The VA requested that the Assisted Living Facility monthly charge be broken down into Base Rate and Medical & Nursing Services, to be eligible for Veteran’s Benefits.

The VA responded to a veteran’s benefit’s application for Aid and Attendance requesting information about his living arrangements. The application clearly indicated that the veteran, is rated A & A, resides in an Assisted Living Facility and not in a nursing home nor on Medicaid. 

The requests

1.       The type of facility – foster home, adult day care, rest home, group home or ALF?

2.       What medical or nursing services are provided?

3.       Describe the services provided.

4.       Are medical or nursing services provided or supervised by a licensed health professional?

5.       Will care be needed indefinitely?

6.       Is part of the cost covered by Medicare, Medicaid or insurance?

Additionally, the VA requested that the Assisted Living Facility monthly charge be broken down into Base Rate and Medical & Nursing Services per month and signed certification from the administrator and veteran that “all statements are true and complete to the best of my knowledge.”

Our philosophy is, if they request it, give it to them. However, in this case, the veteran was rated A & A by the doctor. Therefore, the entire facility cost is UME regardless of whether or not the care is being provided by a licensed provider. The M21-1MR VA Adjudicator’s manual states that if a claimant is rated housebound or A & A, all reasonable fees paid to an assisted livening facility for the veteran’s care are an allowable medical expense. The facility does not have to have to be a licensed facility or have licensed staff. This is why fees to an assisted living facility are not broken down, but declared in their entirety, provided the veteran is rated, by the physician, housebound or A & A. 

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