[Federal Register Volume 66, Number 123 (Tuesday, June 26, 2001)]
[Rules and Regulations]
[Pages 33845-33887]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-15773]


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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.

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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: June 26, 2001. Comments must be received by VA 
on or before August 27, 2001.
    The incorporation by reference of certain publications in this rule 
is approved by the Director of the Office of the Federal Register as of 
June 26, 2001.

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 <a href="/cdn-cgi/l/email-protection#b2fdf5f1e0d7d5c7ded3c6dbdddcc1f2dfd3dbde9cc4d39cd5ddc4"><span class="__cf_email__" data-cfemail="c9868e8a9bacaebca5a8bda0a6a7ba89a4a8a0a5e7bfa8e7aea6bf">[email protected]</span></a>. 
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. The substantive differences from the 
previous regulations are discussed below.
    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:
    <bullet> 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 (Pub. 
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.
    <bullet> 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.
    <bullet> The Act provides that VA may not accord any priority to 
projects for the construction or acquisition of a hospital.
    <bullet> 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.
    <bullet> The Act provides that a grant may not include maintenance 
and repair work.
    <bullet> 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 subpriorities for each 
priority category that reflect the statutory priority scheme. In 
addition, further subpriorities in ``priority group 1--subpriority 1'' 
are established to give higher priorities to the most urgently needed 
projects. Further subpriorities in ``priority group 1--subpriority 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 subpriorities, 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

[[Page 33846]]

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 for priority 
group 1 applications. 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 that 
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 reliance factor 
projected for VA for 2009. We also project that the VA national 
reliance factor for VA nursing homes and community nursing homes will 
be 11.5 percent for 2009. These percentages are based upon recent 
historical and projected data in VA's market share in providing nursing 
home care for veterans.
    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 Sec. 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. The numbers for making 
these calculations will be made available to the public on a VA website 
at http://www.va.gov/About_VA/Orgs/VHA/VHAProg.htm.
    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 health 
care (Secs. 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

    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

    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

[[Page 33847]]

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

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

Unfunded Mandates

    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

    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 six States and we expect that each 
year fewer than 10 States will submit applications. If VA expects to 
receive 10 or more applications in any year, we will seek approval 
under the Paperwork Reduction Act for this collection of information.

List of Subjects

38 CFR Part 17

    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.

38 CFR Part 59

    Administrative practice and procedure, Alcohol abuse, Alcoholism, 
Claims, Day care, Dental health, Drug abuse, Foreign relations, 
Government contracts, Grant programs-health, Government programs-
veterans, Health care, Health facilities, Health professions, Health 
records, Homeless, Incorporation by reference, 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: June 7, 2001.
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 Sec. 17.200, remove the undesignated center 
heading, the note, and Secs. 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.
59.1   Purpose.
59.2   Definitions.
59.3   Federal Application Identifier.
59.4   Decisionmakers, notifications, and additional information.
59.5   Submissions of information and documents to VA.
59.10   General requirements for a grant.
59.20   Initial application requirements.
59.30   Documentation.
59.40   Maximum number of nursing home care and domiciliary care 
beds for veterans by State.
59.50   Priority list.
59.60   Additional application requirements.
59.70   Award of grants.
59.80   Amount of grant.
59.90   Line item adjustments to grants.
59.100   Payment of grant award.
59.110   Recapture provisions.
59.120   Hearings.
59.121   Amendments to application.
59.122   Withdrawal of application.
59.123   Conference.
59.124   Inspections, audits, and reports.
59.130   General requirements for all State home facilities.
59.140   Nursing home care requirements.
59.150   Domiciliary care requirements.
59.160   Adult day health care requirements.
59.170   Forms.

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


Sec. 59.1  Purpose.

    This part sets forth the mechanism for a State to obtain a grant:
    (a) 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
    (b) 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).


Sec. 59.2  Definitions.

    For the purpose of this part:
    Acquisition 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 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 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 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 
veterans 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 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.

[[Page 33848]]

    Secretary means the Secretary of the United States Department of 
Veterans Affairs.
    State means each of the several States, the District of Columbia, 
the Virgin Islands, and the Commonwealth of Puerto Rico.
    State representative means the official designated in accordance 
with State authority with responsibility for matters relating to the 
request for a grant under this part.
    VA means the United States Department of Veterans Affairs.

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


Sec. 59.3  Federal Application Identifier.

    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).


Sec. 59.4  Decisionmakers, notifications, and additional information.

    The decisionmaker 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 decisionmaker 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).


Sec. 59.5  Submissions of information and documents to VA.

    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), VA 
Central Office, 810 Vermont Avenue, NW., Washington, DC 20420.

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


Sec. 59.10  General requirements for a grant.

    For a State to obtain a grant under this part and grant funds, its 
initial application for the grant must be approved under Sec. 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. It must meet the additional application requirements in 
Sec. 59.60, and it 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).


Sec. 59.20  Initial application requirements.

    (a) For a project to be considered for inclusion on the priority 
list in Sec. 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 Sec. 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 Sec. 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, if 
further developed, could meet the requirements for a grant under this 
part.
    (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).


Sec. 59.30  Documentation.

    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 Sec. 59.20.

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


Sec. 59.40  Maximum number of nursing home care and domiciliary care 
beds for veterans by State.

    (a) Except as provided in paragraph (b) of this section, a State 
may not request a grant for a project to construct or acquire a new 
State home facility, to increase the number of beds available at a 
State home facility, or to replace beds at a State home facility if the 
project would increase the total number of State home nursing home and 
domiciliary beds beyond the maximum number designated for that State. 
The maximum number of State home nursing home and domiciliary beds 
designated for each State is (for maximum numbers see VA website at 
http://www.va.gov/About_VA/Orgs/VHA/VHAProg.htm). 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 (the availability of VA and 
community nursing home beds in each State will also be considered at 
the time of grant application for bed-producing projects):

------------------------------------------------------------------------
                                                             State home
                                                            nursing home
                           State                                 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

[[Page 33849]]

 
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 paragraph (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 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).

Sec. 59.50  Priority list.

    (a) The Secretary will make a list prioritizing the applications 
that were received on or before August 15 and that were approved under 
Sec. 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--subpriority 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 subpriority 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 subpriority 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--subpriority 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 subpriority 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--subpriority 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 subpriority 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--subpriority 4. An application from a State 
for renovations to a State Home facility other than renovations that 
would be included in subpriority 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 the Americans with Disabilities Act; building systems 
and utilities (e.g., electrical; heating, ventilation, and air 
conditioning (HVAC); 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 subpriority 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--subpriority 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 subpriority 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--subpriority 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 subpriority 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 to paragraph (a)(1): The following chart is intended to 
provide a graphic aid for understanding Priority group 1 and its 
subpriorities.

BILLING CODE 8320-01-P

[[Page 33850]]

[GRAPHIC] [TIFF OMITTED] TR26JN01.000

BILLING CODE 8320-01-C

[[Page 33851]]

    (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 
subpriorities) 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 Sec. 59.20 on the date that the application was approved under 
Sec. 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:
    (i) Has no State homes with nursing home or domiciliary beds, or
    (ii) 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 the 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 the State has an unmet need of 999 or fewer nursing home and 
domiciliary beds.
    (f) Projects that could be placed in more than one subpriority will 
be placed in the subpriority toward which the preponderance of the cost 
of the project is allocated. For example, under priority group 1--
subpriority 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 subpriority 
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).

Sec. 59.60  Additional application requirements.

    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:
    (a) 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 Sec. 59.170 of this part), 
and
    (b) A completed VA Form 10-0388 and all information and 
documentation specified by VA Form 10-0388 (the form is set forth at 
Sec. 59.170h).

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

Sec. 59.70  Award of grants.

    (a) The Secretary, during the fiscal year for which a priority list 
is made under this part, will:
    (1) Award a grant for each application that has been approved under 
Sec. 59.20, that is sufficiently high on the priority list so that 
funding is available for the application, that meets the additional 
application requirements in Sec. 59.60, and that 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 the 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

[[Page 33852]]

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 in 
Sec. 59.170.

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


Sec. 59.80  Amount of grant.

    (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 Sec. 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, and 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 five percent of the 
total cost of the project for new construction or eight 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).


Sec. 59.90  Line item adjustments to grants.

    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 Sec. 59.170(o) 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).


Sec. 59.100  Payment of grant award.

    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 a completed VA Form 10-0388 (see 
Sec. 59.170(i)). The equipment list and the completed VA form 10-0388 
must be submitted to the Chief Consultant, Geriatrics and Extended Care 
(114), VA Central Office, 810 Vermont Avenue, NW., Washington, DC 
20420.

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


Sec. 59.110  Recapture provisions.

    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

[[Page 33853]]

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:

------------------------------------------------------------------------
                                                               Recovery
            Grant amount  (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).


Sec. 59.120  Hearings.

    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 Sec. 17.133 of 
this order.

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


Sec. 59.121  Amendments to application.

    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).


Sec. 59.122  Withdrawal of application.

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

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


Sec. 59.123  Conference.

    At any time, VA may recommend that a conference (such as a design 
development conference) be held in 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).


Sec. 59.124  Inspections, audits, and reports.

    (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. The State will provide evidence that it has 
met its responsibility under the Single Audit Act of 1984 (see part 41 
of this chapter) and submit that evidence 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).


Sec. 59.130  General requirements for all State home facilities.

    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 residents with needed 
services as required by this part and as identified in each resident'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 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

[[Page 33854]]

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).

Sec. 59.140  Nursing home care requirements.

    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 also be located 
near the residents dining and recreational areas);
    (5) Be at or above grade level;
    (6) Be designed or equipped to ensure full visual privacy for each 
resident;
    (7) Except in private rooms, each bed must have ceiling suspended 
curtains that 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.

                  Table to Paragraph (b)--Nursing Home
------------------------------------------------------------------------
 
------------------------------------------------------------------------
I. Support facilities [allowable
 square feet (or metric
 equivalent) 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   500 (for each room)
     area, in-service training).
    Lobby/waiting area. (150        3 (per bed)
     minimum/600 maximum per
     facility).
    Public/resident toilets (male/  25 (per fixture)
     female).
    Pharmacy \1\..................
    Dietetic service \1\..........
    Dining area...................  20 (per bed)
    Canteen/retail sales..........  2 (per bed)
    Vending machines (450 max. per  1 (per bed)
     facility).
    Resident toilets (male/female)  25 (per fixture)
    Child day care \1\............
    Medical support (staff offices/ 140 (for each room)
     exam/treatment room/family
     counseling, etc.).
    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 (500 max. per   120
     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 \1\...........
II. Bed units:
    One...........................  150

[[Page 33855]]

 
    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
------------------------------------------------------------------------
\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; 
Sections 2, 3, 4, and 4a of the Architectural Barriers Act of 1968, 
as amended, Public Law 90-480, 42 U.S.C. 4151-4157).


Sec. 59.150  Domiciliary care requirements.

    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 Sec. 59.140 of this part.

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


Sec. 59.160  Adult day health care requirements.

    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 (with at least one bed), 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 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 a garden 
area. It should be easily supervised by staff.
    (d) Furnishings 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.

[[Page 33856]]



              Table to Paragraph (e)--Adult Day Health Care
------------------------------------------------------------------------
 
------------------------------------------------------------------------
I. Support facilities [allowable
 square feet (or metric
 equivalent) 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   500 (for each room).
     area, in-service training).
    Lobby/receiving/waiting area    3 (per participant)
     (150 minimum).
    Public/resident toilets (male/  25 (per fixture).
     female).
    Dining area (may be included    20 (per participant).
     in the multipurpose room).
    Vending machines..............  1 (per participant).
    Participant toilets (male/      25 (per fixture).
     female).
    Medical support (staff offices/ 140 (for each room).
     family counseling, etc.).
    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 \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       75
     rooms.
    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
------------------------------------------------------------------------
\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; 
Sections 2, 3, 4, and 4a of the Architectural Barriers Act of 1968, 
as amended, Public Law 90-480, 42 U.S.C. 4151-4157).


Sec. 59.170  Forms.

    All forms set forth in this part are available on the Internet at 
http://www.va.gov/About_VA/Orgs/VHA/VHAProg.htm.
BILLING CODE 8330-01-P

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

[FR Doc. 01-15773 Filed 6-25-01; 8:45 am]
BILLING CODE 8320-01-C


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