On November 9, 2023, after reviewing veteran policy and legislative efforts in 50 states and engaging with over 30 nonprofit partners and 75 local VSOs covering more than 100 municipalities, the Governor filed An Act Honoring, Empowering and Recognizing Our Servicemembers and Veterans.

The HERO Act would revise Chapter 115 and Chapter 115A with gender neutral and inclusive language and remove antiquated references, increase the annuity payment by $500, and increase access to EOVS benefits and services by broadening the definition of veteran to align with the VA’s definition and expanding the scope of the Veterans Equality Review Board. It would also ensure:

• that cost-of-living adjustments made to SSI/SSDI don’t result in a person being found ineligible for Chapter 115 benefits in the year the adjustment was made; and

• the consistent, efficient, and economic provision of medical assistance, behavioral health assistance, and dental assistance benefits over and above other Chapter 115 benefits.

The HERO Act would also provide veterans free license plates and issue a series of plates recognizing their unique service, increase the tax credit to employers for hiring veterans by $500, create a public-private working group to study the mental health benefits of psychedelics for veterans, and provide reimbursement for IVF to eligible disabled same-sex women veterans with a 2-year pilot program.

• The IVF program will focus on women veterans who have been denied IVF reimbursement by the VA solely because they are in a same-sex marriage.

• A working group will be formed to review and advise EOVS on the pilot program, long-term funding strategies, and any additional areas where any veterans are receiving disparate access to VA healthcare services.

• Chapter 1 – General

• Chapter 11 – Compensation for Service-Connected Disability or Death

• Chapter 13 – Dependency & Indemnity Compensation for Service-Connected Deaths

• Chapter 15 – Pension for Non-Service-Connected Disability or Death or For Service

• Chapter 51 – Claims, Effective Dates & Payments

• Chapter 53 – Special Provisions Relating to Benefits

• Chapter 59 – Agents & Attorneys

• Chapter 71 – Board of Veterans’ Appeals

• Chapter 72 – United States Court of Appeals for Veterans’ Claims

• Part 1 – General Provisions

• Part 3 – Adjudication

• Part 4 – Schedule for Rating Disabilities

• Part 14 – Legal Services, General Counsel & Miscellaneous Claims

• Part 19 – Board of Veterans' Appeals: Legacy Appeals Regulations

• Part 20 – Board of Veterans' Appeals: Rules of Practice

Factors Considered

• The extent and type of services the representative performed

• The complexity of the case

• The level of skill and competence required of the representative in giving the services

• The amount of time the representative spent on the case

• The results the representative achieved, including the amount of any benefits recovered

• The level of review to which the claim was taken and at which the representative was retained

• The rates charged by other representatives for similar services

• Whether, and to what extent, the payment of fees is contingent upon the results achieved

• If Applicable: The reasons why an agent or attorney was discharged or withdrew from representation before the date of the decision awarding benefits

VHA Directive 1110.02 (dated July 26, 2019) ensures social work practice issues and standards are delivered appropriately at all VA medical facilities and off-site VHA health care programs. VA medical facility Social Workers are responsible for:

• Providing services including, but not limited to, those outlined in Appendix A.

• Advocating for Veterans, their families, and caregivers when they experience challenges in meeting their health care needs.

• Assisting Veterans, their families, and caregivers to navigate the complexities of the VA and U.S. health care system.

• Assessing resource gaps and working with the social work supervisor to create additional resource availability and programming for Veterans, their families, and caregivers.

• Incorporating performance improvement in their assigned work area and participating in performance improvement activities.

• Obtaining and maintaining a full and unrestricted social work license, to include meeting continuing education and professional development requirements established by state licensing boards required for licensure.

• Participating in professional development, to include pursuing social work trainings, certifications, and advanced licensure.

  • If pursuing advanced clinical licensure, seeking and participating in clinical supervision hours with other clinical social workers to obtain regulatory supervision requirements needed.

• Adhering to professional practice standards of the National Association of Social Workers Code of Ethics.

Appendix A – VA Social Work Practice Requirements

All VA Social Workers are responsible for the provision of social work services in the following social work functions, as clinically indicated and in accordance with licensure level, scope of practice, credentialing, privileging, and clinical assignment.

• Psychosocial assessment.

• Mental health assessment and diagnosis.

• Psychosocial treatment and intervention.

• Psychosocial rehabilitation.

• Psychosocial case management and care coordination. NOTE: See VHA Handbook 1110.04, Case Management and Standards of Practice, updated May 20, 2020, for details.

• Advance care planning and goals of care conversations.

• Resource referral and community services coordination.

• Discharge or after care planning and coordination.

• Community care and community resource linkage.

• Interdisciplinary collaboration, coordination, and consultation.

• Pre-admission planning.

• Admission diversion services.

• Patient and family education.

• Client advocacy.

• Mandatory reporting (abuse, neglect, or exploitation).

• Suicide assessment, crisis intervention, and safety planning.

• Individual, marriage, couple, family, and group counseling or therapy.

The Social Work Service Chief is the facility subject matter expert and local authority on matters of social work practice and policy and must be involved in decision making on social work practice and policy throughout the facility. The Chief is responsible for executing VA Social Work Practice Requirements (Appendix A).

VA medical facility directors are responsible for ensuring the Social Work Service Chief provides oversight of all social work practice and services, regardless of organizational alignment. VA facility chiefs of staff are responsible for ensuring that all clinical program areas, regardless of organizational alignment, consult with the Social Work Service Chief on matters of social work practice and policy.

Appendix A in VHA Directive 1110.02 establishes that all VA Social Workers are responsible for the provision of social work services in the following social work functions, as clinically indicated and in accordance with licensure level, scope of practice, credentialing, privileging, and clinical assignment.

• Psychosocial assessment.

• Mental health assessment and diagnosis.

• Psychosocial treatment and intervention.

• Psychosocial rehabilitation.

• Psychosocial case management and care coordination. NOTE: See VHA Handbook 1110.04, Case Management and Standards of Practice, updated May 20, 2020, for details.

• Advance care planning and goals of care conversations.

• Resource referral and community services coordination.

• Discharge or after care planning and coordination.

• Community care and community resource linkage.

• Interdisciplinary collaboration, coordination, and consultation.

• Pre-admission planning.

• Admission diversion services.

• Patient and family education.

• Client advocacy.

• Mandatory reporting (abuse, neglect, or exploitation).

• Suicide assessment, crisis intervention, and safety planning.

• Individual, marriage, couple, family, and group counseling or therapy.

The VA facility Social Work Service Chief is the facility subject matter expert and local authority on matters of social work practice and policy and must be involved in decision making on social work practice and policy throughout the facility. The Chief is responsible for executing the VA Social Work Practice Requirements found in Appendix A.

VA-enrolled patients have the right to receive prompt and appropriate treatment. VHA provides case management services to assist eligible Service members and Veterans, who have complex chronic care needs and socio-economic vulnerabilities, with system navigation, care coordination, and biopsychosocial rehabilitation.

VHA Directive 1110.04, issued September 6, 2019 and updated in May 18, 2020, established a new policy introducing integrated case management in the VA. Once implemented by local VA facilities, this VA policy will bring an innovative approach to VHA by making case management services coordinated, collaborative, and Veteran-centric throughout VHA.

As a growing number of VHA-enrolled Veterans seek care in the community, it is vital that VHA strengthens and integrates its care coordination services and resources. Care coordination services, including case management, must be synchronized along the health care continuum wherein Veterans needs are stratified, per their complexity, across levels of care.

VHA Standards of Practice for Case Managers

VHA CM standards are based on the Case Management Society of America’s 2016 Standards of Practice, American Case Management Association’s 2013 Standards of Practice and Scope of Services, and National Association of Social Work’s 2013 Standards for Social Work Case Management Practice.

VHA Case Managers are responsible for ADVOCACY. Case Managers will support and promote the rights, interests, and decisions of Service members and Veterans with individuals, groups, and institutional systems to: protect and advance their dignity, autonomy, wishes, and whole health; remove barriers to care; lend voice to diversity and multicultural concerns and challenges; and seek out new services, resources, and opportunities for growth and well-being.

• Self Determination. Case Managers will, to the maximum extent possible, support Veterans’ autonomy and right to be involved in the shared decision making and determination of their own plan of care to include provision of and education on Living Wills & Advance Directives.

• Safety. Case Managers will, to the extent possible, help ensure a Veterans’ well-being, rights, and decisions within all domains of living (physical, emotional, environmental, financial, intellectual, occupational, social, and spiritual) are free of influence, exploitation, or coercion by other individuals, including both health and non-health care professionals.

• Multi-Culturalism and Diversity. Case Managers will work respectfully and inclusively with all Veterans, as well as incorporate such multi-various factors and sensitivities into all assessment and care plan interviews and documentation.

VHA Case Managers are responsible for PROFESSIONALISM. Case Managers will carry out all duties expected, per theirassigned service or program role and functional statement, with technical proficiencyand integrity to instill Veteran confidence, trust, and credibility in both case managementand VA. Professionalism aligns competency and practice with the mission of theorganization. In VHA, professionalism specifically encompasses:

• Ethical Conduct. Case Manager practice and behavior will be in accordance with their discipline’s specific code of ethics and VHA ideals, codes, and standards. Case Managers should act with beneficence, demonstrate truthfulness and non-malfeasance, and maintain appropriate boundaries with both Veterans and colleagues.

• Education

VHA Case Managers are responsible for ACCOUNTABILITY. Case Managers will demonstrate shared accountability that is intrinsic to collaborative practice and follow through on commitments made to Veterans, their families and caregivers, and interprofessional teams. Case Managers must work within their scope of practice and abide by all applicable Federal, State, and local laws and regulations, which have full force and effect of law. In VHA, accountability specifically encompasses:

• Documentation & Coding. Case Managers will document all information in a Veteran’s EHR or any VHA-approved EHR within 48 hours.

• Privacy & Confidentiality

VHA Case Managers are responsible for FACILITATION. Case Managers will establish rapport and build and maintain therapeutic relationships with Veterans to foster trust and engage them in care and empower and equip them in self-care and self-management with the goal of improving positive health and wellness outcomes. Case Managers will utilize facilitation throughout the process of working with the Veteran to organize, streamline, and expedite service delivery. In VHA care, facilitation specifically encompasses:

• Communication, Collaboration, Coordination. Case Managers will facilitate proactive, patient-centric communication and information sharing to enhance awareness and clarity, reduce misunderstandings, increase process efficiencies, and improve care plan efficacy; collaboration to engage in shared decision making, and develop a safe, integrated and whole health care plan that considers the best scientific evidence available as well as the Veteran’s values and preferences; and the coordination of care through integrated, well-sequenced care plans, assisting with system navigation, and linking Veterans in a timely manner, to needed health, mental health, health education, self-management and social services, community-based resources, or benefits, as clinically indicated.

• Case Management Process

• Therapeutic Engagement

VHA Case Management Process Standards

The CM process is dependent on patient progress and thus is cyclical and not linear in nature, and previous steps and actions may need to be revisited. The major goal of the CM process is to increase Veteran autonomy and decrease the long-term dependence on the Case Manager.

• Early Identification. Veterans are identified for the potential need for case management through self-referral, referral from a family member or caregiver, referral through VA, other government programs, and community agencies as early as possible.

• Screening for Clinical Eligibility Criteria. The use of a standardized level of care coordination tool ensures there is consistency amongst providers, patient stratification, and validity of scoring.

  • Veterans found not to require the frequency and intensity of case management services are recommended for either care management or care coordination services through PACT or another clinical area.

• Case Manager Assignment. Following a thorough screening of needs, qualifying Veterans identified as appropriate for case management will be offered services from a Nurse or Social Work Case Manager within a care setting or program per the predominate need of Veteran and their location within the system.

  • For Veterans with a complex level of care coordination need, more than one Case Manager may be involved in care planning and service delivery. Assignment of a Lead Coordinator (LC) is recommended to coordinate service delivery and reduce confusion, fragmentation, and unnecessary duplication.

• Informed Consent. To ensure the Veteran is appropriately informed, the case manager must provide a clear definition of CM and its process including: purpose, roles, and responsibilities (of both Veteran and Case Manager), benefits, and risks.

• Comprehensive Assessment. A Case Manager completes a comprehensive assessment of the Veteran’s needs and goals. NOTE: See national note template titled, “Social Work Comprehensive Assessment” in EHR. Reassessment is required at each subsequent contact as part of the monitoring and evaluation process.

• Resource Assessment. A resource assessment is completed to identify available assistive options and appropriate services and benefits.

• Referrals and Transition. Access to the appropriate level of care is ensured by coordinating effective and timely referrals, transitioning the Veteran to VHA, DOD, other Federal, State, and local home and community-based services along a continuum of care to restore or maintain Veterans independent functioning.

• Need Identification.

• Problem Solving & Goal Identification

• Planning & Implementation

• Monitoring & Evaluation

• Program & Outcome Evaluation

It is VHA policy that all veterans and service members accessing care through VHA will receive coordinated care and that those with complex care coordination needs will have access to case management services that follow evidence-based case management practice standards within an evidence-based case management model. VA policy provides the following definitions for case management roles:

• Care Coordination is a system-wide approach to the deliberate organization of all Veteran care activities between two or more participants or systems to facilitate the appropriate delivery of health care services. It can include, but is not limited to, care management and case management. This is a basic level of care coordination.

• Care Management is a population health approach to longitudinal care coordination focused on primary or secondary prevention of chronic disease and acute condition management. It applies a systems approach to collaboration and the linkage of Veterans, their families, and caregivers to needed services and resources. Care management manages and maintains oversight of a comprehensive plan for a specific cohort of Veterans. Care management is a moderate level of care coordination.

• Case Management is a proactive and collaborative population health approach to longitudinal care coordination focused on chronic disease and acute condition management. Case management includes systems collaboration and the linking of Veterans, families, and caregivers with needed services and resources, including wellness opportunities. Case management includes responsibility for the oversight and management of a comprehensive plan for Veterans with complex care needs. Case management is a complex level of care coordination.

  • VHA Case Managers are specially trained clinical staff with expertise in case management (e.g., complex care coordination) who are required to follow Case Management Standards of Practice and Case Management Process Standards.

• Integrated Case Management (ICM) is a specialized, collaborative practice among multiple interprofessional health care teams that provides structure and standards to support collaboration throughout the continuum of care and optimal utilization of health care resources. Its focus is on program intersections, care transitions, and provider and patient match. ICM emphasizes the importance of patient stratification by acuity, risk, and intensity into an appropriate level of care coordination. ICM services correspond with a complex level of care coordination. Services are higher in intensity and frequency, and delivered to Veterans with greater complexity.

  • Lead Coordinators (LCs) are a single, readily accessible, and clearly identifiable point of contact for a Service member or Veteran, their family and caregiver, and care team members with primary responsibility for ensuring the Veteran’s care is coordinated across settings, services, and episodes of care, and that the care plan is delivered as clinically indicated. Other care team members will provide direct services to the Veteran while the LC oversees care coordination and facilitates interprofessional team communication, reduces task and intervention duplication, and improves the quality of care plan delivery. The LC is a critical component of the ICM framework and expansion of the DoD/VA Lead Coordinator Model for transitioning Post 9/11-era service members to all service era Veterans.

Since 2003, VA has collaborated with the DoD to transition injured and ill service members and veterans from Military Treatment Facilities to VA medical facilities. VHA Directive 1010(1) published February 23, 2022 (updated May 27, 2022) specifies policy for the transition into VA care and provision of case management by VHA Post-9/11 Military2VA Case Management staff.

The primary responsibility of Post-9/11 M2VA Case Managers is to coordinate care and services for transitioning service members and post-9/11 era veterans with health and/or social complexity. The Case Manager is also responsible for:

• Adhering to VHA case management practice and process standards. NOTE: See VHA Directive 1110.04, Integrated Case Management Standards of Practice.

• Contacting transitioning Service members and Veterans prior to transfer to VA to facilitate their registration, enrollment, initial VA appointment scheduling or inpatient admission and provide education on VA care, services, and benefits.

• Coordinating any necessary appointments and services at the VA medical facility under TRICARE that the Service member will use while still on active duty including terminal leave and convalescent leave.

• Entering case management documentation into EHR.

• Continually reassessing Veteran’s acuity and complexity of biopsychosocial need(s) and adjusting level of case management intensity as clinically indicated.

• Providing case management during transitions of care for service members and Post-9/11 era Veterans.

  • Transfer from a DoD military treatment facility or other VA medical facility.

  • Transfer from Warrior Care Network academic medical center or Marcus Institute for Brain Health.

  • Veteran relocation from one VA medical facility to another VA medical facility.

  • Change in Veteran’s psychosocial status (e.g., perception and level of social support, significant relationship stressors (e.g., abuse, separation), death of a family member, change in employment status, substance use).

  • Significant change in health or functional status and level of care coordination need (e.g., newly diagnosed acute or chronic health condition).

• Applying clinical interventions uniquely tailored to the Service member or Veteran, their family, and caregiver, and communicating with them on the contents of the agreed upon plan of care, including case management contact frequency.

• Serving as the Lead Coordinator when deemed appropriate.

The primary responsibility of Post-9/11 M2VA Transition Patient Advocate is to assist with the short and long-term needs of transitioning service members and post-9/11 era Veterans and their families as assigned. The TPA reports to the medical center’s Post-9/11 M2VA Case Management Program Manager. The TPA position is partially funded by the VA Central Office. Click here for information on VA Patient Advocates in general.

VHA Handbook 1163.06 issued January 7, 2016 incorporates requirements for the VA’s Mental Health Intensive Case Management (MHICM) program as outlined in VHA Handbook 1160.01, Uniform Mental Health Services in VA. ICMHR Services are intended to provide necessary mentalhealth treatment and support for Veterans who meet all of the following criteria:

• Serious Mental Illness. The primary target population for MHICM services is veterans with severe psychosis, severe mood disorders, or severe PTSD whose functional status is severely impaired. Once the target of 75% has been reached, veterans with other diagnoses and similar impairments in functional status may be enrolled, including patients with co-occurring Mild TBI, substance use disorders, or personality disorders.

• Inadequately Served. Veterans are inadequately served by conventional clinic-based outpatient treatment. They are unable to maintain successful and stable community integration through the use of these conventional services, even with augmented services such as VA Psychosocial Rehabilitation and Recovery Centers.

• High Resource Use. High resource use includes frequent hospital use (over 30 days of inpatient MH unit care or 3+ episodes of MH hospitalization over the past year) or with lower priority, frequent emergency department visits, contacts with law enforcement, use of crisis support services, or contact with emergency responders that consistently impair their ability to maintain adequate housing or community function.

• Clinically Appropriate for Outpatient Status. The positive aspects of MHICM Services must not be used to justify moving Veterans to a community-based model who would be better served by inpatient care.

Veterans who otherwise meet the definition of the target population cannot be denied services participation based solely upon the length of current abstinence from alcohol or non-prescribed controlled substances, the use of prescribed controlled substances, the number of previous treatment episodes, legal history, homelessness, personality disorder, or previous treatment non-adherence.

The screening process must consider each of these special circumstances and determine whether the program can meet the Veteran's needs while maintaining program safety, security, and integrity. ICMHR Services are described as both frequent and complex.

• Veterans are seen frequently (typically up to 2 to 3 contacts per week) for the delivery of MHICM Services. Veterans may be seen more or less frequently as warranted by their clinical needs at a given time, recognizing that recovery is a non-linear process.

• Events such as hospital discharges, transitions in living environments, initiation or changes in psychopharmacological treatment, or times of loss often require increased intensity of contact for limited periods of time.

• At least 1 visit per week must be face-to-face, preferably in the Veteran’s home or community. When desired and with the consent of the Veteran, ICMHR Services team members need to have contacts with the Veteran’s caregivers, family members, and other natural supports.

• Caseloads are limited to 7 to 15 veterans per clinical case manager for MHICM teams to allow time for regular travel to veterans’ homes and communities and in consideration of needs.

Each VA Facility Director is responsible for ensuring adequate resources are continuously available to address the needs of the exceptionally vulnerable veterans served by MHICM.

VHA Directives articulate the reason for the issue of directives and related issues, in addition to providing key definitions. VHA Directives supersede other national, VISN-level, and facility-level policies or memos issued to the extent they are in conflict. Within VHA Directives, you will find background for a policy and related authorities; exemptions; and offices and individuals responsible for implementation, training, and oversight at the national, regional, and local facility levels.

What is Included in the VA Medical Benefits Package

In general, the entire VA Medical Benefits Package is available to all VA enrolled veterans with specific care provided when it is determined by a VA provider that it aligns with generally accepted practice standards and will promote, preserve, or restore the health of a particular veteran.

• Care preserves health if it maintains a veteran’s current quality of life or daily functioning, prevents disease progression, cures disease, or extends the veteran’s life span.

• Care promotes health if it enhances a veteran’s quality of life or daily functioning, prevents future disease, or identifies a predisposition for a condition or early disease onset which can be ameliorated to any extent through monitoring or early diagnosis and treatment.

• Care restores health if it restores a veteran’s quality of life or daily functioning lost due to illness or injury.

Patients have rights under 38 CFR § 17.33 which all VA employees must respect and support in addition to all other statutory, constitutional, or other legal rights. In general:

• VA patients have the right to be treated with dignity in a humane environment that affords them both reasonable protection from harm and appropriate privacy with regard to their personal needs.

• VA patients have the right to receive prompt and appropriate treatment for any physical or emotional disability to the maximum extent of their eligibility.

• VA patients have the right to achieve treatment purposes under the least restrictive conditions necessary and to be free from physical restraint or seclusion.

• VA patients have the right to be free from unnecessary or excessive medication.

• VA patients have the right to present grievances without fear or reprisal with respect to perceived infringement of these patient rights or any other matter on behalf of themselves or others.

VA patients’ legal rights can't be denied by virtue of being involuntarily committed or voluntarily admitted in a VA facility, unless otherwise provided for by Massachusetts law. Visit our Healthcare page for more information on VA Patient Rights and The Role of VA Patient Advocates. You can also locate VHA facility Patient Advocates in Massachusetts here.

38 CFR § 0.600 describes Core Values, Characteristics, and Customer Experience Principles that serve as internal guidelines for VA employees that “define VA employees, articulate what VA stands for, and underscore its moral obligation to veterans, their families, and other beneficiaries” and establish overarching guidelines that apply to all VA offices.

• VA’s Core Values under 38 CFR § 0.601 serve as the foundation for VA employees’s actions – Integrity, Commitment, Advocacy, Respect, and Excellence (I CARE). To adopt Advocacy in day-to-day operations, “VA employees will be truly veteran-centric by identifying, fully considering, and appropriately advancing the interests of veterans and their beneficiaries.”

• VA’s Core Characteristics under 38 CFR § 0.602 outline what VA stands for and strives to be as an organization that it wants to be associated with VA and its workforce – Trustworthy, Accessible, Quality, Innovative, Agile, and Integrated. Integrated means linking care and services across the VA and other local, federal, and state agencies, partners, and VSOs.

• VA’s Customer Experience principles under 38 CFR § 0.603 are to provide the best customer experience guided by VA’s Core Values & Characteristics with interactions measured “through Ease, Effectiveness, and Emotion, all of which impact the overall trust the customer has in the organization.” The purpose of the Ease principle is to make access to VA “smooth and easy.”