[Federal Register: July 10, 2009 (Volume 74, Number 131)]
[Proposed Rules]
[Page 33192-33196]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr10jy09-13]
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DEPARTMENT OF VETERANS AFFAIRS
38 CFR Part 59
RIN 2900-AM70
Grants to States for Construction or Acquisition of State Home
Facilities--Update of Authorized Beds
AGENCY: Department of Veterans Affairs.
ACTION: Proposed rule.
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SUMMARY: The Department of Veterans Affairs (VA) proposes to amend its
regulations regarding grants to States for construction or acquisition
of State homes to update the maximum number of nursing home and
domiciliary beds designated for each State and to amend the definition
of ``State'' for purposes of these grants to include Guam, the
[[Page 33193]]
Northern Mariana Islands, and American Samoa.
DATES: Comments must be received on or before September 8, 2009.
ADDRESSES: Written comments may be submitted by: Mail or hand-delivery
to Director, Regulations Management (02REG), Department of Veterans
Affairs, 810 Vermont Avenue, NW., Room 1068, Washington, DC 20420; fax
to (202) 273-9026; or e-mail at http://www.regulations.gov. Comments
should indicate that they are submitted in response to ``RIN 2900-
AM70--Grants to States for Construction or Acquisition of State Home
Facilities--Update of Authorized Beds.'' All comments received will be
available for public inspection in the Office of Regulation Policy and
Management, Room 1063B, between the hours of 8 a.m. and 4:30 p.m.,
Monday through Friday (except holidays). Please call (202) 461-4902 for
an appointment. (This is not a toll-free number.) In addition, during
the comment period, comments may be viewed online through the Federal
Docket Management System (FDMS) at http://www.regulations.gov.
FOR FURTHER INFORMATION CONTACT: James F. Burris, MD, Chief Consultant,
Geriatrics and Extended Care State Home Construction Grant Program
(114), Veterans Health Administration, Department of Veterans Affairs,
810 Vermont Avenue, NW., Washington, DC 20420, (202) 461-6774.
SUPPLEMENTARY INFORMATION: Congress has authorized VA to provide grants
to States for the construction or acquisition of State home facilities
for the provision of care to veterans. See 38 U.S.C. 8131-8138. The
term ``State home'' means ``a home established by a State (other than a
possession) for veterans disabled by age, disease, or otherwise who by
reason of such disability are incapable of earning a living'' and
``includes such a home which furnishes nursing home care for
veterans.'' 38 U.S.C. 101(19). For purposes of State home grants, the
term ``State'' means each of the several States and Territories of the
United States, the District of Columbia, and the Commonwealth of Puerto
Rico, see 38 U.S.C. 101(20), but not possessions of the United States,
see 38 U.S.C. 101(19), 8131(2). The Department of the Interior, which
has administrative responsibility for coordinating Federal policy in
Island groups in the Insular Area, has identified Guam and American
Samoa as territories of the United States, and the Northern Mariana
Islands as a Commonwealth in Political Union with the United States,
which is treated as a U.S. territory for purposes of the State home
grant program, see VAOPGCCONCL 10-98. The regulatory definition of the
term ``State'' in current 38 CFR 59.2 already includes the several
States, the District of Columbia, the Commonwealth of Puerto Rico, and
the Virgin Islands. We propose to amend this definition to include
Guam, the Northern Mariana Islands, and American Samoa.
Section 8134(a)(2) of title 38, U.S.C., mandates that VA prescribe
for each State the number of nursing home and domiciliary beds for
which grants may be furnished, which the proposed note to 38 CFR
59.40(a) would refer to as a State's ``unmet need'' number. To compute
this number, VA estimates for each State the maximum number of nursing
home and domiciliary beds needed by veterans in that State (which is
the maximum number of such beds designated for each State, as shown on
the chart in proposed Sec. 59.40(a)), and then subtracts the number of
existing State home beds plus the number of those beds under
construction or that would be constructed in accordance with the
State's grant applications. In addition, section 8134(a)(3) mandates
that VA prioritize State home grant applications. The priorities set
forth in the law require VA to compute whether a State applying for a
grant has a great, significant, or limited need for State home beds. VA
currently uses a State's ``unmet need'' number to determine whether the
State has a great, significant, or limited need for new State home
beds. See 38 CFR 59.50(e).
The Veterans Millennium Health Care and Benefits Act (the ``Act'')
(Public Law 106-117, enacted on November 30, 1999) requires that, not
less often than every four years, VA must review and, as necessary,
revise the regulations concerning the maximum number of State home beds
designated for each State. 38 U.S.C. 8134(a)(4). Section 8134(a)(2)
requires that these numbers be based on the projected demand for
nursing home and domiciliary care on November 30, 2009 (10 years after
the date of enactment of the Act) by veterans who at such time are 65
years of age or older and who reside in that State. In 2001, VA
originally established the maximum number of State home beds for each
State based on the projected demand for such beds in 2009. See 66 FR
33845-46 (June 26, 2001). VA now believes that Congress intended VA to
recalculate the maximum number of beds for each State based on the
projected demand for care ten years in the future and that this method
would be consistent with the Act's requirement for establishing maximum
State home bed numbers. VA thus proposes to revise in proposed Sec.
59.40(a) the maximum bed numbers based on the projected demand from
veterans who, in 2020, are 65 years of age or older and who reside in
that State.
To compute the maximum number of beds for each State in compliance
with the Act, we first estimated the total number of veterans 65 years
of age or older residing in each State, projected to the year 2020. We
then totaled the projected population of these veterans at 8,672,045,
which would be an increase from the 2000 projected population of such
veterans in 2009. In computing these estimates, we considered many
factors, such as movement of these veterans to new States, the
mortality rate of these veterans, and the fact that the life expectancy
of these veterans is projected to be longer than before. We then
considered the projected total demand for nursing home and domiciliary
beds in State homes. In 2000, we estimated the demand in 2009 would be
for 55,299 State home beds nationwide. We believe that this estimated
demand may also be used for 2020, despite the estimated increase in the
projected veteran population, due to the many emerging alternatives to
institutional long-term care and advancing technologies, such as
Telehealth, Home-Based Primary Care, and Respite Care, and due to the
fact that veterans are choosing to stay longer in their own homes. VA's
philosophy is to provide extended care services in the least
restrictive environment that is safe for the veteran, and whenever
possible in non-institutional home and community-based settings. VA now
provides a spectrum of non-institutional extended care services
including home telehealth, homemaker/home health aide, skilled home
care, home-based primary care, adult day healthcare, in-home respite
care, and hospice and palliative care that were unavailable or not
widely available in 2000. VA has been increasing the capacity to
provide these services in recent years and will continue to do so in
order to meet the demand. Many similar services are now available in
the private sector through Medicare/Medicaid and long-term care
insurance, and some veterans will choose to avail themselves of those
services rather than seeking care from VA. The non-institutional
services make it possible for many veterans who would otherwise require
nursing home care to remain in their own homes, and reduce the need for
additional nursing home beds. New technologic advances that may become
available over the next decade, such as robotic assistive devices, will
also reduce the need for additional nursing home beds. It is
[[Page 33194]]
likely that these trends will offset the growth in population and mean
that no additional nursing home beds will be needed beyond those
previously projected. Should these assumptions prove incorrect, VA will
adjust the total number of beds in a future revision of this
regulation. ``We are specifically interested in comments concerning
this analysis and our estimate that the demand in 2020 for State home
beds will be for 55,299 nationwide.
We allocated the 55,299 beds based on the percentage of veterans
who in 2020 are projected to reside in each State. Although the
projected total demand for State home beds nationwide will remain the
same in 2020, some States will experience an increase and other States
a decrease in the maximum number of beds that are eligible to receive a
grant from the State Veterans Home Construction Grant program depending
on the projected population of veterans 65 years of age or over for
each State. The table below shows the changes in the maximum numbers of
beds for each State. We would welcome comments regarding our
projections for individual States.
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New max of beds
State Old max of beds (based on 2020 Difference (+/
projections) -)
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Alabama....................................... 883............................. 1007 124
Alaska........................................ 79.............................. 179 100
American Samoa................................ not applicable.................. 0 0
Arizona....................................... 1068............................ 1520 452
Arkansas...................................... 557............................. 653 96
California.................................... 5754............................ 4363 -1391
Colorado...................................... 717............................. 1114 397
Connecticut................................... 738............................. 559 -179
Delaware...................................... 165............................. 207 42
DC............................................ 104............................. 83 -21
Florida....................................... 4471............................ 4049 -422
Georgia....................................... 1202............................ 1975 773
Guam.......................................... not applicable.................. 12 12
Hawaii........................................ 216............................. 268 52
Idaho......................................... 233............................. 394 161
Illinois...................................... 2271............................ 1754 -517
Indiana....................................... 1209............................ 1216 7
Iowa.......................................... 632............................. 578 -54
Kansas........................................ 542............................. 518 -24
Kentucky...................................... 759............................. 818 59
Louisiana..................................... 785............................. 638 -147
Maine......................................... 301............................. 362 61
Maryland...................................... 1020............................ 1102 82
Massachusetts................................. 1348............................ 944 -404
Michigan...................................... 1896............................ 1786 -110
Minnesota..................................... 932............................. 1058 126
Mississippi................................... 500............................. 480 -20
Missouri...................................... 1230............................ 1257 27
Montana....................................... 198............................. 281 83
Nebraska...................................... 355............................. 371 16
Nevada........................................ 428............................. 649 221
New Hampshire................................. 264............................. 361 97
New Jersey.................................... 1683............................ 992 -691
New Mexico.................................... 344............................. 417 73
New York...................................... 3220............................ 2209 -1011
North Carolina................................ 1454............................ 1900 446
North Dakota.................................. 121............................. 137 16
Northern Mariana Islands...................... not applicable.................. 1 1
Ohio.......................................... 2530............................ 2143 -387
Oklahoma...................................... 747............................. 766 19
Oregon........................................ 804............................. 907 103
Pennsylvania.................................. 3173............................ 2336 -837
Puerto Rico................................... 350............................. 288 -62
Rhode Island.................................. 254............................. 157 -97
South Carolina................................ 750............................. 1089 339
South Dakota.................................. 155............................. 179 24
Tennessee..................................... 1050............................ 1311 261
Texas......................................... 3226............................ 4119 893
Utah.......................................... 304............................. 426 122
Vermont....................................... 124............................. 1312 1188
Virginia...................................... 1312............................ 1903 591
Virgin Islands................................ 8............................... 12 4
Washington.................................... 1215............................ 1687 472
West Virginia................................. 455............................. 406 -49
Wisconsin..................................... 1070............................ 1062 -8
Wyoming....................................... 93.............................. 154 61
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[[Page 33195]]
In prioritizing applications to receive grants, VA identifies
States as having a ``great'', ``significant'', or ``limited'' need for
additional beds. ``Great'' need is defined as a need for 2,000 or more
new beds; ``significant'' need as a need for 1,000-1,999 new beds, and
``limited'' as a need for 999 or fewer new beds. A State that moves
into a higher priority category as a result of the reallocation of beds
in this rule will be more likely to receive a future grant than under
the current allocation of beds. A State that moves into a lower
priority category will be less likely to receive a future grant than
under the current allocation of beds. A State that remains within the
same priority category (even if the allocation of beds to the State
increases or decreases) will have an equal likelihood of receiving a
future grant under the new allocation as under the current allocation.
Our decision to use the same estimated demand for State home beds
nationwide in 2020, as that which was projected for 2009, would not
keep States from receiving grants for construction of new State home
beds. At this time, there are 28,823 recognized State home beds. In
addition, States are building facilities that when recognized will add
2,256 beds for a total of 31,079 beds. Therefore, States will soon have
in use 56 percent of the total estimated number of State home beds
needed in 2020. Of course, States will also need to replace existing
State home facilities that become obsolete or otherwise need replacing.
We thus believe that most States would continue to be able to apply for
State home grants if that is what the State chooses to do.
Unfunded Mandates
The Unfunded Mandates Reform Act of 1995 (2 U.S.C 1532) requires
that agencies prepare an assessment of anticipated costs and benefits
before issuing any rule that may result in an expenditure by the State,
local, or Tribal governments, in the aggregate, or by the private
sector, of $100 million or more (adjusted annually for inflation) in
any given year. This proposed rule would have no such effect on State,
local, or Tribal governments, or on the private sector.
Executive Order 12866
Executive Order 12866 directs agencies to assess all costs and
benefits of available regulatory alternatives and, when regulation is
necessary, to select regulatory approaches that maximize net benefits
(including potential economic, environmental, public health and safety,
and other advantages; distributive impacts; and equity). The Executive
Order classifies a ``significant regulatory action,'' requiring review
by the Office of Management and Budget (OMB) unless OMB waives such
review, as any regulatory action that is likely to result in a rule
that may: (1) Have an annual effect on the economy of $100 million or
more or adversely affect in a material way the economy, a sector of the
economy, productivity, competition, jobs, the environment, public
health or safety, or State, local, or Tribal governments or
communities; (2) create a serious inconsistency or otherwise interfere
with an action taken or planned by another agency; (3) materially alter
the budgetary impact of entitlements, grants, user fees, or loan
programs or the rights and obligations of recipients thereof; or (4)
raise novel legal or policy issues arising out of legal mandates, the
President's priorities, or the principles set forth in the Executive
Order. VA has examined the economic, interagency, budgetary, legal, and
policy implications of this proposed rule and has concluded that it
does constitute a significant regulatory action under the Executive
Order.
Paperwork Reduction Act
This document contains no provisions constituting a collection of
information under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501-
3521).
Regulatory Flexibility Act
The Secretary hereby certifies that this proposed rule would not
have a significant economic impact on a substantial number of small
entities as they are defined in the Regulatory Flexibility Act, 5
U.S.C. 601-612. The proposed rule would affect grants to States and
would not directly affect small entities. Therefore, pursuant to 5
U.S.C. 605(b), this proposed rule would be exempt from the initial and
final regulatory flexibility analyses requirements of sections 603 and
604.
Catalog of Federal Domestic Assistance
The Catalog of Federal Domestic Assistance program number and title
for this proposed rule is as follows: 64.005, Grants to States for
Construction of State Home Facilities.
List of Subjects in 38 CFR Part 59
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, Reporting and
recordkeeping requirements, Travel and transportation expenses, and
Veterans.
Approved: April 3, 2009.
John R. Gingrich,
Chief of Staff, Department of Veterans Affairs.
For the reasons stated above, the Department of Veterans Affairs
proposes to amend 38 CFR part 59 as follows:
PART 59--GRANTS TO STATES FOR CONSTRUCTION OR ACQUISITION OF STATE
HOMES
1. The authority citation for part 59 is revised to read as
follows:
Authority: 38 U.S.C. 101, 501, 1710, 1742, 8105, 8131-8138.
2. Amend Sec. 59.2 by revising the definition of ``State'' to read
as follows:
Sec. 59.2 Definitions.
* * * * *
State means each of the several States, the District of Columbia,
the Virgin Islands, the Commonwealth of Puerto Rico, Guam, the
Commonwealth of the Northern Mariana Islands, and American Samoa.
* * * * *
3. Amend Sec. 59.40 by revising paragraph (a) to read as follows:
Sec. 59.40 Maximum number of nursing home care and domiciliary care
beds for veterans by State.
(a) Except as provided in paragraph (b) of this section, a State
may not request a grant for a project to construct or acquire a new
State home facility, to increase the number of beds available at a
State home facility, or to replace beds at a State home facility if the
project would increase the total number of State home nursing home and
domiciliary beds in that State beyond the maximum number designated for
that State, as shown in the following chart. The provisions of 38
U.S.C. 8134 require VA to prescribe for each State the number of
nursing home and domiciliary beds for which grants may be furnished
(i.e., the unmet need). A State's unmet need for State home nursing
home and domiciliary beds is the number in the following chart for that
State minus the sum of the number of nursing home and domiciliary beds
in operation at State home facilities and the number of State home
nursing home and domiciliary beds not yet in operation but for which a
grant has either been requested or awarded under this part.
[[Page 33196]]
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Maximum number of
state home
nursing home &
State domiciliary beds
based on 2020
projections
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Alabama.............................................. 1,007
Alaska............................................... 179
American Samoa....................................... 0
Arizona.............................................. 1,520
Arkansas............................................. 653
California........................................... 4,363
Colorado............................................. 1,114
Connecticut.......................................... 559
Delaware............................................. 207
District of Columbia................................. 83
Florida.............................................. 4,049
Georgia.............................................. 1,975
Guam................................................. 12
Hawaii............................................... 268
Idaho................................................ 394
Illinois............................................. 1,754
Indiana.............................................. 1,216
Iowa................................................. 578
Kansas............................................... 518
Kentucky............................................. 818
Louisiana............................................ 638
Maine................................................ 362
Maryland............................................. 1,102
Massachusetts........................................ 944
Michigan............................................. 1,786
Minnesota............................................ 1,058
Mississippi.......................................... 480
Missouri............................................. 1,257
Montana.............................................. 281
Nebraska............................................. 371
Nevada............................................... 649
New Hampshire........................................ 361
New Jersey........................................... 992
New Mexico........................................... 417
New York............................................. 2,209
North Carolina....................................... 1,900
North Dakota......................................... 137
Northern Mariana Islands............................. 1
Ohio................................................. 2,143
Oklahoma............................................. 766
Oregon............................................... 907
Pennsylvania......................................... 2,336
Puerto Rico.......................................... 288
Rhode Island......................................... 157
South Carolina....................................... 1,089
South Dakota......................................... 179
Tennessee............................................ 1,311
Texas................................................ 4,119
Utah................................................. 426
Vermont.............................................. 142
Virginia............................................. 1,903
Virgin Islands....................................... 12
Washington........................................... 1,687
West Virginia........................................ 406
Wisconsin............................................ 1,062
Wyoming.............................................. 154
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Note to Sec. 59.40(a): The provisions of 38 U.S.C. 8134 require
that the ``unmet need'' numbers be based on a 10-year projection of
demand for nursing home and domiciliary care by veterans who at such
time are 65 years of age or older and who reside in that State. In
determining the projected demand, VA must take into account travel
distances for veterans and their families.
* * * * *
[FR Doc. E9-16341 Filed 7-9-09; 8:45 am]
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