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56 rows where part_number = 51 and title_number = 38 sorted by section_id
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| section_id ▼ | title_number | title_name | chapter | subchapter | part_number | part_name | subpart | subpart_name | section_number | section_heading | agency | authority | source_citation | amendment_citations | full_text |
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| 38:38:2.0.1.1.20.1.360.1 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | A | Subpart A—General | § 51.1 Purpose and scope of this part. | VA | The purpose of this part is to establish VA's policies, procedures, and standards applicable to the payment of per diem to State homes that provide nursing home care, domiciliary care, or adult day health care to eligible veterans. Subpart B of this part sets forth the procedures for recognition and certification of a State home. Subpart C sets forth requirements governing the rates of, and procedures applicable to, the payment of per diem; the provision of drugs and medicines; and for which veterans VA will pay per diem. Subparts D, E, and F set forth standards that any State home seeking per diem payments for nursing home care (subpart D), domiciliary care (subpart E), or adult day health care (subpart F) must meet. | |||||
| 38:38:2.0.1.1.20.1.360.2 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | A | Subpart A—General | § 51.2 Definitions. | VA | For the purposes of this part: Activities of daily living (ADLs) means the functions or tasks for self-care usually performed in the normal course of a day, i.e., mobility, bathing, dressing, grooming, toileting, transferring, and eating. Adult day health care means a therapeutic outpatient care program that includes one or more of the following services, based on patient care needs: Medical services, rehabilitation, therapeutic activities, socialization, and nutrition. Services are provided in a congregate setting. Clinical nurse specialist means a licensed professional nurse with a master's degree in nursing and a major in a clinical nursing specialty from an academic program accredited by the National League for Nursing. Director means the Director of the VA medical center of jurisdiction, unless the reference is specifically to another type of director. Domiciliary care means the furnishing of a home to a veteran, including the furnishing of shelter, food, and other comforts of home, and necessary medical services as defined in this part. For purposes of the definition of “domiciliary care,” necessary medical services means the medical services subpart E of this part requires the State home to provide. Eligible veteran means a veteran whose care in a State home may serve as a basis for per diem payments to the State. The requirements that an eligible veteran must meet are set forth in §§ 51.50 (nursing home care), 51.51 (domiciliary care), and 51.52 (adult day health care). Licensed medical practitioner means a nurse practitioner, physician, physician assistant, or primary care physician. Nurse practitioner means a licensed professional nurse who is currently licensed to practice in a State; who meets that State's requirements governing the qualifications of nurse practitioners; and who is currently certified as an adult, family, or gerontological nurse practitioner by a nationally recognized body that provides such certification for nurse practitioners, such as the American Nurses Credent… | |||||
| 38:38:2.0.1.1.20.2.360.1 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | B | Subpart B—Obtaining Recognition and Certification for per Diem Payments | § 51.20 Recognition of a State home. | VA | (a) How to apply for recognition. To apply for recognition of a home for purposes of receiving per diem from VA, a State must submit a letter requesting recognition to the Office of Geriatrics and Extended Care in VA Central Office, 810 Vermont Avenue NW, Washington, DC 20420. The letter must be signed by the State official authorized to make the request. The letter will be reviewed by VA, in accordance with this section. (b) Survey and recommendation by Director. (1) After receipt of a letter requesting recognition, VA will survey the home in accordance with § 51.31 to determine whether the facility and program of care meet the applicable requirements of subpart C and the applicable standards in subpart D, E, or F of this part. For purposes of the recognition process including the survey, references to State homes in the standards apply to homes that are being considered by VA for recognition as State homes. (2) If the Director of the VA Medical Center of jurisdiction determines that the applicable requirements and standards are met, the Director will submit a written recommendation for recognition to the Under Secretary for Health. (3) If the Director does not recommend recognition, the Director will submit a written recommendation against recognition to the Under Secretary for Health and will notify in writing the State official who signed the letter submitted under paragraph (a) of this section and the State official authorized to oversee operations of the home. The notification will state the following: (i) The specific standard(s) not met; and (ii) The State's right to submit a response to the Under Secretary for Health, including any additional evidence, no later than 30 calendar days after the date of the notification to the State. (c) Decision by the Under Secretary for Health. After receipt of a recommendation from the Director, and allowing 30 calendar days for the state to respond to a negative recommendation and to submit evidence, the Under Secretary for Health will award or deny recogni… | |||||
| 38:38:2.0.1.1.20.2.360.2 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | B | Subpart B—Obtaining Recognition and Certification for per Diem Payments | § 51.30 Certification of a State home. | VA | (a) General certification requirement. To be certified, the State home must allow VA to survey the home in accordance with § 51.31. A State home must be certified no later than 450 calendar days after the State home is recognized. Certifications expire 600 calendar days after the date of their issuance. (b) Periodic certifications required. The Director of the VA medical center of jurisdiction will certify a State home based on a survey conducted at least once every 270-450 calendar days, at VA's discretion, and will notify the State official authorized to oversee operations of the State home of the decision regarding certification. (c) Decreasing capacity for a program of care. The State must report any decreases in the capacity for a particular program of care to the Office of Geriatrics and Extended Care in VA Central Office, 810 Vermont Avenue NW, Washington, DC 20420 no later than 30 calendar days after such decrease, and must provide an explanation for the decrease. (d) Provisional certification —(1) When issuance is required. After a VA survey, the Director must issue a provisional certification for the surveyed State home if the Director determines that all of the following are true: (i) The State home does not meet one or more of the applicable requirements or standards in this part; (ii) None of these deficiencies immediately jeopardize the health or safety of any resident or participant; (iii) No later than 20 working days after receipt by the State home of the survey report, the State submitted to the Director a written plan to remedy each deficiency in a specified amount of time; and (iv) The plan is reasonable and the Director has sent a written notice to the appropriate person(s) at the State home informing him or her that the Director agrees to the plan. (2) Surveys to continue while under provisional certification. VA will continue to survey the State home while it is under a provisional certification in accordance with this section and § 51.31. After such a survey, the Directo… | |||||
| 38:38:2.0.1.1.20.2.360.3 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | B | Subpart B—Obtaining Recognition and Certification for per Diem Payments | § 51.31 Surveys for recognition and/or certification. | VA | (a) General. Both before and after a home is recognized and certified, VA may survey the home as necessary to determine whether it complies with applicable regulations. VA will provide advance notice before a recognition survey, but advance notice is not required before other surveys. A survey, as necessary, may cover all parts of the home or only certain parts, and may include review, audit, and production of any records that have a bearing on compliance with the requirements of this part (including any reports from state or local entities), as well as the completion and submission to VA of all required forms. The Director will designate the VA officials and/or contractors to survey the home. (b) Recognition surveys. VA will not conduct a recognition survey unless the following minimum requirements are met: (1) For nursing homes and domiciliaries, the home has at least 20 residents or has a number of residents consisting of at least 50 percent of the resident capacity of the home; (2) For adult day health care programs of care, the program has at least 10 participants or has a number of participants consisting of at least 50 percent of participant capacity of the program. (c) Threats to public, resident, or participant safety. If VA identifies a condition at the home that poses an immediate threat to public, resident or participant safety, or other information indicating the existence of such a threat, the Director of the VA medical center of jurisdiction will immediately report this to the VA Network Director (10N1-22); the Office of Geriatrics and Extended Care in VA Central Office; and the State official authorized to oversee operations of the home. | |||||
| 38:38:2.0.1.1.20.2.360.4 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | B | Subpart B—Obtaining Recognition and Certification for per Diem Payments | § 51.32 Terminating recognition. | VA | Once a home has achieved recognition, the recognition will be terminated only if the State requests that the recognition be terminated, or if VA makes a final decision that affirms the Director's decision not to certify the State home. | |||||
| 38:38:2.0.1.1.20.3.360.1 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | C | Subpart C—Requirements Applicable to Eligibility, Rates, and Payments | § 51.40 Basic per diem rates. | VA | [83 FR 61274, Nov. 28, 2018] | (a) Basic rate. Except as provided in § 51.41, VA will pay per diem for care provided to an eligible veteran at a State home at the lesser of the following rates: (1) One-half of the daily cost of the care for each day the veteran is in the State home, as calculated under paragraph (b) of this section. (2) The basic per diem rate for each day the veteran is in the State home. The basic per diem rate is established by VA for each fiscal year in accordance with 38 U.S.C. 1741(a) and (c). To determine the number of days that a veteran was in a State home, see paragraph (c) of this section. (b) How to calculate the daily cost of a veteran's care. The daily cost of care consists of those direct and indirect costs attributable to care at the State home, divided by the total number of residents serviced by the program of care. Cost principles are set forth in Office of Management and Budget (OMB) regulations. 2 CFR 200.400-200.475. (c) Determining whether a veteran spent a day receiving nursing home or domiciliary care —(1) Nursing homes. VA will pay per diem for each day that the veteran is receiving nursing home care and has an overnight stay at the State home. Per diem also will be paid for a day when there is no overnight stay if the State home nursing home care program has an occupancy rate of 90 percent or greater on that day. However, these payments will be made only for the first 10 consecutive days during which the veteran is admitted as a patient for any stay in a VA or other hospital (a hospital stay could occur more than once in a calendar year once there is an overnight stay in the State home between hospital stays) and only for the first 12 days in a calendar year during which the veteran is absent for purposes other than receiving hospital care. Occupancy rate is calculated by dividing the total number of residents (including nonveterans) in the nursing home on that day by the total recognized nursing home capacity in that State home. (2) Domiciliaries. VA will pay per diem for each day tha… | ||||
| 38:38:2.0.1.1.20.3.360.2 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | C | Subpart C—Requirements Applicable to Eligibility, Rates, and Payments | § 51.41 Contracts and State home care agreements for certain veterans with service-connected disabilities. | VA | [77 FR 72741, Dec. 6, 2012, as amended at 84 FR 67872, Dec. 12, 2019; 88 FR 83033, Nov. 28, 2023] | (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: (1) Are in need of nursing home care for a VA adjudicated service-connected disability, or (2) Have a singular or combined rating of 70 percent or more based on one or more service-connected disabilities or a rating of total disability based on individual unemployability and are in need of nursing home care. (b) Payments under contracts. Contracts under this section will be subject to this part to the extent provided for in the contract and will be governed by federal acquisition law and regulation. Contracts for payment under this section will provide for payment either: (1) At a rate or rates negotiated between VA and the State home; or (2) On request from a State home that provided nursing home care on August 5, 2012, for which the State home was eligible for payment under 38 U.S.C. 1745(a)(1), at a rate that reflects the overall methodology of reimbursement for such care that was in effect for the State home on August 5, 2012. (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. A State home care agreement for nursing home care under this section will provide for payments at the rate determined by the following formula. (i) Determine whether the Resource Utilization Groups (RUG) or Skilled Nursing Facility Prospective Payment System (SNF-PPS) applies. (A) For State homes in a metropolitan statistical area, use the published fiscal year Centers for Medicare and Medicaid Services (CMS) RUG case-mix levels for the applicable metropolitan statistical area. (B) For State homes in a rural area, use the published fiscal year CMS SNF-PPS case-mix levels for the applicable rural area. (ii) Comput… | ||||
| 38:38:2.0.1.1.20.3.360.3 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | C | Subpart C—Requirements Applicable to Eligibility, Rates, and Payments | § 51.42 Payment procedures. | VA | [83 FR 61274, Nov. 28, 2018, as amended at 89 FR 86249, Oct. 30, 2024] | (a) Forms required —(1) Forms required at time of admission or enrollment. As a condition for receiving payment of per diem under this part, the State home must submit the forms identified in paragraphs (a)(1)(i) and (ii) of this section to the VA medical center of jurisdiction for each veteran at the time of the veteran's admission to or enrollment in a State home. If the home is not a recognized State home, the home must, after recognition, submit forms for Veterans who received care on and after the date of the completion of the VA survey that provided the basis for determining that the home met the standards of this part. The State home must also submit the appropriate form with any request for a change in the type of per diem paid on behalf of a veteran as a result of a change in the veteran's program of care or a change in the veteran's service-connected disability rating that makes the veteran's care eligible for payment under § 51.41. Copies of VA Forms can be obtained from any VA Medical Center and are available on our website at www.va.gov/vaforms. The required forms are: (i) A completed VA Form 10-10EZ, Application for Medical Benefits (or VA Form 10-10EZR, Health Benefits Renewal Form, if a completed Form 10-10EZ is already on file at VA). Domiciliary applicants and residents must complete the financial disclosure sections of VA Forms 10-10EZ and 10-10EZR, and adult day health care applicants may be required to complete the financial disclosure sections of these forms in order to enroll with VA. Although the nursing home applicants or residents or adult day health care participants do not complete the financial disclosure sections of VA Forms 10-10EZ and 10-10EZR, an unsigned form is incomplete, and VA will not accept the form. (ii) A completed VA Form 10-10SH, State Home Program Application for Care—Medical Certification. (2) Form required for monthly payments. Except as provided in paragraphs (b)(1) and (2) of this section, VA pays per diem on a monthly basis for care provided during the … | ||||
| 38:38:2.0.1.1.20.3.360.4 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | C | Subpart C—Requirements Applicable to Eligibility, Rates, and Payments | § 51.43 Drugs and medicines for certain veterans. | VA | [83 FR 61274, Nov. 28, 2018] | (a) In addition to the per diem payments under § 51.40 of this part, the Secretary will furnish drugs and medicines to a State home as may be ordered by prescription of a duly licensed physician as specific therapy in the treatment of illness or injury for a veteran receiving nursing home care in a State home if— (1) The veteran: (i) Has a singular or combined rating of less than 50 percent based on one or more service-connected disabilities and needs the drugs and medicines for a service-connected disability; and (ii) Needs nursing home care for reasons that do not include care for a VA adjudicated service-connected disability; or (2) The veteran: (i) Has a singular or combined rating of 50 or 60 percent based on one or more service-connected disabilities and needs the drugs and medicines; and (ii) Needs nursing home care for reasons that do not include care for a VA adjudicated service-connected disability. (b) VA will also furnish drugs and medicines to a State home for a veteran receiving nursing home, domiciliary, or adult day health care in a State home pursuant to 38 U.S.C. 1712(d), as implemented by § 17.96 of this chapter, subject to the limitation in § 51.41(c)(2). (c) VA may furnish a drug or medicine under paragraph (a) of this section and under § 17.96 of this chapter only if the drug or medicine is included on VA's National Formulary, unless VA determines a non-Formulary drug or medicine is medically necessary. (d) VA may furnish a drug or medicine under this section and under § 17.96 of this chapter by having the drug or medicine delivered to the State home in which the veteran resides by mail or other means and packaged in a form that is mutually acceptable to the State home and to VA set forth in a written agreement. (e) As a condition for receiving drugs or medicine under this section or under § 17.96 of this chapter, the State must submit to the VA medical center of jurisdiction a completed VA Form 10-0460 with the corresponding prescription(s) for each eligible veteran. | ||||
| 38:38:2.0.1.1.20.3.360.5 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | C | Subpart C—Requirements Applicable to Eligibility, Rates, and Payments | § 51.50 Eligible veterans—nursing home care. | VA | [83 FR 61275, Nov. 28, 2018, as amended at 89 FR 45601, May 23, 2024] | A veteran is an eligible veteran for the purposes of payment of per diem for nursing home care under this part if VA determines that the veteran needs nursing home care; is not barred from receiving care based on his or her service (see 38 U.S.C. 5303, 5303A), is not barred from receiving VA pension, compensation or dependency and indemnity compensation based on the character of a discharge from military service (see 38 CFR 3.12) and is within one of the following categories: (a) Veterans with service-connected disabilities; (b) Veterans who are former prisoners of war, who were awarded the Purple Heart, or who were awarded the medal of honor under 10 U.S.C. 3741, 6241, or 8741 or 14 U.S.C. 491; (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 solely seeking care for a disorder associated with exposure to a toxic substance or radiation, 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), or for any illness associated with service in combat in a war after the Gulf War or during a period of hostility after November 11, 1998, as provided and limited in 38 U.S.C. 1710(e); (i) Veterans of World War II; (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). Neither enrollment in the VA healthcare … | ||||
| 38:38:2.0.1.1.20.3.360.6 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | C | Subpart C—Requirements Applicable to Eligibility, Rates, and Payments | § 51.51 Eligible veterans—domiciliary care. | VA | [83 FR 61275, Nov. 28, 2018, as amended at 89 FR 86249, Oct. 30, 2024] | (a) A veteran is an eligible veteran for the purposes of payment of per diem for domiciliary care in a State home under this part if VA determines that the veteran is not barred from receiving care based on his or her service (see 38 U.S.C. 5303, 5303A), is not barred from receiving VA pension, compensation or dependency and indemnity compensation based on the character of a discharge from military service (see 38 CFR 3.12), and the veteran is: (1) A veteran whose annual income does not exceed the maximum annual rate of pension payable to a veteran in need of regular aid and attendance; or (2) A veteran who VA determines has no adequate means of support. When an applicant's annual income exceeds the rate of pension described in paragraph (a)(1) of this section, VA will determine if the applicant has no adequate means of support. This determination will be made through an assessment of the veteran's deficits in health or functional status that may render the veteran incapable of achieving or sustaining independence in the community as determined by the Chief of Staff of the VA medical center of jurisdiction, or designee. Assessment of whether the veteran has no adequate means of support will be based on objective evidence that considers factors that are inclusive of but not limited to: (i) The impact of the severity of the veteran's medical condition, disabilities, and symptoms on the veteran's safety in the community; (ii) The impact of the severity of the veteran's medical condition, disabilities, and symptoms on the veteran's ability to provide self-care; (iii) The availability of community or family support systems; (iv) The impact of the severity of the veteran's medical condition, disabilities, and symptoms on the veteran's ability to access and utilize community support systems; (v) The risk of loss of housing in the community; (vi) The risk of loss of the veteran's income; (vii) Access to outpatient mental health and substance use disorder care; and (viii) The current effectiveness of any outpati… | ||||
| 38:38:2.0.1.1.20.3.360.7 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | C | Subpart C—Requirements Applicable to Eligibility, Rates, and Payments | § 51.52 Eligible veterans—adult day health care. | VA | [83 FR 61275, Nov. 28, 2018] | A veteran is an eligible veteran for payment of per diem to a State for adult day health care if VA determines that the veteran: (a) Is not barred from receiving VA pension, compensation or dependency and indemnity compensation based on the character of a discharge from military service (see 38 CFR 3.12); (b) Is enrolled in the VA health care system; (c) Would otherwise require nursing home care; and (d) Needs adult day health care because the veteran meets any one of the following conditions: (1) The veteran has three or more Activities of Daily Living (ADL) dependencies. (2) The veteran has significant cognitive impairment. (3) The veteran has two ADL dependencies and two or more of the following conditions: (i) Seventy-five years old or older; (ii) High use of medical services, i.e., three or more hospitalizations per calendar year, or 12 or more visits to an outpatient clinic or to an emergency evaluation unit per calendar year; (iii) Diagnosis of clinical depression; or (iv) Living alone in the community. (4) The veteran does not meet the criteria in paragraph (d)(1), (2), or (3) of this section, but nevertheless a licensed VA medical practitioner determines the veteran needs adult day health care services. | ||||
| 38:38:2.0.1.1.20.3.360.8 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | C | Subpart C—Requirements Applicable to Eligibility, Rates, and Payments | § 51.58 Requirements and Standards applicable for payment of per diem. | VA | [83 FR 61276, Nov. 28, 2018] | A State home must meet the requirements in subpart C and the standards in the applicable subpart to be recognized, certified, and receive per diem for that program of care: (a) For nursing home care, subpart D. (b) For domiciliary care, subpart E. (c) For adult day health care, subpart F. | ||||
| 38:38:2.0.1.1.20.3.360.9 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | C | Subpart C—Requirements Applicable to Eligibility, Rates, and Payments | § 51.59 Authority to continue payment of per diem when veterans are relocated due to emergency. | VA | [83 FR 61276, Nov. 28, 2018] | (a) Definition of emergency. For the purposes of this section, emergency means an occasion or instance where all of the following are true: (1) It would be unsafe for veterans receiving care at a State home to remain in that home. (2) The State is not, or believes that it will not be, able to provide care in the State home on a temporary or long-term basis for any or all of its veteran residents due to a situation involving the State home, and not due to a situation where a particular veteran's medical condition requires that the veteran be transferred to another facility, such as for a period of hospitalization. (3) The State determines that the veterans must be evacuated to another facility or facilities. (b) General authority to pay per diem during a relocation period. Notwithstanding any other provision of this part, VA will continue to pay per diem for a period not to exceed 30 calendar days for any eligible veteran who resided in a State home, and for whom VA was paying per diem, if such veteran is evacuated during an emergency into a facility other than a VA nursing home, hospital, domiciliary, or other VA site of care if the State is responsible for providing or paying for the care. VA will not pay per diem under this section for more than 30 calendar days of care provided in the evacuation facility, unless the official who approved the emergency response under paragraph (e) of this section determines that it is not reasonably possible to return the veteran to a State home within the 30-calendar-day period, in which case such official will approve additional period(s) of no more than 30 calendar days in accordance with this section. VA will not pay per diem if VA determines that a veteran is or has been placed in a facility that does not meet the standards set forth in paragraph (c)(1) of this section, and VA may recover all per diem paid for the care of the veteran in that facility. (c) Selection of evacuation facilities. The following standards and procedures in paragraphs (c)(1) through (3) … | ||||
| 38:38:2.0.1.1.20.4.360.1 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | D | Subpart D—Standards Applicable to the Payment of Per Diem for Nursing Home Care. | § 51.60 Standards applicable for payment of per diem. | VA | The provisions of this subpart are the standards that a State home and facility management must meet for the State to receive per diem for nursing home care. | |||||
| 38:38:2.0.1.1.20.4.360.10 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | D | Subpart D—Standards Applicable to the Payment of Per Diem for Nursing Home Care. | § 51.150 Physician services. | VA | [65 FR 968, Jan. 6, 2000, as amended at 74 FR 19434, Apr. 29, 2009] | A physician must personally approve in writing a recommendation that an individual be admitted to a facility. Each resident must remain under the care of a physician. (a) Physician supervision. The facility management must ensure that— (1) The medical care of each resident is supervised by a primary care physician; (2) Each resident's medical record lists the name of the resident's primary physician, and (3) Another physician supervises the medical care of residents when their primary physician is unavailable. (b) Physician visits. The physician must— (1) Review the resident's total program of care, including medications and treatments, at each visit required by paragraph (c) of this section; (2) Write, sign, and date progress notes at each visit; and (3) Sign and date all orders. (c) Frequency of physician visits. (1) The resident must be seen by the primary physician at least once every 30 days for the first 90 days after admission, and at least once every 60 days thereafter, or more frequently based on the condition of the resident. (2) A physician visit is considered timely if it occurs not later than 10 days after the date the visit was required. (3) Except as provided in paragraphs (c)(4) of this section, all required physician visits must be made by the physician personally. (4) At the option of the physician, required visits in the facility after the initial visit may alternate between personal visits by the physician and visits by a physician assistant, nurse practitioner, or clinical nurse specialist in accordance with paragraph (e) of this section. (d) Availability of physicians for emergency care. The facility management must provide or arrange for the provision of physician services 24 hours a day, 7 days per week, in case of an emergency. (e) Physician delegation of tasks. (1) Except as specified in paragraph (e)(2) of this section, a primary physician may delegate tasks to: (i) a certified physician assistant or a certified nurse practitioner, or (ii) a clinical nurse spec… | ||||
| 38:38:2.0.1.1.20.4.360.11 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | D | Subpart D—Standards Applicable to the Payment of Per Diem for Nursing Home Care. | § 51.160 Specialized rehabilitative services. | VA | [65 FR 968, Jan. 6, 2000, as amended at 74 FR 19434, Apr. 29, 2009] | (a) Provision of services. If specialized rehabilitative services such as but not limited to physical therapy, speech therapy, occupational therapy, and mental health services for mental illness are required in the resident's comprehensive plan of care, facility management must— (1) Provide the required services; or (2) Obtain the required services from an outside resource, in accordance with § 51.210(h) of this part, from a provider of specialized rehabilitative services. (b) Specialized rehabilitative services must be provided under the written order of a physician by qualified personnel. | ||||
| 38:38:2.0.1.1.20.4.360.12 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | D | Subpart D—Standards Applicable to the Payment of Per Diem for Nursing Home Care. | § 51.170 Dental services. | VA | (a) A facility must provide or obtain from an outside resource, in accordance with § 51.210(h) of this part, routine and emergency dental services to meet the needs of each resident; (b) A facility may charge a resident an additional amount for routine and emergency dental services; and (c) A facility must, if necessary, assist the resident— (1) In making appointments; (2) By arranging for transportation to and from the dental services; and (3) Promptly refer residents with lost or damaged dentures to a dentist. | |||||
| 38:38:2.0.1.1.20.4.360.13 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | D | Subpart D—Standards Applicable to the Payment of Per Diem for Nursing Home Care. | § 51.180 Pharmacy services. | VA | [65 FR 968, Jan. 6, 2000, as amended at 74 FR 19434, Apr. 29, 2009] | The facility management must provide routine and emergency drugs and biologicals to its residents, or obtain them under an agreement described in § 51.210(h) of this part. The facility management must have a system for disseminating drug information to medical and nursing staff. (a) Procedures. The facility management must provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident. (b) Service consultation. The facility management must employ or obtain the services of a pharmacist licensed in a State in which the facility is located or a VA pharmacist under VA contract who— (1) Provides consultation on all aspects of the provision of pharmacy services in the facility; (2) Establishes a system of records of receipt and disposition of all controlled drugs in sufficient detail to enable an accurate reconciliation; and (3) Determines that drug records are in order and that an account of all controlled drugs is maintained and periodically reconciled. (c) Drug regimen review. (1) The drug regimen of each resident must be reviewed at least once a month by a licensed pharmacist. (2) The pharmacist must report any irregularities to the primary physician and the director of nursing, and these reports must be acted upon. (d) Labeling of drugs and biologicals. Drugs and biologicals used in the facility management must be labeled in accordance with currently accepted professional principles, and include the appropriate accessory and cautionary instructions, and the expiration date when applicable. (e) Storage of drugs and biologicals. (1) In accordance with State and Federal laws, the facility management must store all drugs and biologicals in locked compartments under proper temperature controls, and permit only authorized personnel to have access to the keys. (2) The facility management must provide separately locked, permanently affixed compartments for storage of cont… | ||||
| 38:38:2.0.1.1.20.4.360.14 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | D | Subpart D—Standards Applicable to the Payment of Per Diem for Nursing Home Care. | § 51.190 Infection control. | VA | [65 FR 968, Jan. 6, 2000, as amended at 74 FR 19434, Apr. 29, 2009] | The facility management must establish and maintain an infection control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of disease and infection. (a) Infection control program. The facility management must establish an infection control program under which it— (1) Investigates, controls, and prevents infections in the facility; (2) Decides what procedures, such as isolation, should be applied to an individual resident; and (3) Maintains a record of incidents and corrective actions related to infections. (b) Preventing spread of infection. (1) When the infection control program determines that a resident needs isolation to prevent the spread of infection, the facility management must isolate the resident. (2) The facility management must prohibit employees with a communicable disease or infected skin lesions from engaging in any contact with residents or their environment that would transmit the disease. (3) The facility management must require staff to wash their hands after each direct resident contact for which hand washing is indicated by accepted professional practice. (c) Linens. Personnel must handle, store, process, and transport linens so as to prevent the spread of infection. | ||||
| 38:38:2.0.1.1.20.4.360.15 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | D | Subpart D—Standards Applicable to the Payment of Per Diem for Nursing Home Care. | § 51.200 Physical environment. | VA | [65 FR 968, Jan. 6, 2000, as amended at 74 FR 19434, Apr. 29, 2009; 76 FR 11340, Mar. 2, 2011; 80 FR 44862, July 28, 2015] | The facility management must be designed, constructed, equipped, and maintained to protect the health and safety of residents, personnel and the public. (a) Life safety from fire. The facility must meet the applicable provisions of NFPA 101, Life Safety Code and NFPA 99, Health Care Facilities Code. (b) Emergency power. (1) An emergency electrical power system must be provided to supply power adequate for illumination of all exit signs and lighting for the means of egress, fire alarm and medical gas alarms, emergency communication systems, and generator task illumination. (2) The system must be the appropriate type essential electrical system in accordance with the applicable provisions of NFPA 101, Life Safety Code and NFPA 99, Health Care Facilities Code. (3) When electrical life support devices are used, an emergency electrical power system must also be provided for devices in accordance with NFPA 99, Health Care Facilities Code. (4) The source of power must be an on-site emergency standby generator of sufficient size to serve the connected load or other approved sources in accordance with NFPA 101, Life Safety Code and NFPA 99, Health Care Facilities Code. (c) Space and equipment. Facility management must— (1) Provide sufficient space and equipment in dining, health services, recreation, and program areas to enable staff to provide residents with needed services as required by these standards and as identified in each resident's plan of care; and (2) Maintain all essential mechanical, electrical, and patient care equipment in safe operating condition. (d) Resident rooms. Resident rooms must be designed and equipped for adequate nursing care, comfort, and privacy of residents: (1) Bedrooms must— (i) Accommodate no more than four residents; (ii) Measure at least 115 net square feet per resident in multiple resident bedrooms; (iii) Measure at least 150 net square feet in single resident bedrooms; (iv) Measure at least 245 net square feet in small double resident bedrooms; and (v) Measure a… | ||||
| 38:38:2.0.1.1.20.4.360.16 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | D | Subpart D—Standards Applicable to the Payment of Per Diem for Nursing Home Care. | § 51.210 Administration. | VA | [65 FR 968, Jan. 6, 2000, as amended at 72 FR 30243, May 31, 2007; 74 FR 19434, Apr. 29, 2009; 76 FR 52275, Aug. 22, 2011; 78 FR 51675, Aug. 21, 2013; 83 FR 61276, Nov. 28, 2018] | A facility must be administered in a manner that enables it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well being of each resident. (a) Governing body. (1) The State must have a governing body, or designated person functioning as a governing body, that is legally responsible for establishing and implementing policies regarding the management and operation of the facility; and (2) The governing body or State official with oversight for the facility appoints the administrator who is— (i) Licensed by the State where licensing is required; and (ii) Responsible for operation and management of the facility. (b) Disclosure of State agency and individual responsible for oversight of facility. The State must give written notice to the Office of Geriatrics and Extended Care, VA Headquarters, 810 Vermont Avenue, NW, Washington, DC 20420, at the time of the change, if any of the following change: (1) The State agency and individual responsible for oversight of a State home facility; (2) The State home administrator; (3) The director of nursing services (or other individual in charge of nursing services); and (4) The State employee responsible for oversight of the State home if a contractor operates the State home. (c) Required Information. The facility management must submit the following to the director of the VA medical center of jurisdiction as part of the application for recognition and thereafter as often as necessary to be current or as specified: (1) The copy of legal and administrative action establishing the State-operated facility (e.g., State laws); (2) Site plan of facility and surroundings; (3) Legal title, lease, or other document establishing right to occupy facility; (4) Organizational charts and the operational plan of the facility; (5) The number of the staff by category indicating full-time, part-time and minority designation (annual at time of survey); (6) The number of nursing home patients who ar… | ||||
| 38:38:2.0.1.1.20.4.360.2 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | D | Subpart D—Standards Applicable to the Payment of Per Diem for Nursing Home Care. | § 51.70 Resident rights. | VA | [65 FR 968, Jan. 6, 2000, as amended at 74 FR 19434, Apr. 29, 2009; 88 FR 83034, Nov. 28, 2023] | The resident has a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility. The facility management must protect and promote the rights of each resident, including each of the following rights: (a) Exercise of rights. (1) The resident has the right to exercise his or her rights as a resident of the facility and as a citizen or resident of the United States. (2) The resident has the right to be free of interference, coercion, discrimination, and reprisal from the facility management in exercising his or her rights. (3) The resident has the right to freedom from chemical or physical restraint. (4) In the case of a resident determined incompetent under the laws of a State by a court of jurisdiction, the rights of the resident are exercised by the person appointed under State law to act on the resident's behalf. (5) In the case of a resident who has not been determined incompetent by the State court, any legal-surrogate designated in accordance with State law may exercise the resident's rights to the extent provided by State law. (b) Notice of rights and services. (1) The facility management must inform the resident both orally and in writing in a language that the resident understands of his or her rights and all rules and regulations governing resident conduct and responsibilities during the stay in the facility. Such notification must be made prior to or upon admission and periodically during the resident's stay. (2) The resident or his or her legal representative has the right: (i) Upon an oral or written request, to access all records pertaining to himself or herself including current clinical records within 24 hours (excluding weekends and holidays); and (ii) After receipt of his or her records for review, to purchase at a cost not to exceed the community standard photocopies of the records or any portions of them upon request and with 2 working days advance notice to the facility management. (3) The resident has… | ||||
| 38:38:2.0.1.1.20.4.360.3 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | D | Subpart D—Standards Applicable to the Payment of Per Diem for Nursing Home Care. | § 51.80 Admission, transfer and discharge rights. | VA | [65 FR 968, Jan. 6, 2000, as amended at 74 FR 19434, Apr. 29, 2009] | (a) Transfer and discharge. (1) Definition: Transfer and discharge includes movement of a resident to a bed outside of the facility whether that bed is in the same physical plant or not. Transfer and discharge does not refer to movement of a resident to a bed within the same facility. (2) Transfer and discharge requirements. The facility management must permit each resident to remain in the facility, and not transfer or discharge the resident from the facility unless— (i) The transfer or discharge is necessary for the resident's welfare and the resident's needs cannot be met in the nursing home; (ii) The transfer or discharge is appropriate because the resident's health has improved sufficiently so the resident no longer needs the services provided by the nursing home; (iii) The safety of individuals in the facility is endangered; (iv) The health of individuals in the facility would otherwise be endangered; (v) The resident has failed, after reasonable and appropriate notice to pay for a stay at the facility; or (vi) The nursing home ceases to operate. (3) Documentation. When the facility transfers or discharges a resident under any of the circumstances specified in paragraphs (a)(2)(i) through (a)(2)(vi) of this section, the primary physician must document this in the resident's clinical record. (4) Notice before transfer. Before a facility transfers or discharges a resident, the facility must— (i) Notify the resident and, if known, a family member or legal representative of the resident of the transfer or discharge and the reasons for the move in writing and in a language and manner they understand. (ii) Record the reasons in the resident's clinical record; and (iii) Include in the notice the items described in paragraph (a)(6) of this section. (5) Timing of the notice. (i) The notice of transfer or discharge required under paragraph (a)(4) of this section must be made by the facility at least 30 days before the resident is transferred or discharged, except when specified in paragraph (a)… | ||||
| 38:38:2.0.1.1.20.4.360.4 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | D | Subpart D—Standards Applicable to the Payment of Per Diem for Nursing Home Care. | § 51.90 Resident behavior and facility practices. | VA | [65 FR 968, Jan. 6, 2000, as amended at 74 FR 19434, Apr. 29, 2009] | (a) Restraints. (1) The resident has a right to be free from any chemical or physical restraints imposed for purposes of discipline or convenience. When a restraint is applied or used, the purpose of the restraint is reviewed and is justified as a therapeutic intervention. (i) Chemical restraint is the inappropriate use of a sedating psychotropic drug to manage or control behavior. (ii) Physical restraint is any method of physically restricting a person's freedom of movement, physical activity or normal access to his or her body. Bed rails and vest restraints are examples of physical restraints. (2) The facility management uses a system to achieve a restraint-free environment. (3) The facility management collects data about the use of restraints. (4) When alternatives to the use of restraint are ineffective, a restraint must be safely and appropriately used. (b) Abuse. The resident has the right to be free from mental, physical, sexual, and verbal abuse or neglect, corporal punishment, and involuntary seclusion. (1) Mental abuse includes humiliation, harassment, and threats of punishment or deprivation. (2) Physical abuse includes hitting, slapping, pinching, or kicking. Also includes controlling behavior through corporal punishment. (3) Sexual abuse includes sexual harassment, sexual coercion, and sexual assault. (4) Neglect is any impaired quality of life for an individual because of the absence of minimal services or resources to meet basic needs. Includes withholding or inadequately providing food and hydration (without physician, resident, or surrogate approval), clothing, medical care, and good hygiene. May also include placing the individual in unsafe or unsupervised conditions. (5) Involuntary seclusion is a resident's separation from other residents or from the resident's room against his or her will or the will of his or her legal representative. (c) Staff treatment of residents. The facility management must develop and implement written policies and procedures that prohibit mistreatme… | ||||
| 38:38:2.0.1.1.20.4.360.5 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | D | Subpart D—Standards Applicable to the Payment of Per Diem for Nursing Home Care. | § 51.100 Quality of life. | VA | [65 FR 968, Jan. 6, 2000, as amended at 74 FR 19434, Apr. 29, 2009] | A facility management must care for its residents in a manner and in an environment that promotes maintenance or enhancement of each resident's quality of life. (a) Dignity. The facility management must promote care for residents in a manner and in an environment that maintains or enhances each resident's dignity and respect in full recognition of his or her individuality. (b) Self-determination and participation. The resident has the right to— (1) Choose activities, schedules, and health care consistent with his or her interests, assessments, and plans of care; (2) Interact with members of the community both inside and outside the facility; and (3) Make choices about aspects of his or her life in the facility that are significant to the resident. (c) Resident Council. The facility management must establish a council of residents that meet at least quarterly. The facility management must document any concerns submitted to the management of the facility by the council. (d) Participation in resident and family groups. (1) A resident has the right to organize and participate in resident groups in the facility; (2) A resident's family has the right to meet in the facility with the families of other residents in the facility; (3) The facility management must provide the council and any resident or family group that exists with private space; (4) Staff or visitors may attend meetings at the group's invitation; (5) The facility management must provide a designated staff person responsible for providing assistance and responding to written requests that result from group meetings; (6) The facility management must listen to the views of any resident or family group, including the council established under paragraph (c) of this section, and act upon the concerns of residents, families, and the council regarding policy and operational decisions affecting resident care and life in the facility. (e) Participation in other activities. A resident has the right to participate in social, religious, and comm… | ||||
| 38:38:2.0.1.1.20.4.360.6 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | D | Subpart D—Standards Applicable to the Payment of Per Diem for Nursing Home Care. | § 51.110 Resident assessment. | VA | [65 FR 968, Jan. 6, 2000, as amended at 74 FR 19434, Apr. 29, 2009; 77 FR 26184, May 3, 2012; 88 FR 83034, Nov. 28, 2023] | The facility management must conduct initially, annually and as required by a change in the resident's condition a comprehensive, accurate, standardized, reproducible assessment of each resident's functional capacity. (a) Admission orders. At the time each resident is admitted, the facility management must have physician orders for the resident's immediate care and a medical assessment, including a medical history and physical examination, within a time frame appropriate to the resident's condition, not to exceed 72 hours after admission, except when an examination was performed within five days before admission and the findings were recorded in the medical record on admission. (b) Comprehensive assessments. (1) The facility management must make a comprehensive assessment of a resident's needs: (i) Using the Centers for Medicare and Medicaid Services (CMS) Resident Assessment Instrument Minimum Data Set, Version 3.0; and (ii) Describing the resident's capability to perform daily life functions, strengths, performances, needs as well as significant impairments in functional capacity. (2) Frequency. Assessments must be conducted— (i) No later than 14 days after the date of admission; (ii) Promptly after a significant change in the resident's physical, mental, or social condition; and (iii) In no case less often than once every 12 months. (3) Review of assessments. The nursing facility management must examine each resident no less than once every 3 months, and as appropriate, revise the resident's assessment to assure the continued accuracy of the assessment. (4) Use. The results of the assessment are used to develop, review, and revise the resident's individualized comprehensive plan of care, under paragraph (d) of this section. (c) Accuracy of assessments. (1) Coordination— (i) Each assessment must be conducted or coordinated with the appropriate participation of health professionals. (ii) Each assessment must be conducted or coordinated by a registered nurse that signs and certifies the c… | ||||
| 38:38:2.0.1.1.20.4.360.7 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | D | Subpart D—Standards Applicable to the Payment of Per Diem for Nursing Home Care. | § 51.120 Quality of care. | VA | [65 FR 968, Jan. 6, 2000, as amended at 74 FR 19434, Apr. 29, 2009; 83 FR 61276, Nov. 28, 2018] | Each resident must receive and the facility management must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care. (a) Reporting of Sentinel Events —(1) Definition. A sentinel event is an adverse event that results in the loss of life or limb or permanent loss of function. (2) Examples of sentinel events are as follows: (i) Any resident death, paralysis, coma or other major permanent loss of function associated with a medication error; or (ii) Any suicide of a resident, including suicides following elopement (unauthorized departure) from the facility; or (iii) Any elopement of a resident from the facility resulting in a death or a major permanent loss of function; or (iv) Any procedure or clinical intervention, including restraints, that result in death or a major permanent loss of function; or (v) Assault, homicide or other crime resulting in patient death or major permanent loss of function; or (vi) A patient fall that results in death or major permanent loss of function as a direct result of the injuries sustained in the fall. (3) The facility management must report sentinel events to the director of VA medical center of jurisdiction within 24 hours of identification. The VA medical center of jurisdiction must report sentinel events by calling VA Network Director (10N 1-22) and Office of Geriatrics and Extended Care in VA Central Office within 24 hours of notification. (4) The facility management must establish a mechanism to review and analyze a sentinel event resulting in a written report no later than 10 working days following the event. The purpose of the review and analysis of a sentinel event is to prevent injuries to residents, visitors, and personnel, and to manage those injuries that do occur and to minimize the negative consequences to the injured individuals and facility. (b) Activities of daily living. Based on the comprehensive assessment o… | ||||
| 38:38:2.0.1.1.20.4.360.8 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | D | Subpart D—Standards Applicable to the Payment of Per Diem for Nursing Home Care. | § 51.130 Nursing services. | VA | [65 FR 968, Jan. 6, 2000, as amended at 74 FR 19434, Apr. 29, 2009] | The facility management must provide an organized nursing service with a sufficient number of qualified nursing personnel to meet the total nursing care needs, as determined by resident assessment and individualized comprehensive plans of care, of all patients within the facility 24 hours a day, 7 days a week. (a) The nursing service must be under the direction of a full-time registered nurse who is currently licensed by the State and has, in writing, administrative authority, responsibility, and accountability for the functions, activities, and training of the nursing services staff. (b) The facility management must provide registered nurses 24 hours per day, 7 days per week. (c) The director of nursing service must designate a registered nurse as a supervising nurse for each tour of duty. (1) Based on the application and results of the case mix and staffing methodology, the director of nursing may serve in a dual role as director and as an onsite-supervising nurse only when the facility has an average daily occupancy of 60 or fewer residents in nursing home. (2) Based on the application and results of the case mix and staffing methodology, the evening or night supervising nurse may serve in a dual role as supervising nurse as well as provides direct patient care only when the facility has an average daily occupancy of 60 or fewer residents in nursing home. (d) The facility management must provide nursing services to ensure that there is direct care nurse staffing of no less than 2.5 hours per patient per 24 hours, 7 days per week in the portion of any building providing nursing home care. (e) Nurse staffing must be based on a staffing methodology that applies case mix and is adequate for meeting the standards of this part. | ||||
| 38:38:2.0.1.1.20.4.360.9 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | D | Subpart D—Standards Applicable to the Payment of Per Diem for Nursing Home Care. | § 51.140 Dietary services. | VA | [65 FR 968, Jan. 6, 2000, as amended at 83 FR 61276, Nov. 28, 2018] | The facility management must provide each resident with a nourishing, palatable, well-balanced diet that meets the daily nutritional and special dietary needs of each resident. (a) Staffing. The facility management must employ a qualified dietitian either full-time, part-time, or on a consultant basis. (1) If a dietitian is not employed, the facility management must designate a person to serve as the director of food service who receives at least a monthly scheduled consultation from a qualified dietitian. (2) A qualified dietitian is one who is qualified based upon registration by the Commission on Dietetic Registration of the Academy of Nutrition and Dietetics. (b) Sufficient staff. The facility management must employ sufficient support personnel competent to carry out the functions of the dietary service. (c) Menus and nutritional adequacy. Menus must— (1) Meet the nutritional needs of residents in accordance with the recommended dietary allowances of the Food and Nutrition Board of the National Research Council, National Academy of Sciences; (2) Be prepared in advance; and (3) Be followed. (d) Food. Each resident receives and the facility provides— (1) Food prepared by methods that conserve nutritive value, flavor, and appearance; (2) Food that is palatable, attractive, and at the proper temperature; (3) Food prepared in a form designed to meet individual needs; and (4) Substitutes offered of similar nutritive value to residents. (e) Therapeutic diets. Therapeutic diets must be prescribed by the primary care physician. (f) Frequency of meals. (1) Each resident receives and the facility provides at least three meals daily, at regular times comparable to normal mealtimes in the community. (2) There must be no more than 14 hours between a substantial evening meal and the availability of breakfast the following day, except as provided in (f)(4) of this section. (3) The facility staff must offer snacks at bedtime daily. (4) When a nourishing snack is provided at bedtime, up to 16 hour… | ||||
| 38:38:2.0.1.1.20.5.360.1 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | E | Subpart E—Standards Applicable to the Payment of Per Diem for Domiciliary Care | § 51.300 Resident rights and behavior; State home practices; quality of life. | VA | [83 FR 61277, Nov. 28, 2018, as amended at 88 FR 83034, Nov. 28, 2023; 89 FR 86250, Oct. 30, 2024] | The State home must protect and promote the rights and quality of life of each resident receiving domiciliary care, and otherwise comply with the requirements in § 51.70, except § 51.70(b)(9), (h)(1), and (m); § 51.80, except § 51.80(a)(2) and (4) and (b); § 51.90; and § 51.100, except § 51.100(g)(2), (h), and (i)(5) through (7). The State Home must have a written procedure for admissions, discharges, and transfers. For purposes of this section, the terms “nursing home” and “nursing facility” or “facility” in the applicable provisions of the cited sections apply to a domiciliary. (a) Notice of rights and services—notification of changes. (1) Facility management must immediately inform the resident and consult with the primary care physician when there is (i) An accident involving the resident that results in injury and has the potential for requiring physician intervention; (ii) A significant change in the resident's physical, mental, or psychosocial status ( i.e., a deterioration in health, mental, or psychosocial status in either life-threatening conditions or clinical complications); (iii) A need to alter treatment significantly ( i.e., a need to discontinue an existing form of treatment due to adverse consequences, or to commence a new form of treatment); or (iv) A decision to transfer or discharge the resident from the facility as specified in paragraph (d) of this section. (2) The facility management must also promptly notify the resident when there is (i) A change in room or roommate assignment as specified in § 51.100(f)(2); or (ii) A change in resident rights under Federal or State law or regulations as specified in § 51.70(b)(1). (3) The facility management must record and periodically update the address and phone number of the resident's legal representative or interested family member, but the resident has the right to decide whether to have the State home notify his or her legal representative or interested family member of changes. (b) [Reserved] (c) Married couples. The resident ha… | ||||
| 38:38:2.0.1.1.20.5.360.2 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | E | Subpart E—Standards Applicable to the Payment of Per Diem for Domiciliary Care | § 51.310 Resident admission, assessment, care plan, and discharge. | VA | The State home must conduct accurate, written, medical and comprehensive assessments of each resident's medical and functional capacity upon admission, annually, and as required by a change in the resident's condition. The comprehensive assessment will use information from the medical assessment, and both assessments will inform the comprehensive care plan. The State home must have a written policy to determine how to coordinate and complete the comprehensive assessment process, including how it will review, and revise the comprehensive assessment in implementing the comprehensive care plan. The State home must review comprehensive assessments annually, and promptly after every significant change in the resident's physical, mental, or social condition. (a) Admission orders and medical assessment. At the time each resident is admitted, the State home must have physician orders for the resident's immediate care. A medical assessment, including a medical history and physical examination, must be performed by a physician, or other health care provider qualified under State law, and recorded in the medical record no later than 7 calendar days after admission, unless one was performed no earlier than 5 calendar days before admission and the findings were recorded in the medical record. The medical assessment will be part of the comprehensive assessment. (b) Comprehensive assessments. (1) The state home must complete a comprehensive assessment of each resident no later than 14 calendar days after admission, annually, and as required by a change in the resident's condition. (2) Each comprehensive assessment must be conducted or coordinated by a registered nurse with the participation of appropriate healthcare professionals, including at least one physician, the registered nurse, and one social worker. The registered nurse must sign and certify the assessment. The comprehensive assessment is to determine the care, treatment, and services that will meet the resident's initial and continuing needs. It is an objective… | |||||
| 38:38:2.0.1.1.20.5.360.3 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | E | Subpart E—Standards Applicable to the Payment of Per Diem for Domiciliary Care | § 51.320 Quality of care. | VA | The State home must provide each resident with the care described in this subpart in accordance with the assessment and comprehensive care plan. (a) Reporting of sentinel events. (1) A sentinel event is an adverse event that results in the loss of life or limb or permanent loss of function. (2) Examples of sentinel events are as follows: (i) Any resident death, paralysis, coma or other major permanent loss of function associated with a medication error; (ii) Any suicide of a resident; (iii) Assault, homicide or other crime resulting in resident death or major permanent loss of function; or (iv) A resident fall that results in death or major permanent loss of function as a direct result of the injuries sustained in the fall. (3) The State home must report sentinel events to the Director no later than 24 hours after identification. The VA medical center of jurisdiction must report sentinel events by notifying the VA Network Director (10N1-10N22) and the Director, Office of Geriatrics and Extended Care—Operations (10NC4) no later than 24 hours after notification. (4) The State home must establish a mechanism to review and analyze a sentinel event resulting in a written report to be submitted to the VA Medical Center of jurisdiction no later than 10 working days following the event. The purpose of the review and analysis of a sentinel event is to prevent injuries to residents, visitors, and personnel, and to manage those injuries that do occur and to minimize the negative consequences to the injured individuals and the State home. (b) Activities of daily living. Based on the comprehensive assessment of a resident, the State home must ensure that a resident's abilities in activities of daily living do not diminish unless circumstances of the individual's clinical condition demonstrate that diminution was unavoidable, and the resident is given appropriate treatment and services to maintain or improve his activities of daily living. This includes the resident's ability to: (1) Bathe, dress, and groom; (2)… | |||||
| 38:38:2.0.1.1.20.5.360.4 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | E | Subpart E—Standards Applicable to the Payment of Per Diem for Domiciliary Care | § 51.330 Nursing care. | VA | The State home must provide an organized nursing service with a sufficient number of qualified nursing personnel to meet the total nursing care needs of all residents within the facility, 24 hours a day, 7 days a week, as determined by their comprehensive assessments and their comprehensive care plans. The nursing service must be under the direction of a full-time registered nurse who is currently licensed by the State and has, in writing, administrative authority, responsibility, and accountability for the functions, activities, and training of the nursing service's staff. | |||||
| 38:38:2.0.1.1.20.5.360.5 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | E | Subpart E—Standards Applicable to the Payment of Per Diem for Domiciliary Care | § 51.340 Physician and other licensed medical practitioner services. | VA | The State home must provide its residents the primary care necessary to enable them to attain or maintain the highest practicable physical, mental, and psychosocial well-being. When a resident needs care other than the State home is required to provide under this subpart, the State home is responsible to assist the resident to obtain that care. The State home must ensure that a physician personally approves in writing a recommendation that an individual be admitted to a domiciliary. Each resident must remain at all times under the care of a licensed medical practitioner assigned by the State home. The name of the practitioner will be listed in the resident's medical record. The State home must ensure that all of the following conditions in paragraphs (a) through (e) of this section are met: (a) Supervision of medical practitioners. Any licensed medical practitioner who is not a physician may provide medical care to a resident within the practitioner's scope of practice without physician supervision when permitted by State law. (b) Availability of medical practitioners. If the resident's assigned licensed medical practitioner is unavailable, another licensed medical practitioner must be available to provide care for that resident. (c) Visits. The primary care physician or other licensed medical practitioner, for each visit required by paragraph (d) of this section, must (1) Review the resident's total program of care, including medications and treatments; (2) Write, sign, and date progress notes; and (3) Sign and date all orders. (d) Frequency of visits. The primary care physician or other licensed medical practitioner must conduct an in-person medical assessment of the resident at least once a calendar year, or more frequently based on the resident's condition. (e) Availability of emergency care. The State home must assist residents in obtaining emergency care. | |||||
| 38:38:2.0.1.1.20.5.360.6 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | E | Subpart E—Standards Applicable to the Payment of Per Diem for Domiciliary Care | § 51.350 Provision of certain specialized services and environmental requirements. | VA | The State home domiciliary care programs must comply with the requirements of § 51.140, except § 51.140(f)(2) through (4) concerning dietary services; § 51.170 concerning dental services; § 51.180, except § 51.180(c) concerning pharmacy services; § 51.190 concerning infection control; and § 51.200, except § 51.200(a), (b), (d)(1)(ii) through (x), (f), and (h)(3) concerning the physical environment. For purposes of this section, the references to “facility” in the cited sections also refer to a domiciliary. (a) Dietary services. (1) There must be no more than 14 hours between a substantial evening meal and the availability of breakfast the following day, except as provided in (a)(3) of this section. (2) The facility staff must offer snacks at bedtime daily. (3) Sixteen hours may elapse between a substantial evening meal and breakfast the following day when a nourishing snack is offered at bedtime. (b) Pharmacy services. (1) The drug regimen of each resident must be reviewed at least once every six months by a licensed pharmacist. (2) The pharmacist must report any irregularities to the primary care physician and the director of nursing, and these reports must be acted upon. (c) Life safety from fire. The facility must meet the applicable requirements of the National Fire Protection Association's NFPA 101, Life Safety Code, as incorporated by reference in § 51.200. (d) Privacy. The facility must provide the means for visual privacy for each resident. | |||||
| 38:38:2.0.1.1.20.5.360.7 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | E | Subpart E—Standards Applicable to the Payment of Per Diem for Domiciliary Care | § 51.390 Administration. | VA | The State home must follow § 51.210 regarding administration in providing domiciliary care. For purposes of this section, the references in the cited section to nursing home and nursing home care refer to a domiciliary and domiciliary care. | |||||
| 38:38:2.0.1.1.20.6.360.1 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | F | Subpart F—Standards Applicable to the Payment of per Diem for Adult Day Health Care | § 51.400 Participant rights. | VA | The State home must protect and promote the rights of a participant in an adult day health care program, including the rights set forth in § 51.70, except for the right set forth in § 51.70(m). For purposes of this section, the references to resident in the cited section also refer to a participant in this section. | |||||
| 38:38:2.0.1.1.20.6.360.10 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | F | Subpart F—Standards Applicable to the Payment of per Diem for Adult Day Health Care | § 51.440 Dietary services. | VA | The State home must comply with the requirements concerning the dietary services set forth in § 51.140, except paragraph 51.140(f). For purposes of this section, the references in the cited section to resident refer to a participant in subpart F of this part. The State home adult day health care program will provide nourishment to participants on the following schedule: (a) At regular times comparable to normal mealtimes in the community, each participant may receive and program management must provide at least two meals daily for those veterans staying more than four hours and at least one meal for those staying less than four hours. (b) The program management must offer snacks and fluids as appropriate to meet the participants' nutritional and fluid needs. | |||||
| 38:38:2.0.1.1.20.6.360.11 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | F | Subpart F—Standards Applicable to the Payment of per Diem for Adult Day Health Care | § 51.445 Physician services. | VA | As a condition of enrollment in adult day health care program, a participant must have a written physician order for admission. Each participant's medical record must contain the name of the participant's primary care physician. If a participant's medical needs require that the participant be placed in an adult day health care program that offers medical supervision, the primary care physician must state so in the order for admission. Each participant must remain under the care of a physician. (a) Physician supervision. If the adult day health care program offers medical supervision, the program management must ensure that (1) The medical care of each participant is supervised by a primary care physician; and (2) Another physician is available to supervise the medical care of participants when their primary care physician is unavailable. (b) Frequency of physician reviews. If the adult day health care program offers medical supervision: (1) The participant must be seen by the primary care physician at least annually and as indicated by a change of condition. (2) The program management must have a policy to help ensure that adequate medical services are provided to the participant. (3) At the option of the primary care physician, required reviews in the program after the initial review may alternate between personal physician reviews and reviews by a physician assistant, nurse practitioner, or clinical nurse specialist in accordance with paragraph (e) of this section. (c) Availability of acute care. If the adult day health care program offers medical supervision, the program management must provide or arrange for the provision of acute care when it is indicated. (d) Availability of physicians for emergency care. In case of an emergency, the program management must ensure that participants are able to obtain necessary emergency care. (e) Physician delegation of tasks. (1) A primary care physician may delegate tasks to (i) A certified physician assistant or a certified nurse practitioner, or (i… | |||||
| 38:38:2.0.1.1.20.6.360.12 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | F | Subpart F—Standards Applicable to the Payment of per Diem for Adult Day Health Care | § 51.450 Specialized rehabilitative services. | VA | (a) Provision of services. If specialized rehabilitative services such as, but not limited to, physical therapy, speech therapy, occupational therapy, and mental health services for mental illness are required in the participant's comprehensive care plan, program management must (1) Provide the required services; or (2) Obtain the required services and equipment from an outside resource, in accordance with § 51.210(h), from a provider of specialized rehabilitative services. (b) Written order. Specialized rehabilitative services must be provided under the written order of a physician by qualified personnel. | |||||
| 38:38:2.0.1.1.20.6.360.13 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | F | Subpart F—Standards Applicable to the Payment of per Diem for Adult Day Health Care | § 51.455 Dental services. | VA | (a) If the adult day health care program offers medical supervision, program management must, if necessary, assist the participant and family/caregiver (1) In making dental appointments; and (2) By arranging for transportation to and from the dental services. (b) If the adult day health care program offers medical supervision, program management must promptly assist and refer participants with lost or damaged dentures to a dentist. | |||||
| 38:38:2.0.1.1.20.6.360.14 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | F | Subpart F—Standards Applicable to the Payment of per Diem for Adult Day Health Care | § 51.460 Administration of drugs. | VA | If the adult day health care program offers medical supervision, the program management must assist participants with the management of medication and have a system for disseminating drug information to participants and program staff in accordance with this section. (a) Procedures. The State home must (1) Provide reminders or prompts to participants to initiate and follow through with self-administration of medications. (2) Establish a system of records to document the administration of drugs by participants and/or staff. (3) Ensure that drugs and biologicals used by participants are labeled in accordance with currently accepted professional principles, and include the appropriate accessory and cautionary instructions, and the expiration dates when applicable. (4) Store all drugs, biologicals, and controlled schedule II drugs listed in 21 CFR 1308.12 in locked compartments under proper temperature controls, permit only authorized personnel to have access, and otherwise comply with all applicable State and Federal laws. (b) Service consultation. The State home must provide the services of a pharmacist licensed in the State in which the program is located who provides consultation, as needed, on all the provision of drugs. | |||||
| 38:38:2.0.1.1.20.6.360.15 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | F | Subpart F—Standards Applicable to the Payment of per Diem for Adult Day Health Care | § 51.465 Infection control. | VA | The State home must meet the requirements concerning infection control set forth in § 51.190. For purposes of this section, the references in the cited section to resident refer to a participant in this section. | |||||
| 38:38:2.0.1.1.20.6.360.16 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | F | Subpart F—Standards Applicable to the Payment of per Diem for Adult Day Health Care | § 51.470 Physical environment. | VA | The State home must ensure that the physical environment is designed, constructed, equipped, and maintained to protect the health and safety of participants, personnel, and the public. (a) Life safety from fire. The State home must meet the applicable requirements of National Fire Protection Association's NFPA 101, Life Safety from fire, as incorporated by reference in § 51.200. (b) Space and equipment. (1) The State home must— (i) Provide sufficient space and equipment in dining, health services, recreation, and program areas to enable staff to provide participants with needed services as required by this subpart F and as identified in each participant's comprehensive care plan; and (ii) Maintain all essential mechanical, electrical, and patient care equipment in safe operating condition. (2) Each adult day health care program, when it is co-located in a nursing home, domiciliary, or other care facility, must have its own separate designated space during operational hours. (3) The indoor space for adult day health care must be at least 100 square feet per participant including office space for staff and must be 60 square feet per participant excluding office space for staff. (4) Each program of care will need to design and partition its space to meet its needs, but the following functional areas must be available: (i) A dividable multipurpose room or area for group activities, including dining, with adequate table-setting space. (ii) Rehabilitation rooms or an area for individual and group treatments for occupational therapy, physical therapy, and other treatment modalities. (iii) A kitchen area for refrigerated food storage, the preparation of meals and/or training participants in activities of daily living. (iv) An examination and/or medication room. (v) A quiet room (with a bed or a reclining chair), which functions to separate participants who become ill or disruptive, or who require rest, privacy, or observation. It should be separate from activity areas, near a restroom, and supervised. (v… | |||||
| 38:38:2.0.1.1.20.6.360.17 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | F | Subpart F—Standards Applicable to the Payment of per Diem for Adult Day Health Care | § 51.475 Administration. | VA | For purposes of this section, the references in the cited section to nursing home and nursing home care refer to adult day health care programs and adult day health care. The State home must comply with all administration requirements set forth in § 51.210 except for the following if the adult day health care program does not offer medical supervision: (a) Medical director. State home adult day health care programs are not required to designate a primary care physician to serve as a medical director, and therefore are not required to comply with § 51.210(i). (b) Laboratory services, radiology, and other diagnostic services. State home adult day health care programs are not required to provide the medical services identified in § 51.210(m) and (n). (c) Quality assessment and assurance committee. State home adult day health care programs are not required to comply with § 51.210(p), regarding quality assessment and assurance committees consisting of specified medical providers and staff. | |||||
| 38:38:2.0.1.1.20.6.360.18 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | F | Subpart F—Standards Applicable to the Payment of per Diem for Adult Day Health Care | § 51.480 Transportation. | VA | Transportation of participants to and from the adult day health care facility must be a component of the overall program of care. (a)(1) Except as provided in paragraph (a)(2) of this section, the State home must provide for transportation to enable participants, including persons with disabilities, to attend the program and to participate in State home-sponsored outings. (2) The veteran or the family of a veteran may decline transportation offered by the adult day health care program and make their own arrangements for transportation. (b) The State home must have a transportation policy that includes procedures for routine and emergency transportation. All transportation (including that provided under contract) must be in compliance with such procedures. (c) The State home must ensure that the transportation it provides is by drivers who have access to a device for two-way communication. (d) All systems and vehicles used by the State home to comply with this section must meet all applicable local, State and Federal regulations. (e) The State home must ensure that the care needs of each participant are addressed during transportation furnished by the home. | |||||
| 38:38:2.0.1.1.20.6.360.2 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | F | Subpart F—Standards Applicable to the Payment of per Diem for Adult Day Health Care | § 51.405 Participant and family caregiver responsibilities. | VA | The State home must post a written statement of participant and family caregiver responsibilities in a place where participants in the adult day health care program and their families will see it and must provide a copy to the participant and caregiver at or before the time of the intake screening. The statement of responsibilities must include the following: (a) Treat personnel with respect and courtesy; (b) Communicate with staff to develop a relationship of trust; (c) Make appropriate choices and seek appropriate care; (d) Ask questions and confirm your understanding of instructions; (e) Share opinions, concerns, and complaints with the program director; (f) Communicate any changes in the participant's condition; (g) Communicate to the program director about medications and remedies used by the participant; (h) Let the program director know if the participant decides not to follow any instructions or treatment; and (i) Communicate with the adult day health care staff if the participant is unable to attend adult day health care. | |||||
| 38:38:2.0.1.1.20.6.360.3 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | F | Subpart F—Standards Applicable to the Payment of per Diem for Adult Day Health Care | § 51.410 Transfer and discharge. | VA | (a) Definition. For purposes of this section, the term “transfer or discharge” includes movement of a participant to a program outside of the adult day health care program whether or not the program of care is in the same facility. (b) Transfer and discharge requirements. At the time of intake screening, the State home must discuss the possible reasons for transfer or discharge with the participant and, to the extent practicable and appropriate, with family members (subject to the consent of the participant) or the participant's legal representatives. In the case of a transfer and discharge to a hospital, the transfer and discharge must be to the hospital closest to the adult day health care facility that can provide the necessary care. The State home must permit each participant to remain in the program of care, and not transfer or discharge the participant from the program of care unless: (1) The transfer and discharge is necessary for the participant's welfare and the participant's needs cannot be met in the adult day health care setting; (2) The transfer and discharge is appropriate because the participant's health has improved sufficiently so that the participant no longer needs the services provided in the adult day health care program; (3) The safety of individuals in the facility is endangered; (4) The health of individuals in the facility would otherwise be endangered; (5) The participant has failed, after reasonable and appropriate notice, to pay for participation in the adult day health care program; or (6) The adult day health care program ceases to operate. (c) Notice before transfer or discharge. Before an adult day health care program undertakes the transfer or discharge of a participant, the State home must: (1) Notify the resident of the transfer or discharge and the reasons for the move in writing and in a language and manner he or she understands. The resident has the right to decide whether to have the State home notify his or her legal representative or interested family member… | |||||
| 38:38:2.0.1.1.20.6.360.4 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | F | Subpart F—Standards Applicable to the Payment of per Diem for Adult Day Health Care | § 51.411 Program practices. | VA | (a) Equal access to quality care. The State home must establish and maintain identical policies and practices regarding transfer and discharge under § 51.410 and the provision of services for all participants regardless of the source of payment. (b) Admission policy. The State home must not require a third-party guarantee of payment as a condition of admission or expedited admission, or continued admission in the program of care. However, the State home may require a participant or an individual who has legal access to a participant's income or resources to pay for the care from the participant's income or resources, when available. (c) Hours of operation. Each adult day health care program must provide at least 8 hours of operation 5 days a week. The hours of operation must be flexible and responsive to caregiver needs. | |||||
| 38:38:2.0.1.1.20.6.360.5 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | F | Subpart F—Standards Applicable to the Payment of per Diem for Adult Day Health Care | § 51.415 Restraints, abuse, and staff treatment of participants. | VA | The State home must meet the requirements regarding the use of restraints, abuse, and other matters concerning staff treatment of participants set forth in § 51.90. For purposes of this section, the references in the cited section to resident refer to a participant in this section. | |||||
| 38:38:2.0.1.1.20.6.360.6 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | F | Subpart F—Standards Applicable to the Payment of per Diem for Adult Day Health Care | § 51.420 Quality of life. | VA | The State home must provide an environment that supports the quality of life of each participant by maximizing the participant's potential strengths and skills. (a) Dignity. The State home must promote care for participants in a manner and in an environment that maintains or enhances each participant's dignity and respect in full recognition of his or her individuality. (b) Self-determination and participation. The State home must ensure that the participant has the right to: (1) Choose activities, schedules, and health care consistent with his or her interests, assessments, and plans of care; (2) Interact with members of the community both inside and outside the facility; and (3) Make choices about aspects of his or her life in the facility that are significant to the participant. (c) Participant and family concerns. The State home must document any concerns submitted to the management of the program by participants or their family members. (1) A participant's family has the right to meet with families of other participants in the program. (2) Staff or visitors may attend meetings of participant or family groups at the group's invitation. (3) The State home must respond to written requests that result from group meetings. (4) The State home must listen to the views of any participant or family group and act upon the concerns of participants and families regarding policy and operational decisions affecting participant care in the program. (d) Participation in other activities. The State home must ensure that a participant has the right to participate in social, religious, and community activities that do not interfere with the rights of other participants in the program. (e) Therapeutic participant activities. (1) The State home must provide for an ongoing program of activities designed to meet, in accordance with the comprehensive assessment, the interests and the physical, mental, and psychosocial well-being of each participant. (2) The activities program must be directed by a qualified p… | |||||
| 38:38:2.0.1.1.20.6.360.7 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | F | Subpart F—Standards Applicable to the Payment of per Diem for Adult Day Health Care | § 51.425 Physician orders and participant medical assessment. | VA | The State home must have a written policy to determine how to coordinate and complete the written initial and comprehensive assessment processes upon admission, annually, and as required by a change in the participant's condition. The State home must also outline in its policy how it will complete, implement, review, and revise the assessments. (a) Admission. At the time each participant is admitted, the State home must have physician orders for the participant's immediate care. An initial medical assessment including a medical history and physical examination with documentation of tuberculosis screening must be completed by a physician or other health care provider qualified under State law no earlier than 30 calendar days before admission and no later than 7 calendar days after admission. The findings must be recorded in the participant's medical record. (b) Comprehensive assessments. The State home must complete the comprehensive assessment no later than 14 calendar days after admission. The State home must develop a comprehensive care plan for each participant based on his or her comprehensive assessment. The State home must review comprehensive assessments annually, as well as promptly after every significant change in the participant's physical, mental, or social condition. The State home must immediately change the participant's comprehensive care plan after a significant change is identified. At minimum, the written comprehensive assessment must address the following: (1) Ability to ambulate, (2) Ability to use bathroom facilities, (3) Ability to eat and swallow, (4) Ability to hear, (5) Ability to see, (6) Ability to experience feeling and movement, (7) Ability to communicate, (8) Risk of wandering, (9) Risk of elopement, (10) Risk of suicide, (11) Risk of deficiencies regarding social interactions, and (12) Special needs (such as medication, diet, nutrition, hydration, or prosthetics). (c) Coordination of assessments. (1) Each initial and subsequent comprehensive assessment must be … | |||||
| 38:38:2.0.1.1.20.6.360.8 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | F | Subpart F—Standards Applicable to the Payment of per Diem for Adult Day Health Care | § 51.430 Quality of care. | VA | Each participant must receive, and the State home must provide, the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and comprehensive care plan. (a) Reporting of sentinel events —(1) Definition. A “sentinel event” is defined in § 51.120(a)(1). (2) Duty to report sentinel events. The State home must comply with the duties to report sentinel events as set forth in § 51.120(a)(3), except that the duty to report applies only to a sentinel event that occurs while the participant is under the care of the State home, including while in State home-provided transportation. (3) Review and prevention of sentinel events. The State home must establish a mechanism to review and analyze a sentinel event resulting in a written report to be submitted to the VA Medical Center of jurisdiction no later than 10 working days after the event. The purpose of the review and analysis of a sentinel event is to prevent future injuries to participants, visitors, and personnel. (b) Activities of daily living. Based on the comprehensive assessment of a participant, the State home must ensure that: (1) No diminution in activities of daily living. A participant's abilities in activities of daily living do not diminish unless the circumstances of the individual's clinical condition demonstrate that diminution was unavoidable. This includes the participant's ability to (i) Bathe, dress, and groom; (ii) Transfer and ambulate; (iii) Toilet; and (iv) Eat. (2) Appropriate treatment and services given. A participant is given the appropriate treatment and services to maintain or improve his or her abilities specified in paragraph (b)(1) of this section. (3) Necessary services provided to participant unable to carry out activities of daily living. A participant who is unable to carry out activities of daily living receives the necessary services to maintain good nutrition, hydration, grooming, personal and ora… | |||||
| 38:38:2.0.1.1.20.6.360.9 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 51 | PART 51—PER DIEM FOR NURSING HOME, DOMICILIARY, OR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES | F | Subpart F—Standards Applicable to the Payment of per Diem for Adult Day Health Care | § 51.435 Nursing services. | VA | The State home must provide an organized nursing service with a sufficient number of qualified nursing personnel to meet the total nursing care needs, as determined by participant assessments and individualized comprehensive care plans, of all participants in the program. (a) There must be at least one registered nurse on duty each day of operation of the adult day health care program. This nurse must be currently licensed by the State and must have, in writing, administrative authority, responsibility, and accountability for the functions, activities, and training of the nursing and program assistants. (b) The number and level of nursing staff is determined by the authorized capacity of participants and the nursing care needs of the participants. (c) Nurse staffing must be adequate for meeting the standards of this part. |
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title_number INTEGER,
title_name TEXT,
chapter TEXT,
subchapter TEXT,
part_number TEXT,
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