veterans Fee-basis Bowel and Bladder Care for Spinal Cord Injured Veterans
In certain circumstances the VA Fee-basis office will pay for a limited amount of bowel and bladder care for spinal cord injured (SCI) veterans in the home setting. Payment for bowel and bladder care is not dependent on service connection or receipt of a VA pension. Any veteran receiving medical care from a VA physician is eligible if he meets the medical requirements as determined by the physician. This is not the case for other types of Fee-basis care ; this article only addresses Fee-basis bowel and bladder care.
Fee-basis home health services are defined as supportive medical services requiring skilled treatment as performed by professional health care providers and technicians, and prescribed by and under the direction of a VA staff physician or VA contract physician. For the purpose of Fee-basis, the basic care procedures of catheter irrigation, colostomy bag changes, and external catheter changes, are defined as medical services. Due to the nature of the physical limitations and special needs of many spinal cord injured patients, bathing may also be provided as a fee-basis home health service when provided in conjunction with bowel and bladder care.
Quadriplegics receiving VA medical care are specifically eligible for bowel and bladder care by definition, and other veterans with spinal cord injuries are eligible when a VA physician determines that the veteran is unable to take care of his own bowel and bladder care, and depends on assistance from others. The regulations specifically state that in no instance will a veteran who can perform these functions unassisted be provided Fee-basis care. Receipt of a VA compensation or pension award for Aid and Attendance (A&A), or a higher level of A&A does not disqualify a veteran from receiving bowel and bladder care through the Fee-basis program.
To be covered under the Fee-basis bowel and bladder program, care must be provided by a licensed or registered health care provider, or a trained paraprofessional working under the direction and supervision of a licensed health care provider. A family member may receive reimbursement for providing bowel and bladder care once they have been trained and certified by a Spinal Cord Injury Center as being competent to provide the care.
Fee-basis payments are made directly to the provider. Reimbursement will be limited to a specific number of hours, not to exceed the hourly rate paid to nursing assistants employed by the VA. Contact the SCI Coordinator for current rate. For VA pensioners , it is important to note that payments for Fee-basis bowel and bladder care from the VA do not count as family income for pension purposes. You should monitor your pension awards closely to ensure it is not counted as income for your spouse. Fee-basis payments may be made retroactively on a case by case basis. In general, most VA retroactive payments are limited to the latter of the date all medical requirements were met, or the date one year prior to the date of application.
Fee-basis authorization will not be considered a permanent status for any veteran, regardless of the permanent status of the disability. There will be active, continuing participation by VA administrative and clinic managers and by other staff working in the fee-basis program to ensure compliance with all policies. Every Fee-basis authorization will be reviewed on an annual basis.
Applications for Fee-basis bowel and bladder care are made through the local VA SCI Coordinator, who will assist you by submitting a consult, and coordinating with your primary care physician and Fee-basis. When authorized care will be provided by a family member, they will be set up with an appointment for certification. In cases where care will not be provided by a family member, a referral for VA assistance in arranging for health care providers will be made
If you have any questions, please contact the your nearest PVA Service Office.