Source: https://www.federalregister.gov/documents/2011/05/05/2011-10962/caregivers-program
Timestamp: 2017-08-23 14:53:45
Document Index: 567765754

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A Rule by the Veterans Affairs Department on 05/05/2011
26147-26176 (30 pages)
2011-10962
71.10 Purpose and Scope
71.15 Definitions
71.20 Eligible Veterans and Servicemembers
71.25 Approval and Designation of Primary and Secondary Family Caregivers
71.30 General Caregivers
71.40 Caregiver Benefits
71.45 Revocation
71.50 Provision of Certain Counseling, Training, and Mental Health Services to Certain Family Members of Veterans
https://www.federalregister.gov/d/2011-10962 https://www.federalregister.gov/d/2011-10962
Written comments may be submitted by email through http://www.regulations.gov;​ by mail or hand-delivery to Director, Regulations Management (02REG), Department of Veterans Affairs, 810 Vermont Avenue, NW., Room 1068, Washington, DC 20420; or by fax to (202) 273-9026. Comments should indicate that they are submitted in response to “RIN 2900-AN94, Caregivers Program.” Copies of comments received will be available for public inspection in the Office of Regulation Policy and Management, Room 1063B, between the hours of 8 a.m. and 4:30 p.m. Monday through Friday (except holidays). Please call (202) 461-4902 for an appointment. In addition, during the comment period, comments may be viewed online through the Federal Docket Management System (FDMS) at http://www.regulations.gov.
We define an “inability to perform an activity of daily living (ADL)” as inability to perform any of six activities that are widely recognized as ADLs by clinicians and are found in the Katz Basic ADL Scale. In addition, we include a seventh activity specific to veterans who require the use of prosthetics or orthopedic appliance. Inability to perform an activity of daily living is one of several alternative bases for a determination that an individual is in need of personal care services under § 71.20(c)(1), and is one of the Start Printed Page 26149alternative bases for such need per section 1720G(a)(2)(C)(i).
We define an eligible veteran as “a veteran, or a servicemember, who is found eligible for a caregiver under § 71.20.” This term is established for ease of reference throughout the part 71 regulations. The term is also used in section 1720G(a).
We define the “[n]eed for supervision or protection based on symptoms or residuals of neurological or other impairment or injury” as requiring supervision or assistance based on any one of seven listed impairments. We based these impairments on the UK Functional Independence Measure and Functional Assessment Measure, and the Neuropsychiatric Inventory. Like the definition of activity of daily living (ADL), we believe that this definition targets the population that section 1720G(a) is clearly intended to benefit. The need for supervision or protection based on symptoms or residuals of neurological or other impairment or injury is the second alternative basis for a determination that an individual is in need of personal care services under § 71.20(c)(2), and is one of the alternative bases for such need per section 1720G(a)(2)(C)(ii). As with the definition of ADL, we welcome suggestions from the public as to additional impairments that should be included in this list.
We define “[u]ndergoing medical discharge” by requiring “that the servicemember has been found unfit for duty due to a medical condition by their Service's Physical Evaluation Board, and a date of medical discharge has been issued.” This term is used to determine eligibility for a caregiver for active duty servicemembers. The Start Printed Page 26150process of disability evaluation and medical discharge in some cases can be quite lengthy, and we do not believe that Congress intended to authorize prolonged caregiver benefits for active duty servicemembers, particularly because they have authorized Department of Defense to provide similar benefits to active duty servicemembers. Rather, we interpret the inclusion of servicemembers undergoing medical discharge in 38 U.S.C. 1720G(a)(2)(A) as an effort to ensure that, upon discharge, the individual will have a person identified and prepared to provide care. Therefore, this definition will ensure that the individual is far enough along in the medical discharge process that there will not be extended overlap between the individual's period of service and the time that he or she achieves veteran status. This definition will however, allow sufficient opportunity for a servicemember and caregiver to initiate an application for, and begin participation in, the VA program.
Paragraph (d) requires a clinical determination that it is in the best interest of the individual to participate in the program. This requirement is Start Printed Page 26151based on 38 U.S.C. 1720G(a)(1)(B), which requires that the Secretary only provides support under the program if it is in the best interest of the individual to do so.
The rules governing approval and designation of particular individuals to serve as Family Caregivers, including the rules governing such individuals' eligibility to serve as Primary or Secondary Family Caregivers, are set forth in § 71.25. Paragraph (a)(1) requires anyone who would serve as a Primary or Secondary Family Caregiver to complete and sign a joint application, along with the eligible veteran. This implements the joint-application requirement in 38 U.S.C. 1720G(a)(4).
Upon receiving the application, § 71.25(a)(2) requires VA to determine whether the caregivers, as identified on the joint application, are appropriate to serve as caregivers and, if so, whether to designate applicants as Primary and Secondary Family Caregivers. These determinations require VA to perform all clinical evaluations and decide whether the application should be granted and, if so, whether each applicant should be designated as identified in the application, i.e., whether the identified Primary Family Caregiver should be so designated. Section 1720G(a)(7)(A) requires that VA, not the veteran, officially make the designation of Primary Family Caregiver, and, generally, section 1720G(a) requires VA to make certain evaluations prior to approving an application. In § 71.25(a)(3) we recognize that veterans and servicemembers may not have a “continuous” GAF score available at the time of their application. Therefore, in these instances, an application may be put on hold for no more than 90 days, from the date the application was received. This will enable VA to determine whether the GAF score of 30 or less is simply a transient condition likely to respond quickly to treatment obviating the need for a caregiver.
Assessment for caregiver training is required under paragraph (c)(1), and authority is delegated to the eligible veteran's primary care team in collaboration with the facility Caregiver Support Coordinator, who will be in the best position to determine whether specific applicants are able to meet the Start Printed Page 26152needs of a specific eligible veteran. Paragraphs (c)(1)(A) and (B) prescribe basic requirements for any assessment, which concern the applicant's ability to communicate and whether the applicant will be capable of following without supervision the eligible veteran's treatment plan. These two requirements are essential to completion of caregiver training, the ability to appropriately care for the eligible veteran, and there is no reason to provide such training to individuals who cannot meet these two basic requirements.
Paragraph (d) concerns the education and training of applicants who wish to be Family Caregivers. Under section 1720G(a)(6)(C), “subject to regulations [VA] shall prescribe, [VA shall] provide for necessary travel, lodging, and per diem expenses incurred by a family member of an eligible veteran in undergoing instruction, preparation, and training” to be a Family Caregiver. The statute does not link this benefit to VA's beneficiary travel authority under 38 U.S.C. 111(e); however, the requirement to promulgate regulations authorizes VA to make such a link in this rulemaking. Moreover, we note that after the caregiver education and training is complete, section 1720G(a)(3)(A)(i)(IV) requires VA to provide Primary and Secondary Family Caregivers with “lodging and subsistence under [38 U.S.C.] 111(e).” Rather than establish a different program for travel benefits before and after training, we authorize beneficiary travel benefits (as implemented in 38 CFR part 70) in § 71.25(d) to support the education and training of family members. This means that the provision of beneficiary travel is subject to any limitations or exclusions under part 70 as well. There is no reason to believe that section 1720G extends beneficiary travel benefits to Family Caregivers but does not also require the equal application of the limitations that apply to all individuals eligible for benefits under part 70.
Paragraph (f) authorizes the facility Caregiver Support Coordinator or designee to approve or disapprove applications, based on the clinical assessment of the primary care team, and designate the applicants as Primary and/or Secondary Caregivers. We note that such approval is predicated on the veteran or servicemember's and caregivers' continuing eligibility under part 71, and we cross-reference § 71.45, which concerns revocation.
Pursuant to 38 U.S.C. 1720G(b)(1), VA is required to establish a program, distinct from the Family Caregiver program, of support services for caregivers of veterans who are enrolled in the VA health care system and who are in need of personal care services because they are either unable to perform an ADL or have a “need for supervision or protection based on symptoms or residuals of neurological care or other impairment or injury.” These caregivers are referred to in our regulations as General Caregivers, to distinguish them from Primary or Secondary Family Caregivers. Unlike Family Caregivers, a General Caregiver need not be a family member of the veteran within the meaning of the law, and the veteran to whom service is provided need not have had a “serious injury” or have served on or after September 11, 2001. The benefits provided under section 1720G to General Caregivers are significantly less than those provided to Family Caregivers and are described in § 71.40(a). Section 71.30(a) and (b) describe these General Caregivers using the statutory requirements.
Paragraph (c) of § 71.30 states that no formal application is required to obtain General Caregiver benefits. In most cases, General Caregivers are individuals who live with or near a veteran and help that veteran with less-critical personal care, such as cooking meals, but they may, in some cases, benefit from the caregiver education and training that we offer under § 71.40(a), particularly if the veteran whom they assist is profoundly disabled. We want to make it easy for these types of “good Samaritans” to obtain education and training. The cost of providing these benefits is negligible in comparison to the benefits that veterans derive from having caring people voluntarily assisting them at home.
Under section 38 U.S.C. 1720G(b)(3)(A)(i), VA must provide General Caregivers with specified “support services” including “(I) educational sessions made available both in person and on an Internet Web site; (II) use of telehealth and other available technologies; and (III) teaching techniques, strategies, and skills for caring for a disabled veteran[.]” We implement all of these services under paragraph (a)(1), using virtually the same language as required by the statute.Start Printed Page 26153
Section 1720G(b)(3)(A)(ii) requires that VA provide General Caregivers with “[c]ounseling and other services” under 38 U.S.C. 1782. We define the scope of these benefits in this rulemaking under § 71.50.
Paragraph 71.40(b) implements the benefits to be provided to Secondary Family Caregivers under 38 U.S.C. 1720G(a)(3)(A). Secondary Family Caregivers are generally eligible for all of the benefits authorized for General Caregivers, based on our interpretation and application of section 1720G(a)(3)(A) and (B), in addition to the Secondary Family Caregiver benefits discussed further, below. Similarly, Primary Family Caregivers are authorized by section 1720G(a)(3)(A)(ii)(I) to receive all of the benefits that VA provides to Secondary Family Caregivers—in addition to a higher level of benefits authorized only for Primary Family Caregivers. Thus, we discuss the benefits provided to Secondary Family Caregivers under § 71.40(b) in terms of providing those benefits to both types of Family Caregivers, despite the fact that the paragraph's title only refers to Secondary Family Caregivers. The paragraph title is for ease of readability: A Secondary Family Caregiver can tell, based on the paragraph title, that all of his or her benefits will be described in § 71.40(b).
Under section 1720G(a)(3)(A)(i)(III), VA must provide Primary and Secondary Family Caregivers with “counseling.” Similarly, under section 1720G(a)(3)(A)(ii)(II), VA must provide Primary Family Caregivers with “such mental health services as the Secretary determines appropriate.” We understand that the stresses of caregiving can lead to depression, anger, interpersonal conflict, anxiety, substance use, sleep disturbances, social isolation, and other personal and social issues. We also believe that these concerns are not unique to Primary Family Caregivers and intend to provide Secondary Family Caregivers with the same mental health services. We therefore interpret “counseling” for the purposes of the benefits offered to Primary and Secondary Family Caregivers to include individual and group therapy, counseling and peer support groups. We do not interpret the provision to include medication, inpatient psychiatric care, or other medical procedures related to mental health treatment. We also note that these services are broader than the “[c]ounseling and other services” provided to General Caregivers under § 71.40(a)(3) because the services under that authority, derived from 38 U.S.C. 1782, require that the services provided to the caregiver be connected to the treatment plan of the veteran. No such limitation exists under the section 1720G(a)(3)(A)(i)(III) or 1720G(a)(3)(A)(ii)(II) authorities. The counseling provided to Family Caregivers is intended to treat those Family Caregivers, independent of whether that treatment is likely to support the clinical objectives of the eligible veteran's treatment plan.
Under section 1720G(a)(3)(A)(i)(IV), VA must provide Primary and Secondary Family Caregivers with “lodging and subsistence under [38 U.S.C.] 111(e).” In addition, section 104 of Public Law 111-163 amended 38 U.S.C. 111(e) to authorize VA to provide to family caregivers the “expenses of travel (including lodging and subsistence)” during the period of time in which the veteran is traveling to and from a VA facility for the purpose of medical examination, treatment, or care, and the duration of the medical examination, treatment, or care episode for the veteran. VA implements 38 U.S.C. 111(e) through regulation under 38 CFR part 70. In § 71.40(b)(6), we state that Family Caregivers “are to be considered eligible for beneficiary travel under 38 CFR part 70.” This means that the provision of beneficiary travel is subject to any limitations or exclusions under part 70 as well. There is no reason to believe that section 1720G extends beneficiary travel benefits to Start Printed Page 26154Family Caregivers but does not also require the equal application of the limitations that apply to all individuals eligible for benefits under part 70.
The benefits available to Primary Family Caregivers are described in § 71.40(c).
First, in paragraph (c)(4), we explain that “[t]o determine the stipend amount, VA first will determine the eligible veteran's level of dependency based on the degree to which the eligible veteran is unable to perform one or more ADLs, or the degree to which the veteran is in need of supervision or protection based on symptoms or residuals of neurological or other impairment or injury.” The ADLs and supervision/protection needs will be the 14 ADLs and needs (which we will call categories for the purposes of this discussion) that are listed in the definitions of those terms in § 71.15 (i.e., the seven ADLs and the seven “needs” or impairments).
In paragraph (c)(4)(iii) we explain that each of 14 categories will be assigned a clinical rating of zero to four, with zero meaning that no caregiver assistance is required by the eligible veteran in that category and a four meaning that the eligible veteran requires total assistance in that category, which is parenthetically defined as being able to Start Printed Page 26155complete less than 25 percent of the specific task or function. These percentages, and the zero-to-four scale used in the regulation, are based on three widely accepted clinical tools for measuring ADLs and functional dependence, as applicable: The Katz Basic Activities of Daily Living Scale; the UK Functional Independence Measure and Functional Assessment Measure; and the Neuropsychiatric Inventory.
We also note that these scoring criteria are based on the definitions of ADL and need of supervision or protection based on symptoms or residuals of neurological or other impairment or injury, but under § 71.20(c)(4), Caregiver eligibility extends to a veteran who is service connected for a serious injury that was incurred or aggravated in the line of duty in the active military, naval, or air service on or after September 11, 2001, and has been rated 100 percent disabled for that serious injury, and has been awarded special monthly compensation that includes an aid and attendance allowance. Such a veteran will also have impairment in the categories used for this formula, and therefore it is reasonable to calculate the stipend for such a veteran using this formula. Likewise veterans and servicemembers who establish eligibility under § 71.20(c)(3) will also have an impairment in the categories used for this formula.
Under 38 U.S.C. 1720G(a)(7)(C), the eligible veteran may revoke the status of a Primary Family Caregiver. We implement this authority in § 71.45(b) and apply it to Secondary Family Caregivers as well. We establish straightforward procedures for such revocation, and we allow for a maximum 30-day period during which VA will review the request for revocation and determine whether there is a possibility for remediation. We allow up to 30 days because in some cases it may be necessary to allow for a “cooling off,” during which time the eligible veteran may reconsider his or her request.
But this 30-day extension, which is not specifically authorized by statute, is not without limitation. First, if VA determines that the revoked individual committed fraud or abused or neglected the eligible veteran, we will not continue the benefits after the date of revocation. Second, we will terminate caregiver benefits immediately if the revoked individual was the Primary Family Caregiver, and another Primary Family Caregiver is assigned within 30 days after the date of revocation because the law allows for there to be only one individual receiving benefits as the Primary Family Caregiver. Similarly, caregiver benefits will terminate if another individual becomes a Family Caregiver during the 30-day period, because our regulations will only allow for three Family Caregivers at any one time. Finally, if the revoked individual stops living with the eligible veteran or dissolves his or her relationship with the eligible veteran, we do not believe that it is appropriate to continue to Start Printed Page 26156provide support to that individual. We recognize that neither the 30-day post-revocation period during which benefits may continue, nor the limitations on that period, are clearly contemplated by statute. However, we believe that these rules are consistent with the legislation's purpose. We would like to consider public comment on this issue.
Under 38 U.S.C. 1782(a), VA is required to provide specified benefits to eligible individuals in connection with the treatment of veterans with certain service-connected disabilities, and under § 1782(b), VA may provide the same benefits to eligible individuals in connection with the treatment of veterans with certain nonservice-connected disabilities. In the Veterans' Mental Health and Other Care Improvements Act of 2008, Public Law 110-387, § 301(a), Congress expanded the benefits that VA is authorized to provide to family members by adding “marriage and family counseling” to a list of benefits that already included consultation, professional counseling, training, and mental health services. Those benefits are listed in 38 CFR 17.38(a)(1)(vii) as part of the medical benefits package, as a result of a recent amendment to that section. 75 FR 54028 (Sep. 3, 2010).
The 2010 regulatory amendment to § 17.38 did not explain or clarify the scope of the benefits offered under 38 U.S.C. 1782. Many benefits listed in § 17.38 cross-reference sections that explain the benefit in more detail when the meaning or scope of the listed benefit is not entirely clear on its face, when the benefit is specifically limited by law, or when other regulations govern the actual provision of the benefit. See, e.g., 38 CFR 17.38(a)(1)(v) (bereavement counseling), (a)(1)(viii) (certain durable medical equipment), (a)(1)(xii) (beneficiary travel). We believe that such a clarifying regulation would be helpful to explain the scope of the benefits provided under section 1782 as well, notwithstanding that these benefits have been authorized and provided by VA for several years without regulation.
Moreover, the Caregivers and Veterans Omnibus Health Services Act of 2010 amended section 1782 to provide eligibility for certain caregivers to the benefits and services authorized under section 1782. See Public Law 111-163, § 103(a) (amending section 1782(c)). General Caregivers of covered veterans under part 71 are also eligible for benefits under section 1782 pursuant to 38 U.S.C. 1720G(b)(3)(A)(ii). Thus, we believe it is important to include in part 71 the regulation that implements 38 U.S.C. 1782, collocated with the “Caregivers” rules, notwithstanding that section 1782 benefits are not limited to caregivers identified under part 71.
In § 71.50(a), we do not differentiate between service-connected and non-service-connected disabilities. As noted above, VA is required to provide these benefits to service-connected veterans but is merely authorized to provide them to nonservice-connected veterans. VA has consistently exercised its authority to provide section 1782 benefits without regard to service connection, and we would not change our administration of the benefit now.
The goal of this rule is to provide care to a qualified family member that connects to the treatment plan of the veteran, so that the services provided to the family member will be a component of VA's overall treatment of the veteran's disability. In view of our longstanding primary purpose to provide veteran-focused care and the statutory limitation that VA provide services that are necessary in connection with the treatment of the veteran, we do not interpret section 1782 to allow us to provide medical care for family members unless such care will improve the veteran's own condition from a clinical perspective. Thus, under this rule, VA would not provide treatment to family members for the purposes of overall wellness, but would instead do so to help families participate in the treatment of a veteran. For example, VA would not provide counseling and referral for a depressed family member because his or her depression makes the veteran feel sad out of empathy. However, VA may provide counseling and referral to a veteran's caregiver if the caregiver is unable to help the veteran engage in or sustain engagement in VA treatment. Similarly, if a qualified veteran relies upon a family member to drive him or her to a VA facility on a regular basis, and a mental health condition renders the family member unable to drive a car, then the veteran is left without access to needed treatment. In this instance, VA will provide the appropriate psychotherapy or counseling for the family member's condition, or help the family member find appropriate care in the private sector, because such treatment is necessary in connection Start Printed Page 26157with the course of treatment for the veteran's disability.
The Secretary further finds that it is contrary to the public interest to delay issuance of this rule for the purpose of soliciting prior public comment because there is an immediate and pressing need for the assistance and support services that will be provided under the rule, without which harm to America's wounded, injured veterans and their caregivers would result. The conflicts in Iraq and Afghanistan have led to a sharp increase in the number of servicemembers and veterans returning with serious injuries that require substantial care. Recognizing this problem, Congress required the Secretary to take quick action to assist these veterans and their caregivers. Hundreds of seriously injured servicemembers and veterans have caregivers or potential caregivers who may be eligible for the assistance and support services that will be provided under this rule. Many caregivers, in order to assist their loved ones in a time of dire need, may have left or foregone employment due to the time commitment required to provide care for a seriously injured individual. These caregivers may have lost health insurance as a result of lost employment opportunities and may be in urgent need of mental health counseling due to the great emotional strain of caring for a severely injured servicemember or veteran. Further, caregivers may be in need of the training that will be provided under this rule in order to ensure that they are able to provide care in a manner that protects the safety and well being of their seriously injured servicemember or veteran. The assistance and services to be provided under this rule are needed as soon as Start Printed Page 26158possible to respond to this increase in servicemembers and veterans with serious injuries in order to avoid financial hardship for caregivers and to ensure the provision of appropriate care for eligible seriously injured servicemembers and veterans.
The interim final rule at § 71.25(a) contains a collection of information, which constitutes a collection of information under the Paperwork Reduction Act (44 U.S.C. 3501-3521) and requires approval by the Office of Management and Budget (OMB). Accordingly, under section 3507(d) of the Act, VA has submitted a copy of this rulemaking to OMB for review. OMB assigns a control number for each collection of information it approves. Except for emergency approvals under 44 U.S.C. 3507(j), VA may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. We have requested that OMB approve the collection of information on an emergency basis. If OMB does not approve the collection of information as requested, we will immediately remove § 71.25(a) or take such other action as is directed by OMB.
We are also seeking an approval of the information collection on a non-emergency basis. Accordingly, we are also requesting comments on the collection of information provisions contained in § 71.25(a) on a non-emergency basis. Comments must be submitted by July 5, 2011.
Summary of collection of information: The interim final rule at § 71.25(a) contains application provisions for individuals who wish to be considered for designation by VA as Primary or Secondary Family Caregivers for certain veterans. These provisions require the submission of a joint application completed by a veteran or servicemember and no more than three other individuals who intend to serve as Family Caregivers for an eligible veteran, with no more than one individual serving as veteran's Primary Family Caregiver.
This regulatory action is a major rule under the Congressional Review Act, 5 U.S.C. 801-08, because it is likely to result in an annual effect on the economy of $100 million or more. Although this regulatory action is a major rule within the meaning of the Congressional Review Act, 5 U.S.C. 804(2), it is not subject to the 60-day delay in effective date applicable to major rules under 5 U.S.C. 801(a)(3) because the Secretary finds that good cause exists under 5 U.S.C. 808(2) to make this regulatory action effective Start Printed Page 26159immediately, consistent with the publication of this interim final rule. Congress established this program and intended it to be in effect by January 30, 2011, but the implementing regulations have taken longer to develop. In establishing this program, Congress and VA recognize the immediate and urgent need that many veterans, servicemembers, and their family members have for caregiver assistance and benefits. Accordingly, the Secretary finds that additional advance notice and public procedure thereon are impractical, unnecessary, and contrary to the public interest. In accordance with 5 U.S.C. 801(a)(1), VA will submit to the Comptroller General and to Congress a copy of this regulatory action and VA's Regulatory Impact Analysis (RIA).
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To project the best possible economic impact of this regulation VA conducted an analysis on veterans and servicemembers who incurred or aggravated a serious injury in the line of duty on or after September 11, 2001. The analysis also focused on the number of veterans and servicemembers who have an impairment in one or more of seven activities of daily living (ADLs) or require supervision or protection based on symptoms or residuals of neurological or other impairment or injury, and those whose injury is strictly diagnosed as a mental health condition with a GAF score of no greater than 30. The results of this analysis identified an estimated 3,596 veterans and servicemembers who would meet the eligibility criteria established in § 71.20 of this regulation, thus being eligible for Family Caregiver benefits. The estimated 3,596 number of potentially eligible veterans and servicemembers was applied to the applicable methodologies and calculations in this regulatory impact analysis to project the best possible economic impact of this regulation.
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Oversight for veterans and caregivers who live in remote areas will be contracted with a national home health agency. VA estimated that 40 percent of caregivers (3,596 × 40% = 1,438) would receive oversight or monitoring by VA contractors due to the veteran's or caregiver's geographical location. Costs were estimated using a home health agency contractor for one (1) visit per quarter by a registered nurse (RN) for two (2) hours per visit, using a national hourly rate of $116.40 for skilled nursing visits based on CMS Lupa rates. Based on the publication of this rulemaking (May 2011) and based on Start Printed Page 26168VA's decision to ensure that the first home visit is conducted by VA clinical staff, there are no projected contract costs for FY11. A 4 percent inflation rate was applied to the cost per caregiver per/hr and a 4 percent population growth rate was applied to the projected caregiver caseload to produce costs for out years identified in the chart below.
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Authority: 38 U.S.C. 510, and as noted in specific sections.
2. Section 17.38(a)(1)(vii) is amended by removing “treatment.” and adding, in its place, “treatment as authorized under
3. Part 71 is added to read as follows:
Eligible veterans and servicemembers.
General Caregivers.
End Part (Authority: 38 U.S.C. 501, 1720G, and as noted in specific sections)
For the purposes of this part:Start Printed Page 26173
Eligible veteran means a veteran, or a servicemember, who is found eligible for a Family Caregiver under § 71.20.
General Caregiver means an individual who meets the requirements of § 71.30.
Primary Family Caregiver means an individual who meets the requirements of § 71.25.
Secondary Family Caregiver means an individual who meets the requirements of § 71.25.
(a) Application requirement. (1) Individuals who wish to be considered for designation by VA as Primary or Secondary Family Caregivers must complete and sign a joint application, along with the veteran or Start Printed Page 26174servicemember. Individuals interested in serving as Family Caregivers must be identified as such on the joint application, and no more than three individuals may serve as Family Caregivers at one time for an eligible veteran, with no more than one serving as the Primary Family Caregiver.
(c) No application or clinical evaluation is required to obtain benefits as a General Caregiver. Veterans or General Caregivers may request any of the benefits listed in § 71.40(a) as needed, from the appropriate VA clinicians and staff at their local VA facilities.
(d) A veteran is not required to meet the eligibility requirements in § 71.20 to be considered a covered veteran.
(3) Counseling and other services, as described under § 71.50.
(1) General Caregiver benefits described in paragraph (a) of this section, except that respite care under paragraph (a)(4) is limited to veterans Start Printed Page 26175enrolled in the VA health care system. Respite care may be provided during a Family Caregiver's training, as described under § 71.25(d).
(i) VA will clinically rate the eligible veteran's inability to perform each of the seven ADLs listed in the definition of that term in § 71.15.
(ii) VA will clinically rate the eligible veteran's need for supervision or protection based on symptoms or residuals of neurological or other impairment or injury using the seven impairments listed in the definition of that term in § 71.15.
(vi) Stipend payments for the first month will be adjusted based on the number of days remaining in the month. Stipend payments will also be prorated where a Primary Family Caregiver's status is revoked and/or a new Primary Family Caregiver is designated prior to the end of a month. See § 71.45, Revocation.
(3) VA will review the request for revocation and determine whether there Start Printed Page 26176is a possibility for remediation. This review will take no longer than 30 days. During such review, the veteran, servicemember, or surrogate may rescind the request for revocation. If VA suspects that the safety of the eligible veteran is at risk, then VA may suspend the caregiver's responsibilities, and remove the eligible veteran from the home if requested by the eligible veteran, prior to making a formal revocation.