R 311134Z AUG 11
UNCLASSIFIED//
MARADMIN 501/11
MSGID/GENADMIN/CMC WASHINGTON DC MRA MP//
SUBJ/SPECIAL COMPENSATION FOR ASSISTANCE WITH ACTIVITIES OF DAILY LIVING//
REF/A/MSGID:DOC/PL 111-84/YMD:20091028//
REF/B/MSGID:DOC/PL 111-163/YMD:20100505//
REF/C/MSGID:DOC/PL 111-383/YMD:20110107//
REF/D/MSGID:DOC/USC/YMD:20100201//
REF/E/MSGID:DOC/DOD/YMD:20080623//
REF/F/MSGID:DOC/DOD/YMD:20110831//
NARR/REF A IS THE NATIONAL DEFENSE AUTHORIZATION ACT FOR FY 2010.  REF B IS THE CAREGIVERS AND VETERANS OMNIBUS HEALTH SERVICES ACT OF 2010.  REF C IS THE NATIONAL DEFENSE AUTHORIZATION ACT FOR FY 2011.  REF D IS SECTION 439 OF TITLE 37, UNITED STATES CODE.  REF E IS DOD DIRECTIVE 5124.02, "UNDER SECRETARY OF DEFENSE FOR PERSONNEL AND READINESS."  REF F IS THE DODI FOR SPECIAL COMPENSATION FOR ASSISTANCE WITH ACTIVITIES OF DAILY LIVING.//
POC/T. HERRON/CIV/UNIT:WWR/-/TEL: (703) 784-3694/DSN 278-3694//
POC/Y. JONES/CIV/UNIT:WWR/-/TEL: (703) 784-3689/DSN 278-3689//
POC/K. CERNY/CIV/UNIT:MPO/-/TEL: (703) 784-9386/DSN 278-9386//
POC/J. ADAMS/CWO5/UNIT:RFF/-/TEL: (703) 614-3548/DSN 224-3548//
GENTEXT/REMARKS/1.  THIS MARADMIN PUBLISHES THE MARINE CORPS POLICY ON SPECIAL COMPENSATION FOR ASSISTANCE WITH ACTIVITIES OF DAILY LIVING (SCAADL) AS OUTLINED IN REFS (A) THROUGH (F).  SCAADL IS AN AUTHORIZED COMPENSATION PAID TO THE SERVICE MEMBER THAT OFFSETS THE ECONOMIC BURDEN BORNE BY A PRIMARY CAREGIVER PROVIDING NONMEDICAL CARE, SUPPORT, AND ASSISTANCE FOR THE MEMBER.  SCAADL IS CONSIDERED TAXABLE INCOME FOR THE SERVICE MEMBER.
2.  RESPONSIBILITIES.  CMC (MP) IS RESPONSIBLE FOR SCAADL POLICY WHILE CMC (MF/WWR) IS RESPONSIBLE FOR SCAADL EXECUTION.
3.  PROGRAM GUIDANCE.
    A.  EFFECTIVE 31 AUGUST 11, SERVICE MEMBERS OF A REGULAR OR RESERVE COMPONENT WHO, IN THE LINE OF DUTY, INCUR OR AGGRAVATE A PERMANENT CATASTROPHIC  INJURY OR ILLNESS AND MEET THE BELOW CRITERIA ARE ELIGIBLE TO RECEIVE SCAADL:
        (1)  BE HOMEBOUND.
        (2)  BE CERTIFIED BY A LICENSED DOD OR VETERANS AFFAIRS (VA) PHYSICIAN TO HAVE A PERMANENT CATASTROPHIC INJURY AND NEED ASSISTANCE FROM ANOTHER PERSON TO PERFORM THE PERSONAL FUNCTIONS REQUIRED IN EVERYDAY LIVING OR REQUIRES CONSTANT SUPERVISION AND, IN THE ABSENCE OF SUCH ASSISTANCE, WOULD REQUIRE HOSPITALIZATION, NURSING HOME, OR INSTITUTIONAL CARE.
        (3)  BE AN OUTPATIENT.
        (4)  HAVE A DESIGNATED PRIMARY CAREGIVER WHO PROVIDES ASSISTANCE WITH AT LEAST ONE OF THE FOLLOWING ACTIVITIES OF DAILY LIVING (ADL) DUE TO THE SERVICE MEMBER'S:
             (A)  INABILITY TO DRESS OR UNDRESS HIM/HERSELF.
             (B)  INABILITY TO BATHE OR GROOM IN ORDER TO KEEP SELF CLEAN AND PRESENTABLE.
             (C)  FREQUENT NEED OF ADJUSTMENT OF ANY SPECIAL PROSTHETIC OR ORTHOPEDIC APPLIANCES WHICH BY REASON OF THE PARTICULAR DISABILITY CANNOT BE DONE WITHOUT AID (THIS WILL NOT INCLUDE THE ADJUSTMENT OF APPLIANCES WHICH NORMAL PERSONS WOULD BE UNABLE TO ADJUST WITHOUT AID, SUCH AS SUPPORTS, BELTS, LACING AT THE BACK, ETC.).
             (D)  INABILITY TO TOILET OR ATTEND TO TOILETING WITHOUT ASSISTANCE.
             (E)  INABILITY TO FEED HIM/HERSELF THROUGH LOSS OF COORDINATION OF UPPER EXTREMITIES OR THROUGH EXTREME WEAKNESS OR INABILITY TO SWALLOW.
             (F)  INCAPACITY, PHYSICAL OR MENTAL WHICH REQUIRES CARE OR ASSISTANCE ON A REGULAR BASIS TO PROTECT THE SERVICE MEMBER FROM HAZARDS OR DANGERS INCIDENT TO HIS OR HER DAILY ENVIRONMENT.
        (5)  IN ADDITION TO MEETING AT LEAST ONE OF THE ABOVE CRITERIA, THE SERVICE MEMBER MUST ALSO MEET ALL OF THE FOLLOWING CRITERIA:
             (A)  REQUIRES CONTINUAL MEDICAL MANAGEMENT OR IS AT HIGH RISK FOR PERSONAL SAFETY;
             (B)  WITHOUT CAREGIVER SUPPORT PROVIDING PERSONAL CARE SERVICES AT HOME IN AN ONGOING MANNER, WOULD REQUIRE HOSPITALIZATION, NURSING HOME, OR OTHER INSTITUTIONAL CARE; AND
             (C)  NOT BE PROVIDED CONCURRENT SERVICES BY ANOTHER ENTITY.
        (6)  ELIGIBILITY FOR SCAADL REQUIRES THE SERVICE MEMBER TO BE IN OUTPATIENT STATUS AND NO LONGER DETERMINED TO BE AN INPATIENT AT MILITARY TREATMENT FACILITY, DEPARTMENT OF VA MEDICAL CENTER, CIVILIAN HOSPITAL, NURSING HOME, OR OTHER RESIDENTIAL INSTITUTIONAL CARE.  ALTHOUGH INDIVIDUALS MAY BE TEMPORARILY PLACED IN AN INPATIENT STATUS DURING THE MONTH FOR TESTS, EXAMINATIONS, OR TREATMENT, THEY REMAIN ELIGIBLE FOR THE FULL MONTHLY SCAADL PAYMENT PROVIDED THEY ARE IN AN OUTPATIENT STATUS THE MAJORITYOF THE MONTH (I.E., MORE THAN 15 DAYS A MONTH).
        (7)  IF A MEMBER MEETS ALL ELIGIBILITY REQUIREMENTS STATED ABOVE, THE EFFECTIVE DATE OF ENTITLEMENT OF SCAADL WILL BE THE DATE A LICENSED DOD OR VA PHYSICIAN CERTIFIES THE MEMBER MEETS THE CRITERIA FOR SPECIAL COMPENSATION.
    B.  SERVICE MEMBERS MAY NOT DESIGNATE ANOTHER MILITARY MEMBER AS THEIR PRIMARY CAREGIVER.
    C.  SCAADL MAY NOT BE PAID TO A QUALIFIED MEMBER IF ANY OTHER FEDERAL AGENCY IS PROVIDING OUTPATIENT OR IN-HOME SERVICES TO ASSIST WITH ADL OR SUPERVISION TO AVOID HARM TO SELF OR OTHERS.
        (1) SCAADL MAY NOT BE PAID TO A QUALIFIED MEMBER IF THEIR PRIMARY CAREGIVER IS RECEIVING A MONTHLY CAREGIVER STIPEND FROM THE DEPARTMENT OF VA UNDER THE CAREGIVERS AND VETERANS OMNIBUS HEALTH SERVICES ACT OF 2010.
        (2) SERVICE MEMBERS WHO QUALIFY FOR AND ACCCEPT IN-HOME ASSISTANCE WITH ADL (CUSTODIAL CARE) PAID WITH SUPPLEMENTAL HEALTH CARE PROGRAM FUNDS AND PROVIDED BY A TRICARE-AUTHORIZED HOME HEALTH AGENCY (HHA) ARE NOT ELIGIBLE FOR SCAADL.
    D.  SERVICE MEMBERS WHO QUALIFY FOR SCAADL SHALL HAVE THE QUALIFYING PAYMENTS CONTINUE UNTIL THE EARLIEST DATE OF THE FOLLOWING CONDITIONS:
        (1) THE LAST DAY OF THE MONTH DURING WHICH A 90-DAY PERIOD ENDS THAT BEGINS FROM THE DATE OF SEPARATION OR RETIREMENT OF THE MEMBER (EX: 1 JUNE 2011 (SEPARATION DATE) PLUS 90 DAYS EQUALS 1 SEPTEMBER 2011) LAST DAY OF ENTITLEMENT IS 30 SEPTEMBER 2011.
        (2) THE LAST DAY OF THE MONTH DURING WHICH A MEMBER DIES.
        (3) THE LAST DAY OF THE MONTH DURING WHICH THE MEMBER IS DETERMINED TO BE NO LONGER AFFLICTED WITH THE CATASTROPHIC INJURY OR ILLNESS.  THE RELEVANT MONTH IS THE MONTH DURING WHICH THE MEMBER BECOMES NO LONGER AFFLICTED WITH A CATASTROPHIC ILLNESS OR INJURY.  A MEMBER IS NOT ENTITLED TO SCAADL IF THE MEMBER IS NO LONGER AFFLICTED WITH A CATASTROPHIC ILLNESS OR INJURY BUT HAS NOT MET WITH A PHYSICIAN.
        (4) THE LAST DAY OF THE MONTH PRECEDING THE MONTH DURING WHICH THE MEMBER BEGINS RECEIVING COMPENSATION UNDER THE VA CAREGIVERS AND VETERANS OMNIBUS HEALTH SERVICES ACT OF 2010.
4.  DETERMINATION OF AMOUNT OF MONTHLY SCAADL COMPENSATION.
    A.  THE WOUNDED WARRIOR REGIMENT PAY AND ENTITLEMENT SECTION WILL CERTIFY SCAADL ENTITLEMENT. THE MCB QUANTICO FINANCE OFFICE WILL COMPUTE AND PAY SCAADL BASED ON THE ENTITLEMENT CERTIFICATION.
    B.  THE AMOUNT OF COMPENSATION FOR EACH SERVICE MEMBER WILL BE BASED ON A THREE-TIER SYSTEM, THAT IN TURN IS BASED UPON A CLINICAL DETERMINATION OF THE NUMBER OF ADL NEEDS OF THE SERVICE MEMBERS AND THE HOURS, UP TO 40 HOURS PER WEEK, REQUIRED BY A CAREGIVER TO PERFORM EACH ADL OR SIGNIFICANT MENTAL HEALTH AND/OR BEHAVIOR IMPAIRMENT OF THE SERVICE MEMBER REQUIRING CONTINUOUS SUPERVISION.  A LICENSED DOD OR VA PHYSICIAN WILL UTILIZE DD FORM 2948 TO DETERMINE THE MEMBER'S LEVEL OF DEPENDENCY BASED ON THE DEGREE TO WHICH THE MEMBER IS UNABLE TO PERFORM ONE OR MORE ACTIVITIES OF DAILY LIVING OR THE DEGREE TO WHICH THE MEMBER IS IN NEED OF SUPERVISION OR PROTECTION BASED ON SYMPTOMS OR RESIDUALS OF NEUROLOGICAL OR OTHER IMPAIRMENT OR INJURY.  IF THE SERVICE MEMBER'S ATTENDING PHYSICIAN IS A CIVILIAN PROVIDER NOT AFFILIATED WITH DOD OR VA, ARRANGEMENTS WILL BE MADE TO HAVE A DOD OR VA PHYSICIAN REVIEW THE CASE AND COMPLETE THE CERTIFICATION PROCESS.  BASED ON THE CLINICAL EVALUATION AND SCORE, THE MEMBER WILL BE RATED AS FOLLOWS:
        (1) HIGH TIER:  SERVICE MEMBER WHO SCORES 21 OR HIGHER WILL BE PRESUMED TO NEED A FULL-TIME CAREGIVER, ONE WHO PROVIDES 40 HOURS OF PERSONAL CARE SERVICES PER WEEK.
        (2) MEDIUM TIER:  SERVICE MEMBER WHO SCORES 13-20 WILL BE PRESUMED TO REQUIRE 25 HOURS PER WEEK OF CAREGIVER ASSISTANCE.
        (3) LOW TIER:  SERVICE MEMBER WHO SCORES 1-12 WILL BE PRESUMED TO REQUIRE 10 HOURS PER WEEK OF CAREGIVER ASSISTANCE.
5.  PROCESSES FOR REQUESTS AND APPEALS.
    A.  REQUESTS FOR SCAADL PAYMENT MUST INCLUDE THE COMPLETED DD FORM 2948 WITH THE ADL, SUPERVISION, AND SCORING GUIDE COMPLETED BY A LICENSED DOD OR VA PHYSICIAN.  REQUESTS WILL BE FORWARDED, VIA THE SERVICE MEMBER'S CHAIN OF COMMAND, TO THE COMMANDING OFFICE, WOUNDED WARRIOR REGIMENT (ATTN: PAY AND ENTITLEMENTS), 1998 HILL AVENUE, MARINE CORPS BASE, QUANTICO, VA 22134-5001, FOR APPROVAL AND PAYMENT.  REQUESTS CAN ALSO BE FORWARDED VIA ENCRYPTED E-MAIL TO THE WOUNDED WARRIOR REGIMENT ORGANIZATIONAL MAILBOX:  WWRS1@USMC.MIL.
    B.  APPEALS OF AN INITIAL DETERMINATION THAT A SERVICE MEMBER IS NOT ELIGIBLE FOR SCAADL WILL BE SUBMITTED TO THE CO, WOUNDED WARRIOR REGIMENT (ATTN: PAY AND ENTITLEMENTS).  ENSURE ALL MEDICAL REVIEWS AND OPINIONS ARE INCLUDED.  FOLLOWING A THOROUGH REVIEW AND DEVELOPMENT OF A MEDICAL ADVISORY OPINION BY THE REGIMENTAL SURGEON, THE COMMANDING OFFICER WILL REVIEW THE APPEAL IN ORDER TO DETERMINE SCAADL ENTITLEMENT.
6.  RECERTIFICATION AND PROCEDURES.
    A.  AT A MINIMUM, RECERTIFICATION FOR SCAADL IS REQUIRED EVERY 180 DAYS.  A NEW DD FORM 2948 MUST BE COMPLETED BY A LICENSED DOD OR VA PHYSICIAN AND FORWARDED TO THE CO WOUNDED WARRIOR REGIMENT FOR APPROVAL AND PAYMENT. THE REEVALUATION AND RECERTIFICATION SHALL BE CONSISTENT WITH THE CERTIFICATION PROCESS USED TO ESTABLISH INITIAL SCAADL ELIGIBILITY.
    B.  SERVICE MEMBER ELIGIBILITY FOR SCAADL SHALL BE CONTINUOUSLY EVALUATED TO ENSURE ELIGIBILITY REMAINS INTACT.  IF A SERVICE MEMBER'S ELIGIBILITY CHANGES PRIOR TO THE 180 DAY RECERTIFICATION, (I.E., CHANGE OF LOCATION, IMPROVEMENT/REGRESSION IN MEDICAL CONDITION) THE REEVALUATION AND RECERTIFICATION PAPERWORK WILL BE SUBMITTED AT THAT TIME.
    C.  THE SERVICE MEMBER'S RECOVERY TEAM, TO INCLUDE THE PRIMARY CARE MANAGER, RECOVERY CARE COORDINATOR, NON-MEDICAL CASE MANAGERS, AND UNIT LEADERSHIP, SHALL ENSURE THAT WHENEVER ANY MARKED CHANGES IN THE SERVICE MEMBER'S MEDICAL CONDITION (WHICH MAY WARRANT AN INCREASE OR DECREASE IN THE LEVEL OF CAREGIVER SUPPORT REQUIRED) ARE IDENTIFIED, THE MEMBER IS REFERRED TO A LICENSED DOD OR VA PHYSICIAN FOR A REEVALUATION.
7.  DEFINITIONS:
    A.  ADL.  FEEDS (INCLUDING SPECIAL DIETS), DRESSES AND SHELTERS; PERSONAL HYGIENE SERVICES; OBSERVATION AND GENERAL MONITORING; BOWEL TRAINING OR MANAGEMENT (UNLESS ABNORMALITIES IN BOWEL FUNCTION ARE OF A SEVERITY TO RESULT IN A NEED FOR MEDICAL OR SURGICAL INTERVENTION IN THE ABSENCE OF SKILLED SERVICES; SAFETY PRECAUTIONS; GENERAL PREVENTIVE PROCEDURES (SUCH AS TURNING TO PREVENT BEDSORES); PASSIVE EXERCISE; TRANSPORTATION; AND OTHER SUCH ELEMENTS OF PERSONAL CARE THAT CAN REASONABLY BE PERFORMED BY AN UNTRAINED ADULT WITH MINIMAL INSTRUCTION OR SUPERVISION.  ADL MAY ALSO BE REFERRED TO AS "ESSENTIALS OF DAILY LIVING" AS DEFINED IN PART 199.2(B) OF TITLE 32, CODE OF FEDERAL REGULATIONS.  FOR THE PURPOSES OF ELIGIBILITY OF SCAADL, ADL AND "PERSONAL FUNCTIONS REQUIRED IN EVERYDAY LIVING" ARE THE SAME.
    B.  CATASTROPHIC INJURY AND ILLNESS.  A PERMANENT SEVERELY DISABLING INJURY, DISORDER, OR ILLNESS INCURRED OR AGGRAVATED IN THE LINE OF DUTY THAT THE SECRETARY OF THE MILITARY DEPARTMENT CONCERNED DETERMINES COMPROMISES THE ABILITY OF THE AFFLICTED PERSON TO CARRY OUT ADL TO SUCH A DEGREE THAT THE PERSON REQUIRES PERSONAL OR MECHANICAL ASSISTANCE TO LEAVE HOME OR BED, OR CONSTANT SUPERVISION TO AVOID PHYSICAL HARM TO SELF OR OTHERS.
    C.  HOMEBOUND.  A CONDITION SUCH THAT AN INDIVIDUAL IS UNABLE TO LEAVE HOME AND, CONSEQUENTLY, LEAVING HOME REQUIRES CONSIDERABLE AND TAXING EFFORT.  ANY ABSENCE OF AN INDIVIDUAL FROM THE HOME ATTRIBUTABLE TO RECEIVING HEALTH CARE TREATMENT, INCLUDING REGULAR ABSENCES TO PARTICIPATE IN REHABILITATIVE, THERAPEUTIC, PSYCHOSOCIAL, OR MEDICAL TREATMENT IN AN ADULT DAY-CARE PROGRAM THAT IS LICENSED OR CERTIFIED BY A STATE, OR ACCREDITED TO FURNISH ADULT DAY-CARE SERVICES IN THE STATE, SHALL NOT DISQUALIFY AN INDIVIDUAL FROM BEING HOMEBOUND.  ANY ABSENCE FROM THE HOME THAT IS INFREQUENT OR RELATIVELY SHORT SHALL NOT DISQUALIFY AN INDIVIDUAL.  ANY ABSENCE TO ATTEND A RELIGIOUS SERVICE SHALL BE DEEMED TO BE INFREQUENT OR SHORT.  ABSENCES FROM THE HOME FOR NONMEDICAL PURPOSES SUCH AS AN OCCASIONAL TRIP TO THE BARBER, A WALK AROUND THE BLOCK, OR A DRIVE, DO NOT NEGATE THE BENEFICIARY'S HOMEBOUND STATUS IF THE ABSENCES ARE INFREQUENT AND RELATIVELY SHORT.  ABSENCES, WHETHER REGULAR OR INFREQUENT, FROM THE BENEFICIAY'S PRIMARY HOME TO ATTEND AN EDUCATIONAL PROGRAM IN A PUBLIC OR PRIVATE SCHOOL THAT IS LICENSED AND CERTIFIED BY A STATE, TERRITORY, OR DISTRICT SHALL NOT NEGATE THE BENEFICIARY'S HOMEBOUND STATUS.
    D.  INPATIENT.  A PATIENT WHO HAS BEEN ADMITTED TO A HOSPITAL OR OTHER AUTHORIZED INSTITUTION FOR BED OCCUPANCY FOR PURPOSES OF RECEIVING NECESSARY MEDICAL CARE, WITH THE REASONABLE EXPECTATION THAT THE PATIENT WILL REMAIN IN THE INSTITUTION AT LEAST 24 HOURS, AND WITH REGISTRATION AND ASSIGNMENT OF AN INPATIENT NUMBER OR DESIGNATION. INSTITUTIONAL CARE IN CONJUNCTION WITH IN AND OUT (AMBULATORY) SURGERY IS NOT INCLUDED WITHIN THE MEANING OF INPATIENT, WHETHER OR NOT AN INPATIENT NUMBER OR DESIGNATION IS MADE BY THE HOSPITAL OR OTHER INSTITUTION.  IF THE PATIENT HAS BEEN RECEIVED AT THE HOSPITAL, BUT DEATH OCCURS BEFORE THE ACTUAL ADMISSION OCCURS, AN INPATIENT ADMISSION EXISTS AS IF THE PATIENT HAD LIVED AND HAD BEEN FORMALLY ADMITTED.
    E.  OUTPATIENT.  AN INDIVIDUAL WHO USES A HEALTH CARE FACILITY FOR DIAGNOSIS OR TREATMENT WITHOUT BEING ADMITTED TO A HOSPITAL OR OTHER AUTHORIZED INSTITUTION AS AN INPATIENT; SOMETIMES CALLED A DAY PATIENT.  OUTPATIENT STATUS ALSO INCLUDES IN AND OUT (AMBULATORY) SURGERY.
    F.  PRIMARY CAREGIVER.  AN INDIVIDUAL WHO RENDERS TO AN ELIGIBLE SERVICE MEMBER SERVICES TO SUPPORT ADL AND SPECIFIC SERVICES ESSENTIAL TO THE SAFE MANAGEMENT OF THE BENEFICIARY'S CONDITION.
    G.  GUARDIAN.  A PERSON WHO LEGALLY HAS THE CARE OF ANOTHER PERSON WHO IS INCOMPETENT TO ACT FOR HIMSELF OR HERSELF.
    H.  CUSTODIAL CARE.  TREATMENT OR SERVICES, REGARDLESS OF WHO RECOMMENDS SUCH TREATMENT OR SERVICES OR WHERE SUCH TREATMENT OR SERVICES ARE PROVIDED, THAT EITHER CAN BE RENDERED SAFELY AND REASONABLY BY A PERSON WHO IS NOT MEDICALLY SKILLED; OR IS OR ARE DESIGNED MAINLY TO HELP THE PATIENT WITH ADL.
    I.  LINE OF DUTY.  THE RELATIONSHIP OF AN ILLNESS, INJURY OR DISEASE TO A MEMBER'S MILITARY DUTY OR DUTY STATUS THAT IS SUFFICIENT TO SATISFY THE DUTY OR DUTY STATUS COMPONENT OF ELIGIBILITY FOR DISABILITY RETIREMENT UNDER CHAPTER 61 OF TITLE 10, USC.
8.  SPECIFIC PAYMENT PROCEDURES WILL BE PROVIDED VIA A PAY AND ALLOWANCE ADVISORY NOTICE.
9.  THIS MESSAGE IS APPLICABLE TO THE TOTAL FORCE.
10.  RELEASE AUTHORIZED BY S. E. MURRAY, ASSISTANT DEPUTY COMMANDANT FOR MANPOWER AND RESERVE AFFAIRS.//