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This rulemaking would adopt as final, to include any changes as a result of public comments, the proposed rule that published on June 17, 2015, at 80 FR 34793.   This rulemaking reorganizes, updates, and clarifies State Veterans homes regulations, authorizes greater flexibility in adult day health care programs, and establishes regulations regarding domiciliary care, with clarifications regarding the care that State homes must provide to veterans in domiciliaries.

Statement of Need:

The reorganization would improve consistency and clarity throughout these State home programs.  Currently, we require States to operate these programs exclusively using a medical supervision model.  We expect that these liberalizing changes will result in an increase in the number of States that have adult day health care programs.  Moreover, the regulations governing per diem for State home hospitals will be eliminated because there are no longer any State home hospitals.

Summary of the Legal Basis:

VA pays per diem to State homes for three types of care provided to eligible veterans: nursing home care, domiciliary care, and adult day health care. The statutory authority for these payment programs is set forth at 38 U.S.C. 1741-43 and 1745.

Alternatives:

VA considered the consequences of taking no action. Under VA’s State home per diem program, VA partners States to provide nursing home, domiciliary, and adult day health services to Veterans. The states and organizations that represent them have advised VA for many years that certain of VA’s regulations are outdated, confusing, do not conform with best practices in extended care services, or are otherwise in need of updating. In particular, they have repeatedly requested that VA establish regulatory guidance about the domiciliary care program, and change standards relating to medical supervision of the Adult Day Health Care program. Taking no action would result in VA being unable to make the needed changes to these programs to respond to these concerns of stakeholders.

Anticipated Costs and Benefits:

VA has determined that there are both transfer savings and costs associated with this rulemaking. As a result of the newly increased ADHC services, the government will spend $700,162 less in transfers in FY 2017 and $4,531,095 less over a five year period.  The cost avoidance is based on a high end volume estimate. This final rulemaking contains provisions constituting collections of information under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501 to 3521).  However, there are no increased and/or decreased PRA costs.

Risks: