(A different) EVR question...

[evilipoo]

Hi all,
I'm new to the forum, but your site really helped me navigate the VA A&A process for my mom over the past year or so.  So thank you very much!

I have a question about the EVR, which I somehow was not aware was going to be required until it showed up yesterday!

My concern/question is:  There is a question on the EVR that asks if the recipient is in a Nursing Home.  My mom is in an assisted living facility, which is technically not a nursing home.  So I'm unsure how to answer this question.  What is your interpretation?

Also, I'm wondering how a slight increase in income will affect mom's A&A benefit.  We cashed out some savings bonds (less than $5000) on NY Eve because I don't know how much longer mom will be able to do this kind of thing (mom has Alzheimer's).  This may put her income after healthcare expenses at positive $400 a month for the year 2009.  Does this mean we can expect a decrease in benefit for 2010 and/or have to pay back some of the past year's benefit?

Thanks for any answers you can provide...

Eva

[vetadmin]

Eva,

My concern/question is:  There is a question on the EVR that asks if the recipient is in a Nursing Home.  My mom is in an assisted living facility, which is technically not a nursing home.  So I'm unsure how to answer this question.  What is your interpretation? No, Assisted Living or Yes, Assisted Living – both are correct

Also, I'm wondering how a slight increase in income will affect mom's A&A benefit.  We cashed out some savings bonds (less than $5000) on NY Eve because I don't know how much longer mom will be able to do this kind of thing (mom has Alzheimer's).  This may put her income after healthcare expenses at positive $400 a month for the year 2009.  Does this mean we can expect a decrease in benefit for 2010 and/or have to pay back some of the past year's benefit? ONLY THE INTEREST INCOME ON THE BONDS IS COUNTED AS INCOME, NOT THE FULL $5000.  Make sure you include all medical expenses, not just the assisted living fee – medical ins premiums, trips to doctors. Co-pays, prescription and over counter meds, they all count once you are in the system.

[evilipoo]

Thank you.

Yes, I have counted all those goodies, but she is still approximately  $400 in the positive per month. 

Part of this is because we ended up moving her to a much more affordable ALF in the 3rd month of the year.  And I beleive I neglected to figure this in whilst I was recalling my previous calculations.

Can you see a possibility of having to pay back the benefits already recieved and/or a reduction in benefits for this year?  I'm hoping if this is the case, that next year's EVR will allow for an adjustment again, so the shortfall is not permanent.

I thought for sure I remember that countable income could be up to a certain amount before the benefit was actually reduced, but I am thinking that i am wrong about that...

Thanks,
Eva

[kayellen]

EVA -- You are also considered a caregiver... think about it... You have expenses & mileage associated with your loved one... Use the excess funds to pay your expenses... Just $50.00 a month to you is $600.00.  The form asks for ALL caregiver expenses.  The check for $50.00 has to actually be written & cashed.  Who says you can't use that CASH for your loved ones benefit.

[vetadmin]

A couple of things to keep in mind here is that you must keep a record of care provided and have a monthly phone call with a supervising licensed care provider when a family memeber is acting as the caregiver. 

If you are not providing value and the VA audits, you do risk them – reducing the award, accusing you of fraud and becoming the fiduciary themselves. I do not advocate it as anything you undertake without a lot of seriousness. As I have said in prior posts, track every time you go to the doctors, your time and mileage are a deduction – if you really are providing care, deduct it – but if you are just visiting your mom in an ALF and you claim it’s a PCA visit…well, you run the risk of the VA determining that to be fraud.  That is not a situation you want to find yourself in.

[warrentricia@hotmail.com]

I also need an answer - where it asks if they are in a nursing home, do we put NO because they are in assisted living:

[doey]

If a field representative interviewed my mother (who has dementia) in her ALF and I received a letter from the VA stating her monthly amounts are $3884, do I use this amount times 12 for her anticipated costs for 2010 on her EVR. Last year her benefits were cut off for 4 month and it was a nightmare trying to get them restarted because of a minor error on the evr. HELP...I want to complete this form before they make another excuse to stop her benefit...

[vetadmin]

Yes, as long as they are at least that much.

 

[doey]

I have a record of all of her expenses and can verify each amount. My confusion is that there is a space that says if the expenses are substantially the same, I do not have to submit the additional form, but may be asked for it at a later date. Will this interfere with continuation of benefits at a later date and what do they mean by a "substantial difference?" $100, $1000, $10,000... EVERYTHING they send it so confusing...

[doey]

DOES ANYONE HAVE AN ANSWER TO THIS? PLEASE !!! WHAT DOES THE VA CONSIDER A SUBSTANTIAL DIFFERENCE IN THE EVR? THANKS A MILLION FOR YOUR HELP!!!!!!!!!!!!!!!!

[vetadmin]

An increase of as example, $10,000 should be explained.  Likewise if lower, you would want to detail out the expenses.

[pologal1979]

here is the key - substantially the same is within a $800 difference.  we are talking about medical expenses here.  ie if the preprinted expenses were $5,000 and you project $5,700 for 2010, then VA will use your prediction (assuming you did not return an 8416).

if you return an 8416, then VA will consider the 8416, to predict 2010 expenses not your projected amount you wrote on the EVr.

[doey]

So I should not use the estomated monthly expenses which were determined by the field examiner tomes the 12 month period. That would be a whole lot more than $800, but I don't want to complicate anything. My understanding (if I reading the evr correctly) I do not have to complete the other form IF I just use an amount within $800 of the preprinted amount on the evr...RIGHT? MY HEAD SPINS EVERYTIME I EVEN THINK ABOUT DEALING WITH THE VA

[pologal1979]

doey,

let me break it down.  when the award began, projected medical expenses  and projected income were use to figure the award.  the key word is PROJECTED.

an EVR is a way to verify the income that was ACTUALLY received during the last calendar year, 2009. and it allows the opportunity to report the ACTUAL medical expenses that were paid in 2009.

so, lets say $5000 in meds were projected on the initial award. these meds consisted of Medicare PT B and Private medical insurance. these are predictable medical expenses for va purposes.

now, you get the EVR and 8416.  on that form they are asking you to verify what actually was received in income and expenses for 2009.

for meds, lets say the vet did spend $5000 on ptb and pmi.  but he also paid for doctor bills, prescription medicine, dental bill and over the counter drugs in the year 2009.  so now you total $8000.  the new figure is HIGHER than the amount than the projected medical expenses. use the 8416 and itemize all of the meds paid in 2009.  you will get, in all likelihood, an increase in 2009 VA pension.  the VA will then base thier 2010 projected medical expenses based on what was reported on the 8416.  if you wrote any figure on the EVR regrding your projection of 2010 meds it will adressed in the letter you receive from VA.

another example, lets say again, $5000 was projected.  lets say the vet actually spent $5,500.  the 500 was what he paid in RX over the year of 2009.  then i would just write in the EVR box (8b)$5,500 and, if you want, you can estimate $5,500 for 2010 (box 8c) assuming that you think the vet will pay that amount in ptb, pmi and rx.

but safest bet is just to complete the 8416. the va will the proper adjustments based on what you report.

just be sure to fill out the form completely.

and provide a phone number so if there is questions, they can contact you/claimant.

[jpez]

A nursing home is a nursing home. They are licenced as such. period. If you don't know ....don't ask here. ask the facility. if you tell VA your in a nursing home but are really in a Assited living, they will ask you to apply for medicaid and then send you $90.
But regardless, why risk it?
there is no gray area.