VHA DIRECTIVE 2003-003
Department of Veterans Affairs
Veterans Health Administration
Washington, DC 20420

1. PURPOSE: This Veterans Health Administration (VHA) directive outlines departmental policy and procedures for implementing changes resulting from the Department of Veterans Affairs (VA) Interim Final Regulation governing Provision of Hospital and Outpatient Care to Veterans.

2. BACKGROUND

a. By law, VA is required to maintain an annual enrollment system for managing the provision of quality hospital and outpatient medical care and treatment to all enrolled veterans. VA is required to manage enrollment within its eight enrollment priority categories, and announce in the Federal Register which priority groups of veterans VA will accept for enrollment in the VA Health Care System.

b. On January 17, 2003, VA announced in the Federal Register that VA will enroll all priority groups of veterans, except those veterans in Priority 8 who were not in an enrolled status on January 17, 2003, or who requested disenrollment on or after that date. This Interim Final Rule amends VA's medical regulations by establishing the following new subpriorities for enrollment Priorities 7 and 8:

(1) Non-compensable 0 percent service connected veterans who are in an enrolled status as of January 16, 2003, and who subsequently do not request disenrollment. NOTE: For operational purposes, this will be known as Priority 7a and Priority 8a.

(2) Non-service connected veterans who were in an enrolled status as of January 16, 2003, and who subsequently do not request disenrollment. NOTE: For operational purposes, this will be known as Priority 7c and Priority 8c.

(3) Non-compensable 0 percent service connected veterans not included in Subpriority a as shown in preceding subparagraph 2b(1). NOTE: For operational purposes, this will be known as Priority 7e and Priority 8e.

(4) Non-service connected veterans not included in Subpriority c as shown in preceding subparagraph 2b(2). NOTE: For operational purposes, this will be known as Priority 7g and Priority 8g.

c. Software is being developed for Veterans Health Information Systems and Technology Architecture (VistA) and Health Eligibility Center (HEC) systems to support the Secretary's decision to suspend new enrollments of veterans in Priority 8. This software is expected to be released in March 2003. The software will include functionality to:

(1) Assign the veteran to the correct enrollment sub-priority.

THIS VHA DIRECTIVE WILL EXPIRE ON JANUARY 31, 2008

VHA DIRECTIVE 2003-003
January 17, 2003
(2)

(2) Reject enrollment when a veteran applies for enrollment on or after January 17, 2003, and is in Priority 8e or Priority 8g.

(3) Transmit the Rejected enrollment status to the HEC.

(4) Activate the Rejected - New Applicant Below the Enrollment Group Threshold letter for mail-out from the Austin Automation Center (AAC).

3. POLICY: It is VHA policy to comply with the decision of the Secretary of Veterans Affairs to suspend enrolling new applicants in Priority Group 8.

4. ACTION: Implementation of the Enrollment Level Decision

a. Veterans assigned to Priority 8 who have completed their VA Form 10-10EZ, Application for Health Benefits, and submitted it to VA (or whose mailing envelope is postmarked) prior to January 17, 2003, will be considered to have enrolled prior to the enrollment decision date. It is imperative that sites immediately implement procedures to retain the envelope in which the veteran's VA Form 10-10EZ was submitted to VA as verification of the veteran 's application date. The envelope must be attached to the VA Form 10-10EZ, and filed in the veteran's Consolidated Health Record (CHR).

(1) For veterans who mail their VA Form 10-10EZ to a VA health care facility for processing, the date of the postmark is to be entered into VistA as the date of enrollment application.

(2) For veterans who complete their VA Form 10-10EZ online, the date the form is completed online is to be entered into VistA as the date of enrollment application.

(3) For veterans who apply for enrollment in person, the date of the veteran 's presence at the facility for the purpose of enrollment is to be entered into VistA as the date of enrollment application.

b. Until the software enhancements are deployed, VA health care facility staff must implement the following manual procedures to identify and restrict enrollment of new veterans in Priority 8 effective January 17, 2003.

(1) When a veteran applying for enrollment is placed in Priority 8, VA health care facility staff must enter the date of application in the Ineligible Date Field and enter "Priority Group 8" in the Ineligible Reason Field.

(2) If the veteran is applying in person, VA health care facility staff must advise the veteran that VA is not accepting new enrollees in this priority and provide the veteran a VA Form 4107VHA, "Your Rights to Appeal Our Decision," and the nationally developed Enrollment Decision Frequently Asked Questions (FAQ) prior to the veteran's departure from the medical facility. NOTE: A copy of the FAQ is included as Attachment B.

VHA DIRECTIVE 2003-003
January 17, 2003
(3)

c. When a veteran applies in person, VA must triage the veteran to rule out emergency medical conditions. Veterans with an emergency medical condition are to be provided treatment under VA's humanitarian authority. The veteran must be informed of the conditions under which care will be provided and documentation of the discussion must be placed in the CHR.

d. Veterans in need of health care services who are not eligible for enrollment and who request assistance accessing care in the community need to be referred to Social Work for assistance.

e. When software is available, the HEC staff will delete the Ineligible Date and Ineligible Reason field information entered in VistA and mail veterans assigned to Priority 8e or 8g four items : a letter, "New Applicant Below the Enrollment Group Threshold;" VA Form 4107VHA, "Your Rights to Appeal Our Decision;" Enrollment Decision Frequently Asked Questions (FAQ); and the Enrollment Priority Groups Health Care Fact Sheet. NOTE: Copies of the letter (see Att. A), the FAQ (see Att. B) and the Enrollment Priority Groups Fact Sheet (see Att. C) are included with this Directive.

f. As per existing software functionality, removal of the Ineligible Date and Reason field information from a non-service connected veteran's record will cause an Eligibility Alert Message to be sent to the VistA DGEN ELIGIBILITY ALERT mail group. This Eligibility Alert informs the VA health care facility mail group members that the period of service needs to be reviewed and updated as appropriate.

5. REFERENCES: Title 38 Code of Federal Regulations 17.36.

6. FOLLOW-UP RESPONSIBILITY: The Chief Business Officer is responsible for the content of this directive. Questions may be addressed to 202-254-0400.

7. RESCISSION: This VHA directive will expire on January 31, 2008.

S/ Louise Van Diepen for
Robert H. Roswell, M.D.
Under Secretary for Health

Attachments

DISTRIBUTION: CO: E-mailed 1/17/03 FLD: VISN, MA, DO, OC, OCRO, and 200 - E-mailed 1/17/03

VHA DIRECTIVE 2003-003
January 17, 2003
A-1

ATTACHMENT A

SAMPLE LETTER BEING SENT CENTRALLY FROM THE HEALTH ELIGIBILITY CENTER (HEC)

NEW APPLICANT BELOW THE ENROLLMENT GROUP THRESHOLD LETTER

Dear