VA Health Care:

Copayment Exemption Procedures Should Be Improved

HRD-92-77: Published: Jun 24, 1992. Publicly Released: Jun 24, 1992.

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Pursuant to a congressional request, GAO provided information on: (1) how the Department of Veterans Affairs (VA) determines the medical care copayment exemption status of Vietnam veterans who claim Agent Orange exposure; and (2) VA exemption policies and procedures for determining veterans' Agent Orange exposure.

GAO found that: (1) the VA guidance does not adequately inform medical centers about policies for evaluating the exemption status of Vietnam veterans claiming Agent Orange exposure; (2) some medical centers routinely exempt veterans without requiring examinations, and some medical centers do not involve physicians in determining whether medical conditions resulted from Agent Orange exposure; (3) the VA software program for medical care application prevented centers from properly determining Agent Orange-related copayment waivers; (4) many veterans who received Agent Orange exemption status for non-related conditions had incomes that would have required them to make copayments for their medical care; and (5) VA could have potentially collected $1.9 million in 1989 from veterans improperly exempted for Agent Orange exposure.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: VA issued a directive (VHA 10-92-049) that outlines proper determination, documentation, and billing procedures for medical care received by Vietnam veterans for conditions related to or unrelated to their exposure to Agent Orange. VA policy guidance on Agent Orange has also been revised (VA Manual M-10, Part I). Complete revisions of Chapters 1 and 2 of this guidance were distributed in May 1994.

    Recommendation: The Secretary of Veterans Affairs should provide specific guidance to medical centers on procedures for evaluating the exemption status of Vietnam veterans who claim exposure to Agent Orange. The medical centers should be instructed to exempt from copayment liability only Vietnam veterans whom Veterans Health Administration (VHA) physicians determine to need treatment for conditions that may be related to Agent Orange exposure.

    Agency Affected: Department of Veterans Affairs

  2. Status: Closed - Implemented

    Comments: VA issued a directive (VHA 10-92-049) that outlines proper determination, documentation, and billing procedures for medical care received by Vietnam veterans for conditions related to or unrelated to their exposure to Agent Orange. VA policy guidance on Agent Orange has also been revised (VA Manual M-10, Part I.) Complete revisions of Chapters 1 and 2 were distributed to the field in May 1994.

    Recommendation: The Secretary of Veterans Affairs should provide specific guidance to medical centers on procedures for evaluating the exemption status of Vietnam veterans who claim exposure to Agent Orange. The medical centers should be instructed to determine the copayment liability of Vietnam veterans whom VHA physicians determine to need treatment for conditions unrelated to Agent Orange exposure.

    Agency Affected: Department of Veterans Affairs

  3. Status: Closed - Implemented

    Comments: VA issued a directive making changes to its Decentralized Hospital Computer Program. These changes are designed to help VA medical centers evaluate the copayment exemption status of Vietnam veterans and to make appropriate billing decisions based on that status.

    Recommendation: The Secretary of Veterans Affairs should direct the Chief Medical Director to make the necessary changes to the software program used in the medical application process. These changes should ensure that it is consistent with the revised policy guidance for evaluating the copayment exemption status of Vietnam veterans.

    Agency Affected: Department of Veterans Affairs

 

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