38 U.S.C. § 1720C — Noninstitutional alternatives to nursing home care

(a) The Secretary^* may provide medical, rehabilitation, and health-related services outside institutions to veterans who are eligible under this chapter and need nursing-home care. Priority must go to veterans who receive or need nursing-home care mainly for a service-connected^* disability^*, or whose service-connected disability is rated at least 50 percent.

(b)(1) Under this program, the Secretary must: (A) provide appropriate health-related services only through contracts with suitable public or private agencies; and (B) assign Department^* health-care employees to provide case-management services to veterans served by the program. (2) “Case management services” includes coordinating and facilitating all services the Department provides directly or through contracts. It includes assessing needs, planning, making referrals (to the Department directly, through a contract, or to another entity), monitoring, reassessing, and following up. This section does not otherwise define “case management services.”

(c) The Secretary may give a service provider in-kind help through Department employees and shared Department resources. The help must be under a Department contract with the facility, used only to provide appropriate services under this section, and provided only if the Department is reimbursed for its full cost, including services, supplies, and normal equipment depreciation and amortization. Reimbursement may reduce charges to the United States or be paid to the United States. Money received must be credited to the funds allotted to the Department facility that provided the help.

(d)(1) Unless paragraph (2) applies, the total cost of services or in-kind help for a veteran^* in a fiscal year may not exceed 100 percent of what Department nursing-home care under section 1710 would have cost that year. (2)(A) The total may exceed that amount for a veteran described in (B) if the Secretary decides, considering clinical need, geographic market factors, and other matters set by regulation, that the higher amount is in the veteran's best interest. (B) The veteran must have amyotrophic lateral sclerosis, a spinal-cord injury, or a condition the Secretary decides is similar.

(e) Contract authority under this section applies in a fiscal year only to the extent appropriations are available.

(f) If the Department medical center administering the program is in an area where the veteran can receive services under a PACE program, the Secretary must seek an agreement with that area's PACE program to provide the services. “PACE program” is used as defined in sections 1894(a)(2) and 1934(a)(2) of the Social Security Act (42 U.S.C. 1395eee(a)(2) and 1396u-4(a)(2)); this section does not define it.