Overview
In This Section |
This section contains the following topics:
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1. General Information on the Reduction of A&A Upon Hospitalization
Introduction |
This topic contains general information on the reduction of A&A when a Veteran is hospitalized, including
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Change Date |
March 27, 2018
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III.v.6.C.1.a. Regulatory Requirements of 38 CFR 3.552 |
The provisions of 38 CFR 3.552(b)(1) require the discontinuance of additional compensation or increased disability pension for aid and attendance (A&A) effective the first day of the second calendar month following the month of admission to a Department of Veterans Affairs (VA) medical center (VAMC), unless the disability is
Exception: When a Veteran entitled under 38 U.S.C. 1114(r) is hospitalized at U.S. Government expense, discontinuance of A&A is required under 38 CFR 3.552(b)(2).
References: For more information about
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III.v.6.C.1.b. Effect of the Recovery of Cost of Care |
Under 38 U.S.C. 1729, the United States has the right to recover or collect the cost of medical care VA furnishes to a Veteran for treatment of a non-service connected disability. Costs recoverable from insurance companies or other third parties liable under a healthcare contract are the amounts the Veteran or the service provider would be able to receive if the care had not been provided by the United States. However, recovery of such costs does not limit the applicability of 38 CFR 3.552(b)(1).
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III.v.6.C.1.c. Screening CAPRI Reports |
Use the Special Report for A&A/Pension option available in the Compensation and Pension Record Interchange (CAPRI) Reports menu in CAPRI to generate reports for Veterans who are
Example:
![]() Screen each report against information in the corporate record and, if necessary, review the claims folder to determine if an adjustment under 38 CFR 3.552 is required.
Reference: For more information on generated reports, see the CAPRI User Guide.
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III.v.6.C.1.d. Due Process and Control Procedures for Hospitalization |
Notice of proposed adverse action is required before reducing or adjusting an award. Provide proper notification by
Reference: For information on notice of proposed adverse action requirements, see M21-1, Part I, 2.B.1.
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III.v.6.C.1.e. Procedures for Reducing Awards for Hospitalization |
After the control period expires (or sooner, if the Veteran asks VA to take action to reduce the amount of potential overpayment),
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III.v.6.C.1.f. VETSNET Adjustment of A&A Due to Hospitalization |
When completing A&A or hospitalization adjustments, utilize the following screens in the claims-processing system:
Reference: For more detailed information on adjusting awards using
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III.v.6.C.1.g. Determining Hospitalization Rate Payable |
Use the table below to determine the award rate payable when discontinuing the A&A allowance during hospitalization of the Veteran.
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2. Determining the Need for a Hospital Summary
Introduction |
This topic contains information on determining the need for a hospital summary, including when a hospital summary
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Change Date |
March 27, 2018
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III.v.6.C.2.a. When a Hospital Summary Is Required |
A hospital summary is required in cases that involve conditions that are subject to improvement.
Follow the steps in the table below to request the appropriate reports in these cases.
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3. Granting or Discontinuing an A&A Award During Hospitalization
Introduction |
This topic contains information on granting or discontinuing an A&A award during hospitalization, including
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Change Date |
April 21, 2015
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III.v.6.C.3.a. Granting an A&A Award |
Use the table below to determine the appropriate actions to take when granting an A&A award during hospitalization of a Veteran.
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III.v.6.C.3.b. Discontinuing an A&A Award |
If entitlement to A&A or the housebound rate while hospitalized is discontinued by rating while the Veteran is hospitalized
Note: If the IVAP exceeds the housebound rate, see M21-1, Part III, Subpart v, 6.C.1.g.
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4. Adjusting an A&A Award When a Veteran Leaves or Returns to a Hospital
Introduction |
This topic contains information on adjusting an award when a Veteran is discharged from, granted an authorized absence from, or returns after an absence from a hospital, including
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Change Date |
March 27, 2018
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III.v.6.C.4.b. Adjusting for Hospital Absences of 30 Days or More |
Adjust benefit payments for authorized absences from the hospital of 30 days or more as follows:
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III.v.6.C.4.c. When an Authorized Absence of 30 Days or More Occurs During an Initial Period of Hospitalization |
Under 38 CFR 3.556(a)(1), do not continue a reduced payment for Old-Law or Section 306 Pension when a report showing non-bed care status or authorized absence of 30 days or more is received during an initial period of hospitalization. When notice of non-bed care status or authorized absence of 30 days or more is received, restore the regular pension rate for
For either Old-Law or Section 306 Pension, if entitlement to the A&A allowance had been established, resume payment for SMP effective the date of departure from the hospital.
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III.v.6.C.4.d. When a Veteran Returns From an Authorized Absence of 30 Days or More |
Take the following actions under 38 CFR 3.556(a)(2) when a Veteran resumes his/her hospitalization after an authorized absence of 30 days or more.
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III.v.6.C.4.e. Example: Report of a 30-Day Authorized Absence Received During an Initial Period of Hospitalization |
Situation: A Veteran receiving Section 306 Pension with SMP for A&A is
Result:
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III.v.6.C.4.f. Retroactive Adjustments for Hospital Absences of Less than 30 Days |
Make no adjustment for additional pension or increased compensation for regular A&A for periods of authorized absence of less than 30 days until after discharge from hospitalization.
When a retroactive award is prepared to resume the full A&A rate, from a date earlier than the date of discharge in order to cover several short periods of authorized absence from hospitalization, annotate the award to show the total number of days of absence.
Situation:
Result:
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III.v.6.C.4.g. Readmission for Hospitalization Following an Irregular Discharge |
If notice is received of a Veteran’s readmission for hospitalization
Note: Follow the due process procedures described in M21-1, Part III, Subpart v, 6.C.1.d.
Reference: For a definition of “irregular discharge,” see M21-1, Part III, Subpart v, 6.D.3.f.
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5. Expedited SMP Entitlement Determinations for Chronic Invalids Hospitalized at VA Expense
Introduction |
This topic contains information on expedited SMP entitlement determinations for Veterans who are chronic invalids, including
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Change Date |
March 27, 2018
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III.v.6.C.5.b. Actions Taken by the Medical Facility |
After identifying the type of case described in M21-1, Part III, Subpart v, 6.C.5.a, the VAMC or the Chief, Medical Administrative Specialist (MAS), determines whether
If the conditions described in the preceding bullets are met, the Chief, MAS, or other authorized medical center official
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III.v.6.C.5.c. Actions Taken by the SOO |
The table below describes how the SOO processes the VA Form 21-2680referenced in M21-1, Part III, Subpart v, 6.C.5.b.
Notes:
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Historical_M21-1III_v_6_SecC_8-17-17.docx | May 16, 2019 | 77 KB |
8-17-17_Key-Changes_M21-1III_v_6_SecC.docx | May 16, 2019 | 67 KB |
Transmittal-Sheet-M21-1MR-III_v_6_SecC_TS.docx | May 16, 2019 | 39 KB |
Change-April-21-2015-Transmittal-Sheet-M21-1MRIII_v_6_SecC_TS.doc.docx | May 16, 2019 | 39 KB |
in Chapter 6 Hospitalization at Department of Veterans Affairs (VA) Expense, Part III General Claims Process, Subpart v General Authorization Issues and Claimant Notification
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