of the SVHs, when the
adjustment is related to a change to the value of the VA's A&A benefit.
| 1. |
The Commissioner of Veterans Service, or
designee, will inform the Veterans Service Board in writing of all such
adjustments, as information for the board, at least 60 days prior to the
implementation of the adjusted fee. The Veterans Service Board may disapprove
these fee adjustments at least 45 days prior to the projected implementation of
the adjusted fee. |
| 2. |
The
Commissioner of Veterans Service, or designee, will notify in writing all
veteran patients and their primary family members of adjustments to the value
of the Daily Fee at least 30 days prior to the implementation of the adjusted
fee. |
|
|
| (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
Daily Fee.
| (a) |
The value
of the Daily Fee will be calculated in the following manner: Daily Fee equals
the monthly value of the VA's pension with A&A benefit for a single veteran
with no (zero) income (as adjusted and published periodically by the VA), minus
the monthly value of the pension for a single veteran with no (zero) income,
times 12 months and divided by 365 days. Example: X = ((Y -
Z) x 12) / 365), where X is the Daily Fee, Y is the monthly
value of the VA's pension with A&A benefit for a single veteran with no
(zero) income, and Z is the monthly value of the VA's pension for a single
veteran with no (zero) income. |
| (b) |
As the value of the VA's A&A benefit for a single veteran with no (zero)
income and the value of the VA's pension benefit for a single veteran with no
(zero) income are periodically adjusted by the VA in accordance with federal
law, the value of the Daily Fee will be adjusted accordingly, as provided in
this Chapter. |
|
| (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.
| (a) |
Veteran patients or their immediate
family members (responsible parties) on their behalf will pay the monthly fees,
unless a waiver has been approved as outlined in this Chapter. Pending
applications for the VA's A&A benefit, or the ineligibility to receive cash
payments of the VA's A&A benefit, are not grounds for delaying, or for not
paying the monthly fees. |
| (b) |
When
the monthly fees to be billed are for periods of time less than a month, the
number of days to be included in the calculations will begin on the day of
admission, or the first day of the month, through the day prior to the final
discharges or deaths, which will not be counted. |
|
| (6) |
VA's A&A
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.
| (a) |
All new residents of SVHs and/or their
primary family members will receive appointments at VFSOs located at the SVHs
prior to or at the time of admission to the SVHs, or within the first two weeks
of their residencies at the SVHs for the purpose of applying for the VA A&A
benefits.
| 1. |
It is mandatory for new residents
and/or their primary family members (responsible parties) to attend these
appointments in order to initiate the claims process for timely application for
the VA's A&A benefits. |
| 2. |
In
lieu of filing the application for the VA's A&A benefits at the VFSOs at
the homes, the applications may be filed at the nearest VFSOs to where the
immediate family members (responsible parties) reside; however, copies of the
application documents, or notification (using the department's electronic
claims assistance system documentation) of the application having been filed,
must be provided to the VFSOs at the homes for documentation there by the VFSOs
where the claims are initiated, or the veteran patients and/or immediate family
members (responsible parties). |
|
| (b) |
As part of those claims, the income
verifications contain information on the amounts of money paid for medical care
by the veterans, regardless of providers, to include fees paid to SVHs. Thus,
depending on the VA rules and regulations, individual circumstances and
approval by the VA, veteran patients may get all or part of the fees paid to
SVHs reimbursed back to them by the VA in the form of the VA's A&A benefit
payments. |
| (c) |
For purposes of this
Chapter these reimbursements or payments of the VA's A&A benefits, or full
or partial waivers, will serve as the equivalent of a sliding scale. |
|
| (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.
| (a) |
The
agreements will state the intent and willingness of the veteran patients and
their immediate family members (responsible parties) to comply with the payment
requirements of this Chapter and to pay the Daily Fees promptly, or within 10
days of receipt of the monthly invoices for the amount of the Daily Fee times
the number of days in the month. The agreements will also state the
requirements for and willingness of the veteran patients and their immediate
family members to pay any outstanding amounts associated with the monthly
invoices upon deaths or permanent discharges of the veteran patients from the
homes, that the amounts incurred are due and payable and the SVHs will
demand/receive payment and the acknowledgement these agreements shall be
enforceable in the courts of jurisdiction in the counties where the SVHs are
located, or in the counties where the veteran patients resided prior to or
after admission to the SVHs, or in the counties where the veteran patients'
immediate family members (responsible parties) reside at the time of the
non-payment of the Daily Fees. Copies of the agreements will be filed with the
veteran patients' records maintained at the SVHs. |
| (b) |
The Commissioner of Veterans Service, or
designee, will prescribe the format or form for the financial agreement and
changes or modifications to the format or form will be published 30 days in
advance of the implementation of the changes or modifications. |
|
| (8) |
Payments.
| (a) |
Payments of the Daily Fees shall be made using only the following payment forms
and methods.
| 1. |
Personal Checks. (NOTE: The
use of personal checks will be permanently denied for payment after the
financial institution for non-sufficient funds returns a check. In the event
this happens, other authorized payment methods will be use in lieu of personal
checks.) |
| 4. |
Check Payments from Resident Trust
Funds. |
| 5. |
At the time of
implementation of this Chapter, the use of cash, automatic check transfers,
direct deposits, debit and credit cards will not be permitted. Upon approval
and authorization by the Commissioner of Veterans Service, or designee, at a
later time, the use of some or all these financial payment methods may be
allowed and other methods that may from time to time be developed and accepted
for doing business with the State of Georgia may be accepted and
permitted. |
| 6. |
The SVHs will not
accept the assignment of benefits from long term care insurance policies.
Payments from these insurance policies are to be made to the insured and then
used by the insured, if appropriate, to pay for SVHs care and services provided
to them. |
| 7. |
The SVHs will not
accept payments from the Medicaid and Medicare programs, as the SVHs are not
participants in these programs. |
|
| (b) |
Payments due from veteran patients at the
times of admission to SVHs.
| 1. |
The new veteran
patients will provide advance payments equal to the Daily Fee times the number
of days remaining in the calendar month from the dates of admission to the SVHs
through the last day of the month in which the admission occurs. |
| 2. |
The regular invoices for residency will be
billed as of the first day of the first full months of residency and will be
payable by the veteran patients to the SVHs by 10 days following the date of
the billing/invoicing. Subsequent months will be billed and invoiced in a
similar manner and paid in a similar manner by the veteran patients. |
| 3. |
The regular invoices for residency will be
submitted as of January 1, 2013 and will be payable by the veteran patients to
the SVHs by 10 days following the date of the invoice-. Subsequent months will
be billed and invoiced in a similar manner and paid in a similar manner by the
veteran patients. |
|
|
| (9) |
Waivers to payment of
the Daily Fee.
| (a) |
Veteran
patients of SVHs who are subject to regulation by this Chapter may file
requests with the Executive Director of the SVH where they reside for waivers
to pay the Daily Fee provided in this Chapter. Each request shall specify the
specific facts of substantial hardship that would justify a waiver to payment
of the Daily Fee. For purposes of this Chapter, in addition to payments to
veteran patients of cash benefits from the VA's A&A benefits program, full
or partial waivers will serve as the equivalent to a sliding scale.
| 1. |
Eligibility to file a request for a waiver
from paying the Daily Fee.
| (i) |
Periodically,
the Commissioner of Veterans Service, or designee, will publish for use within
the department a notice of the current U.S. Department of Health and
Human Services Poverty Guidelines for the 48 Contiguous States and the District
of Columbia. This notice will be published 30-days prior to the
implementation and use by the department. These guidelines will serve as the
basis for determining eligibility to request a waiver from payment of the Daily
Fee provided for in this Chapter. |
| (ii) |
To request waivers from paying the Daily
fee provided in this Chapter, veteran patients must provide documentation of
their annual income for the number of persons in the immediate family (spouse
and/or children under age 18) is equal to, less than or below, the annual
Poverty Guidelines published by the federal government. Further, the veteran
patient must document he/she has filed a claim for the VA's A&A benefit and
is not receiving a cash payment as part of that benefit. The VA's Form 10-10EZ,
along with a form or format prescribed by the Commissioner of Veterans Service,
or designee, which, will be used for this purpose. There will be a legal
disclaimer/penalty statement based on state law related to the VA's Form 1010EZ
and the department form or format, which will contain a penalty statement for
providing false or misleading information in accordance with O.C.G.A. § 16-10-20. The department form or
format will describe the types and quantities (from 1 to 12 months of
information) of documentation necessary to support the information provided on
the request form. |
| (iii) |
. Veteran
patients whose annual incomes for the number of persons in the immediate
families (spouses and immediate children under the age of 18) are greater than,
or above, the federal Poverty Guidelines are not eligible to request a waiver
from paying the Daily Fee provided in this Chapter. |
| (iv) |
Veteran patients must have applied to
the VA to receive the VA's A&A benefit in order to apply for a waiver from
the Daily Fee provided for in this Chapter. |
|
| 2. |
The following are specific criteria for
establishing substantial hardship, some or all of which must be demonstrated,
for the granting of full or partial waivers.
| (i) |
Payment of the Daily Fee will produce a
situation where the veteran patients' immediate families' (spouse and/or
children under the age of 18) are unable to obtain and purchase food, clothing,
shelter and medications for themselves. |
| (ii) |
Income to the veteran patient and/or
spouse from all sources (e.g., social security, VA compensation and/or pension,
retirement income, unearned income from all sources, to include, investments,
annuities, etc.) is not sufficient to meet necessary expenses for living by the
veteran patient's immediate family (spouse and/or children under age
18). |
| (iii) |
Other (the requestor
must state what the other criterion or criteria are and describe how they
demonstrate substantial hardship for the granting of full or partial
waivers). |
|
| 3. |
The
Executive Directors of the SVHs where the petitioning veteran patients reside
shall approve or disapprove requests for waiver in writing no earlier than 15
days after the receipt of the request and no more than 60 days after the
receipt of the request. The Executive Directors' decisions to deny requests for
waivers shall be in writing and shall contain a statement of the relevant facts
and the reasons supporting the action. |
| 4. |
Veteran patients who are eligible in
accordance with Section 690-1-1-.03(9)(a)4., to request waivers from paying
the Daily Fee provided in this Chapter will submit their requests for waivers
by using the department's form or format, prescribed by the Commissioner of
Veterans Service, or designee, for this purpose. |
|
| (b) |
Veteran patients may appeal disapprovals
of waivers.
| 1. |
Disapprovals of waivers shall
first be appealed to the Commissioner of Veterans Service, or designee, to
arrive/be received by regular mail, or commercial delivery company/courier,
within 30 days of the date of the disapproval actions by the Executive
Directors of the SVHs where they reside. Facsimile or email will
not be used to submit appeals of these decisions. The address for
appeals is: Commissioner, Department of Veterans Service, Floyd Veterans
Memorial Building, Suite-970, 205 Jesse Hill Memorial Drive, Atlanta, Georgia
30334-4800. |
| 2. |
Appeals shall
consist of copies of the initial waiver requests, the disapproval decisions
with reasons for the disapprovals by the Executive Directors of the
SVHs. |
| 3. |
Justifications for the
appeals shall provide the reasons and supporting information and documentation
for why the decisions of the Executive Directors contained clear and
unmistakable errors. |
| 4. |
A
department form or format prescribed by the Commissioner of Veterans Service,
or designee, will be used for this purpose. |
| 5. |
The Commissioner of Veterans Service, or
designee, will review the appeal and render a decision to approve or disapprove
it within 30 days of receipt of the appeal. Disapprovals of waiver appeals
shall be accompanied by the reasons for the disapprovals and shall be
communicated to the veteran patients requesting the appeals within five days of
the disapproval actions. |
| 6. |
The
veteran patients whose appeals have been disapproved by the Commissioner of
Veterans Service, or designee, may submit a formal appeal under the provisions
of the state's Administrative Procedure Act to the Office of State
Administrative Hearings (OSAH). The department's decision on appeal to deny a
request for waiver shall be subject to review by the OSAH for clear and
unmistakable errors. |
|
|
| (10) |
Timeliness of
invoicing and payment and actions to require payment.
| (a) |
The SVHs prepare invoices for payment of
the Daily Fee times the number of days for the period or partial period of each
month the veteran patients were on the rolls of the SVHs. This includes the
final invoice sent to the veteran patients' primary family members following
death or permanent discharge of the veteran patients from the SVHs. |
| (b) |
Invoices will be prepared within three
(3) days following the beginning of each month. |
| (c) |
Invoices will be transmitted to the
veteran patients residing at the SVHs, or to designated immediate family
members (responsible parties) who are acting on behalf of the veteran patients
and sent out by hand delivery, mail, commercial company/courier, or other means
as appropriate by the SVHs within 3 days following the end of the
month. |
| (d) |
Payment of the Daily
Fees by the veteran patients or their primary family members (responsible
parties) will be made within 10 days following the date of the invoice for the
month of which the veteran patients were in residence in and services provided
from the SVHs are received. |
| (e) |
If
the payment of the Daily Fees by the veteran patients or their primary family
members (responsible parties) have not been received by the SVHs within 10 days
following the date of the invoice, within 3 days the SVHs will send late
notices to the veteran patients residing at the SVHs or to the veteran
patients' primary family members informing them of the late payment and that
the payment is due and payable immediately. |
| (f) |
If following the sending of the late
payment notice the payment of the Daily Fees by the veteran patients or their
primary family members have not been received by the SVHs within 10 days
following the sending of the late payment notice:
| 1. |
The SVHs will send delinquent payment
notices and payment demands for payments by the end of the month. |
| 2. |
The SVHs will inform the veteran patients
or their immediate family members (responsible parties):
| (i) |
Failure to pay the delinquent payments by
the end of the current month will result in the initiation and execution of
permanent discharges from the SVHs within 30 days following which the amount of
any and all outstanding bills not paid will be due and collectible by the
SVHs. |
| (ii) |
The SVHs and/or the
department may initiate legal action in the courts of appropriate jurisdiction
to require payment of the amounts owed by the veteran patients to the
SVHs. |
|
| 3. |
Payment of all
outstanding amounts on invoices owed by the veteran patients will terminate
permanent discharge actions. |
| 4. |
Only the Commissioner of Veterans Service, or designee, is authorized to waive
the collection of delinquent invoices. |
|
|
| (11) |
Permanent discharge
of veteran patients for non-payment of the Daily Fee.
| (a) |
Following the issuance of two (2)
delinquent payment notices for non-payment of monthly invoices, the SVHs will
issue permanent discharge notices to the veteran patients residing at the SVHs
or to their immediate family members (responsible parties). |
| (b) |
For any permanent discharge situation
related to non-payment of Daily Fees, the SVHs will make the discharges
effective thirty (30) days following the date of the notice and the notice will
be sent to the veteran patients by certified/return receipt/commercial company
delivery. |
| (c) |
If during the 30-day
period following receipt of the certified/return receipt/commercial company
delivery written notices of the action payment of all delinquent amounts owed
are received by the SVHs, the permanent discharge actions will be terminated
and the veteran patients will be permitted to remain at the homes. |
| (d) |
The SVHs will make every effort to find
placement for the veteran patients affected by such permanent discharge actions
within the 30 days. If placement cannot be made, the veteran patient will
continue to be sent invoices each month for the Daily Fees accrued and the
amounts owed will continue to be added to the outstanding invoices and will be
due and payable by the veteran patients. Only the Commissioner of Veterans
Service, or designee, is authorized to waive the permanent discharge for the
nonpayment of delinquent invoices. Even though the SVHs do not participate in
the Medicaid and Medicare programs, the SVHs will comply with Georgia Rule
290-5-39-.11, Transfer
and Discharge, as relates to the transfer and discharge of veteran
patients from the SVHs for nonpayment of the Daily Fees provided for in this
Chapter. |
| (e) |
Notifications to
veteran patients.
| 1. |
Veteran patients who are
residents of the SVHs at the time this Chapter is approved and their immediate
family members (responsible parties): The department and/or the SVHs will issue
a written notice to all veteran patients and their primary family members of
the payment requirements associated with the fee to be collected from the
veteran patients. |
| 2. |
New veteran
patients and their immediate family members (responsible parties): The SVHs
will issue written notices to these individuals prior to and/or at the times of
admission to the SVHs of the payment requirements associated with the fee to be
collected from the veteran patients. |
| 3. |
The veteran patients and/or their
immediate family members (responsible parties) will acknowledge in writing they
have received the notices, read them and understand the contents of them. The
acknowledgements of receipt, reading and understanding of the notices will be
filed as documentation with the admission records of the veteran
patients. |
|
|
| (12) |
Privacy.
| (a) |
The privacy of the individual veteran patients and their family members related
to these Daily Fees will be afforded in accordance with state's open records
requirements. |
|
| (13) |
70% Service Connected Disabled Veteran
Patients.
| (a) |
Under
current federal law, VA payments for the skilled nursing home care in SVHs for
veteran patients who are 70% Service Connected Disabled veterans constitutes
payments in full to the SVHs by the VA for such care furnished to those
veterans. |
| (b) |
State appropriations
have been adjusted in the state budget and the annual appropriations law, so
state funds are not used to pay for any portion of the care provided to these
veteran patients. |
| (c) |
Accordingly,
based on the current federal rules and regulations at 38 CFR 51 - 41 (c), and
since state appropriations are not used to fund any portion of the care
provided to these veteran patients, these veteran patients are exempt from
paying the Daily Fees under this Chapter. |
|
| (1) |
Veterans Service
Board.
| (a) |
The Veterans
Service Board is responsible to provide by rule and regulation for a reasonable
fee for residency in and services provided by SVHs (O.C.G.A. § 38-4-56). This Chapter complies
with this requirement. |
| (b) |
Delegations.
| 1. |
The Veterans Service Board
delegates to the Commissioner of Veterans Service, or his designee, the
authority to periodically adjust the value of the Daily Fee to be charged to
the veteran patients of the SVHs, when the adjustment is related to a change to
the value of the VA's A&A benefit. |
| 2. |
The Veterans Service Board delegates to
the Commissioner of Veterans Service the authority to periodically adjust the
value of the annual Poverty Guidelines based on periodic adjustments from the
U.S. Department of Health and Human Services Poverty Guidelines for the 48
Contiguous States and the District of Columbia to be used as the basis to
determine eligibility to request a waiver from paying the Daily Fee. |
|
| (c) |
The Veterans Service Board
retains approval authority for adjustments to the Daily Fee that are not
related to periodic adjustments by the VA to the VA's A&A
benefit. |
|
| (2) |
Commissioner of Veterans Service.
| (a) |
The Commissioner of Veterans Service is
responsible for the actual duty of executing the policies outlined in this
Chapter and directing the day-to-day activities of the Department in the
carrying out and furtherance of this Chapter (O.C.G.A. § 38-4-1; et.seq.). |
| (b) |
Delegated Authorities.
| 1. |
The Veterans Service Board has delegated
to the Commissioner of Veterans Service the authority to periodically adjust
the value of the Daily Fee to be charged to the veteran patients of the SVHs
when the adjustment is related to a change to the value of the VA's A&A
benefit. The Commissioner of Veterans Service will notify the veteran patients
of changes in amount of the Daily Fee 30 days prior to implementing the
adjustment. |
| 2. |
The Veterans Service
Board has delegated to the Commissioner of Veterans Service the authority to
periodically adjust the value of the annual Poverty Guidelines based on
periodic adjustments from the U.S. Department of Health and Human Services
Poverty Guidelines for the 48 Contiguous States and the District of Columbia to
be used as the basis for applying for a waiver for paying the Daily Fee. The
Commissioner of Veterans Service will notify the veteran patients of the
changes in amounts of the Poverty Guidelines 30 days prior to implementing the
change. |
| 3. |
The Commissioner of
Veterans Service will inform the Veterans Service Board in writing of all such
adjustments, as information for the board 60 days prior to the implementation
of the adjusted Daily Fee and/or the adjusted Poverty Guidelines. |
|
| (c) |
The Commissioner of Veterans
Service, or designee, is authorized to approve/ disapprove appeals of
disapprovals of waivers to payment of the Daily Fee made by Executive Directors
of the SVHs. |
| (d) |
The Commissioner
of Veterans Service, or designee, will approve local policies and procedures of
the SVHs, submitted by the Executive Directors of the SVHs related to the
invoicing and collecting of fees from veteran patients. |
| (e) |
The Commissioner of Veterans Service, or
designee, will approve forms and formats to be used for the administration of
this Chapter. |
|
| (3) |
Veterans Field Service Offices at SVHs.
| (a) |
VFSOs will assist veteran patients of the
SVHs with the filing claims for the VA's A&A benefit. Applications to claim
the VA's A&A benefits will be filed on or before the days of admission to
the SVHs; however, wherever possible on or before 14 days following admissions
to the homes. |
| (b) |
VFSOs will assist
the Executive Directors of the SVHs in evaluating applications for waivers from
paying the Daily Fees. |
| (c) |
VSFOs
will provide other assistance and service to the veteran patients and their
immediate families (responsible parties) and the SVHs related to the
administration of this Chapter. |
|
| (4) |
State Veterans' Homes
(SVHs).
| (a) |
The
approval/disapproval of waiver requests is vested with the Executive Directors
of the SVHs, after consultation with the staffs of the VFSOs located at the
SVHs. |
| (b) |
Collecting the Daily Fees
paid by the veteran patients and depositing them into the appropriate bank
account and reporting the deposits to the Department's accounting and budgeting
functions. |
| (c) |
Counsel with and
inform veteran patients and their immediate family members (responsible
parties) and prospective veterans applying for admission to the SVHs and their
immediate family members (responsible parties) on their responsibilities for
paying the Daily Fee and the potential actions failure to comply with payment
requirements will have on their abilities to continue their residencies at the
SVHs, to include the possibility of permanent discharge from the SVHs and/or
legal actions to collect unpaid amounts. |
| (d) |
Develop in conformity with this Chapter
and implement local policies and procedures to carry out this Chapter. Prior to
implementation, the Executive Directors of the SVHs will submit them for the
approval of the Commissioner of Veterans Service, or designee. |
|
| (5) |
Department
of Veterans Service Accounting and Budgeting Functions.
| (a) |
Budgeting: Projected revenues from the
collection of the Daily Fees will be budgeted into the Department's operating
budget for the respective fiscal programs of the SVHs in accordance with budget
guidance published periodically by the Governor's Office of Planning and
Budget. |
| (b) |
Amending-in of funds
for budgetary purposes: Funds collected by SVHs from Daily Fees will be amended
into the Department's operating budget for the respective fiscal programs of
the SVHs in accordance with budget guidance published periodically by the
Governor's Office of Planning and Budget. The Commissioner of Veterans Service
will provide spending authority to the SVHs, or designee, for the use of the
funds collected for the purpose of providing residency in and services by the
SVHs to the veteran patients. Authorized purposes include:
| 1. |
Direct veteran patients' residency and
services; and |
| 2. |
Routine
maintenance and operations related thereto. |
|
| (c) |
Bank accounts: Bank accounts for the
purpose of depositing the Daily Fees paid by the veteran patients will be
established. The SVHs will have the ability to deposit funds into these
accounts. The SVHs will not be able to draw funds out of these accounts;
however, the Department will be able to do so. These accounts will be
established and maintained in accordance with the guidance periodically
provided by the Office of the Treasury, State Accounting Office and the
Governor's Office of Planning and Budget. |
| (d) |
Accounting for spending: Regular state
accounting rules will be followed for the receipt, retention and expenditures
of the funds collected from the veteran patients in payment of the Daily
Fees. |
|
| (6) |
Veteran Patients at the SVHs and Immediate Family
Members.
| (a) |
The veteran
patients and their immediate family members (responsible parties) are
responsible to pay the Daily Fees within the time frames specified in this
Chapter. |
| (b) |
Failure to comply with
the Daily Fees payment requirements provided in this Chapter will subject the
veteran patients to permanent discharge from the SVHs in accordance with the
policies provided for in this Chapter and potential legal action in the
appropriate courts of proper jurisdiction to enforce collection of Daily Fees
owed but not paid. |
| (c) |
If eligible,
request waivers from paying the Daily Fees in accordance with the guidance
provided in this Chapter. In this regard the veteran patients at the SVHs and
immediate family members (responsible parties) will keep SVHs and the VFSOs at
the SVHs informed of their current fiscal status and other pertinent
information related thereto on at least an annual basis or more often, as
necessary. |
| (d) |
Apply for VA's
A&A benefit upon admission to the SVHs and annually, or more often,
thereafter for the duration of their residencies in the SVHs. |
|
