How Do You Appeal a PCAFC Denial?

[Lemuel]

How do you appeal a Program for Comprehensive Assistance to Family Caregivers (PCAFC) denial?  If you have a higher level of care consult, is it possible to appeal?  My Nurse told me I am being shifted to Directed Care. 

Apparently there is a new program that allows you to hire your own caregivers.  But it requires you to get an unpaid representative to do a lot of paperwork.  And you have to hire your own nurse for part-time work.

There are a lot of problems getting care if you do not have a live in family member.

I have to call my primary care team today and get a new consult for the care I was receiving before I got deceived by Home Instead.  It is a mess trying to deal with care without a PCAFC caregiver.  How can you ask a sister or other family member to volunteer care for you when other veterans are receiving care provided by the VA?

My family did not volunteer me for 13 years in the Navy including 2 years in Danang RVN.  My family did not have anything to do with my SC TBI.  That is what I told the social worker who ask me if I could not get a family member to do it.  Of course your brothers and sisters want to help. But if they need financial assistance why should they not be paid for helping? There are volunteer organizations that help veterans with NSC conditions. 

More and more the VA is trying to push you out to care you have to pay for.  You get community care paid visit or ER visit but then get bills from labs and radiologists because the billing information was not shared or because the service is billing the insurance and then trying to collect from you also.

I think I am going to send the bills to DOJ and ask them to make sure the VA contractor who was supposed to pay the bill pays it or that the provider that is double billing goes to jail.  No one is supervising VA contractors including C&P contractors.  The DRO and RO are still limiting injury examinations contrary to regulations.  And the S!#$t goes on.

Simple question turned into a rant.  Sorry about that, but I feel better now.

[broncovet]

First, you need a denial letter to appeal.  Then file a nod, in the usual manner.  You may have to go to BVA.  BVA takes all kinds of appeals, not just disability compensation.  Cemetary, ILP, etc etc.  

[Lemuel]

I have the denial letter.  The va.gov site seems to be down today.  I signed on but only got white pages with no error message and then unable to sign out, I closed the browser and tried to start over.  Then I got the unavailable notice.

Will try again later.  I am going to re-read the notice.  

Seems you can first appeal to the VAHA.  Will do that with reference to TBI law.  I require upper level care--a nurse to control my medications.  Was getting help bathing.  Taking a seizure medication and need to be watched for falling.  On oxygen but improving since I have been on oxygen.  Fewer collapses which count as falls except when they do not and the recorder needs a hard fall to count it.  I think all my collapses were not counted as falls which is the problem.

I am going to get my cameras to record everything.  I want them to see what I really am.  And how I am working to get better, which I am getting better.  But not beyond needing the aid and attendance that was being provided by Home Instead which I fired because they were cheating the VA by clumping the hours together instead of providing the needed care to keep me out of a nursing home.  My sister has been providing 24-7 watch over me by security cameras.  The cameras only send pictures now on movement.  Need them to record so they can look back to see where the last movement was and trace me to where I may have fallen.

Had the nurse, witnessed by my sister, insist I should sell my house and move to a nursing home where they could control my medication.  So the decision definitely did not go by the guidelines.  To keep from having to go to a nursing home.

[Lemuel]

Forgot, how do you appeal to the VAHA?  That is more specific to my question.

[jbasser]

You can appeal through your Patient advocate. But personally I would go straight to the BVA. Beaudette V McDonnough has ruled that BVA has jurisdiction and since the Caregiver Avt is a  leagal issue. 

[Lemuel]

1 hour ago, jbasser said:

You can appeal through your Patient advocate. But personally I would go straight to the BVA. Beaudette V McDonnough has ruled that BVA has jurisdiction and since the Caregiver Avt is a  leagal issue. 

Cannot get to a patient advocate here so will have to raise the issue at the BVA.  Will have to check out your case citation.  CCK said the appeal would have to be in my caregiver's name.  Will call the White House hotline Monday about the Patient Advocate problem here.  Will post results here as I get them.