TITLE 38-UNITED STATES CODE

VETERANS' BENEFITS

Part II-General Benefits

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Chapter 17-HOSPITAL, DOMICILIARY, AND MEDICAL

CARE

§ 612. Eligibility for medical treatment

(a) Except as provided in subsection (b), the Administrator, within the limits of Veterans' Administration facilities, may furnish such medical services as he finds to be reasonably necessary to any veteran for a service-connected disability. In the case of any veteran discharged or released from the active military, naval, or air service for a disability incurred or aggravated in line of duty, such services may be so furnished for that disability, whether or not service-connected for the purposes of this chapter.

(b) Outpatient dental services and treatment, and related dental appliances, shall be furnished under this section only for a dental condition or disability—

(1) which is service-connected and compensable in degree;

(2) which is service-connected, but not compensable in degree, but only (A) if it is shown to have been in existence at time of discharge or release from active military, naval, or air service and (B) if application for treatment is made within one year after such discharge or release, except that if a disqualifying discharge or release has been corrected by competent authority, application may be made within one year after the date of correction or the date of enactment of this exception, whichever is later;

(3) which is a service-connected dental condition or disability due to combat wounds or other service trauma, or of a former prisoner of war;

(4) which is associated with and is aggravating a disability resulting from some other disease or injury which was incurred in or aggravated by active military, naval, or air service; or

(5) from which a vereran of the Spanish-American War or Indian Wars is suffering.

(c) Dental services and related appliances for a dental condition or disability described in clause (2) of subsection (b) of this section shall be furnished on a one-time completion basis, unless the services rendered on a one-time completion basis are found unacceptable within the limitations of good professional standards, in which event such additional services may be afforded as are required to complete professionally acceptable treatment.

(d) Dental appliances, wheelchairs, artificial limbs, trusses, special clothing, and similar appliances to be furnished by the Administrator under this section may be procured by him either by purchase or by

manufacture, whichever he determines may be advantageous and reasonably necessary.

(e) Any disability of a veteran of the Spanish-American War or Indian wars, upon application for the benefits of this section or outpatient medical services under section 624 of this title, shall be considered for the purposes thereof to be a service-connected disability incurred or aggravated in a period of war.

(f) The Administrator may also furnish medical services for a nonservice-connected disability under the following circumstances:

(1) Where such care is reasonably necessary in preparation for admission of a vereran who has been determined to need hospital care and who has been scheduled for admission.

(2) Where a veteran has been granted hospital care, and outpatient care is reasonably necessary to complete treatment incident to such hospital care.

[(g) Where any veteran is in receipt of pension under chapter 15 of this title based on the need of regular aid and attendance or of an aid and attendance allowance received under section 314 or 334 of this title, or who, but for the receipt of retired pay, would be in receipt of such pension or such an allowance, and

[(1) has received care for not less than one year under paragraph (2) of subsection (f) of this section; and

[(2) is suffering from (A) cardiovascular-renal disease, including hypertension, (B) endocrinopathies, (C) diabetes mellitus, (D) cancer, (E) a neuropsychiatric disorder, or (F) tuberculosis; then the Administrator may furnish the veteran such further care as is reasonably necessary for such disease or disorder.] (g) Where any veteran is in receipt of increased pension or additional compensation or allowance based on the need of regular aid and attendance or by reason of being permanently housebound, or who, but for the receipt of retired pay, would be in receipt of such pension, compensation, or allowance, the Administrator may furnish the veteran such medical services as he finds to be reasonably necessary.

(h) The Administrator shall furnish to each veteran who is receiving additional compensation or allowance under chapter 11, or increased pension as a veteran of World War I, World War II, the Korean conflict, or the Vietnam era, by reason of being permanently housebound or in need of regular aid and attendance, such drugs and medicines as may be ordered on prescription of a duly licensed physician as specific therapy in the treatment of any illness, or injury suffered by such veteran.

§ 622. Statement under oath

(a) For the purposes of section 610(a) (1), section 610(b) (2), section 624 (c), and section 632(b) of this title, the statement 624(c), oath of an applicant on such form as may be prescribed by the Administrator shall be accepted as sufficient evidence of inability to defray necessary expenses.

(b) Notwithstanding the provisions of subsection (a) of this section, the receipt of pension under any law administered by the Veterans' Administration shall constitute sufficient evidence of inability to defray

necessary expenses, and any veteran in receipt of such pension shall be exempt from making any statement under oath regarding his inability to defray necessary expenses.

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OCTOBER 17, 1969.-Ordered to be printed

Filed under authority of the order of the Senate of OCTOBER 16, 1969

Mr. CRANSTON, from the Committee on Labor and Public Welfare, submitted the following

REPORT

[To accompany H.R. 2768]

The Committee on Labor and Public Welfare, to which was referred the bill (H.R. 2768) to amend title 38 of the United States Code in order to eliminate the six-month limitation in the furnishing of nursing home care in the case of veterans with service-connected disabilities, having considered the same, reports favorably thereon without amendment and recommends that the bill do pass.

INTRODUCTION

The Subcommittee on Veterans' Affairs conducted hearings on H.R. 2768 on July 17, 1969. Testimony was presented by spokesmen of the administration, veterans' organizations, and by U.S. Senators. In executive session on October 2, 1969, the subcommittee considered H.R. 2768 and unanimously ordered it reported to the full Labor and Public Welfare Committee. The Committee on Labor and Public Welfare met in executive session on October 9, 1969, at which time H.R. 2768 was unanimously approved and ordered reported.

EXPLANATION OF THE BILL

Section 620 of title 38, United States Code, authorizes the placement. in a community nursing home at the Veterans' Administration's expense (generally for a period of 6 months), hospitalized veterans who are no longer in need of hospital care and whose primary requirements are for nursing care. This bill would authorize such community nursing home care of unlimited duration for veterans hospitalized for a service-connected disability. Service-connected veterans are admitted as a matter of right for their service-connected disabilities to

all Veterans' Administration hospitals. Veterans with non-serviceconnected disabilities are admitted on a bed-available basis if unable to defray the necessary expenses.

Placement in community nursing homes under 38 U.S.C. § 620 has been a factor in bringing about the desired reduction of the workload of the Veterans' Administration hospital system. In the committee's view, the bill's provisions would further reduce that workload and also the cost for medical care for service-connected veterans in Veterans' Administration facilities. Cost of care for beneficiaries of this bill now ranges as high as $50 a day for hospital care in contrast to approximately $19.50 a day for community nursing care.

The committee is also of the view that the original intention of section 620, to aid the veteran and his family in making the transition from a hospital to his place in the community, should be expanded for veterans hospitalized with service-connected disabilities. Such a veteran should be entitled to all necessary nursing home care at Veterans' Administration expense as close as possible to his home community. Indeed, the longer the duration of his stay in a nursing home, the greater may be the veteran's need for location in his home community in order to permit visits by friends and relatives residing there. Unfortunately the location of Veterans' Administration operated nursing home beds does not in many cases permit a veteran to be near his home community.

The Veterans' Administration estimates that approval of this proposed legislation would increase the daily nursing care load in community nursing homes by approximately 350 at a cost of $1,500,000 annually.

As part of its consideration of H.R. 2768, the committee also considered H.R. 692, which the subcommittee had ordered reported to the full committee without recommendation. That bill, also amending section 620, would permit community nursing home confinements of 9, rather than the present 6, months. With the adoption of H.R. 2768 for service-connected veterans, the impact of H.R. 692 would be limited to veterans with non-service-connected disabilities. The full committee did not feel that favorable action on H.R. 692 was warranted in light of testimony from the Chief Medical Director, and the Director, Extended Care Service, of the Veterans' Administration that since establishment of the community nursing home program in 1965 only 302 requests for extensions beyond 6 months confinement were made from a patient population of over 25,000 and that 92 percent of them had been granted.

These officials also testified that the Veterans' Administration was "not reluctant" to grant these exceptions and did so "when there is medical and economic necessity" or "factors of humanity" (hearings, p. 64). However, VA regulation section 6051.1, which limits extensions to "circumstances of a most unusual nature such as when additional time is needed to complete imminent arrangements for other care," seems narrower than the testimony quoted above. In the committee's view, these regulations should be revised in accordance with the testimony. When that is done, the committee believes that extensions will be granted to those non-service-connected veterans for whom there is no other reasonable alternative to continuation of community nursing home care at Veterans' Administration expense beyond 6 months.

S. Rept. 91-482