To
accommodate eligible veterans who are not acutely ill and not in
need of hospital care, but who require skilled nursing care, related
medical services, supportive personal care, and individual adjustment
services (including social, divers ional, recreational and spiritual
activities and opportunities) in a homelike atmosphere.
TYPES
OF ASSISTANCE:
Provision of Specialized Services. Place Cursor Here for Definition
USES
AND USE RESTRICTIONS:
Veterans
in need of care in a VA, State Home, or Contract Nursing Home Care
Unit may be admitted or transferred according to the following priorities:
(1) Any veteran who has a service-connected disability for any disability:
(2) Any veteran whose discharge or release from the active military,
naval, or air service was for a disability incurred or aggravated
in line of duty for any disability; (3) Any veteran who, but for
a suspension pursuant to 38 U.S.C. 1151 (or both suspension and
the receipt of retired pay), would be entitled to disability compensation,
but only to the extent that such veteran's continuing eligibility
for such care is provided for the judgment or settlement described
in such section, for any disability; (4) Any veteran who is a former
prisoner of war, for any disability; (5) Any veteran who served
in Vietnam during the Vietnam era and who may have been exposed
to Agent Orange or other toxic substance and who, during such service
needs care for a condition possibly related to such exposure, and
to veterans who were exposed while on active duty to ionizing radiation
from nuclear testing or participation in the American occupation
of Hiroshima and Nagasaki following World War II and who are in
need of care for a condition possibly related to such exposure;
(6) Any veteran of World War I, for any disability; and (7) Any
nonservice- connected veteran who is: (a) in receipt of VA pension,
or who is unable to defray the expenses of necessary care as determined
by the Category A threshold amounts; or (b) eligible for VA hospital
care, who exceeds the income threshold amounts if the veteran agrees
to pay the applicable co payments for the care rendered by the VA.
ELIGIBILITY
REQUIREMENTS:
Applicant
Eligibility: The need for placement in a nursing
home is based upon medical and nursing care considerations. The
eligible veteran should require skilled nursing supervision, observation
and care by an interdisciplinary team, and/or rehabilitative programs
and supportive health services found only in a hospital based nursing
home program.
Beneficiary
Eligibility: There are two categories of veteran
eligibility (Mandatory and Discretionary) for VA hospital care.
VA shall provide hospital care to veterans within the Mandatory
Category and is permitted to furnish care on a resource-available
basis to veterans in the Discretionary Category. The Mandatory
Category consists of all veterans including those nonservice-connected
disabled with annual incomes below $22,064 for a single veteran
and below $26,480 for a veteran with one dependent plus $1,476
for each additional dependent. Nonservice-connected veterans with
incomes above the established threshold for mandatory care are
in the Discretionary Category. They may be treated by the VA on
a resource-available basis if they agree to pay a copayment.
Credentials/Documentation:
Military discharge papers.
Pre-application
Coordination: None. This program is excluded
from coverage under E.O. 12372.
Application
Procedure: Submit Application for Medical
Benefits, VA Form 10-10, to nearest VA medical facility. A medical
determination as to need for nursing home care will be made by
a VA physician.
Award
Procedure: Not applicable.
Deadlines:
None.
Range
of Approval/Disapproval Time: Not applicable.
Appeals:
Not applicable.
Renewals:
Not applicable.
ASSISTANCE
CONSIDERATIONS:
Formula
and Matching Requirements: Not applicable.
Length
and Time Phasing of Assistance: No limit.
POST
ASSISTANCE REQUIREMENTS:
Reports:
Not applicable.
Audits:
Not applicable.
Records:
Not applicable.
FINANCIAL
INFORMATION:
Account
Identification: 36-0160-0-1-703.
Obligations:
(Salaries and Expenses) FY 01 $1,978,934,000; FY 02 est $2,118,456,000;
and FY 03 est $2,118,456,000.
Range
and Average of Financial Assistance: Not applicable.
In fiscal year 2001, 96,568 patients were treated with an average
daily census of 33,670. The projected corresponding levels for fiscal
year 2002 are 106,723 patients treated and 34,427 average daily
census. For fiscal year 2003, the levels are 111,953 patients treated
and 35,132 average daily census.
REGULATIONS,
GUIDELINES, AND LITERATURE:
VA Manual M-1, Part I, Chapter 12, "Nursing Home Care"; VA Manual
M-5, Part II, Chapter 2; VA IS-1 Fact Sheet, Federal Benefits for
Veterans and Dependents, available from the Superintendent of Documents,
Government Printing Office, Washington, DC 20402.
INFORMATION
CONTACTS:
Regional
or Local Office: See Appendix IV of the Catalog
for Veterans Hospital Facilities listed under Veterans Health Administration.
Headquarters
Office: Chief Consultant, Geriatrics and Extended
Strategic Health Group (114), Department of Veterans Affairs,
Washington, DC 20420. VA Nursing Home Care Program Chief. Telephone:
(202) 273-8544.
