Contracts and State Home Care Agreements for State Home Nursing Home Care

Federal Register, Volume 84 Issue 239 (Thursday, December 12, 2019)
[Federal Register Volume 84, Number 239 (Thursday, December 12, 2019)]
[Rules and Regulations]
[Pages 67868-67873]
From the Federal Register Online via the Government Publishing Office []
[FR Doc No: 2019-26501]
38 CFR Part 51
RIN 2900-AO57
Contracts and State Home Care Agreements for State Home Nursing
Home Care
AGENCY: Department of Veterans Affairs.
ACTION: Final rule.
SUMMARY: This rulemaking adopts as final, with minor changes, an
interim final rule amending the Department of Veterans Affairs (VA)
regulations governing payments under contracts or State home care
agreements between VA and State homes for the nursing home care of
certain disabled veterans. The minor changes include revising the
authority citation to be consistent with the John S. McCain III, Daniel
K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems and
Strengthening Integrated Outside Networks (VA MISSION) Act of 2018.
DATES: This rule is effective on January 13, 2020.
FOR FURTHER INFORMATION CONTACT: Joseph Duran, Director of Policy and
Planning, Office of Community Care (10D), Veterans Health
Administration, Department of Veterans Affairs, Ptarmigan at Cherry
Creek, Denver, CO 80209, (303) 372-4629. (This is not a toll-free
SUPPLEMENTARY INFORMATION: On December 6, 2012, VA published an interim
final rule in the Federal Register, 77 FR 72738, implementing VA's
authority to use contracts and provider agreements to pay for certain
State nursing home care under section 105 of the Honoring America's
Veterans and Caring for Camp Lejeune Families Act of 2012 (the Act),
Public Law 112-154, 126 Stat. 1165, which was enacted on August 6,
2012. The interim final rule became effective on February 2, 2013, in
accordance with the statutory deadline to implement this authority.
Interested persons were invited to submit comments on or before
February 4, 2013. VA received 13 comments.
    Subsequently, section 103 of the VA MISSION Act of 2018, Public Law
115-182 (conforming amendments for State veterans homes), amended 38
U.S.C. 1745(a), which authorizes VA agreements for State home nursing
home care. The amendments require non-substantive changes to Sec.
    In addition to finalizing the interim final rule and implementing
section 103 of the VA MISSION Act of 2018, we are also correcting a
patent error in paragraph (e) and making other non-substantive changes
to bring the section current with amendments to 38 CFR part 51 since
publication of the interim final rule, to include updating a United
States Code citation in paragraph (g). We are also renaming the
agreements VA enters with State homes to ensure the name is not
confused with the name of another type of agreement VA may enter under
the authority of a different section of title 38 United States Code. We
discuss these below, following the responses to the public comments.
[[Page 67869]]
    Based on the rationale set forth in the interim final rule and in
this document, VA is adopting the interim final rule as final with
minor changes described below.
    VA pays State veterans homes for providing nursing home care to
eligible veterans under 38 U.S.C. 1741 and 1745. Prior to the Act, VA
paid State homes for this care on a per diem basis under a grant
program. The revised regulation at 38 CFR 51.41 authorized VA to use
contracts or provider agreements (hereafter State home care agreements)
to pay for the nursing home care of certain veterans in State homes:
Those who need nursing home care for a service-connected disability,
and those who need nursing home care and have either a singular or
combined service-connected disability rating of 70 percent or more or a
rating of total disability based on individual unemployability.
    The Act required VA to consult with State homes to develop the
payment methodology for contracts and State home care agreements. To
accomplish that requirement, VA met with groups representing the State
homes and with representatives of individual State veterans homes
during the development of the interim final rule.
    In the interim final rule, VA adopted a ``prevailing rate'' to
determine the daily payments that VA will make to State homes that
provide care for veterans under State home care agreements. The
prevailing rate is a daily payment rate VA calculates for each State
home. It incorporates, among other things, Centers for Medicare and
Medicaid Services (CMS) payment rates, CMS case-level data for the
geographic area, local labor costs, and physicians' fees.
    During the comment period for the interim final rule, VA received
several comments from State veterans homes and groups representing
them. A consideration of these comments follows. Some of the issues
raised by the commenters can be grouped together by similar topics, and
we have organized our discussion of the comments accordingly.
    Several commenters raised concerns about high-cost drugs and
medications. Some stated that State homes have experienced
extraordinarily high costs for drugs and medications provided to the
veterans whose care would be eligible for payment by contract or State
home care agreement under Sec.  51.41. These commenters have requested
that VA amend its regulations to allow State homes to negotiate with VA
on a case-by-case basis for additional payments to cover the costs of
high-cost drugs and medications required for a veteran's care.
    By law, VA payment to a State home for care of a veteran is payment
in full for care the State home provided that veteran under Sec.
51.41. 38 U.S.C. 1745(a)(3). VA was required by statute to develop a
payment methodology to adequately reimburse State homes for the care
provided under the agreements with VA. 38 U.S.C. 1745(a)(2). With
consultation of the State homes, as discussed above, VA established two
methods of payment in Sec.  51.41, one each for State home care
agreements and contracts respectively. State home care agreements
compensate State homes using the prevailing rate, which is calculated
to compensate State homes for the average cost of providing nursing
home care to the veterans whose care is covered in Sec.  51.41,
including, as indicated in Sec.  51.41(c)(2), the cost of drugs and
medicines. State homes that enter into contracts, on the other hand,
will be compensated at the rate negotiated in the contract. State home
care agreements are not individually negotiated; if a State home cannot
accept the prevailing rate that VA offers (per request by the State
homes) in a State home care agreement, that State home has the option
to request a contract under Sec.  51.41 and would then be able to
negotiate with VA specific rates for payments for drugs and
medications. VA, as required by the statute, consulted with State homes
to establish the prevailing rate, and the availability of contracts
allows for separate rates to be negotiated when necessary. VA believes
that by creating both options it ensures that adequate compensation can
be available to State homes in all situations.
    Finally, there is no clear indication that State homes are being
inadequately compensated for this care, even when drugs and medications
must be supplied. VA received a comment from an organization
representing State homes that expressed uncertainty as to whether the
expenses associated with supplying high-cost drugs and medications
negatively affect the State homes that receive the prevailing rate
under State home care agreements. The organization proposed to study
its members' drug costs after implementation of the contracting and
State home care agreement authority in Sec.  51.41 to see whether State
homes are being adequately reimbursed for the costs of drugs and
medications or whether State homes experience consistent hardships from
providing high-cost medications. We thank the commenter for undertaking
this effort and will review the results when provided. VA makes no
changes to the regulation based on these comments.
    Several commenters requested that VA allow State homes receiving
payments under State home care agreements to opt out of receiving the
physician fee component of the prevailing rate. The physician fee
component is a set dollar figure that represents the average cost to a
State home of providing certain physician services to veterans that are
required by 38 CFR 51.150. Typically, this care is provided by
physicians who are on the staff of the State home. The commenters
explained that some State homes do not retain salaried physicians on
their staffs to provide physician services to veterans; these State
homes instead arrange for outside physicians to provide care. State
homes allow these outside physicians to bill third parties, including
Medicare. By accepting payment under Sec.  51.41, State homes must use
the VA payments to pay the outside physicians and cannot permit these
outside physician services to be reimbursed by other payers.
    VA recognizes that some State homes may not have physicians on
staff, but the law requires VA to adequately reimburse State homes for
nursing home care (38 U.S.C. 1745(a)(2)), and we have determined by
regulation that certain physician services are part of nursing home
care. Moreover, the law provides that VA payment made under the
authority of 38 U.S.C. 1745 to a State home for nursing home care
constitutes payment in full to the State home for the nursing home care
furnished to that veteran. VA thus cannot make an exception for these
State homes in this case. VA therefore makes no changes based on these
    Some commenters requested that VA provide additional payments for
therapy services. One commenter specified, ``VA should reimburse the
full costs of therapy services in the State [h]omes . . . to ensure
residents receive the same high level of services provided in private
nursing homes.'' The commenter explained that State home residents
typically receive 50 percent of the therapy that residents of private
nursing homes would receive because State homes can only bill for
Medicare Part B services in accordance with Medicare Part B
requirements for the level of services provided. If veterans in State
home nursing homes need therapy, State homes are required by Sec.
51.160 to provide it to receive per diem. For veterans in State home
nursing homes on whose behalf VA pays basic per diem under Sec.  51.40,
State homes cannot cut back on providing therapy just because they do
not obtain reimbursement from
[[Page 67870]]
an outside source in addition to the VA per diem. For veterans covered
by this rulemaking, however, payments under State home care agreements
are computed to include reimbursement for necessary therapy. State
homes that believe this payment fails to cover the full cost of therapy
have the option to request a contract under Sec.  51.41 and to
negotiate specific rates for therapy. VA makes no changes based on
these comments.
    One commenter urged VA to ``reimburse the full cost of emergency
ambulance transportation to the VA hospital (or closest acute care
facility in an emergent situation)'' for emergency treatment of
veterans whose care is paid under Sec.  51.41. The commenter stated:
``An ambulance is required to take [residents] to the `nearest
facility' which may not be a VA hospital. Currently, for emergency
ambulance transfers, the VA hospital will bill Medicare Part A and bill
the remainder to the State [h]ome. If a resident is transported to the
hospital for a service-connected disability or secondary service-
connected disability by association the VA should pay for this transfer
consistent with the `total cost of care' reimbursement provision of the
law.'' This comment does not accurately describe the law or VA's
current policies and practices.
    VA has no authority to bill Medicare or State homes for a veteran's
transportation in an ambulance, as suggested by the commenter. The
ambulance service provider would typically be the party seeking payment
for the services it provides. Moreover, in most circumstances, VA could
pay for an ambulance to a VA facility for a veteran for whom VA pays
per diem under Sec.  51.41.
    Whether a veteran's ambulance transportation to a VA facility is
paid for by VA is dependent on that Veteran's eligibility to receive
special mode transportation under VA's beneficiary travel authority, 38
U.S.C. 111, 38 CFR part 70. An ambulance is considered a special mode
of transportation under this authority. VA pays for special modes of
transportation if three criteria set forth in 38 CFR 70.4(d) are met:
The beneficiary is unable to defray the cost of transportation under 38
CFR 70.10(c), the travel is medically required, and VHA approves the
travel in advance or the travel was undertaken in connection with a
medical emergency. By regulation, all veterans who have a service-
connected disability rated at least 30 percent disabling and all
veterans traveling in connection with treatment of a service-connected
disability are considered ``unable to defray'' the expenses of travel.
38 CFR 70.10(c)(3) and 38 CFR 70.10(c)(4). VA makes case-specific
determinations regarding the clinical necessity of the special mode of
    Whether a veteran's ambulance transportation to a non-VA facility
is paid for by VA is dependent on the nature of the treatment provided
and the service-connected disability status of the Veteran. When
emergency treatment can be reimbursed by VA under 38 U.S.C. 1728, the
ambulance transportation will be paid for in accordance with the same
rules relating to beneficiary travel that are described above.
Reimbursement is authorized under 38 U.S.C. 1728 when the emergency
treatment provided is for: An adjudicated service-connected disability;
a non-service-connected disability associated with and held to be
aggravating a service-connected disability; any disability of a veteran
if the veteran has a total disability permanent in nature from a
service-connected disability; or any illness, injury, or dental
condition of a veteran who is a participant in a vocational
rehabilitation program, and is medically determined to have been in
need of care or treatment to make possible the veteran's entrance into
a course of training, or prevent interruption of a course of training,
or hasten the return to a course of training which was interrupted
because of such illness, injury or dental condition.
    When the treatment provided does not meet the criteria of 38 U.S.C.
1728, it may be reimbursed in accordance with the requirements of 38
U.S.C.1725. When the treatment provided meets the requirements for
reimbursement under 38 U.S.C. 1725, ambulance transportation is paid
for in accordance with the payment limitations regulated at 38 CFR
17.1005. Generally speaking, this authority is used to reimburse
emergency treatment that is for a non-service-connected condition.
    Regardless of which authority is being relied upon for
reimbursement of the cost of ambulance transportation, the rates paid
are determined by existing regulations. In many instances VA pays the
actual cost of the transportation, and in other circumstances, when
payment is accepted by vendors, regulations state that it will serve as
payment in full. VA therefore makes no changes to the regulations based
on this comment.
    The same commenter stated that ``VA should reimburse the full cost
of any service'' required by a veteran who has been rated by VA as 100
percent disabled due to a service-connected disability. The commenter
said that when such veterans are ``non-ambulatory due to `patient
safety' '' and are transported to a VA medical facility for treatment
of a non-service-connected disability, the resident or the State must
pay for the care. The commenter further advised that while the option
for a case-by-case agreement between the VA medical facility and the
resident or State home exists for this gap in covered care, if an
agreement is not reached or accepted, the cost is borne by the veteran
with a rating of 100 percent disabled due to service-connected
disability, which is inconsistent with the ``total cost of care''
reimbursement provision in the law.
    This comment does not accurately reflect the State home and VA's
responsibilities to provide care to these veterans. A veteran who is
rated as 100 percent disabled due to a service-connected disability
would not be responsible for the costs of any care provided at a VA
facility under the circumstances described in this comment, including
care for a non-service-connected condition. If the care needed is care
that the State home is required to provide in accordance with the State
home's contract or State home care agreement with VA entered into
pursuant to Sec.  51.41, the State home can choose to use the funds it
receives under that contract or agreement to obtain that care from VA.
VA makes no changes to the regulation based on this comment.
    Several commenters requested that VA include a statement in the
State home care agreement that veterans whose care is eligible for
payment under a State home care agreement ``do not forfeit their
eligibility for VA benefits and programs.'' VA emphasizes that veterans
residing in a State home retain their eligibility for all other VA care
and services. VA will work with State homes by way of national
organizational meetings and through local VA medical center staff to
provide clarification or education that may be needed to ensure
veterans in State homes receive the care and services for which they
are eligible. These comments, however, refer to the content of the
State home care agreements and not the regulation, and VA therefore
makes no changes to the regulation based on these comments.
    Regarding minor changes this final rulemaking makes to the interim
final rule, we are removing the authority citation following Sec.
51.41. Prior to the VA MISSION Act of 2018, section 1745(a) required
that an agreement, other than a contract, between VA and a State home
for nursing care be under section 1720(c)(1) of title 38. The VA
MISSION Act of 2018 removed this requirement. Public Law 115-182, sec.
[[Page 67871]]
103(a). 38 U.S.C. 1720(c)(1)(B) allowed VA to use procedures for
entering into provider agreements under section 1866(a) of the Social
Security Act (codified at 42 U.S.C. 1395cc). By removing the reference
to 38 U.S.C. 1720 from 38 U.S.C. 1745, the MISSION Act makes clear that
VA's authority to enter into contracts and agreements with State homes
for nursing home care derives solely from 38 U.S.C. 1745 and not from
38 U.S.C. 1720 or from 42 U.S.C. 1395cc, as was cited in the interim
final rule.
    We are removing, rather than revising the authority citation to be
consistent with the requirements of the Office of the Federal Register,
which publishes all federal regulations, for placement of authority
citations in the Code of Federal Regulations. The authority for a part
of a title of the Code of Federal Regulations immediately follows the
heading of the part, in this case title 38 CFR part 51. Unique
authority for a section immediately follows the general authority
citation of the part. Without citation to 38 U.S.C. 1720 and 42 U.S.C.
1395cc, Sec.  51.41 does not rely on authority unique to that section.
The general authority citation of part 51 includes the authority for
Sec.  51.41. No additional authority citation is required.
    We are revising the heading of paragraph (a) to name agreements
between VA and State homes under this section ``State home care
agreements.'' We are replacing the terms ``VA provider agreement(s)'',
``provider agreement(s)'', and ``agreement(s)'' with ``State home care
agreement(s)'' throughout the section. This change ensures agreements
under authority of 38 U.S.C. 1745 are not confused with ``Veterans Care
Agreements'' under authority of 38 U.S.C. 1703A. Changing the name
Sec.  51.41 uses for agreements under this section does not affect the
agreements in any other way.
    In addition, we are correcting an error in Sec.  51.41(e) as
amended in the interim final rule. Paragraph (e) required State homes
to submit forms ``in accordance with paragraph (a) of this section.''
However, paragraph (a) of Sec.  51.41 does not mention or otherwise
pertain to forms. The preamble to the interim final rule reveals
paragraph (e) of that section should have referred to 51.43(a). 77 FR
72738, 72742 (Dec. 6, 2012). VA has since amended 38 CFR part 51, 83 FR
61250 (Nov. 28, 2018), and the reference to the procedures for
submitting forms are now in Sec.  51.42. We revise Sec.  51.41(e)
    Additionally, in the interim final rule, we amended Sec.  51.41(e)
to state the forms cited in that paragraph are set forth in full in one
or another of two sections of 38 CFR part 58. VA removed part 58 from
title 38 CFR in August 2013. 78 FR 51673 (Aug. 21, 2013). Copies of VA
forms can be obtained from any VA Medical Center and are available on
our website at We are revising Sec.  51.41(e) to
direct readers to VA forms.
    Section 51.41(f)(2), as amended in the interim final rule, states
that VA provider agreements will terminate on the date of a final
decision that the home is no longer recognized by VA under Sec.  51.30.
VA has since amended part 51 to regulate recognition and denial of
recognition of State homes in Sec.  51.20, certification and denial of
certification in Sec.  51.30, and termination of recognition in Sec.
51.32. Currently, 51.41(f)(2) only refences recognition and refers to
recognition as under Sec.  51.30. Because our regulations already
require recognition and certification to receive per diem payments, we
are revising Sec.  51.42(f) to also refer to certification. For
consistency with part 51's recognition, certification, and termination
sections, we are revising Sec.  51.41(f)(2) by inserting ``or
certified'' following ``recognized'', removing ``under Sec.  51.30.'',
and in its place inserting ``under part 51.''.
    In paragraph (g), we are revising the citation, ``41 U.S.C. 351 et
seq.'', to read, ``41 U.S.C. 7601 et seq.'', consistent with a
redesignation of section numbers in title 41 United States Code after
VA's publication of the interim final rule amending Sec.  51.41.
    Based on the rationale set forth in the interim final rule and in
this document, VA is adopting the interim final rule as a final rule
with the changes described above.
Effect of Rulemaking
    Title 38 of the Code of Federal Regulations, as revised by this
final rulemaking, represents VA's implementation of its legal authority
on this subject. Other than future amendments to this regulation or
governing statutes, no contrary guidance or procedures are authorized.
All existing or subsequent VA guidance must be read to conform with
this rulemaking if possible or, if not possible, such guidance is
superseded by this rulemaking.
Paperwork Reduction Act
    Although this action contains a provision at 38 CFR 51.41(e)
constituting a collection of information under the Paperwork Reduction
Act of 1995 (44 U.S.C. 3501-3521), no new or proposed revised
collections of information are associated with this final rule. The
information collection requirements for Sec.  51.41(e) are currently
approved by the Office of Management and Budget (OMB) and have been
assigned OMB control numbers 2900-0091 and 2900-0160.
Regulatory Flexibility Act
    The Regulatory Flexibility Act, 5 U.S.C. 601-612, is not applicable
to this rulemaking because notice of proposed rulemaking is not
required. 5 U.S.C. 601(2), 603(a), 604(a).
Executive Orders 12866, 13563, and 13771
    Executive Orders 12866 and 13563 direct agencies to assess the
costs and benefits of available regulatory alternatives and, when
regulation is necessary, to select regulatory approaches that maximize
net benefits (including potential economic, environmental, public
health and safety effects, and other advantages; distributive impacts;
and equity). Executive Order 13563 (Improving Regulation and Regulatory
Review) emphasizes the importance of quantifying both costs and
benefits, reducing costs, harmonizing rules, and promoting flexibility.
The Office of Information and Regulatory Affairs has determined that
this rule is not a significant regulatory action under Executive Order
12866. VA's impact analysis can be found as a supporting document at, usually within 48 hours after the
rulemaking document is published. Additionally, a copy of the
rulemaking and its impact analysis are available on VA's website at, by following the link for ``VA Regulations
Published from FY 2004 through FYTD.''
    This rule is not an E.O. 13771 regulatory action because it is not
significant under E.O. 12866.
Unfunded Mandates
    The Unfunded Mandates Reform Act of 1995 requires, at 2 U.S.C.
1532, that agencies prepare an assessment of anticipated costs and
benefits before issuing any rule that may result in the expenditure by
State, local, and tribal governments, in the aggregate, or by the
private sector, of $100 million or more (adjusted annually for
inflation) in any one year. This final rule will have no such effect on
State, local, and tribal governments, or on the private sector.
Congressional Review Act
    Pursuant to the Congressional Review Act (5 U.S.C. 801 et seq.),
the Office of Information and Regulatory Affairs designated this rule
as not a major rule, as defined by 5 U.S.C. 804(2).
[[Page 67872]]
Catalog of Federal Domestic Assistance
    The Catalog of Federal Domestic Assistance numbers and titles for
the programs affected by this document are 64.007, Blind Rehabilitation
Centers; 64.008, Veterans Domiciliary Care; 64.010, Veterans Nursing
Home Care; 64.011, Veterans Dental Care; 64.012, Veterans Prescription
Service; 64.013, Veterans Prosthetic Appliances; 64.015, Veterans State
Nursing Home Care; 64.018, Sharing Specialized Medical Resources;
64.019, Veterans Rehabilitation Alcohol and Drug Dependence; and
64.022, Veterans Home Based Primary Care.
List of Subjects in 38 CFR Part 51
    Administrative practice and procedure; Claims; Day care; Dental
health; Government contracts; Grant programs-health; Grant programs-
veterans; Health care; Health facilities; Health professions; Health
records; Mental health programs; Nursing homes; Reporting and
recordkeeping requirements; Travel and transportation expenses;
Signing Authority
    The Secretary of Veterans Affairs, or designee, approved this
document and authorized the undersigned to sign and submit the document
to the Office of the Federal Register for publication electronically as
an official document of the Department of Veterans Affairs. Pamela
Powers, Chief of Staff, Department of Veterans Affairs, approved this
document on December 4, 2019, for publication.
Consuela Benjamin,
Regulations Development Coordinator, Office of Regulation Policy &
Management, Office of the Secretary, Department of Veterans Affairs.
    For the reasons set out in the preamble, the interim final rule
amending 38 CFR part 51, published December 6, 2012, at 77 FR 72738, is
adopted as final with the following changes:
1. The general authority citation for part 51 continues to read as
    Authority:  38 U.S.C. 101, 501, 1710, 1720, 1741-1743, 1745, and
as follows.
* * * * *
2. Amend Sec.  51.41 by revising the section heading and paragraphs (a)
introductory text, (c), (d), (e), the paragraph (f) subject heading,
and paragraphs (f)(2) and (g) and removing the authority citation at
the end of the section.
    The revisions read as follows:
Sec.  51.41  Contracts and State home care agreements for certain
veterans with service-connected disabilities.
    (a) Contract or State home care agreement required. VA and State
homes may enter into both contracts and State home care agreements. VA
will pay for each eligible veteran's care through either a contract or
a ``State home care agreement.'' Eligible veterans are those who:
* * * * *
    (c) Payments under State home care agreements. (1) State homes must
sign an agreement to receive payment from VA for providing care to
certain eligible veterans under a State home care agreement. State home
care agreements under this section will provide for payments at the
rate determined by the following formula. For State homes in a
metropolitan statistical area, use the most recently published CMS
Resource Utilization Groups (RUG) case-mix levels for the applicable
metropolitan statistical area. For State homes in a rural area, use the
most recently published CMS Skilled Nursing Prospective Payment System
case-mix levels for the applicable rural area. To compute the daily
rate for each State home, multiply the labor component by the State
home wage index for each of the applicable case-mix levels; then add to
that amount the non-labor component. Divide the sum of the results of
these calculations by the number of applicable case-mix levels.
Finally, add to this quotient the amount based on the CMS payment
schedule for physician services. The amount for physician services,
based on information published by CMS, is the average hourly rate for
all physicians, with the rate modified by the applicable urban or rural
geographic index for physician work, then multiplied by 12, then
divided by the number of days in the year.
    Note to paragraph (c)(1): The amount calculated under this formula
reflects the prevailing rate payable in the geographic area in which
the State home is located for nursing home care furnished in a non-
Department nursing home (a public or private institution not under the
direct jurisdiction of VA which furnishes nursing home care). Further,
the formula for establishing these rates includes CMS information that
is published in the Federal Register every year and is effective
beginning October 1 for the entire fiscal year. Accordingly, VA will
adjust the rates annually.
    (2) The State home shall not charge any individual, insurer, or
entity (other than VA) for the nursing home care paid for by VA under a
State home care agreement. Also, as a condition of receiving payments
under paragraph (c), the State home must agree not to accept drugs and
medicines from VA provided under 38 U.S.C. 1712(d) on behalf of
veterans covered by this section and corresponding VA regulations
(payment under this paragraph (c) includes payment for drugs and
    (3) Agreements under this paragraph (c) will be subject to this
part, except to the extent that this part conflicts with this section.
For purposes of this section, the term ``per diem'' in part 51 includes
payments under State home care agreements.
    (4) If a veteran receives a retroactive VA service-connected
disability rating and becomes a veteran identified in paragraph (a) of
this section, the State home may request payment under the State home
care agreement for nursing home care back to the retroactive effective
date of the rating or February 2, 2013, whichever is later. For care
provided after the effective date but before February 2, 2013, the
State home may request payment at the special per diem rate that was in
effect at the time that the care was rendered.
    (d) VA signing official. State home care agreements must be signed
by the Director of the VA medical center of jurisdiction or designee.
    (e) Forms. Prior to entering into a State home care agreement,
State homes must submit to the VA medical center of jurisdiction a
completed VA Form 10-10EZ, Application for Medical Benefits (or VA Form
10-10EZR, Health Benefits Renewal Form, if a completed VA Form 10-10EZ
is already on file at VA), and a completed VA Form 10-10SH, State Home
Program Application for Care--Medical Certification, for the veterans
for whom the State home will seek payment under the State home care
agreement. After VA and the State home have entered into a State home
care agreement, forms for payment must be submitted in accordance with
Sec.  51.42. Copies of VA Forms can be obtained from any VA Medical
Center and are available on our website at
(The Office of Management and Budget has approved the information
collection requirements in this section under control numbers 2900-
0091 and 2900-0160.)
    (f) Termination of State home care agreements.
    (2) State home care agreements will terminate on the date of a
final decision
[[Page 67873]]
that the home is no longer recognized or certified by VA under part 51.
    (g) Compliance with Federal laws. Under State home care agreements
entered into under this section, State homes are not required to comply
with reporting and auditing requirements imposed under the Service
Contract Act of 1965, as amended (41 U.S.C. 6701, et seq.); however,
State homes must comply with all other applicable Federal laws
concerning employment and hiring practices including the Fair Labor
Standards Act, National Labor Relations Act, the Civil Rights Acts, the
Age Discrimination in Employment Act of 1967, the Vocational
Rehabilitation Act of 1973, Worker Adjustment and Retraining
Notification Act, Sarbanes-Oxley Act of 2002, Occupational Health and
Safety Act of 1970, Immigration Reform and Control Act of 1986,
Consolidated Omnibus Reconciliation Act, the Family and Medical Leave
Act, the Americans with Disabilities Act, the Uniformed Services
Employment and Reemployment Rights Act, the Immigration and Nationality
Act, the Consumer Credit Protection Act, the Employee Polygraph
Protection Act, and the Employee Retirement Income Security Act.
[FR Doc. 2019-26501 Filed 12-11-19; 8:45 am]