## Section E. Institutional Awards Specific to Incompetent Veterans

#### Overview

+------------+---------------------------------------------------------+
| ##         | > This section contains the following topics:           |
| ### In thi |                                                         |
| s Section  |                                                         |
+------------+---------------------------------------------------------+

  ---------- ------------------------------------------------ ------------
  Topic      Topic Name                                       See Page

  21         General Information on Institutional Awards for  6-E-2
             Incompetent Veterans                             

  22         General Information on Preparing an              6-E-4
             Institutional Award                              

  23         Institutional Awards to VA and Non-VA            6-E-10
             Institutions                                     

  24         Transferring a Veteran for Contract Nursing Home 6-E-13
             Care Under 38 U.S.C. 1720                        

  25         Awards to Dependents of Incompetent Veterans     6-E-17

  26         Handling Funds in Personal Funds of Patients     6-E-20
             (PFOP) Accounts                                  

  27         Adjusting an Institutional Award During Non-Bed  6-E-23
             Care Status                                      

  28         Discontinuing an Institutional Award When a      6-E-27
             Veteran Is Being Discharged From a Hospital      
  ---------- ------------------------------------------------ ------------

#### 21. General Information on Institutional Awards for Incompetent Veterans

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains general information on            |
| troduction | > institutional awards that are made in cases involving |
|            | > incompetent veterans. It includes information on      |
|            |                                                         |
|            | -   the regulatory provisions of 38 CFR 3.852(a)        |
|            |                                                         |
|            | -   institutional personnel to whom payments may be     |
|            |     authorized                                          |
|            |                                                         |
|            | -   reviewing AMIE or CAPRI system reports, and         |
|            |                                                         |
|            | -   a rating of incompetency subsequent to admission.   |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > April 10, 2007                                        |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### a.   | > Under the provisions of [38 CFR                       |
| Regulatory | > 3.852(a)](http://w                                    |
|  Provision | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_852.DOC), |
| s of 38 CF | > when an incompetent veteran is admitted to an         |
| R 3.852(a) | > institution for the purpose of hospital treatment,    |
|            | > domiciliary or nursing home care (public or private), |
|            | > an award of all or any part of the pension,           |
|            | > compensation, or retirement pay payable may be made   |
|            | > to the chief officer of the institution.              |
|            | >                                                       |
|            | > Although an institutional award is generally          |
|            | > restricted to a situation in which a fiduciary has    |
|            | > not been appointed or recognized, it may also be made |
|            | > on behalf of a veteran for whom a fiduciary has been  |
|            | > appointed, but *only* if specifically requested by    |
|            | > the fiduciary activity.                               |
+------------+---------------------------------------------------------+

Continued on next page

21\. General Information on Institutional Awards for Incompetent
Veterans, Continued

+------------+---------------------------------------------------------+
| ##### b    | > The "chief officer" to whom payments may be           |
| . Institut | > authorized is, in the case of a                       |
| ional Pers |                                                         |
| onnel to W | -   Department of Veterans Affairs (VA) medical center  |
| hom Paymen |     (VAMC), the Director, or                            |
| ts May Be  |                                                         |
| Authorized | -   non-VA institution, the chief officer as certified  |
|            |     under [38 CFR                                       |
|            |     13.61](http://w                                     |
|            | ww.warms.vba.va.gov/regs/38cfr/bookf/part13/s13_59.doc) |
|            |     by the fiduciary activity.                          |
|            |                                                         |
|            | ***Notes***:                                            |
|            |                                                         |
|            | -   Payment on behalf of the primary beneficiary        |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   may be made to a VA institution simultaneously with |
|            |     a request to the fiduciary activity for             |
|            |     certification of a fiduciary, but                   |
|            |                                                         |
|            | -   may not be made to a non-VA institution until the   |
|            |     fiduciary activity certifies a fiduciary.           |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   The chief officer of a non-VA nursing home must not |
|            |     be certified for an institutional award under [38   |
|            |     CFR                                                 |
|            |     13.61](http://w                                     |
|            | ww.warms.vba.va.gov/regs/38cfr/bookf/part13/s13_59.doc) |
|            |     if the veteran is being maintained in that home     |
|            |     under contract, as provided by [38 U.S.C.           |
|            |     1720](http://assembler.law.cornell.edu/             |
|            | uscode/html/uscode38/usc_sec_38_00001720----000-.html). |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   Any institutional award will be continued to the    |
|            |     Director of the VAMC until the Veterans Service     |
|            |     Center Manager (VSCM) certifies a different         |
|            |     fiduciary).                                         |
|            |                                                         |
|            | > ***Reference***: For more information on transfers to |
|            | > nursing home care under [38 U.S.C.                    |
|            | > 1720](http://assembler.law.cornell.edu/               |
|            | uscode/html/uscode38/usc_sec_38_00001720----000-.html), |
|            | > see M21-1MR, Part III, Subpart v, 6.E.24.             |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### c.   | > Use Option 8 on the Automated Medical Information     |
|  Reviewing | > Exchange (AMIE)/Compensation and Pension Records      |
|  AMIE or C | > Interchange (CAPRI) system to obtain reports of       |
| APRI syste | > veterans who have been found incompetent through      |
| m Reports  | > judicial proceedings or rated incompetent for VA      |
|            | > purposes.                                             |
|            | >                                                       |
|            | > Review each report to determine what actions, if any, |
|            | > are required.                                         |
|            | >                                                       |
|            | > Reference: For information on using AMIE, see the     |
|            | > AMIE II User Guide or the CAPRI User GUIDE.           |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### d    | > If a veteran is rated incompetent subsequent to       |
| . A Rating | > admission, request any information, reports, or       |
|  of Incomp | > summaries that may be required as a result of the     |
| etency Sub | > veteran's incompetency. Information from the medical  |
| sequent to | > center should be requested via the AMIE/CAPRI system. |
|  Admission |                                                         |
+------------+---------------------------------------------------------+

#### 22. General Information on Preparing an Institutional Award

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains general information on the        |
| troduction | > appropriate actions to take when preparing            |
|            | > institutional awards under various circumstances. It  |
|            | > includes information on                               |
|            |                                                         |
|            | -   providing *VA Form 21-592, Request for Appointment  |
|            |     of a Fiduciary, Custodian, or Guardian*, to the     |
|            |     fiduciary activity                                  |
|            |                                                         |
|            | -   handling an award when a veteran is transferred to  |
|            |     another institution                                 |
|            |                                                         |
|            | -   notifying the institution of an award               |
|            |                                                         |
|            | -   use of *VA Form 21-592, Request for Appointment of  |
|            |     a Fiduciary, Custodian, or Guardian*, for private   |
|            |     and VA institutions                                 |
|            |                                                         |
|            | -   maintaining controls for future hospital            |
|            |     adjustments, and                                    |
|            |                                                         |
|            | -   assigning a payee number for institutional awards.  |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > April 10, 2007                                        |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > On receipt of notice of commitment constituting a     |
| a. Providi | > judicial determination of incompetency, furnish *VA   |
| ng *VA For | > Form 21-592, Request for Appointment of a Fiduciary,  |
| m 21-592,  | > Custodian, or Guardia*n, to the fiduciary activity    |
| Request fo | > and give consideration to                             |
| r Appointm |                                                         |
| ent of a F | -   immediate payment to a spouse payee                 |
| iduciary,  |                                                         |
| Custodian, | -   apportionment to dependents, or                     |
|  or Guardi |                                                         |
| an*, to th | -   an institutional award.                             |
| e Fiduciar |                                                         |
| y Activity | > ***Note***: *VA Form 21-592, Request for Appointment  |
|            | > of a Fiduciary, Custodian, or Guardia*n is required   |
|            | > for fiduciary activity certification prior to an      |
|            | > award to a non-VA institution.                        |
|            | >                                                       |
|            | > ***References***: For information on                  |
|            |                                                         |
|            | -   payments to a spouse payee, see M21-1MR, Part III,  |
|            |     Subpart v, 9.B.8.a (TBD) or [M21-1, Part IV,        |
|            |     17.18](http                                         |
|            | ://www.warms.vba.va.gov/admin21/m21_1/part4/ch17.doc)), |
|            |     and                                                 |
|            |                                                         |
|            | -   apportionments to dependents, see M21-1MR, Part     |
|            |     III, Subpart v, 6.E.25.b.                           |
+------------+---------------------------------------------------------+

Continued on next page

22\. General Information on Preparing an Institutional Award, Continued

+------------+---------------------------------------------------------+
| ##### b. H | > When a veteran is transferred to another institution  |
| andling an |                                                         |
|  Award Whe | -   do *not* interrupt an institutional award           |
| n a Vetera |                                                         |
| n Is Trans | -   do *not* change the name of the chief officer-payee |
| ferred to  |     without fiduciary activity certification of a       |
| Another In |     non-VA chief officer-payee                          |
| stitution  |                                                         |
|            | -   once certification of the name is received from the |
|            |     fiduciary activity, input the change of name of the |
|            |     chief officer-payee by using the Change of          |
|            |     Fiduciary update in Share, when award action is not |
|            |     otherwise required, and                             |
|            |                                                         |
|            | -   print a copy of the Change of Fiduciary screen from |
|            |     Share and send it to the fiduciary activity of      |
|            |     jurisdiction.                                       |
|            |                                                         |
|            | > ***Note***: The Legal Instruments Examiner (LIE) may  |
|            | > input changes in address or fiduciary name. In such   |
|            | > case, *VA Form 21-555, Certificate of Legal Capacity  |
|            | > to Receive and Disburse Benefits* and any necessary   |
|            | > attachments will be sent from the fiduciary activity  |
|            | > to the authorization activity as notification of the  |
|            | > change.                                               |
|            | >                                                       |
|            | > ***References***:                                     |
|            |                                                         |
|            | -   For information on transfers to nursing home care,  |
|            |     see M21-1MR, Part III, Subpart v, 6.E.24.           |
|            |                                                         |
|            | -   For information about the fiduciary activity action |
|            |     on changes of name or address, see M21-1MR, Part    |
|            |     XI, 4.C.12.a.                                       |
|            |                                                         |
|            | -   For information on entering fiduciary information   |
|            |     in Share, see the Share User\'s Guide.              |
+------------+---------------------------------------------------------+

Continued on next page

22\. General Information on Preparing an Institutional Award, Continued

+------------+---------------------------------------------------------+
| #####      | > When an institutional award has been authorized       |
| c. Notifyi |                                                         |
| ng the Ins | -   notify the Director or chief officer of the         |
| titution o |     institutional award by locally-generated letter     |
| f an Award |                                                         |
|            | -   complete *VA Form 29-4347*, *Notification of Rating |
|            |     of Competency or Incompetency, or of Appointment,   |
|            |     Recognition, Change, or Discharge of Fiduciary*,    |
|            |     and                                                 |
|            |                                                         |
|            | -   send *VA Form 29-4347*, *Notification of Rating of  |
|            |     Competency or Incompetency, or of Appointment,      |
|            |     Recognition, Change, or Discharge of Fiduciary* to  |
|            |     the insurance activity.                             |
|            |                                                         |
|            | > ***Note***: The authorization activity must send *VA  |
|            | > Form 29-4347*, *Notification of Rating of Competency  |
|            | > or Incompetency, or of Appointment, Recognition,      |
|            | > Change, or Discharge of Fiduciary*, to the insurance  |
|            | > activity when                                         |
|            |                                                         |
|            | -   there is a change in the competency or fiduciary    |
|            |     status of a veteran                                 |
|            |                                                         |
|            | -   there is an active insurance file (other than **T** |
|            |     or **N** prefixes), and                             |
|            |                                                         |
|            | -   the fiduciary activity does not indicate it         |
|            |     notified the insurance activity via VA Form 21-555, |
|            |     Certificate of Legal Capacity to Receive and        |
|            |     Disburse Benefits.                                  |
|            |                                                         |
|            | > ***References***: For more information about          |
|            |                                                         |
|            | -   completing and sending VA Form 29-4347,             |
|            |     Notification of Rating of Competency or             |
|            |     Incompetency, or of Appointment, Recognition,       |
|            |     Change, or Discharge of Fiduciary, see M21-1MR,     |
|            |     Part III, Subpart v, 9.A.3.c (TBD) or [M21-1, Part  |
|            |     IV, 17.20                                           |
|            |     b(1)](ht                                            |
|            | tp://www.warms.vba.va.gov/admin21/m21_1/part4/ch17.doc) |
|            |                                                         |
|            | -   the address or routing number for the insurance     |
|            |     activity in Philadelphia, see the *Consolidated     |
|            |     Address and Territorial Bulletin*, and              |
|            |                                                         |
|            | -   identifying an active insurance file through Vet's  |
|            |     Identification Data (VID) and Insurance screens,    |
|            |     see the *Share User's Guide*.                       |
+------------+---------------------------------------------------------+

Continued on next page

22\. General Information on Preparing an Institutional Award, Continued

+------------+---------------------------------------------------------+
| ##### d.   | > Use the table below to determine the appropriate use  |
| Use of *VA | > of *VA Form 21-592, Request for Appointment of a      |
|  Form 21-5 | > Fiduciary, Custodian, or Guardia*n when interacting   |
| 92, Reques | > with both private and VA institutions.                |
| t for Appo |                                                         |
| intment of |                                                         |
|  a Fiducia |                                                         |
| ry, Custod |                                                         |
| ian, or Gu |                                                         |
| ardian*, f |                                                         |
| or Private |                                                         |
|  and VA In |                                                         |
| stitutions |                                                         |
+------------+---------------------------------------------------------+

+----------------------------------+-----------------------------------+
| If the veteran is maintained at  | Then \...                         |
| \...                             |                                   |
+----------------------------------+-----------------------------------+
| -   a private nursing home       | do *not* make an institutional    |
|                                  | award until                       |
| -   any other type of private    |                                   |
|     institution, and             | -   *VA Form 21-592, Request for  |
|                                  |     Appointment of a Fiduciary,   |
| -   not at VA expense            |     Custodian, or Guardia*n is    |
|                                  |     released to the fiduciary     |
|                                  |     activity at the regional      |
|                                  |     office (RO) with jurisdiction |
|                                  |     of the veteran's residence,   |
|                                  |     and                           |
|                                  |                                   |
|                                  | -   *VA Form 21-555, Certificate  |
|                                  |     of Legal Capacity to Receive  |
|                                  |     and Disburse Benefits,* is    |
|                                  |     received from the fiduciary   |
|                                  |     activity.                     |
+----------------------------------+-----------------------------------+

Continued on next page

22\. General Information on Preparing an Institutional Award, Continued

  -----------------------------------------------------------------------
  d\. Use of VA Form 21-592, Request for Appointment of a Fiduciary,
  Custodian, or Guardian, for Private and VA Institutions (continued)

  -----------------------------------------------------------------------

+----------------------------------+-----------------------------------+
| If the veteran is maintained at  | Then \...                         |
| \...                             |                                   |
+----------------------------------+-----------------------------------+
| a VA institution                 | send *VA Form 21-592, Request for |
|                                  | Appointment of a Fiduciary,       |
|                                  | Custodian, or Guardia*n and a     |
|                                  | copy of the institutional award   |
|                                  | to the fiduciary activity with    |
|                                  | jurisdiction over the VAMC for    |
|                                  |                                   |
|                                  | -   certification of the VAMC     |
|                                  |     Director as fiduciary, or     |
|                                  |                                   |
|                                  | -   appointment of an alternate   |
|                                  |     fiduciary.                    |
|                                  |                                   |
|                                  | ***Note***: Payment to the        |
|                                  | Director of a VA facility may be  |
|                                  | made simultaneously with the      |
|                                  | request to the fiduciary activity |
|                                  | for certification of a fiduciary. |
|                                  | There is no need to delay award   |
|                                  | action pending receipt of         |
|                                  | certification of the fiduciary on |
|                                  | VA Form 21-555, Certificate of    |
|                                  | Legal Capacity to Receive and     |
|                                  | Disburse Benefits.                |
+----------------------------------+-----------------------------------+

+------------+---------------------------------------------------------+
| #          | > Maintain EP 290 control for 60 days pending return of |
| #### e. Ma | > *VA Form 21-555, Certificate of Legal Capacity to     |
| intaining  | > Receive and Disburse Benefits* from the fiduciary     |
| Controls f | > activity. If the certification is not received, send  |
| or Future  | > a follow-up inquiry to the fiduciary activity and     |
| Hospital A | > extend the control date.                              |
| djustments |                                                         |
+------------+---------------------------------------------------------+

Continued on next page

22\. General Information on Preparing an Institutional Award, Continued

+------------+---------------------------------------------------------+
| ##### f.   | > Assign payee number 00 (veteran) for an institutional |
|  Assigning | > award on behalf of a veteran. However, assign payee   |
|  a Payee N | > number 99 when                                        |
| umber for  |                                                         |
| Institutio | -   an institutional award for an apportionment is      |
| nal Awards |     required as an additional award under               |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   [38 CFR 3.852                                       |
|            |     (a)(1)](http://w                                    |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_852.DOC); |
|            |     no fiduciary                                        |
|            |                                                         |
|            | -   [38 CFR 3.852                                       |
|            |     (a)(2)](http://w                                    |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_852.DOC); |
|            |     fiduciary not fulfilling duties                     |
|            |                                                         |
|            | -   [38 CFR3.852                                        |
|            |     (b)(2)](http://w                                    |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_852.DOC); |
|            |     veteran does not have dependents, or                |
|            |                                                         |
|            | -   [38 CFR 3.852                                       |
|            |     (b)(3)](http://w                                    |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_852.DOC); |
|            |     veteran has dependents, and                         |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   there is already an existing award to a fiduciary   |
|            |     under payee number 00.                              |
|            |                                                         |
|            | > Handle an institutional award under payee number 99   |
|            | > as apportionee award. This creates a type C           |
|            | > apportionee master record.                            |
|            | >                                                       |
|            | > Under payee number 00, show any amounts not paid      |
|            | > under that award as amounts withheld, including the   |
|            | > amount paid under payee number 99, which is carried   |
|            | > as a Type 1 withholding on the payee 00 award.        |
|            | >                                                       |
|            | > ***Example***: An award under payee number 99 may be  |
|            | > required in a situation in which an active master     |
|            | > record exists under payee number 00 in the name of a  |
|            | > fiduciary, but an institutional award is deemed       |
|            | > necessary to ensure funds are available for the       |
|            | > veteran's welfare.                                    |
+------------+---------------------------------------------------------+

#### 23. Institutional Awards to VA and Non-VA Institutions

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on institutional      |
| troduction | > awards to both VA and non-VA institutions. It         |
|            | > includes information on                               |
|            |                                                         |
|            | -   institutional awards to VAMC Directors              |
|            |                                                         |
|            | -   obtaining certification of the official when the    |
|            |     award is to an officer of a non-VA institution      |
|            |                                                         |
|            | -   preparing an award to a non-VA institution          |
|            |                                                         |
|            | -   the effect of dependents on an award to a non-VA    |
|            |     institution, and                                    |
|            |                                                         |
|            | -   awards to a non-VA institution that involves a      |
|            |     withholding for Personal Funds of Patients (PFOP).  |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > April 10, 2007                                        |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### a    | > When preparing an institutional award to the Director |
| . Institut | > of a VAMC                                             |
| ional Awar |                                                         |
| ds to VAMC | -   prepare the award at the full-rate otherwise        |
|  Directors |     payable subject to any amounts apportioned for      |
|            |     amounts withheld under [38 CFR                      |
|            |     3.551](http://                                      |
|            | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_551.DOC) |
|            |     due to hospitalization                              |
|            |                                                         |
|            | -   pay the award as of the "date of last payment," or, |
|            |     on initial or resumed awards, from the date of      |
|            |     entitlement, as provided under [38 CFR              |
|            |     3.401(d)(2)](http://w                               |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_401.DOC), |
|            |     and                                                 |
|            |                                                         |
|            | -   send *VA Form 21-592, Request for Appointment of a  |
|            |     Fiduciary, Custodian or Guardian*, to the fiduciary |
|            |     activity.                                           |
|            |                                                         |
|            | > ***Note***: These awards are not subject to a Type 3  |
|            | > deduction-offset for Personal Funds of Patients       |
|            | > (PFOP), but the Director will place all funds not     |
|            | > expended for the veteran to his/her credit in the     |
|            | > PFOP account maintained at that institution.          |
|            | >                                                       |
|            | > ***Reference***: For more information of handling of  |
|            | > PFOP funds, see [38 CFR                               |
|            | > 13.103](http://www                                    |
|            | .warms.vba.va.gov/regs/38cfr/bookf/part13/s13_103.doc). |
+------------+---------------------------------------------------------+

Continued on next page

23\. Institutional Awards to VA and Non-VA Institutions, Continued

+------------+---------------------------------------------------------+
| #####      | > Prior to authorizing an institutional award to the    |
|  b. Obtain | > chief officer of a non-VA institution, obtain a       |
| ing Certif | > certification of the name and title of the official   |
| ication of | > authorized to receive and disburse funds.             |
|  the Offic | >                                                       |
| ial When t | > ***Reference***: For more information on receiving    |
| he Award I | > certification on *VA Form 21-555, Certificate of      |
| s to an Of | > Legal Capacity to Receive and Disburse Benefits*, see |
| ficer of a | > M21-1MR, Part III, Subpart v, 6.E.22.d.               |
|  Non-VA In |                                                         |
| stitution  |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #          | > When preparing an award to a non-VA institution       |
| #### c. Pr |                                                         |
| eparing an | -   make the award effective as of                      |
|  Award to  |                                                         |
| a Non-VA I | ```{=html}                                              |
| nstitution | <!-- -->                                                |
|            | ```                                                     |
|            | -   the first day of the month in which the award is    |
|            |     approved, or                                        |
|            |                                                         |
|            | -   the day following the date of last payment to the   |
|            |     veteran, whichever is later, as provided under [38  |
|            |     CFR                                                 |
|            |     3.401(d)(1)](http://                                |
|            | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_401.DOC) |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   under payee number 00, provide a Type 3             |
|            |     deduction-offset (for deposit in the PFOP account   |
|            |     maintained at the Hines Information Technology      |
|            |     Center (ITC)) of all sums otherwise payable in      |
|            |     excess of the amount paid as an apportionment or    |
|            |     awarded to the institution, and                     |
|            |                                                         |
|            | -   do not authorize a monthly rate in excess of \$60 a |
|            |     month.                                              |
|            |                                                         |
|            | > ***Notes***:                                          |
|            |                                                         |
|            | -   When providing the Type 3 deduction-offset, be sure |
|            |     to include amounts payable for any period prior to  |
|            |     the effective date of the veteran's benefits being  |
|            |     paid to the chief officer of the institution.       |
|            |                                                         |
|            | -   If a disability pension award is apportioned and    |
|            |     payments to the institution are reduced to no more  |
|            |     than \$25 monthly under [38 CFR                     |
|            |     3.852(b)](http://w                                  |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_852.DOC), |
|            |     enter the additional amount withheld as a type 1    |
|            |     withholding.                                        |
|            |                                                         |
|            | > ***Reference***: For more information on the use of   |
|            | > withholding and deduction-offset codes, see [M21-1,   |
|            | > Part V,                                               |
|            | > 6.11b](htt                                            |
|            | p://www.warms.vba.va.gov/admin21/m21_1/part5/ch06.doc). |
+------------+---------------------------------------------------------+

Continued on next page

23\. Institutional Awards to VA and Non-VA Institutions, Continued

+------------+---------------------------------------------------------+
| ##### d. T | > Use the table below to determine the requirements for |
| he Effect  | > an award to a non-VA institution when the veteran     |
| of Depende | > does or does not have dependents.                     |
| nts on an  |                                                         |
| Award to a |                                                         |
|  Non-VA In |                                                         |
| stitution  |                                                         |
+------------+---------------------------------------------------------+

+---------------------+------------------------------------------------+
| If the veteran \... | Then \...                                      |
+---------------------+------------------------------------------------+
| *has* a             | disability pension benefits payable as an      |
|                     | institutional award may not exceed \$25 per    |
| -   spouse          | month. Benefits not paid to the veteran may be |
|                     | apportioned to the dependents. For more        |
| -   child, or       | information on awards to dependents, see       |
|                     | M21-1MR, Part III, Subpart v, 6.E.25.          |
| -   dependent       |                                                |
|     parent          | ***Reference***: For authority to apportion    |
|                     | the hospitalized veteran's benefits, see       |
|                     |                                                |
|                     | -   [38 CFR                                    |
|                     |     3.450(a)(1)(i)](http://www.warms.          |
|                     | vba.va.gov/regs/38CFR/BOOKB/PART3/S3_450.DOC), |
|                     |     and                                        |
|                     |                                                |
|                     | -   [38 CFR                                    |
|                     |     3.454(a)](http://www.warms.                |
|                     | vba.va.gov/regs/38CFR/BOOKB/PART3/S3_454.DOC). |
+---------------------+------------------------------------------------+
| *does not* have a   | the amount payable as an institutional award   |
|                     | must not exceed \$60 per month, unless the     |
| -   spouse          | fiduciary activity recommends the payment of   |
|                     | all or any part to the chief officer for the   |
| -   child, or       | veteran's use and benefit when required to     |
|                     |                                                |
| -   dependent       | -   provide adequately for the needs of the    |
|     parent          |     veteran, and                               |
|                     |                                                |
|                     | -   avoid the necessity for appointment of a   |
|                     |     fiduciary.                                 |
+---------------------+------------------------------------------------+

+------------+---------------------------------------------------------+
| ##         | > If an original or reopened award involving a          |
| ### e. Awa | > withholding for PFOP is prepared with a future        |
| rds to a N | > commencing date, it must not be authorized for        |
| on-VA Inst | > processing in any cycle before the first processing   |
| itution In | > cycle of the month in which the withholding is to     |
| volving a  | > become effective.                                     |
| Withholdin | >                                                       |
| g for PFOP | > ***Reference***: The processing cycle is described in |
|            | > [M21-1, Part V,                                       |
|            | > 1.05c](htt                                            |
|            | p://www.warms.vba.va.gov/admin21/m21_1/part5/ch01.doc), |
|            | > and the current processing cycle can be found in the  |
|            | > Schedule of Operations.                               |
+------------+---------------------------------------------------------+

#### 24. Transferring a Veteran for Contract Nursing Home Care Under 38 U.S.C. 1720

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on transferring a     |
| troduction | > veteran for nursing home care under 38 U.S.C. 1720.   |
|            | > It includes information on                            |
|            |                                                         |
|            | -   the applicability of 38 U.S.C. 1720 for nursing     |
|            |     home care                                           |
|            |                                                         |
|            | -   awards subject to reduction under                   |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   38 CFR 3.551, and                                   |
|            |                                                         |
|            | -   38 CFR 3.552                                        |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   action to take if an award was in effect at the     |
|            |     time of the veteran's transfer                      |
|            |                                                         |
|            | -   receiving notification from the VAMC of a change in |
|            |     competency                                          |
|            |                                                         |
|            | -   referring competency evidence to the rating         |
|            |     activity, and                                       |
|            |                                                         |
|            | -   notification of                                     |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   a veteran's release, or                             |
|            |                                                         |
|            | -   termination of care at VA expense.                  |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > April 10, 2007                                        |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##         | > VA may provide for the cost of the nursing home       |
| ### a. App | > expense for private or public nursing home care under |
| licability | > [38 U.S.C.                                            |
|  of 38 U.S | > 1720](http://assembler.law.cornell.edu/               |
| .C. 1720 f | uscode/html/uscode38/usc_sec_38_00001720----000-.html), |
| or Nursing | > for                                                   |
|  Home Care |                                                         |
|            | -   a service member                                    |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   who has been furnished care in an Armed Forces      |
|            |     hospital, and                                       |
|            |                                                         |
|            | -   who will become a veteran on discharge from the     |
|            |     Armed Forces hospital, or                           |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   a veteran                                           |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   who has been furnished VA hospital care, or         |
|            |                                                         |
|            | -   who is directly admitted to nursing home care if    |
|            |     the nursing home care is for an SC condition.       |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > Awards for veterans transferred or directly admitted  |
| b. Awards  | > for care at VA expense are subject to reduction and   |
| Subject to | > discontinuance under                                  |
|  Reduction |                                                         |
|  Under 38  | -   [38 CFR                                             |
| CFR 3.551  |     3.551](http://w                                     |
| and 3.552  | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_551.DOC); |
|            |     (Basic hospital adjustment criteria are described   |
|            |     in M21-1MR, Part III, Subpart v, 6.B.6.a), and      |
|            |                                                         |
|            | -   [38 CFR                                             |
|            |     3.552](http://w                                     |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_552.DOC); |
|            |     (A&A adjustment criteria are described in M21-1MR,  |
|            |     Part III, Subpart v, 6.C.12.a).                     |
+------------+---------------------------------------------------------+

Continued on next page

24\. Transferring a Veteran for Contract Nursing Home Care Under 38
U.S.C. 1720, Continued

+------------+---------------------------------------------------------+
| ##### c    | > If an institutional award to the Director of a VAMC   |
| . Action t | > was in effect at the time of a veteran's transfer to  |
| o Take If  | > a contract nursing home, continue the award until     |
| an Award W |                                                         |
| as in Effe | -   *VA Form 21-555, Certificate of Legal Capacity to   |
| ct at the  |     Receive and Disburse Benefits* is received from the |
| Time of th |     fiduciary activity authorizing payments to a        |
| e Veteran' |     different fiduciary, or                             |
| s Transfer |                                                         |
|            | -   payment may be made directly to the veteran. (See   |
|            |     M21-1MR, Part III, Subpart v, 6.E.28.d for action   |
|            |     to take if a veteran is rerated as competent.)      |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##         | > If there is a change in competency, the VAMC will     |
| ### d. Rec | > furnish a hospital summary to the appropriate         |
| eiving Not | > regional office (RO) upon the veteran's transfer to a |
| ification  | > nursing home.                                         |
| From the V |                                                         |
| AMC of a C |                                                         |
| hange in C |                                                         |
| ompetency  |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #          | > Follow the steps in the table below to refer          |
| #### e. Re | > competency evidence to the rating activity.           |
| ferring Co |                                                         |
| mpetency E |                                                         |
| vidence to |                                                         |
|  the Ratin |                                                         |
| g Activity |                                                         |
+------------+---------------------------------------------------------+

+-------+--------------------------------------------------------------+
| Step  | Action                                                       |
+-------+--------------------------------------------------------------+
| 1     | Forward the summary provided by the VAMC to the rating       |
|       | activity for a determination as to                           |
|       |                                                              |
|       | -   the competency status of the veteran, and                |
|       |                                                              |
|       | -   whether or not the veteran may be entitled to either     |
|       |                                                              |
|       | ```{=html}                                                   |
|       | <!-- -->                                                     |
|       | ```                                                          |
|       | -   Aid and Attendance (A&A), or                             |
|       |                                                              |
|       | -   Housebound benefits.                                     |
+-------+--------------------------------------------------------------+

Continued on next page

24\. Transferring a Veteran for Contract Nursing Home Care Under 38
U.S.C. 1720, Continued

  -----------------------------------------------------------------------
  e\. Referring Competency Evidence to the Rating Activity (continued)

  -----------------------------------------------------------------------

+-------+--------------------------------------------------------------+
| Step  | Action                                                       |
+-------+--------------------------------------------------------------+
| 2     | If the rating activity determines that the veteran is        |
|       |                                                              |
|       | -   *competent*, go to Step 3.                               |
|       |                                                              |
|       | -   *incompetent*, go to Step 4.                             |
+-------+--------------------------------------------------------------+
| 3     | Upon a rating determination of competency and there is       |
|       |                                                              |
|       | -   no VA designated fiduciary, or                           |
|       |                                                              |
|       | -   no VA designated fiduciary, but there is a               |
|       |     court-appointed fiduciary, then                          |
|       |                                                              |
|       | follow the procedures in M21-1MR, Part III, Subpart v,       |
|       | 6.E.28.d.                                                    |
|       |                                                              |
|       | ***Reference***: Background information on controls for      |
|       | funds not paid due to the provisions of 38 CFR 3.557         |
|       | (removed by *Public Law 107-103*) was discussed in the       |
|       | former M21-1, Part IV, 18.43.                                |
+-------+--------------------------------------------------------------+
| 4     | When a rating determination of continued incompetency is     |
|       | made, and no fiduciary has been appointed                    |
|       |                                                              |
|       | -   send *VA Form 21-592, Request for Appointment of a       |
|       |     Fiduciary, Custodian or Guardian*, if not previously     |
|       |     sent, to the fiduciary activity, to note                 |
|       |                                                              |
|       | ```{=html}                                                   |
|       | <!-- -->                                                     |
|       | ```                                                          |
|       | -   the nursing home placement                               |
|       |                                                              |
|       | -   the date of the veteran's transfer to the nursing home   |
|       |                                                              |
|       | -   a notation of possible release in six months, and        |
|       |                                                              |
|       | -   the name and address of next of kin, and                 |
|       |                                                              |
|       | ```{=html}                                                   |
|       | <!-- -->                                                     |
|       | ```                                                          |
|       | -   attach a copy of the hospital summary to *VA Form        |
|       |     21-592, Request for Appointment of a Fiduciary,          |
|       |     Custodian or Guardian*.                                  |
+-------+--------------------------------------------------------------+

Continued on next page

24\. Transferring a Veteran for Contract Nursing Home Care Under 38
U.S.C. 1720, Continued

+------------+---------------------------------------------------------+
| ##         | > The transferring VAMC authorizes and administratively |
| ### f. Not | > controls nursing home care, and notifies the          |
| ification  | > appropriate RO of the veteran's release from the      |
| of a Veter | > contract nursing home or when care at VA expense is   |
| an's Relea | > terminated.                                           |
| se or Term | >                                                       |
| ination of | > Upon receipt of such notification                     |
|  Care at V |                                                         |
| A Expense  | -   immediately make any adjustment in the award        |
|            |     necessitated by the release                         |
|            |                                                         |
|            | -   continue the institutional award to the Director of |
|            |     the VAMC if a different fiduciary has not yet been  |
|            |     appointed, and                                      |
|            |                                                         |
|            | -   send the fiduciary activity a copy of the notice of |
|            |     release.                                            |
+------------+---------------------------------------------------------+

#### 25. Awards to Dependents of Incompetent Veterans

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on awards to          |
| troduction | > dependents of incompetent veterans. It includes       |
|            | > information on                                        |
|            |                                                         |
|            | -   apportionment to dependents of                      |
|            |     non-institutionalized incompetent veterans          |
|            |                                                         |
|            | -   awards to dependents of institutionalized           |
|            |     incompetent veterans                                |
|            |                                                         |
|            | -   making an immediate award to a spouse as "wife or   |
|            |     husband"                                            |
|            |                                                         |
|            | -   apportioning an institutional award                 |
|            |                                                         |
|            | -   making an award to an estranged spouse              |
|            |                                                         |
|            | -   making an award to a dependent parent, and          |
|            |                                                         |
|            | -   the effect of benefits in suspense on               |
|            |     apportionments.                                     |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > April 10, 2007                                        |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##         | > When a veteran has been rated incompetent and an      |
| ### a. App | > apportionment is in order under [38 CFR               |
| ortionment | > 3.452](http://w                                       |
|  to Depend | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_454.DOC), |
| ents of No | > take action immediately unless payment can be made to |
| n-Institut | > a fiduciary or to the spouse as "wife or husband"     |
| ionalized  | > under [38 CFR                                         |
| Incompeten | > 13.57](http://ww                                      |
| t Veterans | w.warms.vba.va.gov/regs/38cfr/bookf/part13/s13_57.doc). |
|            | >                                                       |
|            | > If the veteran's benefits are not paid to a fiduciary |
|            | > or the spouse they may be apportioned to dependent    |
|            | > children upon receipt of evidence of hardship.        |
|            |                                                         |
|            | ***Note***: When VA receives evidence that the spouse   |
|            | is qualified to administer the funds payable and agrees |
|            | to use the amounts paid for the veteran and the         |
|            | veteran's dependents, if any, an "as wife or husband"   |
|            | award can be made under [38 CFR                         |
|            | 3.850(a)(2)](http://w                                   |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_850.DOC), |
|            | and an apportionment may not be necessary.              |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #          | Generally, the full monthly rate otherwise payable,     |
| #### b. Aw | less the reduced rate paid to the institution, may be   |
| ards to De | apportioned for dependents. An apportionment of the     |
| pendents o | veteran's withheld benefits may not be authorized       |
| f Institut | unless evidence of a hardship on the part of the        |
| ionalized  | dependent is received.                                  |
| Incompeten |                                                         |
| t Veterans | > See the following table for action the to take when   |
|            | > an incompetent veteran                                |
|            |                                                         |
|            | -   is receiving institutional care by the United       |
|            |     States or political subdivision thereof, and        |
|            |                                                         |
|            | -   has a spouse, child or dependent parent who is not  |
|            |     being adequately provided for by an award to a      |
|            |     fiduciary or to a spouse as "wife or husband."      |
+------------+---------------------------------------------------------+

  ----------------------------------- -----------------------------------
  For information on \...             See \...

  an award to a spouse as "wife or    M21-1MR, Part III, Subpart v,
  husband"                            6.E.25.c.
  ----------------------------------- -----------------------------------

Continued on next page

25\. Awards to Dependents of Incompetent Veterans, Continued

  -----------------------------------------------------------------------
  b\. Awards to Dependents of Institutionalized Incompetent Veterans
  (continued)

  -----------------------------------------------------------------------

  ----------------------------------- -----------------------------------
  For information on \...             See \...

  apportionment of an institutional   M21-1MR, Part III, Subpart v,
  award                               6.E.25.d.

  an award to an estranged spouse     M21-1MR, Part III, Subpart v,
                                      6.E.25.e.

  an award to a dependent parent      M21-1MR, Part III, Subpart v,
                                      6.E.25.f.
  ----------------------------------- -----------------------------------

+------------+---------------------------------------------------------+
| ##         | > When an immediate award may be made to the spouse as  |
| ### c. Mak | > "wife or husband," subject to concurrent submission   |
| ing an Imm | > of *VA Form 21-592, Request for Appointment of a      |
| ediate Awa | > Fiduciary, Custodian or Guardian* to the fiduciary    |
| rd to a Sp | > activity                                              |
| ouse as Wi |                                                         |
| fe/Husband | -   take such action in lieu of an apportionment, and   |
|            |                                                         |
|            | -   award the spouse the full benefit otherwise payable |
|            |     to the veteran.                                     |
|            |                                                         |
|            | > ***Reference***: For more information on paying the   |
|            | > veteran's benefits to the spouse as "wife or          |
|            | > husband," see M21-1MR III.v.9.B.8, TBD [M21-1, Part   |
|            | > IV,                                                   |
|            | > l7.18](ht                                             |
|            | tp://www.warms.vba.va.gov/admin21/m21_1/part4/ch17.doc) |
|            | > and [38 CFR 3.850                                     |
|            | > (a)(2)](http://w                                      |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_850.DOC). |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ####       | > When an institutional award of disability pension is  |
| # d. Appor | > being made to a non-VA institution, apply the         |
| tioning an | > provisions of [38 CFR                                 |
|  Instituti | > 3.454(a)](http://w                                    |
| onal Award | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_454.DOC), |
|            | > limiting the institutional payment to no more than    |
|            | > \$25 with the balance apportioned to the dependents.  |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### e    | When an incompetent, married veteran with an estranged  |
| . Making a | spouse is receiving disability pension as a single      |
| n Award to | veteran and institutional care at VA expense, reduce    |
|  an Estran | the award under [38 CFR                                 |
| ged Spouse | 3.551](http://                                          |
|            | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_551.DOC) |
|            | on the basis of estrangement from, or failure to,       |
|            | reasonably contribute to the support of his/her spouse. |
|            |                                                         |
|            | However, pay the difference between the institutional   |
|            | rate and the rate payable to a veteran living with a    |
|            | spouse as an apportionment when there is a              |
|            |                                                         |
|            | -   claim for an apportionment, and                     |
|            |                                                         |
|            | -   showing of hardship, per [38 CFR                    |
|            |     3.452(c)(1)](http://                                |
|            | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_452.DOC) |
|            |     and [38 CFR                                         |
|            |     3.454(b)](http://w                                  |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_454.DOC). |
|            |                                                         |
|            |     ***Reference***: For information on apportioning to |
|            |     an estranged spouse if the income causes a          |
|            |     reduction in the veteran's pension rate, see        |
|            |     M21-1MR, Part V, Subpart III, 1.F.38.n (TBD) or     |
|            |     [M21-1, Part IV,                                    |
|            |     16.27F](htt                                         |
|            | p://www.warms.vba.va.gov/admin21/m21_1/part4/ch16.doc). |
+------------+---------------------------------------------------------+

Continued on next page

25\. Awards to Dependents of Incompetent Veterans, Continued

+------------+---------------------------------------------------------+
| #####      | > When an incompetent veteran, having neither spouse    |
| f. Making  | > nor child, is hospitalized by the United States or    |
| an Award t | > any political subdivision thereof, pay all or any     |
| o a Depend | > part of the benefit otherwise payable to the          |
| ent Parent | > dependent parent under [38 CFR                        |
|            | > 3.451](http://w                                       |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_451.DOC). |
|            |                                                         |
|            | If the case involves                                    |
|            |                                                         |
|            | -   *compensation*, the payment to the dependent parent |
|            |     can be in an amount not less than the amount of     |
|            |     additional compensation payable on behalf of the    |
|            |     parent, or                                          |
|            |                                                         |
|            | -   *pension* for an incompetent veteran subject to     |
|            |     reduction under [38 CFR                             |
|            |     3.551](http://w                                     |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_551.DOC), |
|            |     the amount payable must not exceed the              |
|            |     institutional rate.                                 |
|            |                                                         |
|            | > ***Reference***: For information on apportionment to  |
|            | > the parent of a competent veteran, see M21-1MR, Part  |
|            | > III, Subpart v, 3.A.1.                                |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### g. T | > An initial action suspending payments pending         |
| he Effect  | > certification of a fiduciary does not prohibit        |
| of Benefit | > apportionments that are otherwise proper and          |
| s in Suspe | > equitable.                                            |
| nse on App | >                                                       |
| ortionment | > If an apportionment is made prior to certification of |
|            | > the fiduciary, furnish the fiduciary activity with a  |
|            | > copy of the apportionee award with a request for      |
|            | > expedited certification.                              |
|            | >                                                       |
|            | > ***Reference***: For information concerning expedited |
|            | > action required on discharge from institutional care, |
|            | > see M21-1MR, Part III, Subpart v, 6.E.28.a.           |
+------------+---------------------------------------------------------+

#### 26. Handling Funds in Personal Funds of Patients (PFOP) Accounts

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on handling funds in  |
| troduction | > PFOP accounts. It includes information on             |
|            |                                                         |
|            | -   the two types of PFOP accounts                      |
|            |                                                         |
|            | -   taking award action on the two types of PFOP        |
|            |     accounts                                            |
|            |                                                         |
|            | -   the use of funds for "necessary comforts and        |
|            |     desires" by VA medical centers and non-VA           |
|            |     hospitals, and                                      |
|            |                                                         |
|            | -   payment as accrued upon the death of a veteran.     |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > April 10, 2007                                        |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > There are two types of PFOP accounts, as outlined     |
|  a. Two Ty | > below.                                                |
| pes of PFO | >                                                       |
| P Accounts | > ***Accounts for Veterans Hospitalized in VAMCs***     |
|            | >                                                       |
|            | > On August 31, 1950, all balances in Funds Due         |
|            | > Incompetent Beneficiaries (FDIB) accounts that        |
|            | > represented compensation or pension accruing on or    |
|            | > after August 8, 1946, were transferred to the         |
|            | > Directors of the VAMCs in which the veterans were     |
|            | > hospitalized for credit to PFOP accounts. These       |
|            | > accounts are maintained by Directors of VAMCs.        |
|            | >                                                       |
|            | > ***Accounts for Veterans Committed/Confined to a      |
|            | > Non-VA Institution or for Veterans Whose Whereabouts  |
|            | > were Unknown***                                       |
|            | >                                                       |
|            | > On April 30, 1951, money that accrued on or after     |
|            | > August 8, 1946, was transferred from FDIB to PFOP     |
|            | > accounts under RO control and is now maintained by    |
|            | > the Hines ITC for cases in which the veteran was      |
|            | > confined or committed in a non-VA institution or the  |
|            | > whereabouts of the veteran were unknown. These        |
|            | > accounts are under the control of the Hines           |
|            | > Information Technology Center (ITC).                  |
|            | >                                                       |
|            | > ***Note***: August 8, 1946, was the date of passage   |
|            | > of *Public Law (PL) 662, 79^th^ Congress*.            |
+------------+---------------------------------------------------------+

Continued on next page

26\. Handling Funds in Personal Funds of Patients (PFOP) Accounts,
Continued

+------------+---------------------------------------------------------+
| ###        | > Because there are two types of PFOP accounts, a       |
| ## b. Taki | > distinction must be made in taking award action. The  |
| ng Award A | > distinctions for award action on each type of account |
| ction on t | > are listed below.                                     |
| he Two Typ |                                                         |
| es of PFOP | -   An award should never provide for a Type 3          |
|  Accounts  |     deduction-offset when it is an institutional award  |
|            |     to a Director of VAMC.                              |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   Award the total amount payable to the Director,     |
|            |     VAMC, for the account of the veteran.               |
|            |                                                         |
|            | -   The Director will deposit into the PFOP accounts    |
|            |     under his/her control all money not immediately     |
|            |     required for the veteran's needs                    |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   Money is not placed in a PFOP account under the     |
|            |     control of the Hines ITC, unless a Type 3           |
|            |     deduction-offset is input into the award to specify |
|            |     that a definite sum be applied to the PFOP.         |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   This is done only when a veteran is                 |
|            |     institutionalized in a non-VA institution.          |
+------------+---------------------------------------------------------+

Continued on next page

26\. Handling Funds in Personal Funds of Patients (PFOP) Accounts,
Continued

+------------+---------------------------------------------------------+
| ##         | > Use the table below to determine how funds from PFOP  |
| ### c. Use | > accounts needed for the comforts and desires of the   |
|  of Funds  | > veteran are obtained by                               |
| for Necess |                                                         |
| ary Comfor | -   the Director of a VAMC, or                          |
| ts and Des |                                                         |
| ires by VA | -   a non-VA institution.                               |
|  Medical C |                                                         |
| enters and |                                                         |
|  Non-VA In |                                                         |
| stitutions |                                                         |
+------------+---------------------------------------------------------+

+-------------------------------+--------------------------------------+
| If funds from PFOP accounts   | Then \...                            |
| for the comforts and desires  |                                      |
| of the veteran are needed by  |                                      |
| \...                          |                                      |
+-------------------------------+--------------------------------------+
| a Director of a VAMC          | he/she may use funds in the PFOP     |
|                               | account at his/her RO.               |
+-------------------------------+--------------------------------------+
| a non-VA institution          | funds are released on the basis of a |
|                               | memorandum from the fiduciary        |
|                               | activity authorizing partial or full |
|                               | release of money on deposit.         |
|                               |                                      |
|                               | Take award action as provided in     |
|                               | M21-1MR, Part III, Subpart v,        |
|                               | 6.E.28.g.                            |
|                               |                                      |
|                               | ***Note***: Computer processing of   |
|                               | the amended award results in a       |
|                               | notice to the Hines ITC Accounting   |
|                               | Section. On request of the           |
|                               | Accounting Section, the finance      |
|                               | activity at the RO authorizes the    |
|                               | release or transfer of the money on  |
|                               | deposit in the PFOP account.         |
+-------------------------------+--------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > For information on payment as accrued on the death of |
|  d. Paymen | > a veteran, see M21-1MR, Part VIII, 1.1.a.             |
| t as Accru |                                                         |
| ed Upon th |                                                         |
| e Death of |                                                         |
|  a Veteran |                                                         |
+------------+---------------------------------------------------------+

#### 27. Adjusting an Institutional Award During Non-Bed Care Status

+------------+---------------------------------------------------------+
| ##### Int  | > This topic contains information on adjusting          |
| roduction  | > institutional awards during non-bed care status of a  |
|            | > veteran. It includes information on                   |
|            |                                                         |
|            | -   the definition of ***non-bed care***                |
|            |                                                         |
|            | -   receiving and forwarding notice of non-bed care     |
|            |                                                         |
|            | -   continuing awards while on non-bed care             |
|            |                                                         |
|            | -   adjustments for absences of 30 days or more, and    |
|            |                                                         |
|            | -   extension of non-bed care.                          |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > April 10, 2007                                        |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ####       | > ***Non-bed care*** is a temporary release from a      |
| # a. Defin | > hospital to determine                                 |
| ition: Non |                                                         |
| -Bed Care  | -   the veteran's ability to make a satisfactory        |
|            |     adjustment outside the hospital, and                |
|            |                                                         |
|            | -   whether the veteran should be discharged from or    |
|            |     returned to the hospital, based on his/her ability  |
|            |     to make that adjustment.                            |
|            |                                                         |
|            | > ***Note***: Release on furlough by non-VA             |
|            | > institutions is synonymous with release to non-bed    |
|            | > care status.                                          |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### b    | > If the Veterans Service Center (VSC) requested a      |
| . Receivin | > notice of discharge report, the VAMC will notify the  |
| g and Forw | > RO of the veteran's departure on, or return from,     |
| arding Not | > non-bed care of 30 days or more.                      |
| ice of Non | >                                                       |
| -Bed Care  | > Use the table below for information on forwarding     |
|            | > this report, upon receipt.                            |
+------------+---------------------------------------------------------+

  ---------------------- ------------------------------------------------
  If the veteran \...    Then forward the report to the fiduciary
                         activity having jurisdiction over \...

  *has* a fiduciary      the veteran's fiduciary.

  *does not have* a      the area in which the hospital is located.
  fiduciary              
  ---------------------- ------------------------------------------------

Continued on next page

27\. Adjusting an Institutional Award During Non-Bed Care Status,
Continued

+------------+---------------------------------------------------------+
| ##### c.   | > Because a veteran for whom no fiduciary has been      |
|  Continuin | > appointed is considered to be in the constructive     |
| g Awards W | > custody of the chief officer of the institution while |
| hile on No | > on non-bed care, continue                             |
| n-Bed Care |                                                         |
|            | -   the institutional award on the veteran's behalf,    |
|            |     and                                                 |
|            |                                                         |
|            | -   special apportionments to the veteran's dependents. |
|            |                                                         |
|            | > The chief officer is authorized to                    |
|            |                                                         |
|            | -   provide funds to a veteran on non-bed care for whom |
|            |     no other fiduciary has been appointed, or           |
|            |                                                         |
|            | -   pay the person into whose custody the veteran is    |
|            |     released.                                           |
|            |                                                         |
|            | > ***Note***: Use this procedure for non-VA hospitals   |
|            | > if arrangements have been made by the fiduciary       |
|            | > activity with officials of the non-VA hospital to     |
|            | > comply with the same rules that bind Directors of     |
|            | > VAMCs.                                                |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##         | > Use the table below to determine how to make various  |
| ### d. Adj | > adjustments to awards for release to non-bed care or  |
| ustments f | > an authorized absence of 30 days or more.             |
| or Absence |                                                         |
| s of 30 Da |                                                         |
| ys or More |                                                         |
+------------+---------------------------------------------------------+

+----------------------------+-----------------------------------------+
| If \...                    | Then \...                               |
+----------------------------+-----------------------------------------+
| notice showing release to  | adjust awards that were reduced due to  |
| non-bed care or authorized | hospitalization to                      |
| absence of 30 days or more |                                         |
| is received                | -   pay the full amount on the basis of |
|                            |     the last rating, effective the date |
|                            |     of departure, and                   |
|                            |                                         |
|                            | -   discontinue any deduction-offset    |
|                            |     for PFOP, subject to the prior      |
|                            |     approval of the fiduciary activity, |
|                            |     when required.                      |
+----------------------------+-----------------------------------------+

Continued on next page

27\. Adjusting an Institutional Award During Non-Bed Care Status,
Continued

  -----------------------------------------------------------------------
  d\. Adjustments for Absences of 30 Days or More (continued)

  -----------------------------------------------------------------------

+----------------------------+-----------------------------------------+
| If \...                    | Then \...                               |
+----------------------------+-----------------------------------------+
| -   notice showing release | take no action unless the facts show    |
|     to non-bed care or     | the veteran's or apportionee's          |
|     authorized absence of  | situation has changed and that a new    |
|     30 days or more is     | special apportionment decision should   |
|     received, and          | be made.                                |
|                            |                                         |
| -   the total award amount |                                         |
|     is being paid either   |                                         |
|                            |                                         |
| ```{=html}                 |                                         |
| <!-- -->                   |                                         |
| ```                        |                                         |
| -   to the Director of a   |                                         |
|     VAMC, or               |                                         |
|                            |                                         |
| -   by special             |                                         |
|     apportionment between  |                                         |
|     the institution and    |                                         |
|     dependents             |                                         |
+----------------------------+-----------------------------------------+
| -   notice showing release | provide funds from PFOP accounts in     |
|     to non-bed care or     | accordance with M21-1MR, Part III,      |
|     authorized absence of  | Subpart v, 6.E.26.c.                    |
|     30 days or more is     |                                         |
|     received               |                                         |
|                            |                                         |
| -   funds in excess of the |                                         |
|     veteran's monthly      |                                         |
|     entitlement are        |                                         |
|     required, and          |                                         |
|                            |                                         |
| -   entitlement has been   |                                         |
|     terminated             |                                         |
+----------------------------+-----------------------------------------+

Continued on next page

27\. Adjusting an Institutional Award During Non-Bed Care Status,
Continued

+------------+---------------------------------------------------------+
| ####       | > If the original period of non-bed care or authorized  |
| # e. Exten | > absence is extended, make no further adjustment of a  |
| sion of No | > special apportionment or the institutional award      |
| n-Bed Care | > pending the expiration of the extension.              |
|            | >                                                       |
|            | > The Director or Chief Officer of the institution must |
|            | > carefully review each case in which there is an       |
|            | > extension to ascertain if any special circumstances   |
|            | > exist which                                           |
|            |                                                         |
|            | -   relate to the safeguarding of the interests of the  |
|            |     veteran and his/her dependents, or                  |
|            |                                                         |
|            | -   may indicate that continuance of the existing       |
|            |     payments is not justifiable.                        |
|            |                                                         |
|            | > If the facts warrant, the Director or chief officer   |
|            | > will submit appropriate recommendations to the VSC as |
|            | > to any action or adjustment considered advisable.     |
+------------+---------------------------------------------------------+

#### 28. Discontinuing an Institutional Award When a Veteran Is Being Discharged From a Hospital 

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on discontinuing      |
| troduction | > institutional awards and authorizing payment to a     |
|            | > veteran or guardian when a veteran is being           |
|            | > discharged from a hospital. It includes information   |
|            | > on                                                    |
|            |                                                         |
|            | -   preventing the interruption of award payments       |
|            |                                                         |
|            | -   discontinuing an institutional award when a veteran |
|            |     is discharged from a hospital                       |
|            |                                                         |
|            | -   awaiting receipt of a contemplated discharge date   |
|            |     before requesting a fiduciary                       |
|            |                                                         |
|            | -   referring the hospital summary to the rating        |
|            |     activity                                            |
|            |                                                         |
|            | -   requesting a field examination and possible         |
|            |     reconsideration by the rating activity              |
|            |                                                         |
|            | -   notification requirements for payments made         |
|            |     directly to a veteran or to a fiduciary, and        |
|            |                                                         |
|            | -   terminating PFOP withholding.                       |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > April 10, 2007                                        |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### a. P | > Avoid interruption of payments when an incompetent    |
| reventing  | > veteran in receipt of an institutional award is       |
| Interrupti | > finally discharged from the hospital.                 |
| on of Awar | >                                                       |
| d Payments | > This requires close coordination between the medical  |
|            | > institution and the VSC.                              |
+------------+---------------------------------------------------------+

Continued on next page

28\. Discontinuing an Institutional Award When a Veteran Is Being
Discharged From a Hospital, Continued

+------------+---------------------------------------------------------+
| ##### b. D | > When a veteran is discharged from a hospital,         |
| iscontinui | > discontinue an institutional award effective the date |
| ng an Inst | > of last payment, per [38 CFR                          |
| itutional  | > 3.501(j)](http://w                                    |
| Award When | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_501.DOC). |
|  a Veteran | >                                                       |
|  Is Discha | > If another fiduciary has been appointed, discontinue  |
| rged From  | > the institutional award by amended award to a         |
| a Hospital | > fiduciary per [38 CFR                                 |
|            | > 3.852](http://w                                       |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_852.DOC). |
|            | > Make payment of all funds due the incompetent person, |
|            | > including money on deposit in PFOP, to the fiduciary, |
|            | > if otherwise in order, as provided in M21-1MR, Part   |
|            | > III, Subpart v, 6.E.28.b.                             |
|            | >                                                       |
|            | > ***Note***: Notify the Director of the hospital when  |
|            | > an institutional award is discontinued.               |
|            | >                                                       |
|            | > ***Reference***: For information concerning a         |
|            | > transfer to a nursing home, see M21-1MR, Part III,    |
|            | > Subpart v, 6.E.24.                                    |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ####       | > Due to the indefinite period during which non-bed     |
| # c. Await | > care status may continue and the possibility that     |
| ing Receip | > competency may be regained, do not request another    |
| t of a Con | > fiduciary to replace the institutional award until a  |
| templated  | > contemplated date of discharge has been determined.   |
| Discharge  | >                                                       |
| Date Befor | > When a veteran without a guardian for whom an         |
| e Requesti | > institutional award has been authorized is being      |
| ng Another | > discharged from hospital treatment, the medical       |
|  Fiduciary | > center will advise the VSC of an impending discharge  |
|            | > and furnish an interim summary.                       |
|            | >                                                       |
|            | > Following submission of this report, the Chief        |
|            | > Officer of the medical center will retain the patient |
|            | > on non-bed care status until the necessary rating and |
|            | > guardianship procedures have been concluded.          |
+------------+---------------------------------------------------------+

Continued on next page

28\. Discontinuing an Institutional Award When a Veteran Is Being
Discharged From a Hospital, Continued

+------------+---------------------------------------------------------+
| ###        | > On receipt of a hospital summary indicating a medical |
| ## d. Refe | > opinion of regained competency, refer the summary to  |
| rring the  | > the rating activity for consideration.                |
| Hospital S | >                                                       |
| ummary to  | > Use the table below to determine the appropriate      |
| the Rating | > action to take based on the determination by the      |
|  Activity  | > rating activity.                                      |
|            | >                                                       |
|            | > ***Reference***: For more information or rating       |
|            | > competency issues, see M21-1MR, Part III, Subpart iv, |
|            | > 8.A.1.                                                |
+------------+---------------------------------------------------------+

+----------------------+-----------------------------------------------+
| If the rating        | Then \...                                     |
| activity makes a     |                                               |
| determination of     |                                               |
| \...                 |                                               |
+----------------------+-----------------------------------------------+
| competency           | -   discontinue any institutional award       |
|                      |     effective the date of last payment, and   |
|                      |                                               |
|                      | -   pay benefits directly to the veteran.     |
|                      |                                               |
|                      | ***Note***: Accomplish this by a CFID         |
|                      | transaction, unless award action is otherwise |
|                      | required to accomplish an action such as      |
|                      | terminating withholding for PFOP.             |
+----------------------+-----------------------------------------------+
| -   competency, and  | do not award benefits directly to the veteran |
|                      | until the fiduciary activity furnishes        |
| -   there is a       | certification to that effect.                 |
|     court-appointed  |                                               |
|     fiduciary        | On receipt of the certification, award the    |
|                      | veteran the full amount of compensation or    |
|                      | pension effective the date of last payment,   |
|                      | per [38 CFR                                   |
|                      | 3.501(j)](http://www.warms.v                  |
|                      | ba.va.gov/regs/38CFR/BOOKB/PART3/S3_501.DOC), |
|                      | by processing a CFID transaction if award     |
|                      | action is not required.                       |
|                      |                                               |
|                      | Establish a control for expiration of the     |
|                      | six-month period following the finding of     |
|                      | competency by VA. At the end of this period,  |
|                      | restore payment of withheld amounts under [38 |
|                      | CFR                                           |
|                      | 3.556](http://www.warms.                      |
|                      | vba.va.gov/regs/38CFR/BOOKB/PART3/S3_556.DOC) |
|                      | as provided in M21-1MR, Part III, Subpart v,  |
|                      | 6.E.28.g.                                     |
+----------------------+-----------------------------------------------+

Continued on next page

28\. Discontinuing an Institutional Award When a Veteran Is Being
Discharged From a Hospital, Continued

  -----------------------------------------------------------------------
  d\. Referring the Hospital Summary to the Rating Activity (continued)

  -----------------------------------------------------------------------

+----------------------+-----------------------------------------------+
| If the rating        | Then \...                                     |
| activity makes a     |                                               |
| determination of     |                                               |
| \...                 |                                               |
+----------------------+-----------------------------------------------+
| incompetency         | -   inform the fiduciary activity of the      |
|                      |     rating and impending discharge, and       |
|                      |                                               |
|                      | -   request the appointment of a fiduciary    |
|                      |     using                                     |
|                      |                                               |
|                      | ```{=html}                                    |
|                      | <!-- -->                                      |
|                      | ```                                           |
|                      | -   *VA Form 21-592, Request for Appointment  |
|                      |     of a Fiduciary, Custodian or Guardian*,   |
|                      |     if not previously submitted, or           |
|                      |                                               |
|                      | -   a memorandum, if *VA Form 21-592, Request |
|                      |     for Appointment of a Fiduciary, Custodian |
|                      |     or Guardian* was previously submitted.    |
|                      |                                               |
|                      | ***Note***: The fiduciary activity will       |
|                      | request a field examination to determine the  |
|                      | need for a fiduciary.                         |
|                      |                                               |
|                      | ***Reference***: For information on requests  |
|                      | by the fiduciary activity for a field         |
|                      | examination, see M21-1MR, Part III, Subpart   |
|                      | v, 6.E.28.e.                                  |
+----------------------+-----------------------------------------------+

Continued on next page

28\. Discontinuing an Institutional Award When a Veteran Is Being
Discharged From a Hospital, Continued

+------------+---------------------------------------------------------+
| #          | > Upon receipt of a copy of the hospital summary based  |
| #### e. Re | > on the impending discharge, along with the rating     |
| questing a | > decision (see M21-1MR, Part III, Subpart v,           |
|  Field Exa | > 6.E.28.d), the fiduciary activity may initiate a      |
| mination a | > field examination to determine the need for           |
| nd Possibl | > appointment of another fiduciary.                     |
| e Reconsid | >                                                       |
| eration by | > The table below describes the process for requesting  |
|  the Ratin | > a field examination and submitting an opinion for     |
| g Activity | > possible reconsideration by the rating activity.      |
|            | >                                                       |
|            | > ***Reference***: For more information on the field    |
|            | > examination process, see M21-1MR, Part XI, 2.A.1.     |
+------------+---------------------------------------------------------+

+-------+--------------------------------------------------------------+
| Stage | Description                                                  |
+-------+--------------------------------------------------------------+
| 1     | > Upon receipt of *VA Form 21-592, Request for Appointment   |
|       | > of a Fiduciary, Custodian or Guardian* requesting the      |
|       | > appointment of a fiduciary, the fiduciary activity         |
|       | > requests a field examination to determine                  |
|       |                                                              |
|       | -   the need for appointment of a fiduciary, and             |
|       |                                                              |
|       | -   if necessary, the most appropriate type of fiduciary.    |
+-------+--------------------------------------------------------------+
| 2     | > Based on the results of the field examination, the         |
|       | > fiduciary either concludes that the veteran is             |
|       |                                                              |
|       | -   *incompetent*, and proceeds with the appointment of a    |
|       |     fiduciary, or                                            |
|       |                                                              |
|       | -   *competent* to administer funds payable, and refers the  |
|       |     facts supporting that opinion to the VSC for further     |
|       |     consideration by the rating activity.                    |
+-------+--------------------------------------------------------------+
| 3     | > The rating activity may                                    |
|       |                                                              |
|       | -   consider the facts in the fiduciary's submission         |
|       |     sufficient to support a finding of competency            |
|       |                                                              |
|       | -   request further development, including an "at once"      |
|       |     examination or period of examination and observation, or |
|       |                                                              |
|       | -   confirm the prior finding of incompetency.               |
|       |                                                              |
|       | ***Note***: request an "at once" examination through CAPRI   |
|       | just as any other examination request. CAPRI does not have a |
|       | specific option for "at once" examinations.                  |
+-------+--------------------------------------------------------------+

Continued on next page

28\. Discontinuing an Institutional Award When a Veteran Is Being
Discharged From a Hospital, Continued

  -----------------------------------------------------------------------
  e\. Requesting a Field Examination and Possible Reconsideration by the
  Rating Activity (continued)

  -----------------------------------------------------------------------

+-------+--------------------------------------------------------------+
| Stage | Description                                                  |
+-------+--------------------------------------------------------------+
| 4     | > If the rating activity determines that the veteran remains |
|       | > incompetent, the VSR authorizes supervised direct pay as   |
|       | > provided in M21-1MR, Part III, Subpart v, 9.B.7 (TBD) or   |
|       | > [M21-1. Part IV,                                           |
|       | > 17.1                                                       |
|       | 7](http://www.warms.vba.va.gov/admin21/m21_1/part4/ch17.doc) |
|       | > or as otherwise certified by the fiduciary activity.       |
|       | >                                                            |
|       | > ***Note***: Do not make direct payments to a veteran who   |
|       | > has not regained competency by VA rating, unless the       |
|       | > fiduciary activity has certified the case as a supervised  |
|       | > direct pay case or the court has adjudicated the veteran   |
|       | > as competent per [38 CFR                                   |
|       | > 3.850(a)](htt                                              |
|       | p://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_850.DOC). |
+-------+--------------------------------------------------------------+
| 5     | > The VSR notifies the following of the award, or of *any*   |
|       | > actions taken:                                             |
|       |                                                              |
|       | -   fiduciary activity                                       |
|       |                                                              |
|       | -   spouse or fiduciary, and                                 |
|       |                                                              |
|       | -   Chief Officer of the hospital involved.                  |
+-------+--------------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### f.   | > If the fiduciary activity furnishes a *VA Form        |
|  Notificat | > 21-555, Certificate of Legal Capacity to Receive and  |
| ion Requir | > Disburse Benefits*, notify the fiduciary activity     |
| ements for | > when payments are made                                |
|  Payments  |                                                         |
| Made Direc | -   directly to the veteran                             |
| tly to a V |                                                         |
| eteran or  | ```{=html}                                              |
| Fiduciary  | <!-- -->                                                |
|            | ```                                                     |
|            | -   under supervised direct pay, per [38 CFR            |
|            |     13.56](http://ww                                    |
|            | w.warms.vba.va.gov/regs/38cfr/bookf/part13/s13_56.doc), |
|            |     or                                                  |
|            |                                                         |
|            | -   based on regained competency, or                    |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   to a fiduciary.                                     |
+------------+---------------------------------------------------------+

Continued on next page

28\. Discontinuing an Institutional Award When a Veteran Is Being
Discharged From a Hospital, Continued

+------------+---------------------------------------------------------+
| ##### g    | > Discontinue a withholding for PFOP to release         |
| . Terminat | > accumulated funds or to provide for direct payment of |
| ing PFOP W | > current benefits, when                                |
| ithholding |                                                         |
|            | -   PFOP are needed for care and maintenance, under     |
|            |     M21-1MR, Part III, Subpart v, 6.E.26.c              |
|            |                                                         |
|            | -   a veteran is discharged from medical care, under    |
|            |     M21-1MR, Part III, Subpart v, 6.E.28.b              |
|            |                                                         |
|            | -   a new fiduciary is appointed, under M21-1MR, Part   |
|            |     III, Subpart v, 6.E.28.b, or                        |
|            |                                                         |
|            | -   competency is restored, under M21-1MR, Part III,    |
|            |     Subpart v, 6.E.28.d.                                |
|            |                                                         |
|            | > Authorize payments to the veteran or fiduciary.       |
|            | >                                                       |
|            | > Zero out the Type 3 withholding effective             |
|            |                                                         |
|            | -   as of the date first effected when full release is  |
|            |     in order ,or                                        |
|            |                                                         |
|            | -   from the date of last payment when only release of  |
|            |     current benefits is in order.                       |
+------------+---------------------------------------------------------+