[Federal Register: July 1, 2004 (Volume 69, Number 126)]
[Rules and Regulations]
[Page 39845-39851]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr01jy04-11]
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DEPARTMENT OF VETERANS AFFAIRS
38 CFR Part 17
RIN 2900-AL49
Copayments for Extended Care Services
AGENCY: Department of Veterans Affairs.
ACTION: Final rule.
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SUMMARY: This document amends VA's medical regulations by modifying
provisions regarding the methodology of computing copayments for
extended care services provided to veterans. This final rule enhances
the protection of veterans' spouses by not counting certain assets as
available resources for computing these copayments. Other non-
substantive changes are made for purposes of clarification.
DATES: Effective Date: The final rule is effective August 2, 2004.
FOR FURTHER INFORMATION CONTACT: Eileen Downey, Chief Business Office
(161), at (202) 254-0347 and Daniel Schoeps, Geriatrics and Extended
Care (114), at (202) 273-8540. Both are officials in the Veterans
Health Administration, 810 Vermont Avenue, NW., Washington, DC 20420.
(These are not toll free numbers.)
SUPPLEMENTARY INFORMATION: In a document published in the Federal
Register on October 16, 2003 (68 FR 59557), we proposed to amend VA's
medical regulations by modifying provisions regarding the methodology
of computing copayments for extended care services provided to veterans
either directly by VA or by contract. These changes are as follows: We
are revising the formulas to clarify what resources veterans have
available for purposes of determining the appropriate copayment. We are
excluding from the definition of ``available resources'' contained in
paragraph (d)(1) of Sec. 17.111 income, assets, expenses and allowance
of legally separated spouses. We are removing from the definition of
``veterans allowance'' the inclusion of expenses because we are now
including expenses in the definition of ``available resources''
contained in paragraph (d)(1) of Sec. 17.111. We are also changing the
definition of ``expenses,'' to include (1) insurance premiums of the
veteran and the veteran's spouse and dependents and (2) personal
property taxes, not just income taxes. Further, we are clarifying that
the definition of ``liquid assets,'' includes art, rare coins, stamp
collections, and collectibles and changing that definition to exclude
household and personal items such as
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furniture, clothing, and jewelry when the veteran's spouse or the
veteran's dependents are living in the community or the veteran is
receiving noninstitutional extended care services. We are adding at
paragraph (d)(2)(vi) of Sec. 17.111 a definition of ``spousal resource
protection amount'' to permit a spouse to maintain some liquid assets
while they live in the community. Lastly, we are clarifying that a
veteran must report a change in marital status to a VA medical facility
within 10 days of the change.
The public comment period ended on December 15, 2003, without any
comment. Based on the rationale set forth in the proposed rule, we are
adopting the provisions of the proposed rule as a final rule without
any changes.
Paperwork Reduction Act
The Office of Management and Budget has approved the collections of
information requirements related to this rulemaking proceeding under
OMB control number 2900-0629.
Unfunded Mandates
The Unfunded Mandates Reform Act requires, at 2 U.S.C. 1532, that
agencies prepare an assessment of anticipated costs and benefits before
developing any rule that may result in an expenditure by State, local,
or tribal governments, in the aggregate, or by the private sector, of
$100 million or more in any given year. This rule would have no such
effect on State, local, or tribal governments, or the private sector.
Regulatory Flexibility Act
The Secretary hereby certifies that this regulatory amendment will
not have a significant economic impact on a substantial number of small
entities as they are defined in the Regulatory Flexibility Act (RFA), 5
U.S.C. 601-612. This amendment would not directly affect any small
entities. Only individuals could be directly affected. Therefore,
pursuant to 5 U.S.C. 605(b), this amendment is exempt from the initial
and final regulatory flexibility analysis requirements of sections 603
and 604.
Catalog of Federal Domestic Assistance Numbers
The Catalog of Federal Domestic Assistance numbers for the programs
affected by this document are 64.005, 64.007, 64.008, 64.009, 64.010,
64.011, 64.012, 64.013, 64.014, 64.015, 64.016, 64.018, 64.019, 64.022,
and 64.025.
List of Subjects in 38 CFR Part 17
Administrative practice and procedure, Alcohol abuse, Alcoholism,
Claims, Day care, Dental health, Drug abuse, Foreign relations,
Government contracts, Grant programs-health, Grant programs-veterans,
Health care, Health facilities, Health professions, Health records,
Homeless, Medical and dental schools, Medical devices, Medical
research, Mental health programs, Nursing homes, Philippines, Reporting
and record-keeping requirements, Scholarships and fellowships, Travel
and transportation expenses, Veterans.
Approved: May 28, 2004.
Anthony J. Principi,
Secretary of Veterans Affairs.
0
For the reasons set out in the preamble, 38 CFR part 17 is amended as
set forth below:
PART 17--MEDICAL
0
1. The authority citation for part 17 continues to read as follows:
Authority: 38 U.S.C. 501, 1721, unless otherwise noted.
0
2. In Sec. 17.111, paragraphs (d) through (g) and the authority
citation at the end of the section are revised to read as follows:
Sec. 17.111 Copayments for extended care services.
* * * * *
(d) Effect of the veteran's financial resources on obligation to
pay copayment. (1) A veteran is obligated to pay the copayment to the
extent the veteran and the veteran's spouse have available resources.
For veterans who have been receiving extended care services for 180
days or less, their available resources are the sum of the income of
the veteran and the veteran's spouse, minus the sum of the veterans
allowance, the spousal allowance, and expenses. For veterans who have
been receiving extended care services for 181 days or more, their
available resources are the sum of the value of the liquid assets, the
fixed assets, and the income of the veteran and the veteran's spouse,
minus the sum of the veterans allowance, the spousal allowance, the
spousal resource protection amount, and (but only if the veteran--has a
spouse or dependents residing in the community who is not
institutionalized) expenses. When a veteran is legally separated from a
spouse, available resources do not include spousal income, expenses,
and assets or a spousal allowance.
(2) For purposes of determining available resources under this
section:
(i) Income means current income (including, but not limited to,
wages and income from a business (minus business expenses), bonuses,
tips, severance pay, accrued benefits, cash gifts, inheritance amounts,
interest income, standard dividend income from non tax deferred
annuities, retirement income, pension income, unemployment payments,
worker's compensation payments, black lung payments, tort settlement
payments, social security payments, court mandated payments, payments
from VA or any other Federal programs, and any other income). The
amount of current income will be stated in frequency of receipt, e.g.,
per week, per month.
(ii) Expenses means basic subsistence expenses, including current
expenses for the following: rent/mortgage for primary residence;
vehicle payment for one vehicle; food for veteran, veteran's spouse,
and veteran's dependents; education for veteran, veteran's spouse, and
veteran's dependents; court-ordered payments of veteran or veteran's
spouse (e.g., alimony, child-support); and including the average
monthly expenses during the past year for the following: utilities and
insurance for the primary residence; out-of-pocket medical care costs
not otherwise covered by health insurance; health insurance premiums
for the veteran, veteran's spouse, and veteran's dependents; and taxes
paid on income and personal property.
(iii) Fixed Assets means:
(A) Real property and other non-liquid assets; except that this
does not include--
(1) Burial plots;
(2) A residence if the residence is:
(i) The primary residence of the veteran and the veteran is
receiving only noninstitutional extended care service; or
(ii) The primary residence of the veteran's spouse or the veteran's
dependents (if the veteran does not have a spouse) if the veteran is
receiving institutional extended care service.
(3) A vehicle if the vehicle is:
(i) The vehicle of the veteran and the veteran is receiving only
noninstitutional extended care service; or
(ii) The vehicle of the veteran's spouse or the veteran's
dependents (if the veteran does not have a spouse) if the veteran is
receiving institutional extended care service.
(B) [Reserved]
(iv) Liquid assets means cash, stocks, dividends received from IRA,
401K's and other tax deferred annuities, bonds, mutual funds,
retirement accounts (e.g., IRA, 401Ks, annuities), art, rare coins,
stamp collections, and collectibles of the veteran, spouse, and
dependents. This includes household and personal items (e.g.,
furniture, clothing, and jewelry) except when the veteran's
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spouse or dependents are living in the community.
(v) Spousal allowance is an allowance of $20 per day that is
included only if the spouse resides in the community (not
institutionalized).
(vi) Spousal resource protection amount means the value of liquid
assets but not to exceed $89,280 if the spouse is residing in the
community (not institutionalized).
(vii) Veterans allowance is an allowance of $20 per day.
(3) The maximum amount of a copayment for any month equals the
copayment amount specified in paragraph (b)(1) of this section
multiplied by the number of days in the month. The copayment for any
month may be less than the amount specified in paragraph (b)(1) of this
section if the veteran provides information in accordance with this
section to establish that the copayment should be reduced or
eliminated.
(e) Requirement to submit information. (1) Unless exempted under
paragraph (f) of this section, a veteran must submit to a VA medical
facility a completed VA Form 10-10EC and documentation requested by the
Form at the following times:
(i) At the time of initial request for an episode of extended care
services;
(ii) At the time of request for extended care services after a
break in provision of extended care services for more than 30 days; and
(iii) Each year at the time of submission to VA of VA Form 10-10EZ.
(2) When there are changes that might change the copayment
obligation (i.e., changes regarding marital status, fixed assets,
liquid assets, expenses, income (when received), or whether the veteran
has a spouse or dependents residing in the community), the veteran must
report those changes to a VA medical facility within 10 days of the
change.
(f) Veterans and care that are not subject to the copayment
requirements. The following veterans and care are not subject to the
copayment requirements of this section:
(1) A veteran with a compensable service-connected disability;
(2) A veteran whose annual income (determined under 38 U.S.C. 1503)
is less than the amount in effect under 38 U.S.C. 1521(b);
(3) Care for a veteran's noncompensable zero percent service-
connected disability;
(4) An episode of extended care services that began on or before
November 30, 1999;
(5) Care authorized under 38 U.S.C. 1710(e) for Vietnam-era
herbicide-exposed veterans, radiation-exposed veterans, Persian Gulf
War veterans, or post-Persian Gulf War combat-exposed veterans;
(6) Care for treatment of sexual trauma as authorized under 38
U.S.C. 1720D; or
(7) Care or services authorized under 38 U.S.C. 1720E for certain
veterans regarding cancer of the head or neck.
(g) VA Form 10-10EC.
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* * * * *
(Authority: 38 U.S.C. 101(28), 501, 1701(7), 1710, 1710B, 1720B,
1720D, 1722A)
[FR Doc. 04-14798 Filed 6-30-04; 8:45 am]
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