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| 1 | Caregivers_Tool_CareT_v1_Build 4.zip\core\portlets\caret-portlet\docroot\letters | Veteran_No_Longer_Clinically_Eligible.pdf | Thu Aug 9 14:02:10 2018 UTC |
| 2 | Caregivers_Tool_CareT_v1_Build 4.zip\core\portlets\caret-portlet\docroot\letters | Veteran_No_Longer_Clinically_Eligible.pdf | Thu Aug 16 01:46:33 2018 UTC |
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| 9 | ||
| 10 | Date | |
| 11 | Dear | |
| 12 | As you are aware, co ntinued el igibility for the Pr ogram of C omprehensi ve Assista nce for | |
| 13 | Family Car egivers re quires ong oing asses sment by y our clinic al team. The purpos e of | |
| 14 | these asse ssments is to determ ine contin ued clinic al eligibi lity and t o evaluate the level of | |
| 15 | Caregiver assistance that migh t be requi red to mee t your nee ds in the home setti ng. | |
| 16 | ||
| 17 | During our conversat ion on we discussed that | |
| 18 | the clinic al team ha s determin ed you no longer mee t the elig ibility re quirements for the | |
| 19 | Program of Comprehen sive Assis tance for Family Car egivers. | |
| 20 | ||
| 21 | ||
| 22 | ||
| 23 | In accorda nce with t he Program of Compre hensive As sistance f or Family Caregivers | |
| 24 | guidelines your Prim ary Family Caregiver ’s CHAMPVA and Stipe nd benefit s will be | |
| 25 | extended f or 90 days after the revocatio n date. Th e Chief Bu siness Off ice, Purch ased Care | |
| 26 | will send a detailed letter to the Prima ry Caregiv er regardi ng benefit terminati on. | |
| 27 | ||
| 28 | ||
| 29 | YOUR RIGHT S TO APPEA L THE DECI SION | |
| 30 | ||
| 31 | ||
| 32 | HOW CAN I APPEAL A C LINICAL DE CISION? | |
| 33 | You may ap peal to th e VA Medic al Center (VAMC) whe re the Vet eran is re ceiving ca re by | |
| 34 | explaining why you d isagree wi th the dec ision. If you are n ot satisfi ed with th e VAMC | |
| 35 | Director’s decision you may re quest to h ave your d ecision re viewed by the Vetera ns | |
| 36 | Integrated Service N etwork (VI SN) Direct or or his/ her design ee. | |
| 37 | ||
| 38 | ||
| 39 | NOTE: To a void unnec essary del ays, the a ppeal must be submit ted to the address o f the | |
| 40 | VA Medical Center. Please con tact your Caregiver Support Co ordinator or Patient Advocate | |
| 41 | for local VA Medical Center po licy, proc edures and timelines for appea ls. | |
| 42 | ||
| 43 | ||
| 44 | WHAT CAN I EXPECT IF I APPEAL TO THE VAM C DIRECTOR AND/OR VI SN | |
| 45 | DIRECTOR? | |
| 46 | A clinical appeal is your form al request to have t he VAMC Di rector or designee, review you r | |
| 47 | dispute. Submit you r disagree ment to yo ur local V A Patient Advocate. The Patie nt | |
| 48 | Advocate a t the faci lity enter s the clin ical appea l into a n ational co mputerized Patient | |
| 49 | ||
| 50 | Veteran No Longer C linically Eligible L etter | |
| 51 | ||
| 52 | ||
| 53 | 2 | |
| 54 | ||
| 55 | Complaint database w here the a ppeal was originated . All det ails and d ecisions m ust be | |
| 56 | included i n the fina l document ation befo re the cas e is close d. The di spute must arise fro m | |
| 57 | clinical e valuations that may result in a differen t outcome or an erro r in fact related to the | |
| 58 | evaluation . The Chi ef Medical Officer o r designee will cont act you or your repr esentative | |
| 59 | within fiv e days to notify you of receip t of your appeal and to reques t informat ion that w ill | |
| 60 | support yo ur disagre ement. | |
| 61 | ||
| 62 | If you are not satis fied with the local VA facilit y’s decisi on, you ca n elect to appeal yo ur | |
| 63 | decision t o the VISN Director. A fair a nd imparti al review will be co nducted of the | |
| 64 | documentat ion receiv ed. The V ISN Direct or or desi gnee, if n ecessary, may have a n | |
| 65 | external p rofessiona l board re view your disagreeme nt; you ca n expect t o have a f inal | |
| 66 | decision w ithin 30 d ays of the appeal re quest. Ho wever, if an externa l professi onal board | |
| 67 | reviews yo ur complai nt; you ca n expect a final dec ision with in 45 days of the ap peal | |
| 68 | request. | |
| 69 | ||
| 70 | CAN I GET A HEARING WITH THE B OARD OF VE TERANS APP EAL? | |
| 71 | No. The c linical ap peals proc ess does n ot allow f or you or your repre sentative to appeal a | |
| 72 | clinical d ecision to the Board of Vetera ns Appeal. You shou ld follow the clinic al appeals | |
| 73 | process as outlined in this le tter. The clinical decision i s final an d cannot b e appealed to a | |
| 74 | higher aut hority. | |
| 75 | ||
| 76 | CAN I GET SOMEONE TO HELP ME W ITH MY APP EAL? | |
| 77 | Yes. You can have a Veterans’ Service O rganizatio n represen tative, an attorney- at-law, or | |
| 78 | an "agent" help you with your appeal. B ut you’re not requir ed to have someone r epresent | |
| 79 | you. It’s your choi ce. | |
| 80 | ||
| 81 | ||
| 82 | GENERAL CA REGIVER SE RVICES AND BENEFITS | |
| 83 | ||
| 84 | Even thoug h you no l onger qual ify for th e Program of Compreh ensive Ass istance fo r Family | |
| 85 | Caregivers , your Car egiver may still qua lify for G eneral Car egiver ser vices and benefits. | |
| 86 | Based on t he law and Federal r egulations , Caregive rs of enro lled Veter ans of all eras | |
| 87 | receive th e followin g General Caregiver services a nd benefit s: educati on and tra ining on | |
| 88 | caring for his or he r Veteran; counselin g and othe r services under 38 U.S.C. § 1 782 (Healt h | |
| 89 | Care of Pe rsons Othe r Than Vet erans); an d respite care under 38 U.S.C. § 1720B ( Respite | |
| 90 | and Relate d Services Provided to Veteran s Residing at Home). | |
| 91 | ||
| 92 | Caregivers also have access to the Natio nal Caregi ver Suppor t Line, wh ich can be reached | |
| 93 | toll free at 1-855-2 60-3274. The line i s staffed by license d independ ent social workers w ho | |
| 94 | are availa ble to ans wer Caregi ver questi ons, liste n to conce rns, and p rovide edu cation on | |
| 95 | VA support ive servic es and com munity res ources tha t may assi st Caregiv ers. | |
| 96 | ||
| 97 | You may al so visit o ur website to find h elpful res ources, to ols, and s upport inf ormation. Our | |
| 98 | website is located a t http://w ww.caregiv er.va.gov. In additi on, the Ca regiver Su pport | |
| 99 | Program of fers many unique pro grams such as Buildi ng Better Caregivers , Peer Sup port | |
| 100 | Mentoring, Caregiver Support L ine Nation al Educati on Calls, Caregiver Self Care Courses | |
| 101 | as well as Please contact me if you | |
| 102 | would like additiona l informat ion about these supp ortive pro grams and services. | |
| 103 | ||
| 104 | ||
| 105 | 3 | |
| 106 | ||
| 107 | If you hav e question s regardin g the info rmation co ntained in this lett er, the ap peals | |
| 108 | process or about oth er matters , please f eel free t o contact me at | |
| 109 | ||
| 110 | ||
| 111 | Sincerely, | |
| 112 | ||
| 113 | ||
| 114 | ||
| 115 | ||
| 116 | ||
| 117 | Caregiver Support Co ordinator | |
| 118 | ||
| 119 | ||
| 120 | cc: | |
| 121 |
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