WELCOME

1. WELCOME

2. MISSION ACT UPDATE

3. Eligibility Overview

4. Best medical interest • Quality Standards 6Criteria Access Standards VA cannot furnish care within certain designated access standards • To be eligible under this criterion, VA would have to be unable to schedule a VA appointment for a Veteran at a facility that can provide the requested service within the designated average drive time and within the designated number of days (wait time). • 30-minute average drive time for primary care, mental health, and non-institutional extended care services (including adult day health care) • 60-minute average drive time for specialty care • 20 days for primary care, mental health care, and non-institutional extended care services, unless the Veteran agrees to a later date in consultation with their VA health care provider. • 28 days specialty care from the date of request, unless the Veteran agrees to a later date in consultation with their VA health care provider. • Services unavailable at VA • Access Standards • State with no full-service VA medical facility • Grandfathered Choice eligibility

5. Best medical interest Quality Standards 6Criteria Grandfathered Choice Eligibility Grandfathered Choice Eligibility The first two requirements must be met in every case: • Veteran was eligible under the 40-mile criterion under the Veterans Choice Program on the day before the VA MISSION Act was enacted into law (June 6, 2018), and • Veteran continues to reside in a location that would qualify them under that criterion. If both requirements have been met, Veteran may be eligible if one of the following is also true: • Veteran lives in one of the five States with the lowest population density from the 2010 Census: North Dakota, South Dakota, Montana, Alaska, and Wyoming, or • Veteran • lives in another State, • received care between June 6, 2017, and June 6, 2018, and • requires care before June 6, 2020 Services unavailable at VA Access Standards State with no full-service VA medical facility Grandfathered Choice eligibility

6. Best medical interest • Quality Standards 6Criteria State with No Full-Service VA Medical Facility Residence in a State without a full-service VA medical facility • In this scenario, a Veteran lives in a U.S. state or territory that does not have a full-service VA medical facility. Specifically, this applies to Veterans living in Alaska, Hawaii, New Hampshire, and the U.S. territories of Guam, American Samoa, Northern Mariana Islands, and Virgin Islands. • Example: If a Veteran lives in Alaska, they would be eligible to receive community care. • Services unavailable at VA • Access Standards • State with no full-service VA medical facility • Grandfathered Choice eligibility

7. Best medical interest • Quality Standards 6Criteria Services Unavailable at VA Services unavailable at VA(e.g., maternity care, IVF) • In this situation, a Veteran needs a specific type of care or service that VA does not provide in-house at any of its medical facilities. Services unavailable at current VA facility(e.g., ortho, cardiology) • In this situation, a Veteran needs a specific type of care or service that the local VA does not provide in-house. • The Veteran can receive care in the community if the wait times >28 days for specialty care or the average drive time >60 minutes. The Veteran may opt to receive care at another VA that provides the service. • Services unavailable at VA • Access Standards • State with no full-service VA medical facility • Grandfathered Choice eligibility

8. Best medical interest • Quality Standards 6Criteria Best Medical Interest The VA Provider and Veteran may determine it is in the Best Medical Interest. • Two types: Episodic Best Medical Interest vs. General Hardship • Episodic Best Medical Interest if for a specific episode of care. • Distance between Veteran and the facility or facilities that could provide required care or services • Nature or complexity of the hospital care or medical services • Frequency that such hospital care or medical services need to be furnished to the Veteran • Need for medical attendant • Potential for improved continuity of care • Potential for improved quality of care • Timeliness of available appointments • Another reason as determined in consultation with the Veteran • General Hardship is for a period of one year. • Potential reasons for general best medical interest (hardship) include geographical challenges, environmental factors, a medical condition that impacts the ability to travel, or if a Veteran has a need to travel to their nearest VA medical facility by air, boat, or ferry. • Approved by the Chief of Staff • Services unavailable at VA • Access Standards • State with no full-service VA medical facility • Grandfathered Choice eligibility

9. Best medical interest • Quality Standards 6Criteria Quality Standards Needing care from a VA medical service line that is not compliant with VA’s standards for quality • In this scenario, if VA has identified a medical service line is not meeting VA’s standards for quality based on specific conditions, Veterans can elect to receive care from a community provider under certain limitations. • This criteria will be implemented after June 2019. • Services unavailable at VA • Access Standards • State with no full-service VA medical facility • Grandfathered Choice eligibility

10. Urgent Care Benefit As part of the VA MISSION Act of 2018, VA will offer an urgent care benefit that provides eligible Veterans with greater choice and access to timely, high-quality care. Eligible Veterans will be able to receive Urgent Care from an urgent care provider that is part of the VA’s contracted network of community providers without prior authorization from VA.

11. What is Urgent Care? Urgent care is medical services provided for illnesses or injuries which require prompt attention but are not life-threatening, such as strep throat, pink eye or influenza. Veterans believing their life or health are in danger should call 911 or go to the nearest emergency department right away. NOTE: VA can only pay for care an eligible Veteran receives from a community emergency department in certain circumstances and under certain conditions.

12. Urgent Care Benefit • Eligibility • Any enrolled Veteran who has received care in or through the VA in the last 24 months. • Veterans can receive urgent care at any in-network urgent care facility or retail clinic. • Included in Urgent Care Benefit • Diagnostic services like X-rays are included • 14 day supply of prescription medication through a local non-VA in-network pharmacy • There will be no charge for filling a 14 days or less supply at an in-network pharmacy • Using an out of network pharmacy will require the Veteran to pay for the prescription and file a claim for reimbursement with the local VA facility. • Routine prescriptions greater than 14 days must be submitted to the VA to be filled. • Diagnostic lab testing is included • Preventative vaccines when given for treatment or mitigate complications from such illness example: a treatment for a wound caused by rusted metal and may require a tetanus vaccine as part of the course of treatment.

13. Urgent Care Benefit • Urgent care (Non-emergency care) • VA Network of community providers • Supplements care Veteran may have access to at a VA medical center (VAMC) • Veterans are encouraged to contact their Primary Care Provider or team if the urgent care need occurs during operating hours or if the Veteran is concerned that an Urgent Care provider will not understand their needs and medical history. • Out of Network care is not eligible for urgent care benefit • Veterans insurance will be billed or Veterans will be required to pay out of pocket.

14. Urgent Care Co-Payments Requirement • Priority Group 1-5 • Up to three visits $0 copay • Four or more visits require $30 copay per visit • Priority Group 6 • If related to combat experience, special authority or exposure • Up to three visits $0 copay • Four or more visits require $30 copay per visit • If not related to combat experience • $30 copay per visit • Priority Group 7-8 • $30 per visit

15. Copayment Information • No limit to the amount of urgent care visits. • Veterans must identify their priority group to the provider • Preventative care is not included • Flu shots are included in the urgent care benefit • Do not require copayment • Does not count towards an urgent care visit • Copayments are not paid out-of-pocket at the time the eligible Veteran receives care the urgent care provider. Eligible Veterans are billed separately by VA as part of the VA’s normal billing process.

16. Urgent Care Process

17. Urgent Care Sign

19. Urgent Care Frequently Asked Questions • Will VA reimburse beneficiary travel for urgent care? • VA will reimburse beneficiary travel for eligible Veterans that travel to receive community care. Payment will be made for the distance to either the nearest VA or community medical facility that could have provided the care or services. Payment will only be made on a one-way basis for unscheduled care. • Can the Urgent care benefit be used by a family member? • Only eligible Veterans can use this benefit. • How are Copayments handled? • Veterans will be billed by the VA if they are subject to a copay for the urgent care visit or prescription fill.

20. Caregiver Support Currently available to eligible Veterans who incurred or aggravated a serious injury in the line of duty, on or after September 11, 2001. Phase One by 2020: Eligible Veterans who incurred or aggravated a serious injury in the line of duty on or before May 7, 1975. Phase Two by 2022: Veterans injured in service after May 7, 1975 and before September 11, 2001 will be integrated by 2022.

21. Questions and Contacts For Questions Regarding the Mission Act: National MISSION Hotline at 800-360-8387 Option 6

22. U.S. Department of Veterans Affairs Veterans Benefits Administration Indianapolis Regional Office

23. VBA Benefits

24. Disability Compensation A monetary benefit paid to Veterans with service-connected disabilities that are the result of a disease or injury incurred or aggravated during active military service. Compensation may also be paid for post-service disabilities that are presumed to be related to circumstances of military service.

25. Compensation Disability Examples • Torn knee ligament • Amputation • Heart disease • Post Traumatic Stress Disorder (PTSD) including as a result of sexual trauma • Skin conditions, such as psoriasis

26. Disability Compensation • Disabilities are rated from 0% to 100% • VA rating is independent of any military rating • Payments begin with 10% ratings • Additional allowance for dependents with a 30% or higher rating • Additional Special Monthly Compensation may apply • Concurrent retired pay at 50% service-connection • Compensation is tax-free

27. Compensation – Related Benefits • VA healthcare for all rated service-connected conditions • Vocational Rehabilitation and Employment services • $10,000 life insurance • Federal employment preference • VA loan funding fee waived • Possible state and local benefits available

28. Compensation Eligibility • Veterans who served in the active military, naval or air service and who were discharged or released under conditions other than dishonorable • Former Reservists who served full-time and for operational or support (excludes training purposes) • Former National Guard members if mobilized by a Federal order

29. Pension Needs-based benefit paid to wartime Veterans who meet certain age or non-service-connected disability requirements. Also for Veterans who are permanently and totally disabled or age 65 or older and their eligible survivors.

30. Pension Eligibility • At least 90 days of active military service (generally, 24 months for enlistments after September 7, 1980) • At least one day of wartime service (combat service not required) • Within income limits

31. Vocational Rehabilitation and Employment • Pathway to suitable employment and career stability or increased independence in daily living for eligible Veterans and Service Members with service-connected disabilities

32. VR&E VR&E provides services to assist Veterans and Service Members with service-connected disabilities to succeed: • In transition – through services to support transition back to civilian life • At work – through services resulting in suitable employment • On campus – through services to support them during education and training • At home and in their communities – through services to maximize independence in daily living

33. VR&E Eligibility Veterans: • Honorable or other than dishonorable discharge • A VA service-connected disability rating of 10% or more; or memorandum rating of 20% Active Duty Service Members: • Expect to receive an honorable discharge • Obtain a VA memorandum rating of 20% or more • Obtain a Proposed Disability Evaluation Service (DES) rating • Awaiting discharge due to a medical condition resulting from a serious injury or illness that occurred in the line of duty – may be automatically entitled to VR&E benefits

34. How to Apply for Benefits • Visit our office: 575 North Pennsylvania Street • Visit Marion VAMC, Building 138, Room 267a (Wednesday and Thursday) • Visit Fort Wayne VAMC, Lobby of Main Building (Monday, Tuesday and Friday) • Work with an accredited National Veterans Service Organization • Work with a County Veterans Service Organization • File electronically (www.ebenefits.va.gov) • Visit www.VA.gov • Call us at 1-800-827-1000

35. Questions?

36. 150 Years of Keeping the Promise NCA Overview Tom Kulich Marion National Cemetery 150 Years of Keeping the Promise

37. Our Mission 150 Years of Keeping the Promise The National Cemetery Administration honors Veterans and their families with final resting places in national shrines and lasting tributes that commemorate their service and sacrifice to our Nation.

38. Burial Benefits at a National Cemetery 150 Years of Keeping the Promise Gravesite Opening and closing of the grave Grave liner (casket vault) Perpetual care of the gravesite Headstone or Niche Cover U.S. Flag (Post Office) Presidential Memorial Certificate

39. Types of Burials - Full Casket Burial Area Bath National Cemetery, NY 150 Years of Keeping the Promise

40. Types of Burials - Cremated Remains Burial Area South Florida National Cemetery, Lake Worth, FL 150 Years of Keeping the Promise

41. Types of Burials - Columbaria Jacksonville National Cemetery, FL 150 Years of Keeping the Promise

42. Headstones, Markers and Medallions Flat Marker Medallion Upright Headstone Niche Covers “In Memory of…” 150 Years of Keeping the Promise

43. Bronze Veteran Medallion • For placement on markers in private • cemeteries • In lieu of a headstone or niche cover • Death on or after April 6, 1917 150 Years of Keeping the Promise

44. Presidential Memorial Certificate • For active duty and Veterans discharged under conditions other than dishonorable • Inscribed with the deceased’s name 150 Years of Keeping the Promise

45. Eligibility Criteria 150 Years of Keeping the Promise Any member of the U.S. Armed Forces who dies on active duty Any Veteran who served on active duty and was discharged under conditions other than dishonorable (Basic Training active duty considered active duty for training purposes; does not count) National Guard members and Reservists with 20 years of qualifying service, who are entitled to retired pay; Or, received Veteran status as a result of being called to active duty by Executive Order and served the full period for which called to active duty Spouses, minor children & adult dependent children Certain eligible parents (Corey Shea Act)

46. Strategy to Meet Burial Needs of Veterans Extend the service life of existing cemeteries; Marion NC – 16.8 acres from the Marion VAMC New Columbarium Jefferson Barracks National Cemetery, St. Louis, MO 150 Years of Keeping the Promise

47. Strategy to Meet Burial Needs of Veterans Build new Columbarium only National Cemeteries in urban areas; Crown Hill in Indianapolis; VA purchased 15 acres of land to build columbarium burial sites; Ready in approximately 2 years; Administered by Marion NC New Columbarium Jefferson Barracks National Cemetery, St. Louis, MO 150 Years of Keeping the Promise

48. Pre-Need Burial Planning • Allows Veterans, service members, and families to submit copies of military records and discharge documents to streamline eligibility determination at time of need Administration Building Alabama National Cemetery, AL 150 Years of Keeping the Promise

49. Pre-Need Eligibility • Launched December8, 2016. • AssistsVeteranwithfuneraldecisionsinadvanceofneed. • Subjecttoafinal eligibilityverificationat time ofneed. • Doesnot guaranteeburialin aspecificcemeteryorreservea gravesiteuntiltimeofneed. • IfVeteranisnoteligibleduringthe Pre-Needdetermination, theVeteranwill beentitled to VA AppealsRights.

50. How It Works Submit VA Form 40-10007 with proof of military service (DD214 if available) to the National Cemetery Scheduling Office in St. Louis. Receive written notice of eligibility determination. Keep a copy. You have the right to file an appeal if the request is denied. VA will store the information. At time of need, application will be re-verified. * Please note – eligibility does not enable you to reserve a specific burial space.