**§17.111 Copayments for Extended care services.**

\(a\) *General*. This section sets forth requirements regarding
copayments for extended care services provided to veterans by VA (either
directly by VA or paid for by VA).

\(b\) *Copayments*.

\(1\) Unless exempted under paragraph (f) of this section, as a
condition of receiving extended care services from VA, a veteran must
agree to pay VA and is obligated to pay VA a copayment as specified by
this section. A veteran has no obligation to pay a copayment for the
first 21 days of extended care services that VA provided the veteran in
any 12-month period (the 12-month period begins on the date that VA
first provided extended care services to the veteran). However, for each
day that extended care services are provided beyond the first 21 days, a
veteran is obligated to pay VA the copayment amount set forth below to
the extent the veteran has available resources. Available resources are
based on monthly calculations, as determined under paragraph (d) of this
section. The following sets forth the extended care services provided by
VA and the corresponding copayment amount per day:

\(i\) Adult day health care---\$15.

\(ii\) Domiciliary care---\$5.

\(iii\) Institutional respite care---\$97.

\(iv\) Institutional geriatric evaluation---\$97.

\(v\) Non-institutional geriatric evaluation---\$15.

\(vi\) Non-institutional respite care---\$15.

\(vii\) Nursing home care---\$97.

\(2\) For purposes of counting the number of days for which a veteran is
obligated to make a copayment under this section, VA will count each day
that adult day health care, non-institutional geriatric evaluation, and
non-institutional respite care are provided and will count each full day
and partial day for each inpatient stay except for the day of discharge.

\(c\) *Definitions*. For purposes of this section:

\(1\) *Adult day health care* is a therapeutic outpatient care program
that provides medical services, rehabilitation, therapeutic activities,
socialization, nutrition and transportation services to disabled
veterans in a congregate setting.

\(2\) *Domiciliary care* is defined in §17.30(b).

\(3\) *Extended care services* means adult day health care, domiciliary
care, institutional geriatric evaluation, noninstitutional geriatric
evaluation, nursing home care, institutional respite care, and
noninstitutional respite care.

\(4\) *Geriatric evaluation* is a specialized, diagnostic/consultative
service provided by an interdisciplinary team that is for the purpose of
providing a comprehensive assessment, care plan, and extended care
service recommendations.

\(5\) *Institutional* means a setting in a hospital, domiciliary, or
nursing home of overnight stays of one or more days.

\(6\) *Noninstitutional* means a service that does not include an
overnight stay.

\(7\) *Nursing home care* means the accommodation of convalescents or
other persons who are not acutely ill and not in need of hospital care,
but who require nursing care and related medical services, if such
nursing care and medical services are prescribed by, or are performed
under the general direction of, persons duly licensed to provide such
care (nursing services must be provided 24 hours a day). Such term
includes services furnished in skilled nursing care facilities. Such
term excludes hospice care.

\(8\) *Respite care* means care which is of limited duration, is
furnished on an intermittent basis to a veteran who is suffering from a
chronic illness and who resides primarily at home, and is furnished for
the purpose of helping the veteran to continue residing primarily at
home. (Respite providers temporarily replace the caregivers to provide
services ranging from supervision to skilled care needs.)

\(d\) *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 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.

\[Note: Form 10-10EC will be found on the next three pages.\]

> (Authority: 38 U.S.C. 101(28), 501, 1701(7), 1710, 1710B, 1720B,
> 1720D, 1722A)

\[67 FR 35040, May 17, 2002, as amended at 69 FR 39846, July 1, 2004\]

**Supplement *Highlights* references**: 9(1), 24(1).

Application for Extended Services, VAF 10-10EC:

<http://www.va.gov/vaforms/medical/pdf/10-10EC.pdf>