VA Shares Caregiver Program Updates

FACT SHEET: Program of Comprehensive Assistance for Family Caregivers (PCAFC) Updates

On June 30, the Caregiver Support Program office (CSP) hosted a briefing for stakeholders and shared updates on VA’s Program of Comprehensive Assistance for Family Caregivers (PCAFC). The Elizabeth Dole Foundation, along with many of our non-profit partners, participated in the briefing. Here's a detailed recap of the meeting and important updates you should be aware of: Meeting background: Dr. Colleen Richardson, Executive Director of VA CSP, reviewed current data, the recent Biden Administrative Executive Order and how it will be implemented, and the Integrated Project Team (IPT) recommendations following the IPT’s creation last year. Metrics you should know: As of the end of June, the CSP receives roughly 6,100 applications every month, with an average national approval rate of 29%, and 98% of applications dispositioned within 90 days of receipt. Though there was an influx of applications in process when PACT Act benefits were announced, this number now remains steady at 10,000. In terms of reviews and appeals, CSP currently has 1,247 Legacy Notices of Disagreement, 1,123 VHA Higher Level Reviews, and 1,659 VHA Supplemental Claims. In addition, there are 3,708 Requests for Information about PCAFC Decisions. Caregiver Support Program updates:

• As of June 12, 2023, Caregiver Support Line staff can provide additional information on the status of requests for VHA reviews of PCAFC decisions including: awaiting intake, intake complete awaiting assignment to a reviewer, assigned to a reviewer and under review, and decision issued.
• More permanent staff at VISNs across the United Staff have been assigned to the process, in addition to the use of AI tools to assist with the review process.
• Respite Champion VISNs across the United States have been identified to roll out additional respite care options for caregivers and Veterans. Please contact your local VA to learn more about your respite options.
• On April 24, 2023, Legal and Financial Planning Services became available to Primary Family Caregivers enrolled in PCAFC nationwide.

What Executive Order means for PCAFC: Earlier this year, President Biden issued an Executive Order that called for enhanced access to mental health services for caregivers participating in PCAFC, as well as asking VA to issue a notice of proposed rulemaking for the program’s eligibility criteria before the end of the year. VA CSP is partnering with VA’s Office of Mental Health Operations/Suicide Prevention and Clinical Resource Hubs to implement and launch psychotherapy services available to caregivers participating in PCAFC throughout18 VISNs, to be launched in waves. The IPT recommendations: In a continuing effort to reevaluate and improve the Caregiver Support program, an Integrated Project Team (IPT) was created to provide potential recommendations. The IPT has recommended the following program improvements: - Maintain VA’s current definition of serious injury.

• Keep 70% disability rating threshold for PCAFC eligibility.

- Modify definition of “inability to perform an Activity of Daily Living (ADL)” to a more expansive definition.

• This is currently written to indicate that the veteran needs assistance with an ADL “each and every time.” This language is narrow in its definition of how caregivers support veterans in their daily life and may not fully account for caregivers who support veterans with invisible wounds. The IPT recommends that this language become more expansive.

- Align regulatory language with statutory criteria set forth in 1720G(c)(2)(ii) and (iii) in lieu of the current regulatory definition of “need for supervision, protection, and instruction.”

• This is a result of the judgment levied in "Veteran Warriors, Inc v. McDonough."

- Do not employ certain bases as proxies for PCAFC veteran eligibility requirements.

• The IPT does not recommend using a veteran’s eligibility for or participation in other programs, such as Veteran-Directed Care or Home Health Aide, as qualification for PCAFC.

This is an ongoing process that takes time and has opportunities for caregiver feedback. Please be on the lookout for future advocacy opportunities so we can ensure your voice is heard.