What is the VA’s Fast Letter?

The Fast Letter directs that, in the future, VA will
interpret its pension regulations as follows:

  • The
    cost of room and board at a residential facility is a UME if the facility provides custodial care to the
    individual, or the individual's physician states in writing that the
    claimant must reside in that facility to separately contract for custodial
    care with a third-party provider.
  • A
    facility provides custodial care if it assists the individual with two or
    more ADLs.
  • If the
    facility does not provide the claimant custodial care, or the claimant's
    physician does not prescribe care by a third-party provider in that
    facility, VA will not deduct room and board paid to the facility but will
    deduct the cost of any medical or nursing services obtained from a
    third-party provider.

Fast Letter 12-23 goes on to note that VA does not consider
emergency pull cords, 24-hour staffing, and locked exterior doors as a medical
or nursing service. 

In addition, charges for assistance with Instrumental
Activities of Daily Living (IADLs) are not UMEs for pension purposes because
such assistance is not a medical or nursing service. (VA regulations define
IADLs as “activities other than self-care that are needed for independent
living, such as meal preparation, doing housework and other chores, shopping,
traveling, doing laundry, being responsible for one's own medications, and
using a telephone.”) 

However, VA will deduct the cost of assistance with IADLs
from the individual's income in limited circumstances when: (1) The individual
is entitled to pension at the A&A or housebound rate, or a physician has
certified that the claimant has a need to be in a protected environment, AND
(2) the facility provides medical services or assistance with ADLs to the

Note that Fast Letter 12-23 does not apply to residents of
nursing homes and assisted living facilities. And the new UME deduction
clarification will apply only to original claims pending on or filed after the
date of the Fast Letter (October 26, 2012). 

awards will not be terminated based solely on the elimination of room and board
expenses paid to a facility other than a nursing home or assisted living facility,
which VA previously counted as a valid UME. However, if a claimant relocates to
a different facility other than a nursing home or assisted living facility,
these procedures will apply.”

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