38 U.S.C. § 1720 — Transfers for nursing home care; adult day health care

(a)(1) Subject to (b), the Secretary may transfer to a non-Department nursing home, at United States expense: (A) a veteran who received care in a facility directly under the Secretary and whom the Secretary decides needs a long period of nursing-home care that the outside home can provide and, if the veteran received hospital care in that facility, has received the maximum benefit from it; and (B) an Armed Forces member who received care in an Armed Forces hospital, whom the responsible Secretary decides received the maximum benefit but needs a long period of nursing-home care, and who will become a veteran upon discharge. (2) The Secretary may transfer someone only if the cost will not exceed 45 percent of the annual cost of Department general-hospital care directly under the Secretary, or 50 percent if the Secretary, on the Under Secretary for Health's recommendation, decides the higher amount is needed for adequate care. (3) Care under this subsection may not be paid for more than six months in total for one transfer, except for a veteran transferred from a directly controlled hospital whose hospitalization was mainly for a service-connected disability, a case where care is needed for a service-connected disability, or a case where the Secretary believes a longer period is warranted. (4) A veteran cared for in an Alaska or Hawaii Department hospital or domiciliary facility may receive care under this subsection even if that facility is not directly under the Secretary. (b) A veteran may not be transferred or admitted under this section unless the Secretary finds that the institution meets standards the Secretary sets. To the extent possible, the standards and inspection reports made by or for the Secretary must be available to Federal, State, and local agencies responsible for licensing, regulating, or inspecting the institutions. (c)(1)(A) The Secretary may agree for nursing-home, adult-day-health, or other extended-care services with a Medicare provider having a Social Security Act section 1866(a) provider agreement; a Medicaid provider participating under a State plan under title XIX; or another provider eligible for a section 1745(a) contract. (B) For the first two kinds of providers, the Secretary may use the procedures for section 1866(a) provider agreements. (2) For a contract providing veterans' nursing-home care, paying wages at least equal to those in section 6(b) of the Fair Labor Standards Act is treated as compliance with section 6704(a) of title 41. (d)(1) Subject to (b), the Secretary may authorize direct admission, at United States expense, to any non-Department nursing home for a veteran needing care for a service-connected disability. The Secretary may also authorize direct admission for a veteran discharged from a directly controlled hospital who is receiving Department medical services through home health services. (2) Need may be decided by a Department physician, or, where none is available, by a contracted or fee-basis physician after examination. (3) The amount paid and length of care are the same as under (a). (e)(1) The Secretary sets the cost of intermediate care for payment under (a)(2)(B), but its reimbursement rate must be proportionately lower than nursing-home care. (2) “Non-Department nursing home” means a public or private institution not directly under the Secretary that provides nursing-home care. This section does not otherwise define that term. (f)(1)(A) The Secretary may provide adult day health care to a veteran enrolled under section 1705(a) who otherwise would need nursing-home care. (B) The Secretary may provide a facility with in-kind help through Department employees and shared resources under a contract or agreement. It may be used only for adult day health care, and the Department must receive full reimbursement, including services, supplies, and normal equipment depreciation and amortization. Reimbursement may reduce charges to the United States or be paid to the United States, and received funds go to the assisting Department facility's allotted funds. (2) The Secretary may run adult-day-health programs at directly controlled facilities for eligible veterans. Necessary travel or incidental expenses, or transportation instead, may be provided only under section 111's terms and conditions. The program is subject to the duration limits for care under paragraph (1). (g) The Secretary may contract with suitable entities for specialized residential care and rehabilitation for an Operation Enduring Freedom or Operation Iraqi Freedom veteran whom the Secretary decides has traumatic brain injury and accumulated deficits in daily living and instrumental daily-living activities, so that the veteran would otherwise need nursing-home admission even though that care would generally exceed the veteran's nursing needs. (h)(1) During the five years beginning on enactment of the Joseph Maxwell Cleland and Robert Joseph Dole Memorial Veterans Benefits and Health Care Improvement Act of 2022, and subject to paragraph (3), the Secretary may, at a veteran's request, place a veteran for whom section 1710A requires nursing-home care in a Department-standard medical foster home at United States expense under a contract, agreement, or other arrangement. The Secretary may also pay for a veteran already placed there before enactment if the home meets Department standards and there is such an arrangement. (2) A veteran whose care is paid for must agree to accept Secretary-provided home health services under section 1717. (3) In any year, no more than a daily average of 900 veterans receiving such care, whether placed before, on, or after enactment, may have it covered under paragraph (1). (4) Section 1730(b)(3)'s prohibition does not apply to such a veteran. (5) “Medical foster home” means a home designed to provide noninstitutional, long-term supportive care for veterans unable to live independently who prefer a family setting. This section does not otherwise define that term.