
From the U.S. Code Online via GPO Access
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[Laws in effect as of January 23, 2000]
[Document not affected by Public Laws enacted between
  January 23, 2000 and December 4, 2001]
[CITE: 38USC1720]

 
                      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. 1720. Transfers for nursing home care; adult day health 
        care
        
    (a)(1) Subject to subsection (b) of this section, the Secretary may 
transfer to a non-Department nursing home, for care at the expense of 
the United States--
        (A) a veteran--
            (i) who has been furnished care by the Secretary in a 
        facility under the direct jurisdiction of the Secretary; and
            (ii) who the Secretary determines--
                (I) requires a protracted period of nursing home care 
            which can be furnished in the non-Department nursing home; 
            and
                (II) in the case of a veteran who has been furnished 
            hospital care in a facility under the direct jurisdiction of 
            the Secretary, has received maximum benefits from such care; 
            and

        (B) a member of the Armed Forces--
            (i) who has been furnished care in a hospital of the Armed 
        Forces;
            (ii) who the Secretary concerned determines has received 
        maximum benefits from such care but requires a protracted period 
        of nursing home care; and
            (iii) who upon discharge from the Armed Forces will become a 
        veteran.

    (2) The Secretary may transfer a person to a nursing home under this 
subsection only if the Secretary determines that the cost to the United 
States of the care of such person in the nursing home will not exceed--
        (A) the amount equal to 45 percent of the cost of care furnished 
    by the Department in a general hospital under the direct 
    jurisdiction of the Secretary (as such cost may be determined 
    annually by the Secretary); or
        (B) the amount equal to 50 percent of such cost, if such higher 
    amount is determined to be necessary by the Secretary (upon the 
    recommendation of the Under Secretary for Health) to provide 
    adequate care.

    (3) Nursing home care may not be furnished under this subsection at 
the expense of the United States for more than six months in the 
aggregate in connection with any one transfer except--
        (A) in the case of a veteran--
            (i) who is transferred to a non-Department nursing home from 
        a hospital under the direct jurisdiction of the Secretary; and
            (ii) whose hospitalization was primarily for a service-
        connected disability;

        (B) in a case in which the nursing home care is required for a 
    service-connected disability; or
        (C) in a case in which, in the judgment of the Secretary, a 
    longer period of nursing home care is warranted.

    (4) A veteran who is furnished care by the Secretary in a hospital 
or domiciliary facility in Alaska or Hawaii may be furnished nursing 
home care at the expense of the United States under this subsection even 
if such hospital or domiciliary facility is not under the direct 
jurisdiction of the Secretary.
    (b) No veteran may be transferred or admitted to any institution for 
nursing home care under this section, unless such institution is 
determined by the Secretary to meet such standards as the Secretary may 
prescribe. The standards prescribed and any report of inspection of 
institutions furnishing care to veterans under this section made by or 
for the Secretary shall, to the extent possible, be made available to 
all Federal, State, and local agencies charged with the responsibility 
of licensing or otherwise regulating or inspecting such institutions.
    (c) In applying the provisions of section 2(b)(1) of the Service 
Contract Act of 1965 (41 U.S.C. 351(b)(1)) with respect to any contract 
entered into under this section to provide nursing home care of 
veterans, the payment of wages not less than those specified in section 
6(b) of the Fair Labor Standards Act of 1938 (29 U.S.C. 206(b)) shall be 
deemed to constitute compliance with such provisions.
    (d)(1) Subject to subsection (b) of this section, the Secretary may 
authorize for any veteran requiring nursing home care for a service-
connected disability direct admission for such care at the expense of 
the United States to any non-Department nursing home. The Secretary may 
also authorize a direct admission to such a nursing home for nursing 
home care for any veteran who has been discharged from a hospital under 
the direct jurisdiction of the Secretary and who is currently receiving 
medical services as part of home health services from the Department.
    (2) Direct admission authorized by paragraph (1) of this subsection 
may be authorized upon determination of need therefor--
        (A) by a physician employed by the Department; or
        (B) in areas where no such physician is available, by a 
    physician carrying out such function under contract or fee 
    arrangement,

based on an examination by such physician.
    (3) The amount which may be paid for such care and the length of 
care available under this subsection shall be the same as authorized 
under subsection (a) of this section.
    (e)(1) The cost of intermediate care for purposes of payment by the 
United States pursuant to subsection (a)(2)(B) of this section shall be 
determined by the Secretary except that the rate of reimbursement shall 
be commensurately less than that provided for nursing home care.
    (2) For the purposes of this section, the term ``non-Department 
nursing home'' means a public or private institution not under the 
direct jurisdiction of the Secretary which furnishes nursing home care.
    (f)(1)(A) The Secretary may furnish adult day health care services 
to a veteran enrolled under section 1705(a) of this title who would 
otherwise require nursing home care.
    (B) The Secretary may provide in-kind assistance (through the 
services of Department employees and the sharing of other Department 
resources) to a facility furnishing care to veterans under subparagraph 
(A) of this paragraph. Any such in-kind assistance shall be provided 
under a contract between the Secretary and the facility concerned. The 
Secretary may provide such assistance only for use solely in the 
furnishing of adult day health care and only if, under such contract, 
the Department receives reimbursement for the full cost of such 
assistance, including the cost of services and supplies and normal 
depreciation and amortization of equipment. Such reimbursement may be 
made by reduction in the charges to the United States or by payment to 
the United States. Any funds received through such reimbursement shall 
be credited to funds allotted to the Department facility that provided 
the assistance.
    (2) The Secretary may conduct, at facilities over which the 
Secretary has direct jurisdiction, programs for the furnishing of adult 
day health care to veterans who are eligible for such care under 
paragraph (1) of this subsection, except that necessary travel and 
incidental expenses (or transportation in lieu thereof) may be furnished 
under such a program only under the terms and conditions set forth in 
section 111 of this title. The furnishing of care under any such program 
shall be subject to the limitations that are applicable to the duration 
of adult day health care furnished under paragraph (1) of this 
subsection.

(Added Pub. L. 88-450, Sec. 2(a), Aug. 19, 1964, 78 Stat. 500, Sec. 620; 
amended Pub. L. 90-429, July 26, 1968, 82 Stat. 446; Pub. L. 90-612, 
Secs. 1, 3, Oct. 21, 1968, 82 Stat. 1202; Pub. L. 91-101, Oct. 30, 1969, 
83 Stat. 167; Pub. L. 93-82, title I, Sec. 104, Aug. 2, 1973, 87 Stat. 
182; Pub. L. 94-581, title I, Sec. 106, title II, Secs. 202(h), 
210(a)(7), Oct. 21, 1976, 90 Stat. 2847, 2856, 2863; Pub. L. 97-295, 
Sec. 4(19), Oct. 12, 1982, 96 Stat. 1306; Pub. L. 98-160, title I, 
Sec. 103(a)(1), (2), Nov. 21, 1983, 97 Stat. 995; Pub. L. 99-166, title 
I, Sec. 108(a)-(c), Dec. 3, 1985, 99 Stat. 946, 947; Pub. L. 99-272, 
title XIX, Sec. 19011(d)(5), Apr. 7, 1986, 100 Stat. 379; Pub. L. 100-
322, title I, Secs. 103(b), 111(a), May 20, 1988, 102 Stat. 493, 499; 
renumbered Sec. 1720 and amended Pub. L. 102-83, Secs. 4(a)(2)(A)(ii), 
(3)-(5), (b)(1), (2)(E), 5(a), (c)(1), Aug. 6, 1991, 105 Stat. 403-406; 
Pub. L. 102-405, title III, Sec. 302(c)(1), Oct. 9, 1992, 106 Stat. 
1984; Pub. L. 104-262, title I, Sec. 101(d)(8), Oct. 9, 1996, 110 Stat. 
3180; Pub. L. 105-114, title IV, Sec. 402(c), Nov. 21, 1997, 111 Stat. 
2294; Pub. L. 106-117, title I, Sec. 101(d), Nov. 30, 1999, 113 Stat. 
1549.)


                            Prior Provisions

    Prior section 1720 was renumbered section 3520 of this title.


                               Amendments

    1999--Subsec. (f)(1)(A). Pub. L. 106-117 amended subpar. (A) 
generally. Prior to amendment, subpar. (A) read as follows: ``The 
Secretary is authorized to furnish adult day health care as provided for 
in this subsection. For the purpose only of authorizing the furnishing 
of such care and specifying the terms and conditions under which it may 
be furnished to veterans needing such care--
        ``(i) references to `nursing home care' in subsections (a) 
    through (d) of this section shall be deemed to be references to 
    `adult day health care'; and
        ``(ii) a veteran who is eligible for medical services under 
    paragraph (1), (2), or (3) of section 1710(a) of this title shall be 
    deemed to be a veteran described in subsection (a)(1) of this 
    section.''
    1997--Subsec. (a)(1)(A)(i). Pub. L. 105-114 substituted ``care'' for 
``hospital care, nursing home care, or domiciliary care''.
    1996--Subsec. (f)(1)(A)(ii). Pub. L. 104-262, Sec. 101(d)(8)(A), 
substituted ``paragraph (1), (2), or (3) of section 1710(a)'' for 
``section 1712(a)(1)(B)''.
    Subsec. (f)(3). Pub. L. 104-262, Sec. 101(d)(8)(B), struck out par. 
(3) which read as follows: ``Adult day health care may not be furnished 
under this section after September 30, 1991.''
    1992--Subsec. (a)(2)(B). Pub. L. 102-405 substituted ``Under 
Secretary for Health'' for ``Chief Medical Director''.
    1991--Pub. L. 102-83, Sec. 5(a), renumbered section 620 of this 
title as this section.
    Subsec. (a). Pub. L. 102-83, Sec. 4(b)(1), (2)(E), substituted 
``Secretary'' for ``Administrator'' wherever appearing in par. (1) 
introductory provisions and subpar. (A) and pars. (2) to (4).
    Pub. L. 102-83, Sec. 4(a)(5), substituted ``non-Department'' for 
``non-Veterans' Administration'' wherever appearing in pars. (1) and 
(3)(A)(i).
    Pub. L. 102-83, Sec. 4(a)(3), (4), substituted ``Department'' for 
``Veterans' Administration'' in par. (2)(A).
    Subsec. (b). Pub. L. 102-83, Sec. 4(b)(1), (2)(E), substituted 
``Secretary'' for ``Administrator'' wherever appearing.
    Subsec. (d)(1). Pub. L. 102-83, Sec. 4(b)(1), (2)(E), substituted 
``Secretary'' for ``Administrator'' wherever appearing.
    Pub. L. 102-83, Sec. 4(a)(5), substituted ``non-Department'' for 
``non-Veterans' Administration''.
    Pub. L. 102-83, Sec. 4(a)(3), (4), substituted ``Department'' for 
``Veterans' Administration''.
    Subsec. (d)(2)(A). Pub. L. 102-83, Sec. 4(a)(3), (4), substituted 
``Department'' for ``Veterans' Administration''.
    Subsec. (e). Pub. L. 102-83, Sec. 4(b)(1), (2)(E), substituted 
``Secretary'' for ``Administrator'' in pars. (1) and (2).
    Pub. L. 102-83, Sec. 4(a)(5), substituted ``non-Department'' for 
``non-Veterans' Administration'' in par. (2).
    Subsec. (f)(1)(A). Pub. L. 102-83, Sec. 4(b)(1), (2)(E), substituted 
``Secretary'' for ``Administrator'' in introductory provisions.
    Subsec. (f)(1)(A)(ii). Pub. L. 102-83, Sec. 5(c)(1), substituted 
``1712(a)(1)(B)'' for ``612(a)(1)(B)''.
    Subsec. (f)(1)(B). Pub. L. 102-83, Sec. 4(b)(1), (2)(E), substituted 
``Secretary'' for ``Administrator'' before ``may'' in two places.
    Pub. L. 102-83, Sec. 4(a)(3), (4), substituted ``Department'' for 
``Veterans' Administration'' wherever appearing.
    Pub. L. 102-83, Sec. 4(a)(2)(A)(ii), substituted ``Secretary'' for 
``Veterans' Administration'' in second sentence.
    Subsec. (f)(2). Pub. L. 102-83, Sec. 4(b)(1), (2)(E), substituted 
``Secretary'' for ``Administrator'' in two places.
    1988--Subsec. (e)(1). Pub. L. 100-322, Sec. 103(b), struck out ``For 
the purposes of this section, the term `nursing home care' includes 
intermediate care, as determined by the Administrator in accordance with 
regulations which the Administrator shall prescribe.'' at beginning and 
struck out ``(as defined in section 101(28) of this title)'' after 
``provided for nursing home care''.
    Subsec. (f)(3). Pub. L. 100-322, Sec. 111(a), substituted 
``September 30, 1991'' for ``September 30, 1988''.
    1986--Subsec. (f)(1)(A)(ii). Pub. L. 99-272 substituted 
``612(a)(1)(B)'' for ``612(f)(2)''.
    1985--Subsec. (a). Pub. L. 99-166, Sec. 108(a), amended subsec. (a) 
generally. Prior to amendment, subsec. (a) read as follows: ``Subject to 
subsection (b) and except as provided in subsection (e) of this section, 
the Administrator may transfer--
        ``(1) Any veteran who has been furnished care by the 
    Administrator in a hospital under the direct jurisdiction of the 
    Administrator, and
        ``(2) Any person (A) who has been furnished care in any hospital 
    of any of the Armed Forces, (B) who the appropriate Secretary 
    concerned has determined has received maximum hospital benefits but 
    requires a protracted period of nursing home care, and (C) who upon 
    discharge therefrom will become a veteran
to any public or private institution not under the jurisdiction of the 
Administrator which furnishes nursing home care, for care at the expense 
of the United States, only if the Administrator determines that--
        ``(i) such veteran has received maximum benefits from such care 
    in such hospital, but will require a protracted period of nursing 
    home care which can be furnished in such institution, and
        ``(ii) the cost of such nursing home care in such institution 
    will not exceed 45 percent of the cost of care furnished by the 
    Veterans' Administration in a general hospital under the direct and 
    exclusive jurisdiction of the Administrator, as such cost may be 
    determined annually by the Administrator, or not to exceed 50 
    percent of such cost where determined necessary by the 
    Administrator, upon recommendation of the Chief Medical Director, to 
    provide adequate care.
Nursing home care may not be furnished pursuant to this section at the 
expense of the United States for more than six months in the aggregate 
in connection with any one transfer, except (I) in the case of the 
veteran whose hospitalization was primarily for a service-connected 
disability, or (II) where in the judgment of the Administrator a longer 
period is warranted in the case of any other veteran. Any veteran who is 
furnished care by the Administrator in a hospital in Alaska or Hawaii 
may be furnished nursing home care under the provisions of this section 
even if such hospital is not under the direct jurisdiction of the 
Administrator.''
    Subsec. (d). Pub. L. 99-166, Sec. 108(b), designated existing first 
sentence as par. (1), substituted ``to any non-Veterans' Administration 
nursing home'' for ``to any public or private institution not under the 
jurisdiction of the Administrator which furnishes nursing home care'', 
inserted ``The Administrator may also authorize a direct admission to 
such a nursing home for nursing home care for any veteran who has been 
discharged from a hospital under the direct jurisdiction of the 
Administrator and who is currently receiving medical services as part of 
home health services from the Veterans' Administration.'', substituted 
par. (2) for ``Such admission may be authorized upon determination of 
need therefor by a physician employed by the Veterans' Administration 
or, in areas where no such physician is available, carrying out such 
function under contract or fee arrangement based on an examination by 
such physician.'', and designated existing last sentence as par. (3).
    Subsec. (e). Pub. L. 99-166, Sec. 108(c), designated existing 
provisions as par. (1), substituted ``subsection (a)(2)(B)'' for 
``subsection (a)(ii)'' in second sentence, and added par. (2).
    1983--Pub. L. 98-160, Sec. 103(a)(2), inserted ``; adult day health 
care'' in section catchline.
    Subsec. (f). Pub. L. 98-160, Sec. 103(a)(1), added subsec. (f).
    1982--Subsec. (a)(ii) Pub. L. 97-295, Sec. 4(19)(A), substituted 
``percent'' for ``per centum'' wherever appearing.
    Subsec. (c). Pub. L. 97-295, Sec. 4(19)(B), inserted ``(41 U.S.C. 
351(b)(1))'' after ``the Service Contract Act of 1965'' and substituted 
``(29 U.S.C. 206(b))'' for ``, as amended,''.
    1976--Subsec. (a). Pub. L. 94-581, Secs. 106(1)-(3), 202(h), 
inserted ``and except as provided in subsection (e)'' after ``subsection 
(b)'' in provisions preceding par. (1), substituted ``direct 
jurisdiction'' for ``direct and exclusive jurisdiction'' in par. (1), 
substituted ``45 per centum'' for ``40 per centum'' and ``annually'' for 
``from time to time'' in cl. (ii) and inserted ``, or not to exceed 50 
per centum of such cost where determined necessary by the Administrator, 
upon recommendation of the Chief Medical Director, to provide adequate 
care'' at the end thereof, and substituted ``direct jurisdiction'' for 
``direct and exclusive jurisdiction'' in provisions following cl. (ii).
    Subsec. (b). Pub. L. 94-581, Sec. 210(a)(7), substituted ``such 
standards as the Administrator may prescribe'' for ``such standards as 
he may prescribe''.
    Subsec. (e). Pub. L. 94-581, Sec. 106(4), added subsec. (e).
    1973--Subsec. (a). Pub. L. 93-82, Sec. 104(a), (b), designated cls. 
(1) and (2) as (i) and (ii), respectively, and in provisions preceding 
cl. (i) as so designated, substituted authority of the Administrator to 
transfer veterans and other persons under pars. (1) and (2), for 
authority of the Administrator to transfer veterans who have been 
furnished care by the Administrator in a hospital under the direct and 
exclusive jurisdiction of the Administrator, to any public or private 
institution not under the jurisdiction of the Administrator which 
furnishes nursing home care for care at the expense of the United 
States, and in the provisions following cl. (ii) as so designated, 
substituted designations (I) and (II) for designations (A) and (B).
    Subsec. (b). Pub. L. 93-82, Sec. 104(c), inserted provisions 
relating to the admissions of veterans to institutions for nursing home 
care and for the furnishing of standards and reports to Federal, State 
and local agencies charged with the responsibility of licensing or 
otherwise regulating or inspecting such institutions.
    Subsec. (d). Pub. L. 93-82, Sec. 104(d), added subsec. (d).
    1969--Subsec. (a). Pub. L. 91-101 inserted provision authorizing the 
furnishing of nursing home care for more than six months in the 
aggregate in connection with any one transfer in the case of a veteran 
whose hospitalization was primarily for a service-connected disability.
    1968--Subsec. (a). Pub. L. 90-612, Sec. 1, authorized furnishing of 
nursing home care to veterans who are being furnished care by the 
Administrator in hospitals in Alaska or Hawaii even if the hospitals 
involved are not under the direct and exclusive jurisdiction of the 
Administrator.
    Subsec. (a)(2). Pub. L. 90-429 substituted ``40 per centum'' for 
``one-third''.
    Subsec. (c). Pub. L. 90-612, Sec. 3, added subsec. (c).


                    Effective Date of 1986 Amendment

    Amendment by Pub. L. 99-272 applicable to hospital care, nursing 
home care, and medical services furnished on or after July 1, 1986, see 
section 19011(f) of Pub. L. 99-272, set out as a note under section 1710 
of this title.


                    Effective Date of 1976 Amendment

    Amendment by Pub. L. 94-581 effective Oct. 21, 1976, see section 211 
of Pub. L. 94-581, set out as a note under section 111 of this title.


                    Effective Date of 1973 Amendment

    Amendment by Pub. L. 93-82 effective Sept. 1, 1973, see section 501 
of Pub. L. 93-82, set out as a note under section 1701 of this title.


  Comparison Study Between Adult Day Health Care and Nursing Home Care

    Section 111(b), (c) of Pub. L. 100-322 directed Administrator to 
conduct a study of medical efficacy and cost-effectiveness of furnishing 
adult day health care under subsec. (f) of this section as an 
alternative to nursing home care and the comparative advantages and 
disadvantages of providing such care through facilities that are not 
under direct jurisdiction of Administrator and through facilities that 
are under direct jurisdiction of Administrator, with Administrator to 
submit to Committees on Veterans' Affairs of Senate and House of 
Representatives an interim report on the study not later than Feb. 1, 
1988, a final report on such study not later than Feb. 1, 1991.
    Section 103(b), (c) of Pub. L. 98-160, which provided for a study 
and report, not later than Feb. 1, 1988, of the medical efficacy and 
cost-effectiveness of furnishing adult day health care as an alternative 
for nursing home care and of the comparative advantages and 
disadvantages of providing such care in Veterans' Administration or in 
other facilities, was repealed by Pub. L. 100-322, title I, Sec. 111(d), 
May 20, 1988, 102 Stat. 499.

                  Section Referred to in Other Sections

    This section is referred to in sections 1703, 1710B, 1724, 1741, 
1742, 2303, 8105, 8134 of this title; title 42 section 300dd-21.
