
From the U.S. Code Online via GPO Access
[wais.access.gpo.gov]
[Laws in effect as of January 23, 2000]
[Document affected by Public Law 107-103 Section 509(b)]
[Document affected by Public Law 107-14 Section 8(a)(16)]
[Document affected by Public Law 107-14 Section 8(a)(2)]
[CITE: 38USC1710B]

 
                      TITLE 38--VETERANS' BENEFITS
 
                        PART II--GENERAL BENEFITS
 
    CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE
 
 SUBCHAPTER II--HOSPITAL, NURSING HOME, OR DOMICILIARY CARE AND MEDICAL 
                                TREATMENT
 
Sec. 1710B. Extended care services

    (a) The Secretary (subject to section 1710(a)(4) of this title and 
subsection (c) of this section) shall operate and maintain a program to 
provide extended care services to eligible veterans in accordance with 
this section. Such services shall include the following:
        (1) Geriatric evaluation.
        (2) Nursing home care (A) in facilities operated by the 
    Secretary, and (B) in community-based facilities through contracts 
    under section 1720 of this title.
        (3) Domiciliary services under section 1710(b) of this title.
        (4) Adult day health care under section 1720(f) of this title.
        (5) Such other noninstitutional alternatives to nursing home 
    care as the Secretary may furnish as medical services under section 
    1701(10) of this title.
        (6) Respite care under section 1720B of this title.

    (b) The Secretary shall ensure that the staffing and level of 
extended care services provided by the Secretary nationally in 
facilities of the Department during any fiscal year is not less than the 
staffing and level of such services provided nationally in facilities of 
the Department during fiscal year 1998.
    (c)(1) Except as provided in paragraph (2), the Secretary may not 
furnish extended care services for a non-service-connected disability 
other than in the case of a veteran who has a compensable service-
connected disability unless the veteran agrees to pay to the United 
States a copayment (determined in accordance with subsection (d)) for 
any period of such services in a year after the first 21 days of such 
services provided that veteran in that year.
    (2) Paragraph (1) shall not apply--
        (A) to a veteran whose annual income (determined under section 
    1503 of this title) is less than the amount in effect under section 
    1521(b) of this title; or
        (B) with respect to an episode of extended care services that a 
    veteran is being furnished by the Department on the date of the 
    enactment of the Veterans Millennium Health Care and Benefits Act.

    (d)(1) A veteran who is furnished extended care services under this 
chapter and who is required under subsection (c) to pay an amount to the 
United States in order to be furnished such services shall be liable to 
the United States for that amount.
    (2) In implementing subsection (c), the Secretary shall develop a 
methodology for establishing the amount of the copayment for which a 
veteran described in subsection (c) is liable. That methodology shall 
provide for--
        (A) establishing a maximum monthly copayment (based on all 
    income and assets of the veteran and the spouse of such veteran);
        (B) protecting the spouse of a veteran from financial hardship 
    by not counting all of the income and assets of the veteran and 
    spouse (in the case of a spouse who resides in the community) as 
    available for determining the copayment obligation; and
        (C) allowing the veteran to retain a monthly personal allowance.

    (e)(1) There is established in the Treasury of the United States a 
revolving fund known as the Department of Veterans Affairs Extended Care 
Fund (hereafter in this section referred to as the ``fund''). Amounts in 
the fund shall be available, without fiscal year limitation and without 
further appropriation, exclusively for the purpose of providing extended 
care services under subsection (a).
    (2) All amounts received by the Department under this section shall 
be deposited in or credited to the fund.

(Added Pub. L. 106-117, title I, Sec. 101(c)(1), Nov. 30, 1999, 113 
Stat. 1548.)

                       References in Text

    The date of the enactment of the Veterans Millennium Health Care and 
Benefits Act, referred to in subsec. (c)(2)(B), is the date of enactment 
of Pub. L. 106-117, which was approved Nov. 30, 1999.


                             Effective Date

    Pub. L. 106-117, title I, Sec. 101(h), Nov. 30, 1999, 113 Stat. 
1550, provided that:
    ``(1) Except as provided in paragraph (2), the amendments made by 
this section [enacting this section and section 1710A of this title and 
amending sections 1701, 1710, 1720, 1720B and 1741 of this title] shall 
take effect on the date of the enactment of this Act [Nov. 30, 1999].
    ``(2) Subsection (c) of section 1710B of title 38, United States 
Code (as added by subsection (b)), shall take effect on the effective 
date of regulations prescribed by the Secretary of Veterans Affairs 
under subsections (c) and (d) of such section. The Secretary shall 
publish the effective date of such regulations in the Federal Register.
    ``(3) The provisions of section 1710(f) of title 38, United States 
Code, shall not apply to any day of nursing home care on or after the 
effective date of regulations under paragraph (2).''


                Pilot Programs Relating to Long-Term Care

    Pub. L. 106-117, title I, Sec. 102, Nov. 30, 1999, 113 Stat. 1551, 
provided that:
    ``(a) Pilot Programs.--The Secretary [of Veterans Affairs] shall 
carry out three pilot programs for the purpose of determining the 
effectiveness of different models of all-inclusive care-delivery in 
reducing the use of hospital and nursing home care by frail, elderly 
veterans.
    ``(b) Locations of Pilot Programs.--In selecting locations in which 
the pilot programs will be carried out, the Secretary may not select 
more than one location in any given health care region of the Veterans 
Health Administration.
    ``(c) Scope of Services Under Pilot Programs.--Each of the pilot 
programs under this section shall be designed to provide participating 
veterans with integrated, comprehensive services which include the 
following:
        ``(1) Adult-day health care services on an eight-hour per day, 
    five-day per week basis.
        ``(2) Medical services (including primary care, preventive 
    services, and nursing home care, as needed).
        ``(3) Coordination of needed services.
        ``(4) Transportation services.
        ``(5) Home care services.
        ``(6) Respite care.
    ``(d) Program Requirements.--In carrying out the pilot programs 
under this section, the Secretary shall--
        ``(1) employ the use of interdisciplinary care-management teams 
    to provide the required array of services;
        ``(2) determine the appropriate number of patients to be 
    enrolled in each program and the criteria for enrollment; and
        ``(3) ensure that funding for each program is based on the 
    complex care category under the resource allocation system (known as 
    the Veterans Equitable Resource Allocation system) established 
    pursuant to section 429 of Public Law 104-204 (110 Stat. 2929).
    ``(e) Design of Pilot Programs.--To the maximum extent feasible, the 
Secretary shall use the following three models in designing the three 
pilot programs under this section:
        ``(1) Under one of the pilot programs, the Secretary shall 
    provide services directly through facilities and personnel of the 
    Department [of Veterans Affairs].
        ``(2) Under one of the pilot programs, the Secretary shall 
    provide services through a combination of--
            ``(A) services provided under contract with appropriate 
        public and private entities; and
            ``(B) services provided through facilities and personnel of 
        the Department.
        ``(3) Under one of the pilot programs, the Secretary shall 
    arrange for the provision of services through a combination of--
            ``(A) services provided through cooperative arrangements 
        with appropriate public and private entities; and
            ``(B) services provided through facilities and personnel of 
        the Department.
    ``(f) In-Kind Assistance.--In providing for the furnishing of 
services under a contract in carrying out the pilot program described in 
subsection (e)(2), the Secretary may, subject to reimbursement, provide 
in-kind assistance (through the services of Department employees and the 
sharing of other Department resources) to a facility furnishing care to 
veterans. Such reimbursement may be made by reduction in the charges to 
the Secretary under such contract.
    ``(g) Limitation.--In providing for the furnishing of services in 
carrying out a pilot program described in subsection (e)(2) or (e)(3), 
the Secretary shall make payment for services only to the extent that 
payment for such services is not otherwise covered (notwithstanding any 
provision of title XVIII or XIX of the Social Security Act [42 U.S.C. 
1395 et seq., 1396 et seq.]) by another government or nongovernment 
entity or program.
    ``(h) Duration of Programs.--The authority of the Secretary to 
provide services under a pilot program under this section shall cease on 
the date that is three years after the date of the commencement of that 
pilot program.
    ``(i) Report.--(1) Not later than nine months after the completion 
of all of the pilot programs under this section, the Secretary shall 
submit to the Committees on Veterans' Affairs of the Senate and the 
House of Representatives a report on those programs.
    ``(2) The report shall include the following:
        ``(A) A description of the implementation and operation of each 
    such program.
        ``(B) An analysis comparing use of institutional care and use of 
    other services among enrollees in each of the pilot programs with 
    the experience of comparable patients who are not enrolled in one of 
    the pilot programs.
        ``(C) An assessment of the satisfaction of participating 
    veterans with each of those programs.
        ``(D) An assessment of the health status of participating 
    veterans in each of those programs and of the ability of those 
    veterans to function independently.
        ``(E) An analysis of the costs and benefits under each of those 
    programs.''


                Pilot Program Relating to Assisted Living

    Pub. L. 106-117, title I, Sec. 103, Nov. 30, 1999, 113 Stat. 1552, 
provided that:
    ``(a) Program Authority.--The Secretary [of Veterans Affairs] may 
carry out a pilot program for the purpose of determining the feasibility 
and practicability of enabling eligible veterans to secure needed 
assisted living services as an alternative to nursing home care.
    ``(b) Location of Pilot Program.--The pilot program shall be carried 
out in a designated health care region of the Department [of Veterans 
Affairs] selected by the Secretary for purposes of this section.
    ``(c) Scope of Program.--In carrying out the pilot program, the 
Secretary may enter into contracts with appropriate facilities for the 
provision for a period of up to six months of assisted living services 
on behalf of eligible veterans in the region where the program is 
carried out.
    ``(d) Eligible Veterans.--A veteran is an eligible veteran for 
purposes of this section if the veteran--
        ``(1) is eligible for placement assistance by the Secretary 
    under section 1730(a) of title 38, United States Code;
        ``(2) is unable to manage routine activities of daily living 
    without supervision and assistance; and
        ``(3) could reasonably be expected to receive ongoing services 
    after the end of the contract period under another government 
    program or through other means.
    ``(e) Report.--(1) Not later than 90 days before the end of the 
pilot program under this section, the Secretary shall submit to the 
Committees on Veterans' Affairs of the Senate and the House of 
Representatives a report on the program.
    ``(2) The report under paragraph (1) shall include the following:
        ``(A) A description of the implementation and operation of the 
    program.
        ``(B) An analysis comparing use of institutional care among 
    participants in the program with the experience of comparable 
    patients who are not enrolled in the program.
        ``(C) A comparison of assisted living services provided by the 
    Department through the pilot program with domiciliary care provided 
    by the Department.
        ``(D) The Secretary's recommendations, if any, regarding an 
    extension of the program.
    ``(f) Duration.--The authority of the Secretary to provide services 
under the pilot program shall cease on the date that is three years 
after the date of the commencement of the pilot program.
    ``(g) Definition.--For purposes of this section, the term `assisted 
living services' means services in a facility that provides room and 
board and personal care for and supervision of residents as necessary 
for the health, safety, and welfare of residents.
    ``(h) Standards.--The Secretary may not enter into a contract with a 
facility under this section unless the facility meets the standards 
established in regulations prescribed under section 1730 of title 38, 
United States Code.''

                  Section Referred to in Other Sections

    This section is referred to in sections 1710, 1741 of this title.
