Finally, the committee was concerned that a blanket extension from 6 to 9 months of community nursing home care for non-serviceconnected veterans might, by virtue of budget limitations, significantly reduce the number of needy veterans who could receive any care in such facilities at Veterans' Administration expense. AGENCY REPORTS The reports of the Veterans' Administration on H.R. 2768 and H.R. 692 follow: OFFICE OF THE ADMINISTRATOR OF VETERANS' AFFAIRS, Hon. RALPH YARBOROUGH, VETERANS' ADMINISTRATION, Washington, D.C., July 9, 1969. Chairman, Committee on Labor and Public Welfare, U.S. Senate, Washington, D.C. DEAR MR. CHAIRMAN: The following comments are furnished in response to your request for a report by the Veterans' Administration on H.R. 2768, 91st Congress, as passed by the House of Representatives on June 2, 1969. The purpose of the bill is to authorize community nursing home care at Veterans' Administration expense for veterans whose hospitalization was primarily for a service-connected disability without limitations as to the length of time such care may be provided. The proposal would amend section 620 of title 38, United States Code, which was added by Public Law 88-450. That section authorizes transfer of a hospitalized veteran patient, who has reached the nursing home care stage, to a public or private institution for nursing home care at Federal expense for a period of not to exceed 6 months in the aggregate in connection with any one transfer, except when the Administrator determines that a longer period is warranted. The bill, if enacted, would eliminate the 6-month limitation in the case of those veterans whose hospitalization was primarily for a service-connected disability. In the case of other veterans, the Administrator would still have to determine that a longer period of nursing home care is warranted before the 6-month limitation could be exceeded. After reviewing the established modes of nursing home care for service-connected veterans, we conclude there is little need for this legislation. The Veterans' Administration accords the highest priority to service-connected cases for admission to VA nursing home care units. Care for service-connected veterans placed in community nursing homes can be extended at the Administrator's discretion upon expiration of their eligibility for VA-financed care, or they can be returned to a VA facility. Moreover, in the case of veterans with eligibility under medicare or medicaid, the period of care in community nursing homes can be extended by use of those Federal health support programs. Thus, in view of the fact that service-connected veterans are currently receiving appropriate care in extended care facilities, it is difficult to find compelling need for the proposed bill. The only possible advantage that the bill would provide would be the greater convenience of being closer to home for the service-connected veteran whose expected duration of stay in a community nursing home might exceed 6 months. S. Rept. 91-482 Enactment of this legislation would increase by approximately 350 the average daily nursing care load in community nursing homes at VA expense. This would result in a total increased annual cost for the first few years of approximately $1.5 million annually. For the above reasons, I recommend against favorable consideration of this bill at this time. We are advised by the Bureau of the Budget that there is no objection to the presentation of this report from the standpoint of the administration's program. Sincerely, Chairman, Committee on Labor and Public Welfare, U.S. Senate, Washington, D.C. DEAR MR. CHAIRMAN: The following comments are furnished in response to your request for a report by the Veterans' Administration on H.R. 692, 91st Congress, as passed by the House of Representatives on June 2, 1969. The purpose of the bill is to extend the length of time community nursing home care may be provided at the expense of the United States. The bill would amend section 620 of title 38, United States Code, which was added by Public Law 88-450. That section authorizes transfer of a hospitalized veteran patient, who has reached the nursing home care stage, to a public or private institution for nursing home care at Federal expense for a period not to exceed 6 months in the aggregate in connection with any one transfer, except when the Administrator determines that a longer period is warranted. The bill would extend the 6-month limitation to 9 months. The change would not affect the Administrator's existing authority to approve on an individual care basis a longer period, when in his judgment, an extension is warranted. To be eligible for placement in a community nursing home, the veteran must have been admitted to a VA hospital and transferred with a maximum hospital benefits discharge. Only patients needing skilled nursing home care for convalescence, rehabilitation or continued. care for a protracted period of time are eligible for transfer to community nursing homes. Normally this is interpreted to mean a minimum of 2 months. In almost all cases, 6 months of authorized care provides sufficient time to accomplish the primary purpose of this program, which is to aid the veteran and his family in making the transition from a hospital to his place in the community. Patient care, however, in community nursing homes can, upon expiration of 6 months, be extended at the Administrator's discretion, or the veteran can be returned to a VA facility. Moreover, in the case of veterans with eligibility under medicare or medicaid, the period of care in community nursing homes can be extended by use of those Federal health support programs. S. Rept. 91-482 We have not had sufficient experience thus far to determine what, if any, impact medicare or medicaid has on our nursing home care program for veterans eligible for dual nursing home care benefits. Experience to date, however, indicates that the present statutory period of care may be adequate for most veterans age 65 or over who are also entitled to nursing home care under medicare or medicaid. In view of the fact that veterans are currently receiving appropriate care in extended care facilities, it is difficult to find compelling reasons for the proposed legislation. The only possible advantage would be the greater convenience of being closer to home for the veteran whose expected duration of stay in a community nursing home might exceed 6 months. Our estimate of the annual cost for the next 5 fiscal years resulting from enactment of this legislation is as follows: For the reasons stated, I am unable to recommend favorable action on this legislation by your committee. If considered further it is recommended that the bill be amended, as a technical matter, by inserting "next to" after the word "in" in the fourth line. We are advised by the Bureau of the Budget that there is no objection to the presentation of this report from the standpoint of the administration's program. Sincerely, DONALD E. JOHNSON, Administrator. CHANGES IN Existing Law In compliance with subsection (4) of rule XXIX of the Standing Rules of the Senate, changes in existing law made by the bill, as reported, are shown as follows (existing law proposed to be omitted is enclosed in black brackets, new matter is printed in italic, existing law in which no change is proposed is shown in roman): S. Rept. 91-482 TITLE 38-UNITED STATES CODE VETERANS' BENEFITS Part II-General Benefits Chapter 17-HOSPITAL, DOMICILIARY, AND MEDICAL CARE Subchapter II-Hospital or Domiciliary Care and Medical Treatment § 620. Transfers for nursing home care (a) Subject to subsection (b) of this section, the Administrator may transfer any veteran, who has 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, if the Administrator determines that (1) 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 (2) the cost of such nursing home care in such institution will not exceed 40 per centum 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 from time to time by the Administrator. 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 (A) in the case of the veteran whose hospitalization was primarily for a service-connected disability, or (B) 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 and exclusive jurisdiction of the Administrator. (b) No veteran may be transferred to any institution for nursing home care under this section, unless such institution is determined by the Administrator to meet such standards as he may prescribe. (c) In applying the provisions of section 2(b)(1) of the Service Contract Act of 1965 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, as amended, shall be deemed to constitute compliance with such provisions. о S. Rept. 91-482 |