M21-1 Manual  /  Part XIII, Subpart i, Chapter 3, Section D

Eligibility for Medical Services Associated With Aid and Attendance (A&A) or Housebound Status

M21-1, Part XIII, Subpart i, Chapter 3, Section D

Overview

In This Section

 This section contains the following topics:
TopicTopic Name
1 Requests for Aid and Attendance (A&A) and Housebound Medical Benefits
2 Eligibility for Outpatient Medications for A&A Cases in Which Income Is Excessive

1. Requests for A&A and Housebound Medical Benefits

Introduction

This topic contains information on requests for A&A and housebound medical benefits, including

  • eligibility for medical services under 38 U.S.C. 1712(d)
  • providing notification of eligibility to Veterans, and
  • processing eligibility requests.

Change Date

April 12, 2007

XIII.i.3.D.1.a. Eligibility for Medical Services Under 38 U.S.C. 1712 (d)

Under 38 U.S.C. 1712(d), Veterans receiving additional compensation or increased pension for aid and attendance (A&A) or housebound benefits are entitled to medical services, including

XIII.i.3.D.1.b. Providing Notification of Eligibility to Veterans

Notify a Veteran of medical care eligibility and application information when A&A or housebound benefits are awarded. The information is provided on

XIII.i.3.D.1.c. Processing Eligibility Requests

 Follow the steps in the table below when an eligibility request is received for medical services under 38 U.S.C 1712(d).

Step

Action

1

 Complete VA Form 10-7131, Exchange of Beneficiary Information and Request for Administrative and Adjudicative Action, to show entitlement. Note: A future examination diary control has no effect on entitlement.

2

 Complete the Remarks section of Part IIof VA Form 10-7131to show the following, as appropriate: Veteran receiving [additional compensation/increased pension] by reason of being [in need of regular A&A/permanently housebound].


2. Eligibility for Outpatient Medications for A&A Cases in Which Income Is Excessive

Introduction

This topic contains information on eligibility for outpatient medications for A&A cases in which income is excessive, including

  • income limitation for eligibility for medications
  • cases involving the termination of pension awards
  • processing message code 652
  • establishing continued entitlement to medications
  • requesting income information from the Veteran, and
  • completing the Remarks section of VA Form 10-7131.

Change Date

April 13, 2020

XIII.i.3.D.2.a. Income Limitation for Eligibility for Medications

Per 38 U.S.C. 1712(d), the Department of Veterans Affairs (VA) continues to furnish outpatient medications to Veterans entitled to A&A, including those reduced under 38 CFR 3.552(b)(1), whose income exceeds the applicable limit by no more than $1,000.

XIII.i.3.D.2.b. Cases Involving the Termination of Pension Awards

If a pension award to a Veteran entitled to A&A (code 1 or 2) is terminated because of excess income, message code 652, A&A Term—[Year] Income Over Limit by $_____, is issued for routing to the pension management center.

XIII.i.3.D.2.c. Processing Message Code 652

 To process message code 652, follow the steps in the table below.
StepAction
1 Review the claims folder to
  • verify that the Veteran is entitled to A&A, and
  • determine the amount by which income exceeded the maximum annual limit.
2 Annotate VA Form 20-6560, Notice of Benefit PaymentTransaction, with entry of the amount over the income limit in the message legend space “$______”.
3 Date and sign the form.
4 Send the form to the requesting medical facility.
5 Annotate the claims folder to show the income information furnished to the medical facility.

XIII.i.3.D.2.d. Establishing Continued Entitlement to Medications

 Establish continued entitlement to outpatient medications annually in those pension cases in which the current year income did not exceed the limit by more than $1,000. Individual requests from the medical facility for income information for the next calendar year are received on VA Form 10-7131during the last three months of the current year.

XIII.i.3.D.2.e. Requesting Income Information From the Veteran

 Check the claims folder to determine if there is current data sufficient to permit furnishing income information for the next year. If the claims folder does not already contain sufficient income data for the next year,
  • request that the Veteran complete the appropriate Eligibility Verification Report form, and
  • in the transmittal letter, indicate the reason for the request and state that the completed form should be returned within 30 days.

XIII.i.3.D.2.f. Completing the Remarks Section of VA Form 10-7131

 Upon receipt of the desired information, or at the end of 30 days, enter the response in the Remarks, section, Part II, of VA Form 10-7131. Use the table below to determine what to enter into Remarks when income information is received or not received from the Veteran.
If …Then …
  • income information is received, and
  • the Veteran is entitled to A&A benefits, except as to income
indicate the amount by which income for the next year will exceed the applicable maximum income limit.
  • income information is received, and
  • the Veteran is entitled to a resumption of pension, including the A&A allowance
income information is not received
  • annotate VA Form 10-7131 to indicate that no reply was received from the Veteran, and
  • do not take follow-up action.

Source: VA M21-1 Adjudication Procedures Manual, M21-1, Part XIII, Subpart i, Chapter 3, Section D (U.S. government work, reproduced for reference). Browse all sections →