(a) The Secretary (subject to section 1710(a)(4) of this title and subsection (c) of this section) shall operate and maintain a program to provide extended care services to eligible veterans in accordance with this section. Such services shall include the following:
(1) Geriatric evaluation.
(2) Nursing home care (A) in facilities operated by the Secretary, and (B) in community-based facilities through contracts under section 1720 of this title.
(3) Domiciliary services under section 1710(b) of this title.
(4) Adult day health care under section 1720(f) of this title.
(5) Such other noninstitutional alternatives to nursing home care as the Secretary may furnish as medical services under section 1701(10) 1 of this title.
(6) Respite care under section 1720B of this title.
(b) 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.
(c)(1) 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.
(2) Paragraph (1) shall not apply-
(A) 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;
(B) to a veteran being furnished hospice care under this section;
(C) with respect to an episode of extended care services that a veteran is being furnished by the Department on November 30, 1999; or
(D) 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.
(d)(1) 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.
(2) In implementing subsection (c), the Secretary shall develop a methodology for establishing the amount of the copayment for which a veteran described in subsection (c) is liable. That methodology shall provide for-
(A) establishing a maximum monthly copayment (based on all income and assets of the veteran and the spouse of such veteran);
(B) 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
(C) allowing the veteran to retain a monthly personal allowance.
(e)(1) 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).
(2) All amounts received by the Department under this section shall be deposited in or credited to the fund.
(Added
Section 1701(10) of this title, referred to in subsec. (a)(5), was repealed by
Section 491 of title 14, referred to in subsec. (c)(2)(D), was redesignated section 2732 of title 14 by
2018-Subsec. (c)(2)(D).
2016-Subsec. (c)(2)(D).
2004-Subsec. (c)(2)(B), (C).
2001-Subsec. (c)(2)(B).
Subsec. (e)(1).
Amendment by
"(f)
"(g)
"(1) 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].
"(2) 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.
"(3) 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)."
"(a)
"(1) waive the requirement that an area agency on aging process new enrollments and six-month renewals for the Program via an in-person or home visit; and
"(2) allow new enrollments and sixth-month renewals for the Program to be conducted via telephone or telehealth modality.
"(b)
"(1) requested to do so by the veteran or a representative of the veteran; or
"(2) 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.
"(c)
"(d)
"(1) any penalty for late paperwork relating to the Program; and
"(2) 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.
"(e)
[For definition of "public health emergency" as used in section 20006 of
"(a)
"(b)
"(c)
"(1) Adult-day health care services.
"(2) Coordination of services needed by veterans, including services for readjustment and rehabilitation.
"(3) Transportation services.
"(4) Caregiver support services, including education, training, and certification of family members in caregiver activities.
"(5) Home care services.
"(6) Respite care.
"(7) Hospice services.
"(8) Any modalities of non-institutional long-term care.
"(d)
"(e)
"(f)
"(1) a description and assessment of the activities carried out under the pilot program;
"(2) information on the allocation of funds to facilities of the Department under subsection (e); and
"(3) a description of the improvements made with funds so allocated to the support of the provision of caregiver assistance services."
"(a)
"(b)
"(c)
"(1) Adult-day health care services on an eight-hour per day, five-day per week basis.
"(2) Medical services (including primary care, preventive services, and nursing home care, as needed).
"(3) Coordination of needed services.
"(4) Transportation services.
"(5) Home care services.
"(6) Respite care.
"(d)
"(1) employ the use of interdisciplinary care-management teams to provide the required array of services;
"(2) determine the appropriate number of patients to be enrolled in each program and the criteria for enrollment; and
"(3) 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
"(e)
"(1) Under one of the pilot programs, the Secretary shall provide services directly through facilities and personnel of the Department [of Veterans Affairs].
"(2) Under one of the pilot programs, the Secretary shall provide services through a combination of-
"(A) services provided under contract with appropriate public and private entities; and
"(B) services provided through facilities and personnel of the Department.
"(3) Under one of the pilot programs, the Secretary shall arrange for the provision of services through a combination of-
"(A) services provided through cooperative arrangements with appropriate public and private entities; and
"(B) services provided through facilities and personnel of the Department.
"(f)
"(g)
"(h)
"(2) 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.
"(i)
"(2) The report shall include the following:
"(A) A description of the implementation and operation of each such program.
"(B) 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.
"(C) An assessment of the satisfaction of participating veterans with each of those programs.
"(D) An assessment of the health status of participating veterans in each of those programs and of the ability of those veterans to function independently.
"(E) An analysis of the costs and benefits under each of those programs."
"(a)
"(b)
"(2)(A) 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.
"(B) 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.
"(c)
"(d)
"(1) is eligible for placement assistance by the Secretary under section 1730(a) of title 38, United States Code;
"(2) is unable to manage routine activities of daily living without supervision and assistance; and
"(3) could reasonably be expected to receive ongoing services after the end of the contract period under another government program or through other means.
"(e)
"(2) The report under paragraph (1) shall include the following:
"(A) A description of the implementation and operation of the program.
"(B) 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.
"(C) A comparison of assisted living services provided by the Department through the pilot program with domiciliary care provided by the Department.
"(D) The Secretary's recommendations, if any, regarding an extension of the program.
"(f)
"(g)
"(h)
1 See References in Text note below.