VA’s MST Policies and Treatment Benefits

The following is  listing of the laws regarding the Veterans Administration MST Policies and Treatment. I stumbled onto these by accident one day-I feel they may be more useful in the hands of MST survivors and not kept closed and only available to VA staff as the headline I failed to copy had advised. You must read them carefully-and you can use them.

Summary DocumentsSummary of VA Laws, Directives, & National Policies Related to MST

 

Handout summarizing eligibility and billing rules related to MST

‘Office of General Counsel MST Eligibility Guidelines’ summary document

FAQs about payment for travel

• Please see our discussion forum thread on this topic

MST and the Compensation and Pension process (August 7, 2008 MST Teleconference Training Series presentation)

• Audio recording of this presentation

Overview / history of VA’s response to MST

MST-Related Laws, Directives, and Policies
Note: provisions that were changed in later Public Law, Directives, or policies appear with a cross-out line

1992: Public Law 102-585

• Added section 1720D to Chapter 17 of Title 38 (“Veterans Benefits“; 38 CFR 17), US Code of Federal Regulations to authorize VA to provide outreach and counseling (up to December 31, 1995) to help women veterans overcome “psychological trauma” from a “physical assault of a sexual nature, battery of a sexual nature, or sexual harassment” that occurred while the veteran was serving on active duty.
• Sexual harassment was defined as “repeated, unsolicited verbal or physical contact of a sexual nature which is threatening in character.”
• The Secretary was to “give priority to the establishment and operation of the program to provide counseling.”
• Veteran was required to seek counseling within two years of discharge.
• Treatment could last for up to a year.
• Mandated education of “mental health professionals and … other health care personnel” on MST issues.

1994: Public Law 103-452

• Amended section 1720D of 38 CFR 17 to extend VA’s authorization to provide treatment through December 31, 1998.
• Repealed requirement that veteran seek counseling within two years of discharge.
• Expanded treatment to men.
• Expanded treatment to physical conditions resulting from MST.
• Changed outpatient sexual trauma counseling, care, and services to priority I.
• Repealed limits on length of treatment.

1995: VA Directive 10-95-030

• Implemented PL 103-452.
• Made MST-related “counseling, care, and services” free of charge. However, “medication copayments will be charged for services provided for nonservice-connected conditions.”

1997: Under Secretary for Health’s Information Letter IL-10-97-037

• Based on a General Counsel Opinion (VAOPGCADV 17-97), clarified the eligibility rules for veterans seeking treatment for MST.
  • Persons are eligible for MST care and counseling services if they meet the definition of “veteran” in 38 USC Section 1720D. This includes reservists and members of the National Guard who were activated to full-time duty status in the Armed Forces. It does not include those who experienced MST while on active duty for training.
  • No minimum length of service requirements apply.
  • Veterans need not have filed a claim for service-connected disability.

1998: Public Law 105-368 [section 902 on Acrobat page 46 of this document]

• Amended section 1720D of 38 CFR 17 to extend VA’s authorization to provide treatment through December 31, 2001.

1998: VA Directive 98-058

• Notified VA healthcare personnel that VA’s authority to provide treatment had been extended through December 31, 2001 (as per PL 105-368.)

1999: Public Law 106-117 (“Millennium Bill”) [section 115 on Acrobat page 14 of this document]

• Amended section 1720D of 38 CFR 17 to extend VA’s authorization to provide treatment through December 31, 2004.
• Changed wording from VA “may” provide care to “shall” provide care.
• Required outreach to veterans about the MST-related counseling and treatment available, particularly in collaboration with DoD.
• Required VA to submit reports to Congress on outreach activities specified in this Public Law and on the number of veterans receiving MST-related counseling.

1999: VA Directive 99-039

• Instituted a nationwide system (“MST software application”) to “indicate a veteran’s claim of MST; indicate if a veteran’s treatment is related to MST; and generate statistical and demographic reports related to MST”.
• Stated that it is “important” that all Primary Care and Behavioral Health providers screen for MST.

2000: VA Directive 2000-008

• Provided a definition for MST, based on PL 102-585: “The law defines sexual trauma as sexual harassment, sexual assault, rape, and other acts of violence. It further defines sexual harassment as repeated, unsolicited verbal or physical contact of a sexual nature, which is threatening in nature.”
• Given the need for “confidentiality and sensitivity to the impact of MST on veterans”, mandated that all staff receive education on MST-related issues.
• Mandated screening all veterans for MST.
• Per Millennium Bill, required outreach, particularly in collaboration with DOD, to help overcome barriers to treatment.
• Required all facilities to designate an MST Coordinator.
• Required all facilities to implement the “MST software” and “track MST patients.”
• Required monitoring treatment rates for MST, aggegrated by gender.

2004: Public Law 108-422 [section 301 on Acrobat page 4 of this document]

• Amended section 1720D of 38 CFR 17 to make VA’s authority to provide sexual trauma counseling to veterans permanent.
• Extended MST treatment to active duty for training (ADUTRA) service members.

2005: VA Directive 2005-015

• Specified that Medical Center Directors are responsible for appointing a designated MST Coordinator.
• Medical Center Directors must also ensure that a “MST Counselor(s) or Team” is available so that all enrolled veterans are screened for MST.
• Mandated “necessary staff education and training.”
• Scheduling for outpatient MST-related care should be within 30 days, consistent with VHA performance standards of scheduling for special populations and mental health clinics.
• Required documentation of screening, referral, and treatment for MST-related care, aggregated by gender via use of the MST software and MST clinical reminder.
• Specified that even veterans who are otherwise ineligible for VA health care benefits based on length of military service may be provided MST-related care.
• Stated that veterans receiving MST-related counseling and treatment should not be billed for inpatient, outpatient, or pharmaceutical co-payments.
• Veterans “need to be informed of their eligibility to file a claim for service connected disability compensation” and told how to learn more about how to do this.

2007: Code of Federal Regulations, Title 38, 1720D (38 CFR 17) [section 1720D on Acrobat page 204 of this document] Note: This document loads VERY slowly.

• Title 38 description of coverage of veterans’ benefits related to MST, as last updated in 2007.

2008: Uniform Mental Health Services document (VHA Handbook 1160.01) [section 24, Acrobat page 42 of this document in particular, although other sections also reference MST (e.g., section 9, Acrobat page 13)]
Memo releasing this document
Note: Our June, 2008 MST Teleconference Training Series call and our PowerPoint on VA Laws, Directives, & National Policies have more information about this document.

• Describes mental health-related services that must be available at every VA facility.
• All facilities must install the MST clinical reminder in CPRS.
• All veterans must be screened using this reminder.
• Veterans who request treatment must be provided free care for mental and physical health conditions related to MST. Determination as to whether the care is MST-related or not is made by the clinician providing care and is indicated by checking the MST box on the encounter form for the visit.
• Facilities must monitor screening, referral, and treatment related to MST, aggregated by gender, by using the clinical reminder (for tracking screening) and the MST encounter form checkbox (to track treatment)
  Note: The MST clinical reminder and encounter form checkbox are what is used by the Office of Mental Health Services and the MST Support Team to evaluate local screening, referral, and treatment. If they wish, facilities may also choose to use stop code 524 or purpose of visit code 55 for monitoring of treatment, as suggested by the Uniform Mental Health Services Package and Directive 2005-015. However, this should be in addition to, not instead of, the use of the MST encounter form checkbox.
• Scheduling priority for outpatient care is consistent with VHA performance standards for scheduling clinics.
• Veterans may be eligible for free MST-related care even if they are otherwise ineligible for VA services.
• Every VISN must provide access to residential programs that can provide care for conditions resulting from MST.
• Fee basis is permissible if clinical, resource, or geographic reasons make it not feasible to provide counseling in a VA facility.
• Every VAMC must have an MST Coordinator who monitors and ensures that national and VISN-level policies related to MST screening, education and training, and treatment are implemented at the facility; serves as a point person and a source of information and problem-solving for MST-related issues at the facility; establishes and monitors mechanisms to ensure that all veterans are screened for MST and have access to treatment for conditions related to MST.
• Evidence-based mental health care must be available to all veterans with mental health conditions related to MST.
• When clinically indicated, facilities are strongly encouraged to give veterans the option of being assigned a same-sex mental health provider (or opposite-sex provider if the MST involved a same-sex perpetrator).
• “Necessary” staff education and training must be provided.

2009: VA Directive 2009-012

• Specifies that MST-related care is not subject to outpatient co-payments

Tags: MST survivor connected VA laws