38 U.S.C. § 1710B: Extended care services

Geriatric evaluation. Nursing home care (A) in facilities operated by the Secretary, and (B) in community-based facilities through contracts under section 1720 of this title . Domiciliary services under section 1710(b) of this title . Adult day health care under section 1720(f) of this title . Such other noninstitutional alternatives to nursing home care as the Secretary may furnish as medical services under section 1701(10) 1 of this title. 1 See References in Text note below. Respite care under section 1720B of this title . The Secretary shall ensure that the staffing and level of extended care services provided by the Secretary nationally in facilities of the Department during any fiscal year is not less than the staffing and level of such services provided nationally in facilities of the Department during fiscal year 1998. Except as provided in paragraph (2), the Secretary may not furnish extended care services for a non-service-connected disability other than in the case of a veteran who has a compensable service-connected disability unless the veteran agrees to pay to the United States a copayment (determined in accordance with subsection (d)) for any period of such services in a year after the first 21 days of such services provided that veteran in that year. to a veteran whose annual income (determined under section 1503 of this title ) is less than the amount in effect under section 1521(b) of this title ; to a veteran being furnished hospice care under this section; with respect to an episode of extended care services that a veteran is being furnished by the Department on November 30, 1999 ; or to a veteran who was awarded the medal of honor under section 7271, 8291, or 9271 of title 10 or section 491 1 of title 14. A veteran who is furnished extended care services under this chapter and who is required under subsection (c) to pay an amount to the United States in order to be furnished such services shall be liable to the United States for that amount. establishing a maximum monthly copayment (based on all income and assets of the veteran and the spouse of such veteran); protecting the spouse of a veteran from financial hardship by not counting all of the income and assets of the veteran and spouse (in the case of a spouse who resides in the community) as available for determining the copayment obligation; and allowing the veteran to retain a monthly personal allowance. There is established in the Treasury of the United States a revolving fund known as the Department of Veterans Affairs Extended Care Fund (hereinafter in this section referred to as the “fund”). Amounts in the fund shall be available, without fiscal year limitation and without further appropriation, exclusively for the purpose of providing extended care services under subsection (a). All amounts received by the Department under this section shall be deposited in or credited to the fund. Subsection (d) [enacting provisions set out as a note under section 8118 of this title ] and the amendments made by subsection (c) [repealing section 8116 of this title ] shall take effect at the end of the 30-day period beginning on the date on which the Secretary of Veterans Affairs certifies to Congress that the Secretary is in compliance with subsection (b) of section 1710B of title 38 , United States Code. Following a certification under subsection (f), the Secretary shall submit to Congress an annual update on that certification.” Except as provided in paragraph (2), the amendments made by this section [enacting this section and section 1710A of this title and amending sections 1701, 1710, 1720, 1720B and 1741 of this title] shall take effect on the date of the enactment of this Act [ Nov. 30, 1999 ]. Subsection (c) of section 1710B of title 38 , United States Code (as added by subsection (b)), shall take effect on the effective date of regulations prescribed by the Secretary of Veterans Affairs under subsections (c) and (d) of such section. The Secretary shall publish the effective date of such regulations in the Federal Register. The provisions of section 1710(f) of title 38 , United States Code, shall not apply to any day of nursing home care on or after the effective date of regulations under paragraph (2).” waive the requirement that a covered provider process new enrollments and six-month renewals for the Program via an in-person or home visit; and allow new enrollments and sixth-month renewals for the Program to be conducted via telephone or telehealth modality. requested to do so by the veteran or a representative of the veteran; or a mutual decision is made between the veteran and a health care provider of the veteran to suspend or dis-enroll the veteran or caregiver from the Program. During the period specified in subsection (f), the Secretary may waive the requirement for signed, mailed paperwork to confirm the enrollment or renewal of a veteran in the Program and may allow verbal consent of the veteran via telephone or telehealth modality to suffice for purposes of such enrollment or renewal. any penalty for late paperwork relating to the Program; and any requirement to stop payments for veterans or caregivers of veterans under the Program if they are out of State for more than 14 days. the veteran had been receiving extended care services paid for by the Department, such as adult day services or homemaker or home health aide services, immediately preceding such period; and those services are no longer available due to a public health emergency. The period specified in this subsection is the period beginning on the date on which a public health emergency was first declared and ending on the date that is 60 days after the date on which a public health emergency is no longer in effect. an Aging and Disability Resource Center, an area agency on aging, or a State agency (as those terms are defined in section 102 of the Older Americans Act of 1965 ( 42 U.S.C. 3002 )); or a center for independent living (as defined in section 702 of the Rehabilitation Act of 1973 ( 29 U.S.C. 796a )).” Commencing not later than 120 days after the date of the enactment of this Act [ Dec. 22, 2006 ], the Secretary of Veterans Affairs shall carry out a pilot program to assess the feasibility and advisability of various mechanisms to expand and improve caregiver assistance services. The pilot program required by subsection (a) shall be carried out during the three-year period beginning on the date of the commencement of the pilot program. Adult-day health care services. Coordination of services needed by veterans, including services for readjustment and rehabilitation. Transportation services. Caregiver support services, including education, training, and certification of family members in caregiver activities. Home care services. Respite care. Hospice services. Any modalities of non-institutional long-term care. There are authorized to be appropriated to the Department of Veterans Affairs $5,000,000 for each of fiscal years 2007 through 2009 to carry out the pilot program authorized by this section. The Secretary shall allocate funds appropriated pursuant to the authorization of appropriations in subsection (d) to individual medical facilities of the Department in such amounts as the Secretary determines appropriate, based upon proposals submitted by such facilities for the use of such funds for improvements to the support of the provision of caregiver assistance services. Special consideration should be given to rural facilities, including those without a long-term care facility of the Department. a description and assessment of the activities carried out under the pilot program; information on the allocation of funds to facilities of the Department under subsection (e); and a description of the improvements made with funds so allocated to the support of the provision of caregiver assistance services.” The Secretary [of Veterans Affairs] shall carry out three pilot programs for the purpose of determining the effectiveness of different models of all-inclusive care-delivery in reducing the use of hospital and nursing home care by frail, elderly veterans. In selecting locations in which the pilot programs will be carried out, the Secretary may not select more than one location in any given health care region of the Veterans Health Administration. Adult-day health care services on an eight-hour per day, five-day per week basis. Medical services (including primary care, preventive services, and nursing home care, as needed). Coordination of needed services. Transportation services. Home care services. Respite care. employ the use of interdisciplinary care-management teams to provide the required array of services; determine the appropriate number of patients to be enrolled in each program and the criteria for enrollment; and ensure that funding for each program is based on the complex care category under the resource allocation system (known as the Veterans Equitable Resource Allocation system) established pursuant to section 429 of Public Law 104–204 ( 110 Stat. 2929 ). Under one of the pilot programs, the Secretary shall provide services directly through facilities and personnel of the Department [of Veterans Affairs]. services provided under contract with appropriate public and private entities; and services provided through facilities and personnel of the Department. services provided through cooperative arrangements with appropriate public and private entities; and services provided through facilities and personnel of the Department. In providing for the furnishing of services under a contract in carrying out the pilot program described in subsection (e)(2), the Secretary may, subject to reimbursement, provide in-kind assistance (through the services of Department employees and the sharing of other Department resources) to a facility furnishing care to veterans. Such reimbursement may be made by reduction in the charges to the Secretary under such contract. In providing for the furnishing of services in carrying out a pilot program described in subsection (e)(2) or (e)(3), the Secretary shall make payment for services only to the extent that payment for such services is not otherwise covered (notwithstanding any provision of title XVIII or XIX of the Social Security Act [ 42 U.S.C. 1395 et seq., 1396 et seq.]) by another government or nongovernment entity or program. The authority of the Secretary to provide services under a pilot program under this section shall cease on the date that is three years after the date of the commencement of that pilot program. In the case of a veteran who is participating in a pilot program under this section as of the end of the three-year period applicable to that pilot program under paragraph (1), the Secretary may continue to provide to that veteran any of the services that could be provided under the pilot program. The authority to provide services to any veteran under the preceding sentence applies during the period beginning on the date specified in paragraph (1) with respect to that pilot program and ending on December 31, 2005 . Not later than nine months after the completion of all of the pilot programs under this section, the Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and the House of Representatives a report on those programs. A description of the implementation and operation of each such program. An analysis comparing use of institutional care and use of other services among enrollees in each of the pilot programs with the experience of comparable patients who are not enrolled in one of the pilot programs. An assessment of the satisfaction of participating veterans with each of those programs. An assessment of the health status of participating veterans in each of those programs and of the ability of those veterans to function independently. An analysis of the costs and benefits under each of those programs.” the effectiveness of providing assisted living services to eligible veterans, at the election of such veterans; and the satisfaction with the pilot program of veterans participating in such pilot program. The Secretary shall select two Veterans Integrated Service Networks of the Department of Veterans Affairs at which to carry out the pilot program under subsection (a). Within the Veterans Integrated Service Networks selected under paragraph (1), the Secretary shall select facilities at which to carry out the pilot program under subsection (a)(1). the locations of such facilities are in geographically diverse areas; not fewer than one such facility serves veterans in rural or highly rural areas (as determined through the use of the Rural-Urban Commuting Areas coding system of the Department of Agriculture); not fewer than one such facility is located in each Veterans Integrated Service Network selected under paragraph (1); and not fewer than one such facility is a State home. Not more than 60 eligible veterans may participate in the pilot program under subsection (a)(1) in each Veterans Integrated Service Network selected under subsection (b)(1). a provider participating under a State plan or waiver under title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq.); or a State home recognized and certified under subpart B of part 51 of title 38, Code of Federal Regulations, or successor regulations. the facility meets the standards for community residential care established under sections 17.61 through 17.72 of title 38, Code of Federal Regulations, or successor regulations, and any additional standards of care as the Secretary may specify; or in the case of a facility that is a State home, the State home meets such standards of care as the Secretary may specify. with respect to a facility that is a State home, not less frequently than annually and in the same manner as the Secretary conducts inspection of State homes under section 1742 of title 38 , United States Code; and with respect to any other facility, not less frequently than annually and in the same manner as the Secretary conducts inspection of facilities under section 1730 of such title. In the case of a facility participating in the pilot program under subsection (a)(1) that is a State home, the Secretary shall pay to the State home a per diem for each veteran participating in the pilot program at a rate agreed to by the Secretary and the State home. pay to the facility an amount that is less than the average rate paid by the Department for placement in a community nursing home in the same Veterans Integrated Service Network; and re-evaluate payment rates annually to account for current economic conditions and current costs of assisted living services. provide to all veterans participating in the pilot program at the time of such termination the option to continue to receive assisted living services at the site they were assigned to under the pilot program, at the expense of the Department; and ensure such veterans do not experience lapses in care; and provide such veterans with information on, and furnish such veterans with, other extended care services based on their preferences and best medical interest. The Secretary shall determine a method for assessment of quality of care provided to veterans participating in the pilot program under subsection (a)(1) and shall communicate that method to providers of services under the pilot program. an identification of Veterans Integrated Services Networks and facilities of the Department participating in the pilot program and assisted living facilities and State homes at which veterans are placed under the pilot program; the number of participants in the pilot program, disaggregated by facility; general demographic information of participants in the pilot program, including average age, sex, and race or ethnicity; disability status of participants in the pilot program; an identification of any barriers or challenges to furnishing care to veterans under the pilot program, conducting oversight of the pilot program, or any other barriers or challenges; the cost of care at each assisted living facility and State home participating in the pilot program, including an analysis of any cost savings by the Department when comparing that cost to the cost of nursing home care; aggregated feedback from participants in the pilot program, including from veteran resident surveys and interviews; and such other matters the Secretary considers appropriate. includes the matters required under paragraphs (1) through (8) of subsection (g); includes recommendations on whether the model studied in the pilot program should be continued or adopted throughout the Department; and indicates whether the Secretary requests action by Congress to make the pilot program permanent. Not later than three years after the initiation of the pilot program under subsection (a)(1), the Inspector General of the Department of Veterans Affairs shall submit to the Secretary of Veterans Affairs and the Committees on Veterans’ Affairs of House of Representatives and the Senate a report on the pilot program. the quality of care provided to veterans at facilities participating in the pilot program, measured pursuant to the method determined under subsection (f); the oversight of such facilities, as conducted by the Department, the Centers for Medicare & Medicaid Services, State agencies, and other relevant entities; and such other matters as the Inspector General considers appropriate. Not later than 90 days after the submission of the report under paragraph (1), the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a plan to address the deficiencies identified in the report, if any. Subject to paragraph (2), the pilot program under subsection (a)(1) shall terminate on September 30, 2028 . The Secretary may extend the duration of the pilot program for an additional two-year period if the Secretary, based on the results of the reports submitted under subsection (g), determines such an extension is appropriate. The term ‘assisted living services’ means services of a facility in providing room, board, and personal care for and supervision of residents for their health, safety, and welfare. receiving nursing home care paid for by the Department of Veterans Affairs, eligible to receive such care pursuant to section 1710A of title 38 , United States Code, or requires a higher level of care than the domiciliary care provided by the Department of Veterans Affairs, but does not meet the requirements for nursing home level care provided by the Department pursuant to such section; and eligible for assisted living services, as determined by the Secretary or meets such additional criteria for eligibility for the pilot program under subsection (a)(1) as the Secretary may establish. The term ‘State home’ has the meaning given that term in section 101 of title 38 , United States Code.” The Secretary [of Veterans Affairs] may carry out a pilot program for the purpose of determining the feasibility and practicability of enabling eligible veterans to secure needed assisted living services as an alternative to nursing home care. The pilot program shall be carried out in a designated health care region of the Department [of Veterans Affairs] selected by the Secretary for purposes of this section. In addition to the health care region of the Department selected for the pilot program under paragraph (1), the Secretary may also carry out the pilot program in not more than one additional designated health care region of the Department selected by the Secretary for purposes of this section. Notwithstanding subsection (f), the authority of the Secretary to provide services under the pilot program in a health care region of the Department selected under subparagraph (A) shall cease on the date that is three years after the commencement of the provision of services under the pilot program in the health care region. In carrying out the pilot program, the Secretary may enter into contracts with appropriate facilities for the provision for a period of up to six months of assisted living services on behalf of eligible veterans in the region where the program is carried out. is eligible for placement assistance by the Secretary under section 1730(a) of title 38 , United States Code; is unable to manage routine activities of daily living without supervision and assistance; and could reasonably be expected to receive ongoing services after the end of the contract period under another government program or through other means. Not later than 90 days before the end of the pilot program under this section, the Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and the House of Representatives a report on the program. A description of the implementation and operation of the program. An analysis comparing use of institutional care among participants in the program with the experience of comparable patients who are not enrolled in the program. A comparison of assisted living services provided by the Department through the pilot program with domiciliary care provided by the Department. The Secretary’s recommendations, if any, regarding an extension of the program. The authority of the Secretary to provide services under the pilot program shall cease on the date that is three years after the date of the commencement of the pilot program. For purposes of this section, the term ‘assisted living services’ means services in a facility that provides room and board and personal care for and supervision of residents as necessary for the health, safety, and welfare of residents. The Secretary may not enter into a contract with a facility under this section unless the facility meets the standards established in regulations prescribed under section 1730 of title 38 , United States Code.”