**Veterans Benefits Administration M21-1, Part IV**

**Department of Veterans Affairs Change 217**

**Washington, DC 20420 April 19, 2005**

Veterans Benefits Manual M21-1, Part IV, "Authorization Procedures," is
changed as follows:

**Page 18-i:** Remove this page and substitute page 18-i attached.

**Pages 18-II-3 through 18-II-7:** Remove these pages and substitute
pages 18-II-3 through 18-II-7 attached.

Existing paragraph 18.10c is changed to paragraph 18.10d.

New paragraph 18.10c is added to provide instructions for the collection
and transfer of pension-related hospital reports by regional offices to
pension maintenance centers. This change adds consistency with
procedures in M21-1MR, Part V, Subpart iv, Chapter 2, as well as with
Training Letter 03-05 (Revised).

By Direction of the Under Secretary for Benefits

Renée Szybala, Director

> Compensation and Pension Service

Distribution: RPC: 2068

FD: EX: ASO and AR (included in RPC 2068)

LOCAL REPRODUCTION AUTHORIZED

**April 19, 2005 M21-1, Part IV**

**Change 217**

**CHAPTER 18. AUTOMATED MEDICAL INFORMATION EXCHANGE (AMIE) SYSTEM**

**AND BENEFICIARIES INSTITUTIONALIZED AT VA EXPENSE**

**CONTENTS**

PARAGRAPH PAGE

**SUBCHAPTER I. EXCHANGE OF INFORMATION**

18.01 General\--Exchange of Information between Medical Centers,
Outpatient

Clinics, and Regional Offices 18-I- l

2.  Action by the Veterans Service Center upon Receipt of an Admission
    Notice or Specialized

> AMIE Report 18-I- 1

18.03 Reports Which May Be Requested 18-I- 2

18.04 Action by the Veterans Service Center when VA Form 10-7131 is a
Request for a Net Worth

> Decision (Means Test) 18-I- 3

18.05 Reports Submitted by VA Medical Centers or Domiciliaries without

Requests from the Veterans Service Center 18-I- 5

18.06 Notification to Institutions of Changes in Status 18-I- 5

**SUBCHAPTER II. AMIE MAIN MENU AND OPTIONS**

18.07 AMIE Regional Office Main Menu 18-II- l

18.08 Options Related to 7131 Information Requests 18-II-2

18.09 Inquiry Options Available through the AMIE System 18-II-2

18.10 Options Which Generate Specialized Reports 18-II-3

18.11 Discharge Notifications and Issuance of 21-Day Certificates
18-II-7

18.12 Option for Auditing DHCP Data Base 18-II-7

18.13 Electronic Mail System 18-II-7

18.14 C&P Examination Program (2507) 18-II-7

**SUBCHAPTER III. ADJUSTMENTS UNDER 38 CFR 3.551 AND 3.556**

18.15 General 18-III-1

18.16 Reduction Due to Initial Admission 18-III-2

18.17 Action on Readmission 18-III-4

18.18 Authorized Absences and Non-Bed Care Status 18-III-5

18.19 Adjustment Due to Existence of Dependents 18-III-6

18.20 Restoration on Discharge (38 CFR 3.556) 18-III-8

**SUBCHAPTER IV. ADJUSTMENT OF AWARDS INVOLVING AID AND ATTENDANCE
ALLOWANCE**

18.21 Reduction of Aid and Attendance during Hospitalization 18-IV-1

18.22 Determination of Need for Hospital Summary 18-IV-2

18.23 Grant or Termination of Entitlement to Aid and Attendance during
Hospitalization 18-IV-2

18.24 Adjustment of Aid and Attendance Benefits on Departure or
Discharge

from or Return to Institution 18-IV-3

18.25 Expedited Aid and Attendance or Housebound Determinations for

Nonservice-Connected Chronic Invalids Hospitalized at VA Expense 18-IV-4

**SUBCHAPTER V. AWARD ADJUSTMENTS BASED ON HOSPITALIZATION IN EXCESS**

**OF 21 DAYS AND ON TEMPORARY SURGICAL RATINGS**

18.26 Obtaining 21-Day Certificate when Veteran Is Hospitalized in
Excess of 21 Days 18-V- 1

**18-i**

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**Change 217**

-Type of Discharge -Length of Stay

-# of Pass Days -# of Absence Days

-Future Appointments -Remarks

\(2\) The most useful purpose of this option is to verify patient
status. This option should be utilized prior to processing an
\"open-ended\" paragraph 29 award. If the veteran has been discharged,
the type of discharge will be shown.

b\. **Option l0\--Detailed Inpatient Inquiry.** With this option, the
regional office can obtain a list of all prior admissions. From that
list, information for specific admissions can be reviewed in detail.

\(l\) Information available through this inquiry option includes:

-ADMISSION DATE -TREATING SPECIALTY

-WARD LOCATION -ADMITTING DIAGNOSIS

-PTF ENTRY -ADMITTING REGULATION

-DISCHARGE DATE -TYPE OF DISCHARGE

-TRANSFER DATE -TYPE OF MOVEMENT

-LOCATION TO -RETURN DATE

-DATE OF SPECIALTY CHANGE -SPECIALTY

-CLOSING BEDSECTION -ADMITTING/TRANSFER DIAGNOSIS

-PROVIDER

-MOVEMENT NUMBER

\(2\) This option is useful for clarifying treatment history of a
veteran at a particular facility.

c\. **Option 13\--Patient Profile.** This option provides a wealth of
information relative to a veteran\'s use of medical center resources.
Data available includes appointments, clinic visits, and enrollments in
various clinics.

\(l\) Information obtained through this option is helpful to the
regional office in a number of ways.

\(a\) It allows the regional office to make very specific requests. No
longer is it necessary to make \"blanket\" requests for all records
covering lengthy timeframes.

\(b\) Information on past and future appointments is provided. It allows
the regional office to clarify appointment dates in conjunction with a
C&P examination and verify whether the veteran reported for the
examination(s). If an examination was completed, the date the report was
returned to the regional office is a matter of record.

\(2\) This option produces a report of demographic and clinic
information for a selected patient. The following demographic
information will be given: NAME, SEX, DATE OF BIRTH, RACE, EMPLOYMENT
STATUS, MARITAL STATUS, OCCUPATION, RELIGION, SOCIAL SECURITY NUMBER,
and PLACE OF BIRTH. If of record, the following information will also be
given: Eligibility information, temporary address and phone number,
Vietnam information, inpatient ward and bed location, disabilities and
percentages, and period of service.

**18.10 OPTIONS WHICH GENERATE SPECIALIZED REPORTS**

a\. **Preset Timetables.** Award adjustments based upon periods of
hospitalization or nursing home care at VA expense must be accomplished
in a timely manner. Regional offices must adhere to pre-set timetables
for requesting and generating specialized reports. General guidelines
for generating reports can be found in Addendum A of this chapter.

**18-II-3**

**M21-1, Part IV April 19, 2005**

**Change 217**

**NOTE: When generating reports, DO [NOT]{.underline} SORT BY REGIONAL
OFFICE NUMBER!** Information can only be exchanged electronically
between regional offices and medical centers linked by AMIE. Because a
veteran may receive treatment at a medical center not linked to the
regional office retaining jurisdiction of his/her claims folder, when
generating reports and prompted \"SORT BY REGIONAL OFFICE NUMBER?\"
enter \"N\" for NO. Individual reports generated for veterans whose
claims folders are located elsewhere must be FAX\'d promptly to the
regional office retaining jurisdiction of the claims file to the
attention of the Adjudication Officer. If two or more regional offices
are linked to a medical center, the primary regional office will run
reports for ALL, dispose of reports generated for the \"shared\"
regional office and FAX reports to any other regional offices. The other
regional office(s) associated with that medical center can sort by
regional office number.

b\. **Master Log.** To ensure that reports are generated timely, each
regional office will establish and maintain a master log. This master
log will identify each type of specialized report (e.g., S/C Admissions,
A&A Admissions) and will be annotated to show the date run, the period
covered, and any problems noted. This log will ensure that all types of
reports and date ranges have been run.

\(l\) The Adjudication Officer will determine who generates reports,
maintains, and annotates the master log.

\(2\) Master logs must be maintained for one full year. Logs for the
year prior will be destroyed under RCS VB-1, 13-100.300.

c\. **Reports for Pension Maintenance Centers.** No later than the third
business day of each month, the regional office will generate a list of
pension-related reports for the Pension Maintenance Center (PMC).

(1) Pension-related reports include the following (see description of
    reports under subparagraph d):

-   A&A admissions - *Option 11*

-   Pension admission (Section 306) - *Option 11*

-   Pension Admission (Old Law) - *Option 11*

-   Discharge report (Improved Pension) - *Option 7*

-   Readmission report - *Option 12*

(2) These reports will be sent via FedEx to the Hospital Adjustment
    Coordinator (HAC) at the PMC.

(3) The HAC will ensure the reports are reviewed and appropriate action
    is taken.

(4) The HAC should maintain a log of incoming reports, identifying the
    RO that sent the reports and the timeliness of delivery

**NOTE:** Refer to Training Letter 03-05 (Revised) for additional
information on hospital adjustments and M21-1MR, Part V, Subpart iv for
information about PMCs.

d\. **Generated Report Options**

\(1\) **Option 6\--Admission Report for Service-Connected Veterans.**
This option will report all service-connected admissions for any given
date range. The systematic creation of this report will identify
veterans with potential eligibility for temporary total ratings under
Paragraph 29, as well as those cases requiring review of hospital
summaries for possible increases in service-connected disabilities.

\(a\) Since the veteran may not be hospitalized for treatment of his/her
service-connected disability, compare the veteran\'s service-connected
disability to the admitting diagnosis in order to determine what action,
if any, may be required. BDN is usually adequate to complete the review
unless the service-connected disability is non- compensable.

**18-II-4**

**April 19, 2005 M21-1, Part IV**

**Change 217**

\(i\) If the veteran remains hospitalized and was admitted for a
service-connected disability, the standard request will be for a 21-day
certificate, discharge report, and hospital summary.

> \(ii\) If the veteran has already been discharged, generally all that
> will be required is the hospital summary.

\(b\) The timing of this report is subject to some management
discretion. However, all days of admission must be covered. This can be
accomplished a number of ways. After allowing adequate time for hospital
employees to update patient eligibility (usually not more than four
days), the report can be run daily. As an alternative, the report can be
run weekly (e.g., each Thursday run all admissions for the prior week).

\(c\) Regardless of the frequency of running the reports, general
workflow is similar.

\(i\) Use option 6 to generate individual reports.

\(ii\) Screen reports across BDN and establish end product 320 controls,
as necessary.

\(iii\) Request 21-day certificates, hospital summaries, and discharge
reports, as appropriate.

\(iv\) Annotate each report to show information requested and controls
established.

\(v\) Refer the report for filing in the claims folder.

\(d\) Refer to Addendum E for an example of the Admission Report for
Service-Connected Veteran.

\(2\) **Option 7\--Discharge Report.** This option will report
service-connected, A&A, pension or all discharges for any given date
range. In addition, discharges can be printed by specific type (e.g.,
Discharge to CNH, Regular to DOM from Hospital, and Regular to NHCU from
Hospital). Refer to Addendum B for a list of MAS movement/transaction
types.

\(a\) Uses include the following:

\(i\) Improved Pension cases subject to adjustment under 38 CFR 3.557(e)
based of domiciliary or nursing home care by VA can be isolated by
requesting pension cases with related discharges for the month preceding
the three past months.

\(ii\) A&A cases with irregular discharges during the past six months
can also be determined.

\(iii\) Management can use this option to conduct quality reviews of
actions taken on AMIE reports.

\(b\) Refer to Addendum E for an example of a Discharge Report.

\(3\) **Option 8\--Incompetent Veterans Report.** This option will
generate reports for those veterans rated incompetent by VA or found
incompetent through judicial proceedings. For this report to process
correctly, either the \"Date Ruled Incompetent (VA)\" or \"Date Ruled
Incompetent (CIVIL)\" must have been edited by hospital personnel or the
DHCP \"Rated Incompetent\" field must reflect \"yes.\"

\(a\) Since the effective date for hospital adjustments for incompetent
veteran cases falls under \"end-of-month\" criteria, a report generated
on the first workday of the month is adequate.

\(i\) Generated reports must be screened across BDN to verify
incompetency and dependency information. Disregard those cases not
subject to adjustment.

\(ii\) Establish controls for those cases subject to adjustment.

**18-II-5**

**M21-1, Part IV April 19, 2005**

**Change 217**

\(iii\) Development for asset information with the Veterans Services
Division or the appropriate medical center.

\(iv\) Predetermination notification is required prior to any adverse
action. Follow procedure established in Chapter 9.

\(b\) Refer to Addendum E for an example of an Incompetency Report.

\(4\) **Option 11\--Report for Pension and A&A.** This report will
provide information for veterans coded in the hospital data base as
being in receipt of either basic pension or pension with A&A and still
an active patient OR discharged \"at government expense.\" The date
range and types of discharges are selected by the regional office.

\(a\) Reports generated by this option always report active patients.
The regional office must specify discharge types. Discharge types vary
slightly from facility to facility depending upon services available at
a medical center. For example, medical centers with domiciliaries (DOMs)
will have DOM related discharge types (e.g., Regular to DOM). Discharge
types requested by the regional office will depend upon what services
are offered at a particular medical center. Refer to Addendum B for a
list of MAS movement/transaction types.

\(b\) The date range specified by the regional office is the full month
in the past during which an admission would require an adjustment if the
veteran remains institutionalized at VA expense.

**Example l**: The A&A REPORT run on August l would be for the date
range June l through June 30

since one full calendar month separates this date range from August l.

**Example 2**: The PENSION REPORT for Section 306 cases run on August l
would be for the date range

May l through May 31 since two full calendar months separate this date
range from August l.

\(c\) Run pension and A&A reports for each medical facility on the first
day of the month. Months in which the first falls on a holiday or
weekend require a modified procedure. In these months, a report should
be run on the last workday of the old month and also the first workday
of the new month. Any names not appearing on the second report are
veterans discharged over the weekend and/or holiday. Review the patient
inquiry data for the veteran to determine if the discharge was before
the first of the month.

\(d\) Screen all reports across BDN to determine if action is required.
Generally, A&A will require review of the claims folder to determine if
the disability allows for continued payment. For cases requiring
adjustment, due process notification must immediately be sent as these
veterans have been institutionalized the appropriate number of months to
warrant adjustment under the provisions of 38 CFR 3.551 and 3.552.
Follow procedures established in Chapter 9. A copy of the report should
remain in the claims folder as documentation of award adjustment.

\(e\) Refer to Addendum E of this chapter for an example of a Special
A&A Report.

\(5\) **Option 12\--Readmission Report.** The readmission report
identifies cases requiring immediate or end of the month adjustments
under the provisions of 38 CFR 3.551(b)(3), 3.552(c)(2), and
3.551(e)(2). The report prints veterans identified in the hospital
computer database who are eligible for pension or A&A, admitted during
the timeframe specified by the regional office, and who had a hospital
stay during the 185 day period immediately

preceding the current admission date.

\(a\) The report only lists cases where the prior period of
hospitalization exceeded 89 days for pension readmissions (59 days if
the facility has a domiciliary). For A&A cases, the report lists only
A&A cases where the prior admission exceeded 29 days [and]{.underline}
the prior discharge was irregular.

\(b\) Generally, the report is run monthly at the beginning of the month
for admissions during the prior month.

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\(c\) Screen listed names across BDN to determine if benefits were
actually adjusted during the prior six month period. If so, determine if
immediate or end-of-month adjustment is required. Follow due process
procedures in Chapter 9 prior to award adjustment.

\(d\) Refer to Addendum E for an example of a Readmission Report.

**18.11 DISCHARGE NOTIFICATIONS AND ISSUANCE OF 21-DAY CERTIFICATES**

**Option 16\--Regional Office 7132 Menu.** This option allows the
regional office to print and reprint discharge reports and 21-day
certificates. Refer to Addendum F for examples of both.

a\. **Notice of Discharge.** The AMIE system provides discharge
notification automatically and alerts the regional office that there are
new discharge notices to print if there is a discharge request pending,
the veteran dies, or the veteran is discharged to a community nursing
home.

b\. **21-Day Certificate.** A 21-day certificate will only be generated
if one has been requested by the regional office.

\(l\) Once a 21-day certificate has been generated, the system
automatically establishes a pending request for a hospital summary and a
notice of discharge.

\(2\) If a certificate was requested and the veteran was hospitalized
less than 21 days, the system will automatically complete the request as
being \"not applicable\" without operator intervention.

\(3\) When the veteran is hospitalized 21 days, a blank certification is
printed at the appropriate medical center.

\(a\) This certificate is then delivered and reviewed by the physician.

\(b\) The physician assigns a primary diagnosis and signs the
certificate.

\(c\) The certificate is returned to MAS and the diagnosis is entered in
the system.

\(d\) Supervisory personnel must approves the certificate before it can
be released to the regional office.

\(e\) When released, the regional office is notified that a 21-day
certificate is available for printing.

**18.12 OPTION FOR AUDITING DHCP DATA BASE**

**Option 5\--Admission Inquiry By Date (All Admissions).** The AMIE
system will generate complete and accurate reports only if the DHCP data
is accurate. This option is used to conduct periodic audits of the
medical center data base. Audit eligibility coding in the DHCP data base
against BDN information and forward discrepancies to the medical center
for corrective action.

**18.13 ELECTRONIC MAIL SYSTEM**

**Option 15\--Mailman Menu.** Mailman is an electronic communication
link of people having access to the hospital computer system. For
additional information regarding this option, refer to the AMIE User
Manual.

**18.14 C&P EXAMINATION PROGRAM (2507)**

**Option 17\--Regional Office C&P Menu.** This option provides an
electronic means of requesting, modifying, editing, canceling, inquiring
into the status of C&P examinations, and printing completed examination
reports. Refer to Subchapter VIII, AMIE C&P EXAMINATION PROGRAM.

**18-II-7**