# **DEPARTMENT OF VETERANS AFFAIRS**

**38 CFR Parts 17 and 59**

**RIN 2900-AJ43**

**Grants to States for Construction and Acquisition of State Home
Facilities**

**AGENCY: Department of Veterans Affairs.**

**ACTION: Interim final rule.**

**SUMMARY: This document establishes regulations regarding grants to
States for the construction or acquisition of State homes for furnishing
domiciliary and nursing home care to veterans, or for the expansion,
remodeling, or alteration of existing State homes for furnishing
domiciliary, nursing home, or adult day health care to veterans. This is
necessary to update the regulations and to implement statutory
provisions, including provisions of the Veterans Millennium Health Care
and Benefits Act.**

**DATES: [Effective Date]{.underline}: \[[Insert date of publication in
the FEDERAL REGISTER]{.underline}\]. Comments must be received by VA on
or before \[[Insert date 60 days after date of publication in the
FEDERAL REGISTER]{.underline}\].**

**ADDRESSES: Mail or hand-deliver written comments to: Director, Office
of Regulations Management (02D), Department of Veterans Affairs, 810
Vermont Ave., NW, Room 1154, Washington, DC 20420; or fax comments to
(202) 273-9289; or e-mail comments to
[OGCRegulations@mail.va.gov](../OGCRegulations@mail.va.gov). Comments
should indicate that they are submitted in response to \"RIN
2900-AJ43.\" All comments received will be available for public
inspection in the Office of Regulations Management, Room 1158, between
the hours of 8:00 a.m. and 4:30 p.m., Monday through Friday (except
holidays).**

**FOR FURTHER INFORMATION CONTACT: Frank Salvas, Chief, State Home
Construction Grant Program, (114), Veterans Health Administration,
202-273-8534.**

**SUPPLEMENTARY INFORMATION: This document establishes regulations
regarding grants to States for the construction or acquisition of State
homes for furnishing domiciliary and nursing home care to veterans, or
for the expansion, remodeling, or alteration of existing State homes for
furnishing domiciliary, nursing home, or adult day health care to
veterans. The rule, which is set forth in a new 38 CFR part 59, consists
of a comprehensive rewrite of the regulations set forth in 38 CFR 17.210
through 17.222.**

**Public Law 102- 585 changed from 90 days to 180 days the time limit
for States receiving a conditionally approved grant to fully comply with
the requirements for a grant. The rule reflects this statutory
provision.**

**Under authority of Public Law 104-262 (enacted on October 9, 1996),
the rule includes provisions for awarding grants to States to expand,
remodel, or alter existing buildings for furnishing adult day health
care.**

**The rule also includes provisions to implement statutory provisions
established by the Veterans Millennium Health Care and Benefits Act
(Public Law 106-117, enacted on November 30, 1999). This Act made the
following changes that are reflected in the rule:**

-   **The Act requires VA to prescribe for each State the number of
    nursing home and domiciliary beds for which grants may be furnished.
    This is required to 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 Veterans Millennium Health Care and
    Benefits Act (P.L. 106-117) 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.**

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-   **The Act sets forth new criteria for determining the order of
    priority for grants for projects, including provisions regarding
    whether the need for a bed producing project is great, significant,
    or limited.**

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-   The Act provides that VA may not accord any priority to projects for
    the construction or acquisition of a hospital.

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-   **The Act provides that a State may not request a grant for a
    project for which the total cost of construction is not in excess of
    \$400,000.**

#### The Act provides that a grant may not include maintenance and repair work.

-   **The Act requires an application for a grant for construction or
    acquisition of a nursing home or a domiciliary facility to include
    the following in the application for a grant:**

> \(1\) Documentation that the site of the project is in reasonable
> proximity to a sufficient concentration and population of veterans
> that are 65 years of age and older and that there is a reasonable
> basis to conclude that the facility when complete will be fully
> occupied,
>
> **(2) A financial plan for the first three years of operation of such
> facility, and**
>
> **(3) A five-year capital plan for the State home program for that
> State.**

**The rule also includes provisions to reflect that under Public Law
106-419 VA will not recapture amounts for all or portions of a facility
that was changed to an outpatient clinic established and operated by
VA.**

**As noted above, the Veterans Millennium Health Care and Benefits Act
sets forth new criteria for determining the order of priority for grants
for projects. We have also created new sub priorities for each priority
category that reflect the statutory priority scheme. In addition,
further sub priorities in "priority group 1 -- sub priority 1" are
established to give higher priorities to the most urgently needed
projects. Further sub priorities in "priority group 1 sub priority 4"
are established to give higher priority to projects that we have
determined are most needed for care of veterans. As a last resort for
ties in sub priorities, the rule will give projects priority based on
the earliest dates of receipt by VA of applications.**

**For a State's application to be included in priority group 1, a State
must have made sufficient funds available for the project for which the
grant is requested so that such project may proceed upon approval of the
grant without further action required by the State (such as subsequent
issuance of bonds) to make such funds available for such purpose. To
meet this criteria, the State must provide to VA a letter from an
authorized State budget official certifying that the State funds are, or
will be, available for the project, so that if VA awards the grant, the
project may proceed without further State action to make such funds
available. If the certification is based on an Act authorizing the
project and making available the State\'s matching funds for the
project, a copy of the Act must be submitted with the certification.**

**Previously, at the time of prioritizing applications, instead of the
whole amount, a State was merely required to provide a copy of an Act
making available at least one-half of the State's matching funds for the
project. We propose to require the full amount. The change to require
the full amount is necessary to help ensure that the State will actually
have all of the funds available as needed for the project without having
to take further action which could delay the construction of the State
home.**

**As noted above, the Veterans Millennium Health Care and Benefits Act
requires VA to prescribe for each State the number of nursing home and
domiciliary beds for which grants may be furnished. This is required to
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. As described below, we established the maximum number for
each State in accordance with this criteria.**

To determine the maximum number of nursing home beds for each State we
started with the national nursing home utilization by males 65 and older
which came from the Medical Expenditure Panel Survey (MEPS) conducted by
the Department of Health and Human Services in 1996. The MEPS includes
nursing home utilization by age group and by level of dependency in
activities of daily living (ADL). Based on the assumptions that the
national nursing home use rate for males would be approximately the same
for veterans and non-veterans and that the projected number of female
veterans over 65 would be very small, we applied the national rate to
the projected male and female veteran population 65 years and older in
2009 in each State. We multiplied the resulting number for each State by
11.5 percent. This percentage represents the projected national State
nursing home market share projected for VA for 2009. We also project
that the VA national market share for VA nursing homes and community
nursing homes will be 11.5 percent for 2009.

**To determine the maximum number of domiciliary beds for each State
projected to 2009, we applied the current age-specific utilization rates
in existing State home domiciliaries to the projected veteran population
65 years and older in 2009 by State.**

The maximum number of State home beds by State was then derived by
adding the projected number of State nursing home beds for 2009 to the
projected number of State domiciliary beds for 2009.

**The "natural break points" (large gaps between groups of numbers
representing maximum beds needed for States) in the list of maximum
State home beds by State are utilized to define great, significant and
limited need for beds. A State with great need is a State with no State
home beds or with a need for 2000 or more beds; a State with significant
need is a State with a need for 1000 - 1999 beds; and a State with
limited need is a State with a need for less than 1000 beds.**

**For purposes of great, significant, and limited need for beds, the
maximum number of State home nursing home and domiciliary beds for each
State is the number in the chart in § 59.40 for the State minus the sum
of the number of nursing home and domiciliary beds already 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.**

**As noted above, the Veterans Millennium Health Care and Benefits Act
requires that in considering the number of nursing home and domiciliary
beds for which grants may be furnished, VA must take into account travel
distances for veterans and their families. In this regard, the rule
states that a State may request a grant for a project that would
increase the total number of State home nursing home and domiciliary
beds beyond the maximum number for that State if the State submits to
the Chief Consultant, Geriatrics and Extended Care, documentation to
establish a need for an exception based on travel distances of at least
two hours (by land transportation or any other usual mode of
transportation if land transportation is not available) between a
veteran population center sufficient for the establishment of a State
home and any existing State home. We believe this is a reasonable method
for meeting the statutory requirement.**

**The rule contains construction requirements for facilities that would
furnish nursing home care, domiciliary care, and adult day healthcare
(§§ 59.121 through 59.170. The construction requirements for nursing
homes are consistent with the construction requirements that were
recently established for per diem for nursing home care of veterans in
State homes (38 CFR part 51). The proposed construction requirements for
domiciliaries are the same as those for nursing homes because the
construction needs are the same. The construction requirements for adult
day health care are consistent with the proposed construction
requirements for per diem for adult day health care of veterans in State
homes (65 FR 39835).**

**The rule incorporates by reference the 2000 edition of the National
Fire Protection Association Life Safety Code entitled "NFPA 101, Life
Safety Code" and the 1999 edition of the NFPA 99, Standard for Health
Care Facilities (1999 edition). The regulations are designed to ensure
that State homes meet these national standards for fire and safety.**

**[Administrative Procedure Act]{.underline}**

**Pursuant to 5 U.S.C. 553, we have found for this rule that notice and
public procedure are impracticable, unnecessary, and contrary to the
public interest and that we have good cause to dispense with notice and
comment on this rule and to dispense with a 30-day delay of its
effective date. The Veterans' Millennium Health Care and Benefits Act
provides that the Secretary shall prescribe provisions in this rule to
be used for awarding grants for fiscal year 2002. Without this rule
becoming effective immediately, States would not have sufficient time to
meet the requirements for inclusion on the priority list for obtaining a
grant for fiscal year 2002.**

**[Regulatory Flexibility Act]{.underline}**

**The Secretary hereby certifies that the adoption of 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. All of the entities that would be subject to this
proposed rule are State government entities under the control of State
governments. Of the 100 State homes, all are operated by State
governments except for 17 that are operated by entities under contract
with State governments. These contractors are not small entities.
Therefore, pursuant to 5 U.S.C. 605(b), this proposed rule is exempt
from the initial and final regulatory flexibility analysis requirement
of sections 603 and 604.**

**[Executive Order 12866]{.underline}**

**The Office of Management and Budget has reviewed this interim final
rule under Executive Order 12866.**

**[Unfunded Mandates]{.underline}**

**The Unfunded Mandates Reform Act requires (in section 202) 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
consequential effect on State, local, or tribal governments.**

# **[Paperwork Reduction Act]{.underline}**

**This rule is exempt from the collections of information requirements
under the Paperwork Reduction Act (44 U.S.C. 3501-3520). The rule only
applies to States. Further, in 2000 VA received applications for grants
from only 6 States and we expect that each year fewer than 10 States
will submit applications.**

**[List of Subjects in 38 CFR Parts 17 and 59]{.underline}**

**Administrative practice and procedure, Alcohol abuse, Alcoholism,
Claims, Day care, Dental health, Drug abuse, Foreign relations,
Government contracts, Grant programs-health, Government
programs-veterans, Health care, Health facilities, Health professions,
Health records, Homeless, Medical and dental schools, Medical devices,
Medical research, Mental health programs, Nursing home care,
Philippines, Reporting and recordkeeping requirements, Scholarships and
fellowships, Travel and transportation expenses, Veterans.**

**Approved:**

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Anthony J. Principi,**

**Secretary of Veterans Affairs.**

**For the reasons set out in the preamble, 38 CFR Chapter I is amended
as follows:**

**PART 17\--MEDICAL**

**1. The authority citation for part 17 continues to read as follows:**

**AUTHORITY: 38 U.S.C. 501, 1721, unless otherwise noted.**

**2. Immediately after § 17.200, remove the undesignated center heading,
the note, and §§ 17.210 through 17.222.**

**3. A new Part 59 is added to read as follows:**

**PART 59---GRANTS TO STATES FOR CONSTRUCTION OR ACQUISITION OF STATE
HOMES**

**Sec.**

**§ 59.01 [Purpose]{.underline}.**

**§ 59.02 [Definitions]{.underline}.**

**§ 59.03 [Federal Application Identifier]{.underline}.**

**§ 59.04 [Decisionmakers, notifications, and additional
information]{.underline}.**

**§ 59.05 [Submissions of information and documents to
VA]{.underline}.**

**§ 59.10 [General requirements for a grant]{.underline}.**

**§ 59.20 [Initial application requirements]{.underline}.**

**§ 59.30 [Documentation]{.underline}.**

**§ 59.40 [Maximum number of nursing home care and domiciliary care beds
for veterans by State]{.underline}.**

**§ 59.50 [Priority list]{.underline}.**

**§ 59.60 [Additional application requirements]{.underline}.**

**§ 59.70 [Award of grants]{.underline}.**

**§ 59.80 [Amount of grant]{.underline}.**

**§ 59.90 [Line item adjustments to grants]{.underline}.**

§ 59.100 [Payment of grant award]{.underline}.

§ 59.110 [Recapture provisions]{.underline}.

§ 59.120 [Hearings]{.underline}.

**§ 59.121 [Amendments to application]{.underline}.**

**§ 59.122 [Withdrawal of application]{.underline}.**

§ 59.123 [Conference]{.underline}.

**§ 59.124 [Inspections, audits, and reports]{.underline}.**

**§ 59.130 [General requirements for all State home
facilities]{.underline}.**

**§ 59.140 [Nursing home care requirements]{.underline}.**

**§ 59.150 [Domiciliary care requirements]{.underline}.**

**§ 59.160 [Adult day health care requirements]{.underline}.**

**§ 59.170 [Forms]{.underline}.**

**AUTHORITY: 38 U.S.C. 101, 501, 1710, 1742, 8105, 8131-8137).**

**§ 59.01 [Purpose*.*]{.underline}**

**This part sets forth the mechanism for a State to obtain a grant:**

**(1) To construct State home facilities (or to acquire facilities to be
used as State home facilities) for furnishing domiciliary or nursing
home care to veterans, and**

**(2) To expand, remodel, or alter existing buildings for furnishing
domiciliary, nursing home, adult day health, or hospital care to
veterans in State homes.**

**(Authority: 38 U.S.C. 101, 501, 1710, 1742, 8105, 8131-8137).**

**§ 59.02 [Definitions.]{.underline}**

**For the purpose of this part:**

**[Acquisition]{.underline} means the purchase of a facility in which to
establish a State home for the provision of domiciliary and/or nursing
home care to veterans.**

**[Adult day health care]{.underline} is a therapeutically-oriented
outpatient day program, which provides health maintenance and
rehabilitative services to participants. The program must provide
individualized care delivered by an interdisciplinary health care team
and support staff, with an emphasis on helping participants and their
caregivers to develop the knowledge and skills necessary to manage care
requirements in the home. Adult day health care is principally targeted
for complex medical and/or functional needs of elderly veterans.**

**[Construction]{.underline} means the construction of new domiciliary
or nursing home buildings, the expansion, remodeling, or alteration of
existing buildings for the provision of domiciliary, nursing home, or
adult day health care, or hospital care in State homes, and the
provision of initial equipment for any such buildings.**

**[Domiciliary care]{.underline} means providing shelter, food, and
necessary medical care on an ambulatory self-care basis (this is more
than room and board). It assists eligible veterans who are suffering
from a disability, disease, or defect of such a degree that
incapacitates the veteran from earning a living, but who are not in need
of hospitalization or nursing care services. It assists in attaining
physical, mental, and social well-being through special rehabilitative
programs to restore residents to their highest level of functioning.**

**[Nursing home care]{.underline} means the accommodation of
convalescents or other persons who are not acutely ill and not in need
of hospital care, but who require skilled nursing care and related
medical services.**

**[Secretary]{.underline} means the Secretary of the United States
Department of Veterans Affairs.**

**[State]{.underline} means each of the several States, the District of
Columbia, the Virgin Islands, and the Commonwealth of Puerto Rico.**

[State representative]{.underline} means the official designated in
accordance with state authority with responsibility for matters relating
to the request for a grant under this part.

**[VA]{.underline} means the United States Department of Veterans
Affairs.**

**(Authority: 38 U.S.C. 101, 501, 1710, 1742, 8105, 8131-8137).**

**§ 59.03 [Federal Application Identifier]{.underline}.**

**Once VA has provided the State representative with a Federal
Application Identifier Number for a project, the number must be included
on all subsequent written communications to VA from the State or its
agent regarding a request for a grant for that project under this
part.**

**(Authority: 38 U.S.C. 101, 501, 1710, 1742, 8105, 8131-8137).**

**§ 59.04 [Decision makers, notifications, and additional
information]{.underline}.**

**The decision maker for decisions required under this part will be the
Chief Consultant, Geriatrics and Extended Care, unless specified to be
the Secretary or other VA official. The VA decision maker will provide
written notice to affected States of approvals, denials, or requests for
additional information under this part.**

**(Authority: 38 U.S.C. 101, 501, 1710, 1742, 8105, 8131-8137).**

**§ 59.05 [Submissions of information and documents to
VA]{.underline}.**

**All submissions of information and documents required to be presented
to VA must be made, unless otherwise specified under this part, to the
Chief Consultant, Geriatrics and Extended Care (114), VHA Headquarters;
810 Vermont Avenue, N.W.; Washington DC 20420.**

**(Authority: 38 U.S.C. 101, 501, 1710, 1742, 8105, 8131-8137).**

**§ 59.10 [General requirements for a grant]{.underline}.**

**For a State to obtain a grant under this part and grant funds, its
initial application for the grant must be approved under § 59.20, and
the project must be ranked sufficiently high on the priority list for
the current fiscal year so that funding is available for the project,
must meet the additional application requirements in § 59.60, and must
meet all other requirements under this part for obtaining a grant and
grant funds.**

**(Authority: 38 U.S.C. 101, 501, 1710, 1742, 8105, 8131-8137).**

**§ 59.20 [Initial application requirements.]{.underline}**

**(a) For a project to be considered for inclusion on the priority list
in § 59.50 of this part for the next fiscal year, a State must submit to
VA an original and one copy of a completed VA Form 10-0388 and all
information, documentation, and other forms specified by VA form 10-0388
(these forms are set forth at § 59.170 of this part).**

**(b) The Secretary, based on the information submitted for a project
pursuant to paragraph (a) of this section, will approve the project for
inclusion on the priority list in § 59.50 of this part if the submission
includes all of the information requested under paragraph (a) of this
section and if the submission represents a project that could meet the
requirements for a grant under this part if further developed.**

**(c) The information requested under paragraph (a) of this section
should be submitted to VA by April 15 and must be received by VA by
August 15 if the State wishes an application to be included on the
priority list for the award of grants during the next fiscal year.**

**(d) If a State representative believes that VA may not award a grant
to the State for a grant application during the current fiscal year and
wants to ensure that VA includes the application on the priority list
for the next fiscal year, the State representative must prior to August
15 of the current fiscal year\--**

**(1) Request VA to include the application in those recommended to the
Secretary for inclusion on the priority list, and**

**(2) Send any updates to VA.**

**(Authority: 38 U.S.C. 101, 501, 1710, 1742, 8105, 8131-8137).**

**§ 59.30 [Documentation]{.underline}.**

For a State to obtain a grant and grant funds under this part, the State
must submit to VA documentation that the site of the project is in
reasonable proximity to a sufficient concentration and population of
veterans that are 65 years of age and older and that there is a
reasonable basis to conclude that the facility when complete will be
fully occupied. This documentation must be included in the initial
application submitted to VA under § 59.20.

**(Authority: 38 U.S.C. 101, 501, 1710, 1742, 8105, 8131-8137).**

**§ 59.40 [Maximum number of nursing home care and domiciliary care beds
for veterans by State]{.underline}.**

**(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 beyond the maximum number designated for that State.
The maximum number of State home nursing home and domiciliary beds
designated for each State is the number in the following chart for the
State minus the sum of the number of nursing home and domiciliary beds
already 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:**

+-----------------------------------+-----------------------------------+
| **State**                         | **State Home Nursing Home And     |
|                                   | Domiciliary**                     |
|                                   |                                   |
|                                   | **Beds**                          |
+-----------------------------------+-----------------------------------+
|                                   |                                   |
+-----------------------------------+-----------------------------------+
| **Alabama**                       | **883**                           |
+-----------------------------------+-----------------------------------+
| **Alaska**                        | **79**                            |
+-----------------------------------+-----------------------------------+
| **Arizona**                       | **1,068**                         |
+-----------------------------------+-----------------------------------+
| **Arkansas**                      | **557**                           |
+-----------------------------------+-----------------------------------+
| ##### California                  | **5,754**                         |
+-----------------------------------+-----------------------------------+
| **Colorado**                      | **717**                           |
+-----------------------------------+-----------------------------------+
| **Connecticut**                   | **738**                           |
+-----------------------------------+-----------------------------------+
| **Delaware**                      | **165**                           |
+-----------------------------------+-----------------------------------+
| **District of Columbia**          | **104**                           |
+-----------------------------------+-----------------------------------+
| **Florida**                       | **4,471**                         |
+-----------------------------------+-----------------------------------+
| **Georgia**                       | **1,202**                         |
+-----------------------------------+-----------------------------------+
| **Hawaii**                        | **216**                           |
+-----------------------------------+-----------------------------------+
| **Idaho**                         | **233**                           |
+-----------------------------------+-----------------------------------+
| **Illinois**                      | **2,271**                         |
+-----------------------------------+-----------------------------------+
| **Indiana**                       | **1,209**                         |
+-----------------------------------+-----------------------------------+
| **Iowa**                          | **632**                           |
+-----------------------------------+-----------------------------------+
| **Kansas**                        | **542**                           |
+-----------------------------------+-----------------------------------+
| **Kentucky**                      | **759**                           |
+-----------------------------------+-----------------------------------+
| **Louisiana**                     | **785**                           |
+-----------------------------------+-----------------------------------+
| **Maine**                         | **301**                           |
+-----------------------------------+-----------------------------------+
| **Maryland**                      | **1,020**                         |
+-----------------------------------+-----------------------------------+
| **Massachusetts**                 | **1,348**                         |
+-----------------------------------+-----------------------------------+
| **Michigan**                      | **1,896**                         |
+-----------------------------------+-----------------------------------+
| **Minnesota**                     | **932**                           |
+-----------------------------------+-----------------------------------+
| **Mississippi**                   | **500**                           |
+-----------------------------------+-----------------------------------+
| **Missouri**                      | **1,230**                         |
+-----------------------------------+-----------------------------------+
| **Montana**                       | **198**                           |
+-----------------------------------+-----------------------------------+
| **Nebraska**                      | **355**                           |
+-----------------------------------+-----------------------------------+
| **Nevada**                        | **428**                           |
+-----------------------------------+-----------------------------------+
| **New Hampshire**                 | **264**                           |
+-----------------------------------+-----------------------------------+
| **New Jersey**                    | **1,683**                         |
+-----------------------------------+-----------------------------------+
| **New Mexico**                    | **344**                           |
+-----------------------------------+-----------------------------------+
| **New York**                      | **3,220**                         |
+-----------------------------------+-----------------------------------+
| **North Carolina**                | **1,454**                         |
+-----------------------------------+-----------------------------------+
| **North Dakota**                  | **121**                           |
+-----------------------------------+-----------------------------------+
| **Ohio**                          | **2,530**                         |
+-----------------------------------+-----------------------------------+
| **Oklahoma**                      | **747**                           |
+-----------------------------------+-----------------------------------+
| **Oregon**                        | **804**                           |
+-----------------------------------+-----------------------------------+
| **Pennsylvania**                  | **3,173**                         |
+-----------------------------------+-----------------------------------+
| **Puerto Rico**                   | **350**                           |
+-----------------------------------+-----------------------------------+
| **Rhode Island**                  | **254**                           |
+-----------------------------------+-----------------------------------+
| **South Carolina**                | **750**                           |
+-----------------------------------+-----------------------------------+
| **South Dakota**                  | **155**                           |
+-----------------------------------+-----------------------------------+
| **Tennessee**                     | **1,050**                         |
+-----------------------------------+-----------------------------------+
| **Texas**                         | **3,226**                         |
+-----------------------------------+-----------------------------------+
| **Utah**                          | **304**                           |
+-----------------------------------+-----------------------------------+
| **Vermont**                       | **124**                           |
+-----------------------------------+-----------------------------------+
| **Virginia**                      | **1,312**                         |
+-----------------------------------+-----------------------------------+
| **Virgin Islands**                | **8**                             |
+-----------------------------------+-----------------------------------+
| **Washington**                    | **1,215**                         |
+-----------------------------------+-----------------------------------+
| **West Virginia**                 | **455**                           |
+-----------------------------------+-----------------------------------+
| **Wisconsin**                     | **1,070**                         |
+-----------------------------------+-----------------------------------+
| **Wyoming**                       | **93**                            |
+-----------------------------------+-----------------------------------+

NOTE to § 59.40(a): 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. This is required to 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 Veterans Millennium
Health Care and Benefits Act (P.L. 106-117) 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.

\(b\) A State may request a grant for a project that would increase the
total number of State home nursing home and domiciliary beds beyond the
maximum number for that State, if the State submits to VA, documentation
to establish a need for the exception based on travel distances of at
least two hours (by land transportation or any other usual mode of
transportation if land transportation is not available) between a
veteran population center sufficient for the establishment of a State
home and any existing State home. The determination regarding a request
for an exception will be made by the Secretary.

**(Authority: 38 U.S.C. 101, 501, 1710, 1742, 8105, 8131-8137).**

**§ 59.50 [Priority list]{.underline}.**

**(a) The Secretary will make a list prioritizing the applications that
were received on or before August 15 and that were approved under §
59.20 of this part. Except as provided in paragraphs (b) and (c) of this
section, applications will be prioritized from the highest to the lowest
in the following order:**

**(1) Priority group 1. An application from a State that has made
sufficient funds available for the project for which the grant is
requested so that such project may proceed upon approval of the grant
without further action required by the State (such as subsequent
issuance of bonds) to make such funds available for the project. To meet
this criteria, the State must provide to VA a letter from an authorized
State budget official certifying that the State funds are, or will be,
available for the project, so that if VA awards the grant, the project
may proceed without further State action to make such funds available
(such as further action to issue bonds). If the certification is based
on an Act authorizing the project and making available the State\'s
matching funds for the project, a copy of the Act must be submitted with
the certification.**

**(i) Priority group 1 -- sub priority 1. An application for a project
to remedy a condition or conditions at an existing facility that have
been cited as threatening to the lives or safety of the residents in the
facility by a VA Life Safety Engineer, a State or local government
agency (including a Fire Marshal) or an accrediting institution
(including the Joint Commission on Accreditation of Healthcare
Organizations). This priority group does not include applications for
the addition or replacement of building utility systems, such as heating
and air-conditioning systems or building features, such as roof
replacements. Projects in this sub priority will be further prioritized
in the following order: seismic, building construction, egress, building
compartmentalization (e.g., smoke barrier, fire walls), fire
alarm/detection, asbestos/hazardous materials, and all other projects.
Projects in this sub priority will be further prioritized based on the
date the application for the project was received in VA (the earlier the
application was received, the higher the priority given).**

**(ii) Priority group 1 -- sub priority 2. An application from a State
that has not previously applied for a grant under 38 U.S.C. 8131-8137
for construction or acquisition of a State nursing home. Projects in
this sub priority will be further prioritized based on the date the
application for the project was received in VA (the earlier the
application was received, the higher the priority given).**

**(iii) Priority group 1 -- sub priority 3. An application for
construction or acquisition of a nursing home or domiciliary from a
State that has a great need for the beds that the State, in that
application, proposes to establish. Projects in this sub priority will
be further prioritized based on the date the application for the project
was received in VA (the earlier the application was received, the higher
the priority given).**

**(iv) Priority group 1 -- sub priority 4. An application from a State
for renovations to a State Home facility other than renovations that
would be included in sub priority 1 of Priority group 1. Projects will
be further prioritized in the following order: adult day health care
construction, nursing home construction (e.g., patient privacy), code
compliance under Americans with Disabilities Act, building systems and
utilities (e.g., electrical, HVAC (heating, ventilation, and air
conditioning), boiler, medical gasses, roof, elevators); clinical-
support facilities (e.g., for dietetics, laundry, rehabilitation
therapy), and general renovation/upgrade (e.g., warehouse, storage,
administration/office, multipurpose). Projects in this sub priority will
be further prioritized**

**based on the date the application for the project was received in VA
(the earlier the application was received, the higher the priority
given).**

**(v) Priority group 1 -- sub priority 5. An application for
construction or acquisition of a nursing home or domiciliary from a
State that has a significant need for the beds that the State, in that
application, proposes to establish. Projects in this sub priority will
be further prioritized based on the date the application for the project
was received in VA (the earlier the application was received, the higher
the priority given).**

**(vi) Priority group 1 -- sub priority 6. An application for
construction or acquisition of a nursing home or domiciliary from a
State that has a limited need for the beds that the State, in that
application, proposes to establish. Projects in this sub priority will
be further prioritized based on the date the application for the project
was received in VA (the earlier the application was received, the higher
the priority given).**

**NOTE for § 59.50 priority group 1 (including the sub priorities): The
following chart is intended to provide a graphic aid for understanding
Priority group 1 and its sub priorities.**

**\[Insert actual copy of "Example---Prioritization for Priority Group
I"\]**

**(2) Priority group 2. An application not meeting the criteria of
paragraph (a)(1) of this section but meeting the criteria of paragraph
(a)(1)(i) of this section. Projects within this priority group will be
further prioritized the same as in paragraph (a)(1)(i) of this
section.**

**(3) Priority group 3. An application not meeting the criteria of
paragraph (a)(1) of this section but meeting the criteria of paragraph
(a)(1)(ii) of this section. Projects within this priority group will be
further prioritized the same as in paragraph (a)(1)(ii) of this
section.**

**(4) Priority group 4. An application not meeting the criteria of
paragraph (a)(1) of this section but meeting the criteria of paragraph
(a)(1)(iii) of this section. Projects within this priority group will be
further prioritized the same as in paragraph (a)(1)(iii) of this
section.**

**(5) Priority group 5. An application not meeting the criteria of
paragraph (a)(1) of this section but meeting the criteria of paragraph
(a)(1)(iv) of this section. Projects within this priority group will be
further prioritized the same as in paragraph (a)(1)(iv) of this
section.**

**(6) Priority group 6. An application not meeting the criteria of
paragraph (a)(1) of this section but meeting the criteria of paragraph
(a)(1)(v) of this section. Projects within this priority group will be
further prioritized the same as in paragraph (a)(1)(v) of this
section.**

**(7) Priority group 7. An application not meeting the criteria of
paragraph (a)(1) of this section but meeting the criteria of paragraph
(a)(1)(vi) of this section. Projects within this priority group will be
further prioritized the same as in paragraph (a)(1)(vi) of this
section.**

**(b) An application will be given highest priority on the priority list
for the next fiscal year within the priority group to which it is
assigned in paragraph (a) of this section (without consideration of sub
priorities) if:**

**(1) During the current fiscal year the State accepted a grant for that
application that was less than the amount that would have been awarded
if VA had sufficient appropriations to award the full amount of the
grant requested; and**

**(2) The application was the lowest-ranking application on the priority
list for the current fiscal year for which grant funds were available.**

**(c) An application will be given priority on the priority list (after
applications described in paragraph (b) of this section) for the next
fiscal year ahead of all applications that had not been approved under §
59.20 on the date that the application was approved under § 59.20, if:**

\(1\) During the current fiscal year VA would have awarded a grant based
on the application except for the fact that VA determined that the State
did not by July 1 provide evidence that it had its matching funds for
the project, and

**(2) The State was notified prior to July 1 that VA had funding
available for this grant application**

**(d) The priority list will not contain any project for the
construction or acquisition of a hospital or hospital beds.**

\(e\) For purposes of establishing priorities under this section: (1) A
State has a great need for nursing home and domiciliary beds if the
State: (A) has no State homes with nursing home or domiciliary beds, or
(B) has an unmet need of 2,000 or more nursing home and domiciliary
beds; (2) A State has a significant need for nursing home and
domiciliary beds if State has an unmet need of 1,000 to 1,999 nursing
home and domiciliary beds; and (3) A State has a limited need for
nursing home and domiciliary beds if State has an unmet need of 999 or
fewer nursing home and domiciliary beds.

**(f) Projects that could be placed in more than one sub priority will
be placed in the sub priority toward which the preponderance of the cost
of the project is allocated. For example, under priority group 1 -- sub
priority 1, if a project for which 25 percent of the funds needed would
concern seismic and 75 percent of the funds needed would concern
building construction, the project would be placed in the sub priority
for building construction.**

**(g) Once the Secretary prioritizes the applications in the priority
list, VA will not change the priorities unless a change is necessary as
a result of an appeal.**

**(Authority: 38 U.S.C. 101, 501, 1710, 1742, 8105, 8131-8137).**

**§ 59.60 [Additional application requirements]{.underline}.**

**(a) For a project to be eligible for a grant under this part for the
fiscal year for which the priority list was made, during that fiscal
year the State must submit to VA an original and a copy of the
following:**

**(1) Complete, updated Standard Forms 424 (mark the box labeled
application and submit the information requested for an application),
424C, and 424D (the forms are set forth at § 59.170 of this part), and**

**(2) A completed VA Form 10-0388A and all information and documentation
specified by VA form 10-0388A (the form is set forth at § 59.170).**

**(Authority: 38 U.S.C. 101, 501, 1710, 1742, 8105, 8131-8137).**

**§ 59.70 [Award of grants]{.underline}.**

**The Secretary during the fiscal year for which a priority list is made
under this part, will:**

**(1) Award a grant for each application which has been approved under\
§ 59.20, which is sufficiently high on the priority list so that funding
is available for the application, which meets the additional application
requirements in § 59.60, and which meets all other requirements under
this part for obtaining a grant, or**

**(2) Conditionally approve a grant for a project for which a State has
submitted an application that substantially meets the requirements of
this part if the State representative requests conditional approval and
provides written assurance that the State will meet all requirements for
a grant not later than 180 calendar days after the date of conditional
approval. If a State that has obtained conditional approval for a
project does not meet all of the requirements within 180 calendar days
after the date of conditional approval, the Secretary will rescind the
conditional approval and the project will be ineligible for a grant in
the fiscal year in which the State failed to fully complete the
application. The funds that were conditionally obligated for this
project will be deobligated.**

**(b) As a condition of receiving a grant, a State must make sufficient
funds available for the project for which the grant is requested so that
such project may proceed upon approval of the grant without further
action required by the State (such as subsequent issuance of bonds) to
make such funds available for such purpose. To meet this criteria, the
State must provide to VA a letter from an authorized State budget
official certifying that the State funds are, or will be, available for
the project, so that if VA awards the grant, the project may proceed
without further State action to make such funds available (such as
further action to issue bonds). If the certification is based on an Act
authorizing the project and making available the State\'s matching funds
for the project, a copy of the Act must be submitted with the
certification. To be eligible for inclusion in priority group 1 under
this part, a State must make such funds available by August 15 of the
year prior to the fiscal year for which the grant is requested. To
otherwise be eligible for a grant and grant funds based on inclusion on
the priority list in other than priority group 1, a State must make such
funds available by July 1 of the fiscal year for which the grant is
requested.**

**(c) As a condition of receiving a grant, the State representative and
the Secretary will sign three originals of the Memorandum of Agreement
documents (one for the State and two for VA). A sample is set forth in §
59.170.**

**(Authority: 38 U.S.C. 101, 501, 1710, 1742, 8105, 8131-8137).**

**§ 59.80 [Amount of grant]{.underline}.**

**(a) The total cost of a project (VA and State) for which a grant is
awarded under this part may not be less than \$400,000 and, except as
provided in paragraph (i) of this section, the total cost of a project
will not exceed the total cost of new construction. The amount of a
grant awarded under this part will be the amount requested by the State
and approved in accordance with this part, not to exceed 65 percent of
the total cost of the project except that:**

**(1) The total cost of a project will not include the cost of space
that exceeds the maximum allowable space specified in this part, and**

**(2) The amount of the grant may be less than 65 percent of the total
cost of the project if the State accepts less because VA did not have
sufficient funds to award the full amount of the grant requested.**

**(b) The total cost of a project under this part for acquisition of a
facility may also include construction costs.**

**(c) The total cost of a project under this part will not include any
costs incurred before the date VA sent the State written notification
that the application in § 59.20 was approved.**

**(d) The total cost of a project under this part may include
administration and production costs, e.g., architectural and engineering
fees, inspection fees, and printing and advertising costs.**

**(e) The total cost of a project under this part may include the cost
of projects on the grounds of the facility, e.g., parking lots,
landscaping, sidewalks, streets, storm sewers, only if they are
inextricably involved with the construction of the project.**

**(f) The total cost of a project under this part may include the cost
of equipment necessary for the operation of the State home facility.
This may include the cost of:**

**(1) Fixed equipment included in the construction or acquisition
contract. Fixed equipment must be permanently affixed to the building or
connected to the heating, ventilating, air conditioning, or other
service distributed through the building via ducts, pipes, wires, or
other connecting device. Fixed equipment must be installed during
construction. Examples of fixed equipment include kitchen and
intercommunication equipment, built-in cabinets, and cubicle curtain
rods, and**

**(2) Other equipment not included in the construction contract
constituting no more than 10 percent of the total construction contract
cost of the project. Other equipment includes: furniture, furnishings,
wheeled equipment, kitchen utensils, linens, draperies, blinds, electric
clocks, pictures and trash cans.**

**(g) The contingency allowance may not exceed 5 percent of the total
cost of the project for new construction or 8 percent for renovation
projects.**

**(h) The total cost of a project under this part may not include the
cost of:**

**(1) Land acquisition,**

**(2) Maintenance or repair work, or**

**(3) Office supplies or consumable goods (such as, food, drugs, medical
dressings, paper, printed forms, and soap) which are routinely used in a
State home.**

**(i) A grant for expansion, remodeling, or alteration of an existing
State home, which is on or eligible for inclusion in the National
Register of Historic Places, for furnishing domiciliary, nursing home,
or adult day health care to veterans may not be awarded for the
expansion, remodeling, or alteration of such building if such action
does not comply with National Historic Preservation Act procedures or if
the total cost of remodeling, renovating, or adapting such building or
facility exceeds the cost of comparable new construction by more than
five percent. If demolition of an existing building or facility on or
eligible for inclusion in the National Register of Historic Places is
deemed necessary and such demolition action is taken in compliance with
National Historic Preservation Act procedures, any mitigation cost
negotiated in the compliance process and/or the cost to professionally
record the building or facility in the Historic American Buildings
Survey (HABS), plus the total cost for demolition and site restoration,
shall be included by the State in calculating the total cost of new
construction.**

**(j) The cost of demolition of a building cannot be included in the
total cost of construction unless the proposed construction is in the
same location as the building to be demolished or unless the demolition
is inextricably linked to the design of the construction project.**

**(k) With respect to the final award of a conditionally approved grant,
the Secretary may not award a grant for an amount that is 10 percent
more than the amount conditionally approved.**

**(Authority: 38 U.S.C. 101, 501, 1710, 1742, 8105, 8131-8137).**

**§ 59.90 [Line item adjustments to grants]{.underline}.**

**After a grant has been awarded, upon request from the State
representative, VA may approve a change in a line item (line items are
identified in Form 424C which is set forth in § 59.170 of this part) of
up to 10 percent (increase or decrease) of the cost of the line item if
the change would be within the scope or objective of the project and
would not change the amount of the grant.**

**(Authority: 38 U.S.C. 101, 501, 1710, 1742, 8105, 8131-8137).**

§ 59.100 [Payment of grant award]{.underline}.

**The amount of the grant award will be paid to the State or, if
designated by the State representative, the State home for which such
project is being carried out or any other State agency or
instrumentality. Such amount shall be paid by way of reimbursement, and
in such installments consistent with the progress of the project as the
Chief Consultant, Geriatrics and Extended Care may determine and certify
for payment to the appropriate Federal institution. Funds paid under
this section for an approved project shall be used solely for carrying
out such project as so approved. As a condition for the final payment,
the State must comply with the requirements of this part based on an
architectural and engineering inspection approved by VA, must obtain VA
approval of the final equipment list submitted by the State
representative, and must submit to VA of a completed VA form 10-0388B.
The equipment list and the completed VA form 10-0388B must be submitted
to the Chief Consultant, Geriatrics and Extended Care (114), VHA
Headquarters; 810 Vermont Avenue, N.W.; Washington DC 20420.**

**(Authority: 38 U.S.C. 101, 501, 1710, 1742, 8105, 8131-8137).**

§ 59.110 [Recapture provisions.]{.underline}

**If a facility for which a grant has been awarded ceases to be operated
as a State home for the purpose for which the grant was made, the United
States shall be entitled to recover from the State which was the
recipient of the grant or from the then owner of such construction as
follows:**

**(a) If less than 20 years has lapsed since the grant was awarded and
VA provided 65 percent of the estimated cost to construct, acquire or
renovate a State home facility principally for furnishing domiciliary
care, nursing home care, adult day health care, hospital care, or
non-institutional care to veterans, VA shall be entitled to recover 65
percent of the current value of such facility (but in no event an amount
greater than the amount of assistance provided for such under these
regulations), as determined by agreement of the parties or by action
brought in the district court of the United States for the district in
which the facility is situated.**

**(b) Based on the time periods for grant amounts set forth below, if VA
provided between 50 and 65 percent of the estimated cost of expansion,
remodeling, or alteration of an existing State Home facility, VA shall
be entitled to recover the amount of the grant as determined by
agreement of the parties or by action brought in the district court of
the United States for the district in which the facility is situated:**

**\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\--**

**Grant amount Recovery**

**(dollars in thousands) period (in years)**

**\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\--**

**0-250.............................................\...7**

**251-500............................................8**

**501
-750\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\......9**

**751-1,000\...\...\...\...\...\...\...\...\...\...\...\...\...\........10**

**1,001-1,250\...\...\...\...\...\...\...\...\...\...\...\...\...\......11**

**1,251-1,500\...\...\...\...\...\...\...\...\...\...\...\...\...\......12**

**1,501-1,750\...\...\...\...\...\...\...\...\...\...\...\...\...\......13**

**1,751-2,000\...\...\...\...\...\...\...\...\...\...\...\...\...\......14**

**2,001-2,250\...\...\...\...\...\...\...\...\...\...\...\...\...\......15**

**2,251-2,500\...\...\...\...\...\...\...\...\...\...\...\...\...\......16**

**2,501-2,750\...\...\...\...\...\...\...\...\...\...\...\...\...\......17**

**2,751-3,000\...\...\...\...\...\...\...\...\...\...\...\...\...\......18**

**Over
3,000\...\...\...\...\...\...\...\...\...\...\...\...\...\........20**

**\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\--**

**(c ) If the magnitude of the VA contribution is below 50 percent of
the estimated cost of the expansion, remodeling, or alteration of an
existing State home facility recognized by the Department of Veterans
Affairs, the Under Secretary for Health may authorize a recovery period
between 7 and 20 years depending on the grant amount involved and the
magnitude of the project.**

**(d) This section does not apply to any portion of a State home in
which VA has established and operates an outpatient clinic.**

**(Authority: 38 U.S.C. 101, 501, 1710, 1742, 8105, 8131-8137).**

**§ 59.120 [Hearings.]{.underline}**

If the Secretary determines that a submission from a State does not meet
the requirements of this part, the Secretary will advise the State by
letter that a grant is tentatively denied, explain the reasons for the
tentative denial, and inform the State of the opportunity to appeal to
the Board of Veterans Appeals pursuant to 38 U.S.C. 7105. Decisions
under this part are not subject to the provisions of § 17.133.

**(Authority: 38 U.S.C. 101, 501, 511, 1710, 1742, 7101-7298, 8105,
8131-8137).**

**§ 59.121 [Amendments to application]{.underline}.**

Any amendment of an application that changes the scope of the
application or changes the cost estimates by 10 percent or more shall be
subject to approval in the same manner as an original application.

**(Authority: 38 U.S.C. 101, 501, 1710, 1742, 8105, 8131-8137).**

**§ 59.122 [Withdrawal of application]{.underline}.**

A State representative may withdraw an application by submitting a
written document requesting a withdrawal to VA.

**(Authority: 38 U.S.C. 101, 501, 1710, 1742, 8105, 8131-8137).**

§ 59.123 [Conference.]{.underline}

At any time VA may recommend that a conference (such as a design
development conference) be held in the VA Central Office in Washington,
DC., to provide an opportunity for the State and its architects to
discuss requirements for a grant with VA officials.

**(Authority: 38 U.S.C. 101, 501, 1710, 1742, 8105, 8131-8137).**

**§ 59.124 [Inspections, audits, and reports]{.underline}.**

**(a) A State will allow VA inspectors and auditors to conduct
inspections and audits as necessary to ensure compliance with the
provisions of this part. States will prepare audit reports as required
by the Single Audit Act of 1984 (see part 41 of this chapter) and submit
them to VA.**

**(b) A State will make such reports in such form and containing such
information as the Chief Consultant, Geriatrics and Extended Care may
from time to time reasonably require, and give the Chief Consultant,
Geriatrics and Extended Care, upon demand, access to the records upon
which such information is based.**

**(Authority: 38 U.S.C. 101, 501, 1710, 1742, 8105, 8131-8137).**

**§ 59.130 [General requirements for all State home
facilities*.*]{.underline}**

**As a condition for receiving a grant and grant funds under this part,
States must comply with the requirements of this section.**

**(a) The physical environment of a State home must be designed,
constructed, equipped, and maintained to protect the health and safety
of participants, personnel and the public.**

**(b) A State home must meet the general conditions of the American
Institute of Architects or other general conditions required by the
State for awarding contracts for State home grant projects. Facilities
must meet all federal, State, and local requirements, including the
Uniform Federal Accessibility Standards (UFAS) (24 CFR part 40, appendix
A), during the design and construction of projects subject to this part.
If the State or local requirements are different from the federal
requirements, compliance with the most stringent provisions is required.
A State must design and construct the project to provide sufficient
space and equipment in dining, health services, recreation, and program
areas to enable staff to provide participants with needed services as
required by this part and as identified in each participant\'s plan of
care.**

**(c) State homes should be planned to approximate the home atmosphere
as closely as possible. The interior and exterior should provide an
attractive and home-like environment for elderly residents. The site
will be located in a safe, secure, residential-type area that is
accessible to acute medical care facilities, community activities and
amenities, and transportation facilities typical of the area.**

**(d)(1) State homes must meet the applicable provisions of the National
Fire Protection Association's NFPA 101, Life Safety Code (2000 edition)
and the NFPA 99, Standard for Health Care Facilities (1999 edition).
Incorporation by reference of these materials was approved by the
Director of the Federal Register in accordance with 5 U.S.C. 552(a) and
1 CFR part 51. These materials incorporated by reference are available
for inspection at the Office of the Federal Register, Suite 700, 800
North Capitol Street, NW, Washington, DC, and the Department of Veterans
Affairs, Office of Regulations Management (02D),\
Room 1154, 810 Vermont Avenue, NW, Washington, DC 20420. Copies may be
obtained from the National Fire Protection Association, 1 Batterymarch
Park, P.O. Box 9101, Quincy, MA 02269-9101. (For ordering information,
call toll-free 1-800-344-3555.)**

**(2) Facilities must also meet the State and local fire codes.**

**(e) State homes must have an emergency electrical power system to
supply power adequate to operate all exit signs and lighting for the
means of egress, fire and medical gas alarms, and emergency
communication systems. The source of power must be an on-site emergency
standby generator of sufficient size to serve the connected load or
other approved sources.**

**(f) The nurse\'s station must be equipped to receive resident calls
through a communication system from resident rooms, toilet and bathing
facilities, dining areas, and activity areas.**

**(g) The State home must have one or more rooms designated for resident
dining and activities. These rooms must be\--**

**(1) Well lighted;**

**(2) Well ventilated; and**

**(3) Adequately furnished.**

**(h) The facility management must provide a safe, functional, sanitary,
and comfortable environment for the residents, staff and the public. The
facility must\--**

**(1) Ensure that water is available to essential areas when there is a
loss of normal water supply;**

**(2) Have adequate outside ventilation by means of windows, or
mechanical ventilation, or a combination of the two;**

**(3) Equip corridors with firmly secured handrails on each side; and**

**(4) Maintain an effective pest control program so that the facility**

**is free of pests and rodents.**

**(Authority: 38 U.S.C. 101, 501, 1710, 1742, 8105, 8131-8137).**

**§ 59.140 [Nursing home care requirements]{.underline}.**

**As a condition for receiving a grant and grant funds for a nursing
home facility under this part, States must comply with the requirements
of this section.**

**(a) Resident rooms must be designed and equipped for adequate nursing
care, comfort, and privacy of residents. Resident rooms must:**

**(1) Accommodate no more than four residents;**

**(2) Have direct access to an exit corridor;**

**(3) Have at least one window to the outside;**

**(4) Be equipped with or located near toilet and bathing facilities (VA
recommends that public toilet facilities be also located near the
residents dining and recreational areas);**

**(5) Be at or above grade level;**

**(6) Be designed or equipped to assure full visual privacy for each
resident;**

**(7) Except in private rooms, each bed must have ceiling suspended
curtains, which extend around the bed to provide total visual privacy in
combination with adjacent walls and curtains;**

**(8) Have a separate bed for each resident of proper size and height
for the safety of the resident;**

**(9) Have a clean, comfortable mattress;**

**(10) Have bedding appropriate to the weather and climate;**

**(11) Have functional furniture appropriate to the resident\'s needs,
and**

**(12) Have individual closet space with clothes racks and shelves
accessible to the resident.**

**(b) Unless determined by VA as necessary to accommodate an increased
quality of care for patients, a nursing home project may propose a
deviation of no more than 10 percent (more or less) from the following
net square footage for the State to be eligible for a grant of 65
percent of the total estimated cost of the project. If the project
proposes building more than the following net square footage and VA
makes a determination that it is not needed, the cost of the additional
net square footage will not be included in the estimated total cost of
construction.**

**\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\--**

**Nursing Home**

**\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\--**

**I. Support facilities (allowable square feet per facility for VA
participation):**

**Administrator 200**

**Assistant administrator 150**

**Medical officer, director of 150**

**nursing or equivalent**

**Nurse and dictation area 120**

**General administration (each 120**

**office/person)**

**Clerical staff (each) 80**

**Computer area 40**

**Conference room (consultation**

**area, in-service training) 500 (for each room)**

**Lobby/waiting area. (150 minimum/ 3 (per bed)**

**600 maximum per facility)**

**Public/resident toilets (male/female) 25 (per fixture)**

**Pharmacy footnote 1**

**Dietetic service footnote 1**

**Dining area 20 (per bed)**

**Canteen/retail sales 2 (per bed)**

**Vending machines (450 max. 1 (per bed)**

**per facility).**

**Resident toilets (male/female) 25 (per fixture)**

**Child daycare footnote 1**

**Medical support (staff offices/**

**exam/treatment room/family**

**counseling, etc.) 140 (for each room)**

**Barber and/or beauty shops 140**

**Mail room 120**

**Janitor\'s closet 40**

**Multipurpose room 15 (per bed).**

**Employee lockers 6 (per employee)**

**Employee lounge (max. 500 120**

**per facility)**

**Employee toilets 25 (per fixture)**

**Chapel 450**

**Physical therapy 5 (per bed).**

**Office if required 120.**

**Occupational therapy 5 (per bed).**

**Office if required 120.**

**Library 1.5 (per bed)**

**Building maintenance storage 2.5 (per bed)**

**Resident storage 6 (per bed)**

**General warehouse storage 6 (per bed)**

**Medical/dietary/pharmacy 7 (per bed)**

**General laundry footnote 1**

**II. Bed units:**

**One\...\...\...\...\...\...\...\...\... 150**

**Two\...\...\...\...\...\...\...\...\... 245**

**Large two-bed per unit 305**

**Four 460**

**Lounge areas (resident lounge 8 (per bed).**

**with storage)**

**Resident quiet room 3 (per bed).**

**Clean utility. 120**

**Soiled utility 105**

**Linen storage 150**

**General storage 100**

**Nurses station, ward secretary 260**

**Medication room. 75**

**Exam/Treatment room 140**

**Waiting area. 50**

**Unit supply and equipment. 50**

**Staff toilet 25 (per fixture).**

**Stretcher/wheelchair storage 100**

**Kitchenette 150**

**Janitor\'s closet 40**

**Resident laundry 125**

**Trash collection 60**

**III. Bathing and Toilet Facilities:**

**(A) Private or shared facilities:**

**Wheelchair facilities 25 (per fixture).**

**Standard facilities 15 (per fixture).**

**(B) Full bathroom 75**

**(C) Congregate bathing facilities:**

**First tub/shower 80**

**Each additional fixture. 25**

**\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\--**

**footnote 1-- The size to be determined by the Chief Consultant,
Geriatrics and Extended Care as necessary to accommodate projected
patient care needs (must be justified by State in space program
analysis).**

**(Authority: 38 U.S.C. 101, 501, 1710, 1742, 8105, 8131-8137; §§ 2, 3,
4, and 4a of the Architectural Barriers Act of 1968, as amended, Public
Law 90-480, 42 U.S.C. 4151-4157).**

**§ 59.150 [Domiciliary care requirements]{.underline}.**

**As a condition for receiving a grant and grant funds for a domiciliary
under this part, the domiciliary must meet the requirements for a
nursing home specified in § 59.140 of this part.**

**(Authority: 38 U.S.C. 101, 501, 1710, 1742, 8105, 8131-8137).**

**§ 59.160 [Adult day health care requirements]{.underline}.**

**As a condition for receiving a grant and grant funds under this part
for an adult day health care facility, States must meet the requirements
of this section.**

**(a) Each adult day health care program, when it is co-located in a
nursing home, domiciliary, or other care facility, must have its own
separate designated space during operational hours.**

**(b) The indoor space for an adult day health care program must be at
least 100 square feet per participant including office space for staff
and must be 60 square feet per participant excluding office space for
staff.**

**(c) Each program will need to design and partition its space to meet
its own needs, but the following functional areas must be available:**

**(1) A dividable multipurpose room or area for group activities,
including dining, with adequate table setting space.**

**(2) Rehabilitation rooms or an area for individual and group
treatments for occupational therapy, physical therapy, and other
treatment modalities.**

**(3) A kitchen area for refrigerated food storage, the preparation of
meals and/or training participants in activities of daily living.**

**(4) An examination and/or medication room.**

**(5) A quiet room, which functions to isolate participants who become
ill or disruptive, or who require rest, privacy, or observation. It
should be separate from activity areas, near a restroom, and
supervised.**

**(6) Bathing facilities adequate to facilitate bathing of participants
with functional impairments.**

**(7) Toilet facilities and bathrooms easily accessible to people with
mobility problems, including participants in wheelchairs. There must be
at least one toilet for every eight (8) participants. The toilets must
be equipped for use by persons with limited mobility, easily accessible
from all programs areas, i.e. preferably within 40 feet from that area,
designed to allow assistance from one or two staff, and barrier-free.**

**(8) Adequate storage space. There should be space to store arts and
crafts materials, personal clothing and belongings, wheelchairs, chairs,
individual handiwork, and general supplies. Locked cabinets must be
provided for files, records, supplies, and medications.**

**(9) An individual room for counseling and interviewing participants
and family members.**

**(10) A reception area.**

**(11) An outside space that is used for outdoor activities that is
safe, accessible to indoor areas, and accessible to those with a
disability. This space may include recreational space and garden area.
It should be easily supervised by staff.**

**(d) [Furnishings]{.underline} must be available for all participants.
This must include functional furniture appropriate to the participants'
needs.**

**(e) Unless determined by VA as necessary to accommodate an increased
quality of care for patients, an adult day health care facility project
may propose a deviation of no more than 10 percent (more or less) from
the following net square footage for the State to be eligible for a
grant of 65 percent of the total estimated cost of the project. If the
project proposes building more than the following net square footage and
VA makes a determination that it is not needed, the cost of the
additional net square footage will not be included in the estimated
total cost of construction.**

**\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\--**

**Adult Day Health Care**

**\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\--**

**I. Support facilities (allowable square feet per facility for VA
participation):**

**Program Director 200**

**Assistant administrator 150**

**Medical officer, director of 150**

**nursing or equivalent**

**Nurse and dictation area 120**

**General administration (each 120**

**office/person)**

**Clerical staff (each) 80**

**Computer area 40**

**Conference room (consultation**

**area, in-service training) 500 (for each room)**

**Lobby/receiving/waiting area (150 minimum) 3 (per participant)**

**Public/resident toilets (male/female) 25 (per fixture)**

**Dining area (may be included in the 20 (per participant)**

**Multipurpose room)**

**Vending machines 1 (per participant)**

**Participant toilets (male/female) 25 (per fixture)**

**Medical support (staff offices/**

**family counseling, etc.) 140 (for each room)**

**Janitor\'s closet 40**

**Dividable multipurpose room 15 (per participant)**

**Employee lockers 6 (per employee)**

**Employee lounge 120**

**Employee toilets 25 (per fixture).**

**Physical therapy 5 (per participant)**

**Office if required 120**

**Occupational therapy 5 (per participant)**

**Office if required 120**

**Building maintenance storage 2.5 (per participant)**

**Resident storage 6 (per participant)**

**General warehouse storage 6 (per participant)**

**Medical/dietary 7 (per participant)**

**General laundry footnote 1**

**II. Other Areas:**

> **Participant quiet room 3 (per participant)**

**Clean utility 120**

**Soiled utility 105**

**General storage 100**

**Nurses station, ward secretary 260**

**Medication/exam/treatment rooms 75**

**Waiting area 50**

**Program supply and equipment. 50**

**Staff toilet 25 (per fixture).**

**Wheelchair storage 100**

**Kitchen 120**

**Janitor\'s closet 40**

**Resident laundry 125**

**Trash collection 60**

**III. Bathing and Toilet Facilities:**

**(A) Private or shared facilities:**

**Wheelchair facilities 25 (per fixture).**

**Standard facilities 15 (per fixture).**

**(B) Full bathroom 75**

**\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\--**

**footnote 1 -- The size to be determined by the Chief Consultant,
Geriatrics and Extended Care as necessary to accommodate projected
patient care needs (must be justified by State in space program
analysis).**

**(Authority: 38 U.S.C. 101, 501, 1710, 1742, 8105, 8131-8137; §§ 2, 3,
4, and 4a of the Architectural Barriers Act of 1968, as amended, Public
Law 90-480, 42 U.S.C. 4151-4157).**

**§ 59.170 [Forms]{.underline} All forms set forth in this part are
available on the internet at
http:/vaww.va.gov/forms/medical/SearchList.asp. \[Insert actual
photocopy of VA Forms 10-0143, 10-0144, 10-0148a, 10-0148b, 10-0148c,
10-0148d, 10-0388, 10-0388A, and 10-0388B, 10-0392, 10-0392a, and
Standard Forms 271, 424, 424C, and 424D.\]**

**(Authority: 38 U.S.C. 101, 501, 1710, 1742, 8105, 8131-8137; §§ 2, 3,
4, and 4a of the Architectural Barriers Act of 1968, as amended, Public
Law 90-480, 42 U.S.C. 4151-4157)**

VA Form 10-0388

Documents and Information Required for State Home Construction and
Acquisition Grants

## INITIAL APPLICATION

**Note: An initial application should be submitted to the Chief
Consultant, Geriatrics and Extended Care (114) by April 15 and must be
submitted by August 15 if the State wishes an initial application to be
placed on the priority list for the next fiscal year.**

**1. Type of Grant applied for: \_\_\_ Acquisition \_\_\_ Construction**

2\. Documentation that the site of the project is in reasonable
proximity to a sufficient concentration and population of veterans that
are 65 years of age and older and that there is a reasonable basis to
conclude that the facility when complete will be fully occupied,

**3. Applicant's recommendation as to the priority, any sub priority,
and any further priority for purposes of placing the project on the
priority list for the next fiscal year (see 38 CFR § 59.50).**

**4. Standard Form (SF) 424, "Application for Federal Assistance" (mark
the box labeled "preapplication" and submit the information requested
for a "preapplication"); SF 424C, "Budget Information -- Construction
Programs"; SF 424D, "Assurances -- Construction Programs"; and a
description and scope of the project. \[original and one copy
required.\]**

**5. On SF 424C include:**

**(1) An estimate for the cost of the equipment not included in the
construction contract (not to exceed 10 percent of the construction
costs)**

**(2) A contingency estimate (not to exceed 5 percent of the estimated
cost of the project for new construction or 8 percent for remodeling
projects).**

**6. Project site description, including county location.**

**7. Governor's letter or a letter from the agency authorized by the**

**Governor with program oversight designating the State representative
and information that will permit VA to contact the State representative.
The State representative must notify the Chief Consultant, Geriatrics
and Extended Care (114) immediately of any changes in who the State
representative is and how to reach him or her.**

**8. Needs assessment (if adding or replacing nursing home or
domiciliary beds). Include the following documents and supporting
justifications:**

**(a) Demographic characteristics of the veteran population of the
proposed catchment area;**

**(b) Availability of beds if great travel distances (over two hours)
are imposed on veterans and their families;**

\(c\) Number of VA nursing home and domiciliary beds and the occupancy
rate at those facilities for the previous fiscal year;

\(d\) Number of State nursing home and domiciliary beds and occupancy
rate at those facilities for the previous fiscal year;

**(e) Number of community-based nursing home beds and the occupancy rate
of those facilities providing beds for the previous fiscal year.
\[delete: (must have full State certification)\] The State certification
must authorize appropriate level(s) of care to allow veteran placement
in those facilities;**

**(f) Waiting lists for existing State Home programs;**

**(g) Plans for providing acute medical care services as may be required
by the State home residents; and**

**(h) Availability of qualified medical care personnel to staff the
proposed facility.**

**9. Needs assessment (if not adding or replacing nursing home or
domicilliary beds) (a) reason for the project and (b) the scope of the
project.**

**10. If a State proposes new beds that exceed the maximum number of
State home beds as defined in 38 CFR 59.40, the State must provide
documentation to justify an exception on the basis of great travel
distances (greater than two hours) between a significant population
center and an existing State home. The Secretary will consider and
approve/disapprove such justification in the determination of the
priority of the initial application.**

**11. Authorized State representative's certified statement that the
list of the total number of State-operated nursing home and domiciliary
beds for veterans is the total number of such beds existing, under
construction, or pending approval by VA at the time of the initial
application.**

12\. Schematic drawings for the proposed project.

**13. Space program analysis on VA Form 10-0392, "Space Program
Analysis-Nursing Home" (or VA Form 10-0392a, "Space Program
Analysis-Adult Day Health Care") for the proposed project that includes
a list of each room or area and the square footage proposed. The plan
should note special or unusual services or equipment. The information on
VA Form 10-0392, "Space Program Analysis-Nursing Home" (or VA Form
10-0392a, "Space Program Analysis-Adult Day Health Care") should
correspond with the charts contained in 38 CFR 59.140 and 59.160.**

**14. State application identifier number (if applicable).**

**15. Five-year capital plan for State's entire State Home program,
including the proposed project.**

**16. Financial plan for State facility's first three years of operation
following construction.**

**17. Any comments or recommendations made by the appropriate State
clearing house pursuant to policies outlined in Executive Order 12372,
Intergovernmental Review of Federal Programs (part 40 of this chapter).
If the State has no clearing house, the State representative must notify
the Chief Consultant of that.**

**I certify that the information submitted to VA is true and correct to
the best of my knowledge and ability.**

**SIGN HERE**

**(Signature of State Representative) (Date)**

**THE LAW PROVIDES SEVERE PENALTIES FOR WILLFUL SUBMISSION OF FALSE
INFORMATION.**

VA Form 10-0388A

Additional Documents and Information Required for State Home
Construction and Acquisition Grants

## APPLICATION

**1. The State representative must submit the following to VA to receive
a grant:**

**(a) Standard Form SF 424, "Application for Federal Assistance" (mark
the box labeled "application" and submit the information requested for
an application); SF 424C, "Budget Information -- Construction Programs";
SF 424D, "Assurances -- Construction Programs"; and a complete
description and scope of the project. \[original and one copy
required.\].**

**On form 424C include:**

**(1) An estimate for the cost of the equipment not included in the
construction contract (not to exceed 10 percent of the construction
costs)**

**(2) A contingency estimate (not to exceed 5 percent of the estimated
cost of the project for new construction or 8 percent for remodeling
projects).**

**(b) Evidence of the State's authorization of the project (e.g., a copy
of the signed legislation).**

**(c) Evidence that the State has its share of the estimated total cost
of construction and acquisition (e.g., a letter from the State Treasurer
certifying that the State has its share).**

**(d) VA Form 10-0148b, "Certification of State Matching Funds."**

**2. An updated space program analysis for the proposed project that
includes a list of each room or area and the square footage proposed.
The plan should note special or unusual services or equipment. The
information on VA Form 10-0392, "Space Program Analysis-Nursing Home"
(or VA Form 10-0392a, "Space Program Analysis-Adult Day Health Care")
should correspond with the charts contained in 38 CFR 59.140 and 59.160.
This analysis is needed only if there is a change in the space program
analysis that was previously submitted.**

**3. The State representative must submit the following certifications
to VA by March 15 of each year until the project is completed:**

**(a) VA Form 10-0148c, "Certification Regarding Debarment, Suspension,
and Other Responsibility Matters for Primary Covered Transactions"**

**(b) VA Form 10-0143, "Department of Veterans Affairs Certification
Regarding Drug-Free Workplace Requirements for Grantees Other than
Individuals"**

**(c) VA Form 10-0144, "Certification Regarding Lobbying"**

**4. If the State is notified that Federal funds are available, the
State must provide these items:**

**(a) A schedule of when each of the remaining requirements to receive a
proposed grant will be met.**

**(b) "Phase I \-- Environmental Survey." Site plan/map, site survey,
and soil investigation (if applicable) Design development site plan. The
applicant shall submit a site survey which has been performed by a
licensed land surveyor. A description of the site shall be submitted
noting the general characteristics of the site. This should include soil
reports and specifications, easements, main roadway approaches,
surrounding land uses, availability of electricity, water and sewer
lines, and orientation. The description should also include a map
locating the existing and/or new buildings, major roads, and public
services in the geographic area. Additional site plans should show all
site work including property lines, existing and new topography,
building locations, utility data, and proposed grades, roads, parking
areas, walks, landscaping, and site amenities.**

**(c) "Phase II \-- Environmental Assessment." (applies only if the
outside construction exceeds 75,000 gross square feet (GSF)) The
environmental documentation will require approval by VA before a final
award of a construction or acquisition grant for a State veterans home.
(See § 26.6 of this chapter for compliance requirements.) When the
application submission requires an environmental assessment, the State
must describe the possible beneficial and/or harmful effect which the
project may have on the following impact categories:**

**(i) Transportation;**

**(ii) Air quality;**

**(iii) Noise;**

**(iv) Solid waste;**

**(v) Utilities;**

**(vi) Geology (soils/hydrology/flood plains);**

**(vii) Water quality;**

**(viii) Land use;**

**(ix) Vegetation, wildlife, aquatic, and ecology/wetlands;**

**(x) Economic activities;**

**(xi) Cultural resources;**

**(xii) Aesthetics;**

**(xiii) Residential population;**

**(xiv) Community services and facilities;**

**(xv) Community plans and projects; and**

**(xvi) Other.**

**If an adverse environmental impact is anticipated, the action to be
taken to minimize the impact should be explained in the environmental
assessment.**

**If construction outside the walls of an existing structure will
involve more than 75,000 GSF, the application shall include an
environmental assessment to determine if an Environmental Impact
Statement is necessary for compliance with section 102(2)(c) of the
National Environmental Policy Act of 1969. If the proposed actions
involving construction or acquisition do not individually or
cumulatively have a significant effect on the human environment and if
the outside construction does not exceed 75,000 GSF, the applicant shall
submit a letter noting a Categorical Exclusion, subject to approval by
VA.**

**(d) Letter from the State Historical Preservation Officer (SHPO) and
subsequent clearance from the VA Historical Preservation Officer and a
copy from the SHPO stating whether the project area includes any
properties on, eligible for, or likely to meet the criteria for the
National Register of Historic Places. If the property does, or may,
include National Register quality properties, the letter from the SHPO
must discuss the determination of the effect of the proposed project on
such property.**

**(e) Design development (35 percent) drawings. The State must provide
to VA eight sets of prints, rolled individually per set, to expedite the
review process. Please send directly to the Office of Construction
Management, Facilities Quality Service (181A), 810 Vermont Ave., NW,
Washington, DC 20420 and send a copy of the transmittal letter to the
Chief, State Home Construction Program (114). The drawings shall
indicate the designation of all spaces, size of areas and rooms and
indicate in outline the fixed and movable equipment and furniture. The
drawings must be drawn in 1/4\" scale. Bedroom and toilet layouts,
showing clearances and UFAS requirements, must be drawn in 1/4\" scale.
The total floor and room areas shall be shown in the drawings. The
drawings must include:**

**(i) Plan of any proposed demolition work;**

**(ii) A plan for each floor. For renovations, the existing conditions
and extent of new work should be clearly delineated;**

**(iii) Elevations;**

**(iv) Sections and typical details;**

**(v) Roof plan;**

**(vi) Fire protection plans; and**

**(vii) Technical engineering plans, including structural, mechanical,
plumbing, and electrical drawings.**

**If the project involves acquisition, remodeling, or renovation, the
State should include the current as-built site plan, floor plans and
building sections that show the present status of the building and a
description of the building\'s current use and type of construction.**

**(f) Design development outline specifications. The State shall provide
eight copies of outline specifications which shall include a general
description of the project, site, architectural, structural, electrical,
and mechanical systems such as elevators, nurses\' call system, air
conditioning, heating, plumbing, lighting, power, and interior finishes
(floor coverings, acoustical material, and wall and ceiling finishes).**

**(g) Design development cost estimates. Two copies of the updated SF
424, SF 424C cost estimates must be included in the application to VA.
Estimates must show the estimated cost of the buildings or structures to
be acquired or constructed in the project. Cost estimates must list the
cost of construction, contract contingency, fixed equipment not included
in the construction contract, other equipment, architect\'s fees, and
construction supervision and inspection. Unless justified by the State,
the VA allowance for equipment, not included in the construction
contract, must not exceed 10 percent of the construction or acquisition
contract cost. The VA allowance for contingencies shall not exceed 5
percent of the total project cost for new construction or 8 percent of
the total project cost for renovation projects. If the project involves
non-Federal participating areas, such costs must be itemized
separately.**

**(h) Reasonable assurance that the State Home, or another agency or
instrumentality of the State has title to the site for the project.**

**5. If a State has been notified that VA has funding for its project
during a fiscal year and all requirements for a grant will not be met
prior to the end of a fiscal year, a State may wish to consider
requesting conditional approval of a grant under the provisions of 38
CFR 59.70.**

**6. The State representative must submit the following by September
15:**

**a. Final drawings and specifications (100 percent) (one labeled set of
microfiche aperture cards, microfilm, or Compact Disc/Read Only Memory
(CDROM) compact laser disc, with 100% construction documents (plans and
specifications).**

**b. Advertisement for the proposed project and request for bids.**

**c. Two copies of itemized bid tabulations**

> **d. VA Form 10-0148d, "Certification of Compliance with Federal
> Requirements State Home Construction Grant".**

**e. Revised SF 424, SF 424C budget pages, based on the selected bids
(including final cost for all items in the project).**

Three signed originals of the Memorandum of Agreement that includes
provisions in the Sample Memorandum of Agreement set forth in 38 CFR
59.160.

**7. The State representative must submit the following to VA prior to
grant award:**

> **VA Form 10-0148a, "Certification Regarding Debarment, Suspension,
> Ineligibility and Voluntary Exclusion Lower Tier Covered Transactions
> (To be signed by the contractor(s))".**

**I certify that the information submitted to VA is true and correct to
the best of my knowledge and ability.**

**SIGN HERE**

**(Signature of State Representative) (Date)**

**THE LAW PROVIDES SEVERE PENALTIES FOR WILLFUL SUBMISSION OF FALSE
INFORMATION.**

VA Form 10-0388B

Documents/Certifications Required for State Home Construction and
Acquisition Grants

## POST-GRANT REQUIREMENTS

## 

## The State representative must submit to VA the following prior to the final payment of grant funds or when specified below:

1.  **Standard Form 271, "Outlay Report & Request for Reimbursement for
    Construction Programs".**

2.  **A final equipment list (prior to completion of construction) with
    a complete itemized list to include fixed and other equipment (not
    including equipment in the construction contract) by category with
    the cost, quantity, and placement in accordance with the final
    drawings, but not including consumable goods or office supplies.
    \[Note: if no equipment is involved in the project, a statement to
    that effect must be included in the request for the final
    architectural/engineering inspection.\] This equipment list must be
    approved by VA prior to final claim payment.**

3.  **A request in writing for the final architectural/engineering
    inspection, including the name and telephone number of the local
    point of contact for the project.**

4.  **A final claim for payment on SF 271, "Outlay Report & Request for
    Reimbursement for Construction Programs". Add this statement to SF
    271: "It is hereby agreed that the monetary commitment of the
    Federal government will have been met and the project will be
    considered terminated upon payment of this voucher."**

5.  **Evidence that the State has met its responsibility for an audit
    under the Single Audit Act of 1984 and § 59.124 of this part, if
    applicable.**

**I certify that the information submitted to VA is true and correct to
the best of my knowledge and ability.**

**SIGN HERE**

**(Signature of State Representative) (Date)**

**THE LAW PROVIDES SEVERE PENALTIES FOR WILLFUL SUBMISSION OF FALSE
INFORMATION.**

#### VA Form 10-5348

**March 2001**

**SAMPLE MEMORANDUM OF AGREEMENT**

**\[Note: Contact Chief Consultant (114) for Electronic Version\]**

**Memorandum of Agreement for a Grant**

**to Construct or Acquire a State Veterans Home**

**This Memorandum of Agreement is hereby made by and between**

**The Department of Veterans Affairs (VA)**

**810 Vermont Avenue, NW~,~ Washington, DC 20420, and**

**[\[State name and address\] .]{.underline}**

**[\[State\]]{.underline} has submitted to VA an application for a grant
to \[construct, acquire\] a \[nursing home, domiciliary, adult day
health care\] facility for veterans in \[location\]. The Federal
Application Identifier (FAI) for this project is \_\_\_\_. The parties
agree that this application meets the requirements of Federal law for
this grant. The estimated total cost of \[construction and/or
acquisition\], including equipment, in which VA will participate, is
\$\_\_\_\_\_\_\_. The VA grant will total up to \$\_\_\_\_\_\_\_, but
will not exceed sixty-five (65) percent of the actual cost of
\[construction, acquisition\] as determined by the final audit. In
consideration of the foregoing, the parties hereto mutually agree as
follows:**

**(1) \[State\] certifies that the plans and specifications included in
the application meet all applicable Federal requirements.**

**(2) \[State\] agrees that it will \[construct, acquire\] the facility,
(a description of the project, including number of beds if beds are
added or replaced), to be completed in accordance with the documentation
submitted by the State.**

**(3) \[State\] agrees to comply strictly with the assurances contained
in the documentation submitted.**

**(4) \[State\] agrees to enter into a contract to \[construct,
acquire\] (a description of the project, including number of beds if
beds are added or replaced), within 90 days of the date on which both
parties have signed this agreement.**

**(5) \[State\] agrees to periodically inspect the project and certify
to the Chief Consultant for Geriatrics and Extended Care Strategic
Healthcare Group, 810 Vermont Avenue, NW, Washington, DC 20420, for
payment of such sums which it deems are payable by VA.**

**(6) \[State\] agrees to furnish any additional State funds needed to
complete the project.**

**(7) \[State\] agrees that, upon completion of the project, it will
provide adequate financial support to maintain and operate the
facility.**

(8) **\[State\] agrees that following completion of the project it will
    open at least eight beds per month until the home is operating at
    capacity.**

**(9) \[State\] agrees that it will use the facilities principally to
furnish \[nursing home care, domiciliary care, adult day health care\]
to veterans and that not more than 25 percent of the bed occupancy at
any one time will consist of residents who are not receiving such level
of care as veterans.**

> **(10) \[State\] agrees that it will operate and maintain the facility
> in conformance with State standards and with all applicable State and
> local laws, codes~,~ regulations and ordinances, and in conformance
> with the standards prescribed by VA.**
>
> **(11) \[State\] agrees that it will make such reports in such form
> and containing such information as the Secretary may from time to time
> reasonably require, and give the Secretary, upon demand, access to the
> records upon which such information is based.**

**The Secretary of the Department of Veterans Affairs hereby approves
the project. After \[State\] certifies its \[construction, acquisition\]
costs as set forth in paragraph (5) above, the Secretary agrees to make
partial payments of the grant to cover the costs certified. VA payments
will be limited to the unpaid obligated balance of the grant for actual
incurred costs for this project.**

**This grant is subject to the recapture provisions stated in 38 CFR
59.110.**

**IN WITNESS WHEREOF the parties have hereunto affixed their signature
on the dates indicated:**

> **State Representative Date**

**Secretary of the Department of Veterans Affairs Date**