38 C.F.R. Subpart C—Per Diem Payments
Title 38 - Pensions, Bonuses, and Veterans' Relief
(a)(1) VA will pay per diem monthly for nursing home care provided to an eligible veteran in a facility recognized as a State home for nursing home care. During Fiscal Year 2000, VA will pay the lesser of the following: (i) One-half of the cost of the care for each day the veteran is in the facility; or (ii) $50.55 for each day the veteran is in the facility. (2) Per diem will be paid only for the days that the veteran is a resident at the facility. For purposes of paying per diem, VA will consider a veteran to be a resident at the facility during each full day that the veteran is receiving care at the facility. VA will not deem the veteran to be a resident at the facility if the veteran is receiving care outside the State home facility at VA expense. Otherwise, VA will deem the veteran to be a resident at the facility during any absence from the facility that lasts for no more than 96 consecutive hours. This absence will be considered to have ended when the veteran returns as a resident if the veteran's stay is for at least a continuous 24-hour period. (3) As a condition for receiving payment of per diem under this part, the State must submit a completed VA Form 10–5588, State Home Report and Statement of Federal Aid Claimed. This form is set forth in full at §58.11 of this chapter. (4) Initial payments will not be made until the Under Secretary for Health recognizes the State home. However, payments will be made retroactively for care that was provided on and after the date of the completion of the VA survey of the facility that provided the basis for determining that the facility met the standards of this part. (5) As a condition for receiving payment of per diem under this part, the State must submit to the VA medical center of jurisdiction for each veteran the following completed VA Forms 10–10EZ, Application for Medical Benefits, and 10–10SH, State Home Program Application for Care—Medical Certification, at the time of admission and with any request for a change in the level of care (domiciliary, hospital care or adult day health care). These forms are set forth in full at §§58.12 and 58.13 of this chapter, respectively, of this part. If the facility is eligible to receive per diem payments for a veteran, VA will pay per diem under this part from the date of receipt of the completed forms required by this paragraph, except that VA will pay per diem from the day on which the veteran was admitted to the facility if the completed forms are received within 10 days after admission. (b) Total per diem costs for an eligible veteran's nursing home care consist of those direct and indirect costs attributable to nursing home care at the facility divided by the total number of patients at the nursing home. Relevant cost principles are set forth in the Office of Management and Budget (OMB) Circular number A–87, dated May 4, 1995, “Cost Principles for State, Local, and Indian Tribal Governments.” (Authority: 38 U.S.C. 101, 501, 1710, 1741–1743) A veteran is an eligible veteran under this part if VA determines that the veteran needs nursing home care and the veteran is within one of the following categories: (a) Veterans with service-connected disabilities; (b) Veterans who are former prisoners of war; (c) Veterans who were discharged or released from active military service for a disability incurred or aggravated in the line of duty; (d) Veterans who receive disability compensation under 38 U.S.C. 1151; (e) Veterans whose entitlement to disability compensation is suspended because of the receipt of retired pay; (f) Veterans whose entitlement to disability compensation is suspended pursuant to 38 U.S.C. 1151, but only to the extent that such veterans' continuing eligibility for nursing home care is provided for in the judgment or settlement described in 38 U.S.C. 1151; (g) Veterans who VA determines are unable to defray the expenses of necessary care as specified under 38 U.S.C. 1722(a); (h) Veterans of the Mexican border period or of World War I; (i) Veterans solely seeking care for a disorder associated with exposure to a toxic substance or radiation or for a disorder associated with service in the Southwest Asia theater of operations during the Persian Gulf War, as provided in 38 U.S.C. 1710(e); (j) Veterans who agree to pay to the United States the applicable co-payment determined under 38 U.S.C. 1710(f) and 1710(g). (Authority: 38 U.S.C. 101, 501, 1710, 1741–1743)
Title 38: Pensions, Bonuses, and Veterans' Relief
PART 51—PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES
Subpart C—Per Diem Payments
§ 51.40 Monthly payment.
§ 51.50 Eligible veterans.
