[Federal Register Volume 73, Number 71 (Friday, April 11, 2008)]
[Proposed Rules]
[Pages 19785-19789]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E8-7641]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 53

RIN 2900-AM26


Assistance to States in Hiring and Retaining Nurses at State 
Veterans Homes

AGENCY: Department of Veterans Affairs.

ACTION: Proposed rule.

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SUMMARY: The Department of Veterans Affairs (VA) proposes to establish 
a mechanism for States to obtain payments from VA to assist a State 
veterans home in the hiring and retention of nurses for the purpose of 
reducing nursing shortages at the home. This rule would implement 
provisions of the Veterans Health Programs Improvement Act of 2004.

DATES: Comments on the proposed rule must be received on or before June 
10, 2008.

ADDRESSES: Written comments may be submitted through 
www.regulations.gov; by mail or hand-delivery to Director, Regulations 
Management (00REG), Department of Veterans Affairs, 810 Vermont Ave., 
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-AM26-Assistance to States in Hiring and Retaining Nurses at State 
Veterans Homes.'' 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. (This is not a toll-free number.) In addition, during the 
comment period, comments may be viewed online through the Federal 
Docket Management System (FDMS) at www.regulations.gov.

FOR FURTHER INFORMATION CONTACT: Jacquelyn Bean, Chief, State Veterans 
Home Per Diem Program, at (202) 461-6771, or Christa M. Hojlo, PhD, 
Director, State Veterans Home Clinical and Survey Oversight, at (202) 
461-6779; Veterans Health Administration (114), Department of Veterans 
Affairs, 810 Vermont Avenue, NW., Washington, DC 20420. (These are not 
toll-free numbers.)

SUPPLEMENTARY INFORMATION: This document proposes to establish a new 38 
CFR part 53 consisting of regulations captioned ``PAYMENTS TO STATES 
FOR PROGRAMS TO PROMOTE THE HIRING AND RETENTION OF NURSES AT STATE 
VETERANS HOMES'' (referred to below as the proposed regulations). The 
proposed regulations provide a mechanism for a State to obtain payments 
from VA to assist a State Veterans Home (SVH) in the hiring and 
retention of nurses for the purpose of reducing nursing shortages at 
that home. These regulations would implement provisions in section 201 
of the Veterans Health Programs Improvement Act of 2004 (Pub. L. 108-
422), which are codified at 38 U.S.C. 1744.

Definitions

    Definitions applicable to the proposed regulations are set forth at 
Sec.  53.02. We included definitions of nurse, State, SVH, and State 
representative.
    We propose to define nurse to mean an individual who is a 
registered nurse, a licensed practical nurse, a licensed vocational 
nurse, or a nursing assistant certified in the State in which payment 
is made and who is a bedside care giver (e.g., this would not include 
an individual acting in the capacity of an advance practice nurse, an 
administrative nurse, or a director of nursing). We also propose that 
the terms nurses and nursing shall be construed consistent with this 
definition. The proposed definition of nurse reflects the intent of the 
law (38 U.S.C. 1744) to reduce shortages of nurses who provide direct 
bedside care for veterans at least a majority of the time. H. Rep. No. 
108-538, at 5 (2004) (law intended to assist State homes ``in hiring 
nurses to care for veterans''). Advance practice nurses, administrative 
nurses, and directors of nursing generally do not provide direct 
bedside care, and therefore, would generally not be eligible for 
participation in the proposed program. We are particularly interested 
in soliciting comments on the proposed definition of nurse.
    We propose to define State consistent with 38 U.S.C. 101(20) to 
cover places where an SVH could be located, including the States, 
Territories, and possessions of the United States; the District of 
Columbia; and the Commonwealth of Puerto Rico.
    Under 38 U.S.C. 1744(b), a State is eligible for nurse hiring and 
retention payments if it receives per diem payments from VA for 
domiciliary care, nursing home care, adult day health care, and 
hospital care. Accordingly, we propose to define State Veterans Home, 
consistent with VA's per diem programs, to include State facilities 
approved by VA for the purpose of providing domiciliary, nursing home, 
adult day health, and hospital care for certain disabled veterans.
    We propose to define State representative to mean the official who 
would have authority to sign the application on behalf of the State and 
would otherwise be the State contact for actions under the regulations.

Decisions and Notifications

    Under the proposed regulations, authority would be delegated to the 
Chief Consultant, Geriatrics and Extended Care, to make all 
determinations regarding payments. The Chief Consultant would also 
provide written notice to State representatives concerning approvals, 
denials, or requests for additional information under the regulations.

General Requirements for Payments

    Proposed Sec.  53.11 would provide for payments to a State for an 
employee incentive program to reduce the shortage of nurses at a SVH if 
the requirements of proposed Sec.  53.11(a) are met. Except as 
discussed below, these requirements restate the provisions of 38 U.S.C. 
1744.
    To be eligible for payments under proposed Sec.  53.11(a)(3), the 
SVH must have a nursing shortage that is documented by credible 
evidence, including but not limited to SVH records showing vacancies, 
SVH records showing overtime use, and reports documenting that nurses 
are not available in the local area. This is intended to implement the 
section 1744(e) requirement that an application describe the nursing 
shortage at the SVH and to ensure that payments are made only when an 
actual nursing shortage exists.
    Under section 1744(c), a State may use VA's payments only to 
provide funds for an employee incentive scholarship program or other 
employee incentive program designed to promote the hiring and retention 
of nurses and reduce a nursing shortage. Consistent with section 
1744(c), proposed Sec.  53.11(a)(4) would limit the use of VA's 
payments to nursing incentives and expressly prohibit using the funds 
for any other purpose, such as covering all or part of a nurse's 
standard employee benefits (e.g., salary, health insurance, or 
retirement plan). Accordingly, under the proposed regulations, an 
``employee

[[Page 19786]]

incentive program'' would not include standard employee benefits.
    Proposed Sec.  53.11(a)(5) would require the applicant to provide 
documentation concerning an existing employee incentive program or one 
that is ready for immediate implementation upon receipt of VA funding. 
VA would require this information as part of the application process to 
ensure that the payments are in compliance with the limitations in 
section 1744(c). VA would not make payments to a State under the 
proposed regulations if the State is merely considering or developing 
an incentive program.
    Proposed Sec.  53.11(a)(7) would require that an employee incentive 
program include a mechanism to ensure that any individual receiving 
payments under the program will work at the SVH as a nurse for a period 
commensurate with the payments. It would also require States to design 
such a program, if at all possible, to eliminate any nursing shortage 
at the SVH within 3 years of VA's first payment to the State or SVH 
under the program. These provisions are necessary to ensure that the 
program is effective in meeting the goal of expeditiously reducing 
nursing shortages. Given that section 1744(f) specifies that VA funding 
for SVH nurse employee incentive programs comes from general medical 
appropriations and given the competition for funding various VA health 
care activities, it is reasonable to require States to establish 
effective programs.
    Proposed Sec.  53.11(b) would implement the mandate in section 
1744(c) that VA take into consideration the need for flexibility and 
innovation when establishing criteria for receipt of incentive funds. 
We interpret section 1744(c) as authorizing payment of short-term 
scholarships for continuing nursing education, sign-on bonuses for 
nurses, and improvements to working conditions. Ongoing research 
suggests that innovative improvements to the working conditions in 
nursing homes can have a significant impact on nurse retention. While 
creative alternatives are still being developed and researched, some 
examples of ``other improvements to working conditions'' include but 
are not limited to improving the ambiance in the nurse work areas or 
purchasing handheld devices or software to ease the burden of 
documentation. These provisions are designed to provide the proper 
balance between the statutory admonition for VA to use ``flexibility 
and innovation'' when considering employee incentive programs and 
making payments only for those programs that have a likelihood of 
success in reducing nursing shortages. In determining whether an 
employee incentive program is likely to be effective, VA will consider 
any available information, including the program's past performance.

Application Requirements

    To apply for payments during a fiscal year, a State representative 
would be required to submit to the Chief Consultant, Geriatrics and 
Extended Care Service, a completed VA Form 10-0430, including all 
required documentation and other information necessary for determining 
whether the applicant is eligible for payments. VA must receive the 
applicant's VA Form 10-0430 during the first quarter (October 1-
December 31) of the fiscal year in which the VA payments are sought. 
(Note: the Web site given in Sec.  53.20(a) for access to the form will 
be available upon final publication of this rule.) For example, if the 
State intends to request payment for fiscal year 2009, the State must 
submit, and VA must receive, a complete application between October 1, 
2008, and December 31, 2008. This submission requirement is intended to 
ensure that payments and employee incentive activities will occur in 
the same fiscal year that application was made as required by the 
provisions of section 1744. Further, for informational purposes, the 
provisions of proposed Sec.  53.20(a) specify how to obtain VA Form 10-
0430. Moreover, consistent with section 1744, the regulations provide 
that the State must submit a new application for each fiscal year that 
the State seeks payments under the program.
    We interpret section 1744 as expressing congressional intent to 
assist States in funding incentive programs for nurses that provide 
care for veterans by funding up to 50 percent of the cost of an 
employee incentive program. Accordingly, under Sec.  53.20(b), the 
State representative would be required to submit to VA evidence that 
the State has sufficient funding, when combined with the VA payments, 
to fully operate the employee incentive program through the end of the 
fiscal year. This is essential to ensure that VA funds would not be 
unused because they were allocated to a State that is unable to operate 
its program due to lack of funding. To meet this requirement, the State 
representative would provide VA a letter from an authorized State 
official certifying that, if VA were to award payments under this 
program, the non-VA share of the funds would be, by a date or dates 
specified in the certification, available to the State for the employee 
incentive program without further State action to make such funds 
available. Additionally, if the certification references a State law 
that appropriates money for the employee incentive program, a copy of 
the relevant State law would be submitted with the certification.
    In addition, if an application does not contain sufficient 
information for a determination under the proposed regulations, the 
State representative would be notified in writing of any additional 
submission required and would be asked for such additional information. 
If the State representative fails to respond within 30 calendar days 
(which may extend beyond December 31) the submission would be deemed 
abandoned. We expect that the submissions would generally contain all 
of the required information. However, we believe that such an 
occasional delay in a submission would not prevent VA from ensuring 
that payments and employee incentive activities would occur in the same 
fiscal year that application was made.

Payments

    Proposed Sec.  53.30(a) restates the statutory formula at 38 U.S.C. 
1744(d) for making payments.
    Payments under this program would be made to the States in a lump 
sum or installments as deemed appropriate by the Chief Consultant, 
Geriatrics and Extended Care. Payment would be made under Sec.  
53.30(c) to the State or, if designated by the State representative, 
the SVH conducting the employee incentive program. This provides 
flexibility to cover different types of employee incentive programs 
while still meeting the needs of employee incentive programs.
    Consistent with 38 U.S.C. 1744(c), proposed Sec.  53.30(d) provides 
that payments made under the regulations for a specific employee 
incentive program shall be used solely for that purpose.

Annual Report

    Proposed Sec.  53.31(a), which would implement section 1744(i), 
would require any SVH that receives an incentive payment to provide VA 
a detailed report concerning use of the funds, including an analysis of 
how effective the incentive program has been on nurse staffing in the 
SVH.
    Proposed Sec.  53.31(b) advises States and SVHs of the requirements 
of the Single Audit Act of 1984 (see 38 CFR part 41).

Recapture Provisions

    Proposed Sec.  53.32 provides that if a State fails to use the 
funds to assist a SVH to hire and retain nurses through an employee 
incentive program or

[[Page 19787]]

receives payments in excess of the amount allowed under Sec.  53.30, 
the United States is entitled to recover the amount not used for such 
purpose or the excess amount received. This is necessary to permit VA 
to enforce section 1744(c), which authorizes a State to use funds only 
for an approved employee incentive program and only in accordance with 
the specified formula.

Notification of Funding Decision

    Proposed Sec.  53.41 advises affected States how they will be 
notified if VA determines that a submission from a State fails to meet 
the requirements of this part for funding.

Executive Order 12866

    Executive Order 12866 directs agencies to assess all costs and 
benefits of available regulatory alternatives and, when regulation is 
necessary, to select regulatory approaches that maximize net benefits 
(including potential economic, environmental, public health and safety, 
and other advantages; distributive impacts; and equity). The Executive 
Order classifies a ``significant regulatory action,'' requiring review 
by the Office of Management and Budget (OMB) unless OMB waives such 
review, as any regulatory action that is likely to result in a rule 
that may: (1) Have an annual effect on the economy of $100 million or 
more or adversely affect in a material way the economy, a sector of the 
economy, productivity, competition, jobs, the environment, public 
health or safety, or State, local, or tribal governments or 
communities; (2) create a serious inconsistency or otherwise interfere 
with an action taken or planned by another agency; (3) materially alter 
the budgetary impact of entitlements, grants, user fees, or loan 
programs or the rights and obligations of recipients thereof; or (4) 
raise novel legal or policy issues arising out of legal mandates, the 
President's priorities, or the principles set forth in the Executive 
Order.
    The economic, interagency, budgetary, legal, and policy 
implications of this proposed rule have been examined and it has been 
determined to be a significant regulatory action under Executive Order 
12866.

Unfunded Mandates

    The Unfunded Mandates Reform Act requires, at 2 U.S.C. 1532, that 
agencies prepare an assessment of anticipated costs and benefits before 
issuing any rule that may result in expenditure by State, local, or 
tribal governments, in the aggregate, or by the private sector, of $100 
million or more (adjusted annually for inflation) in any given year. 
This proposed rule would have no such effect on State, local, or tribal 
governments, or on the private sector.

Paperwork Reduction Act

    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.
    The proposed rule at Sec. Sec.  53.11, 53.20, 53.31, and 53.40 
contains collections of information under the Paperwork Reduction Act 
(44 U.S.C. 3501-3521). In notices published in the Federal Register on 
April 2, 2007 (72 FR 15763), and July 27, 2007 (72 FR 35303), we 
requested public comments on these collections of information. We did 
not receive any comments. Further, under section 3507(d) of the Act, we 
are submitting a copy of this rulemaking action to OMB for its review 
of these collections of information.

Regulatory Flexibility Act

    The Secretary hereby certifies that 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. The funding for this program would be made by the 
Federal government. The amount contributed by a SVH to fund an 
incentive program would be an insignificant amount of the costs for 
operating the SVH. Therefore, pursuant to 5 U.S.C. 605(b), this 
proposed rule is exempt from the initial and final regulatory 
flexibility analysis requirements of sections 603 and 604.

Catalog of Federal Domestic Assistance Numbers

    The Catalog of Federal Domestic Assistance numbers and titles for 
the programs affected by this document are 64.005, Grants to States for 
the Construction of SVHs; 64.007, Blind Rehabilitation Centers; 64.008, 
Veterans Domiciliary Care; 64.009, Veterans Medical Care Benefits; 
64.010, Veterans Nursing Home Care; 64.011, Veterans Dental Care; 
64.012, Veterans Prescription Service; 64.013, Veterans Prosthetic 
Appliances; 64.014, Veterans State Domiciliary Care; 64.015, Veterans 
State Nursing Home Care; 64.016, Veterans State Hospital Care; 64.018, 
Sharing Specialized Medical Resources; 64.019, Veterans Rehabilitation 
Alcohol and Drug Dependence; 64.022, Veterans Home Based Primary Care; 
and 64.026, Veterans State Adult Day Health Care.

List of Subjects in 38 CFR Part 53

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

    Approved: April 4, 2008.
Gordon H. Mansfield,
Deputy Secretary of Veterans Affairs.

    For reasons set forth in the preamble, the Department of Veterans 
Affairs proposes to amend 38 CFR chapter I by to adding part 53 to read 
as follows:

PART 53--PAYMENTS TO STATES FOR PROGRAMS TO PROMOTE THE HIRING AND 
RETENTION OF NURSES AT STATE VETERANS HOMES

Sec.
53.01 Purpose and scope.
53.02 Definitions.
53.10 Decision makers, notifications, and additional information.
53.11 General requirements for payments.
53.20 Application requirements.
53.30 Payments.
53.31 Annual report.
53.32 Recapture provisions.
53.40 Submissions of information and documents.
53.41 Notification of Funding Decision.

    Authority: 38 U.S.C. 101, 501, 1744.


Sec.  53.01  Purpose and scope.

    In accordance with the provisions of 38 U.S.C. 1744, this part sets 
forth the mechanism for a State to obtain payments to assist a State 
Veterans Home (SVH) in the hiring and retention of nurses for the 
purpose of reducing nursing shortages at that SVH.

(Authority: 38 U.S.C. 101, 501, 1744).

Sec.  53.02  Definitions.

    For the purpose of this part:
    Nurse means an individual who is a registered nurse, a licensed 
practical nurse, a licensed vocational nurse, or a nursing assistant 
certified in the State in which payment is made and who is a bedside 
care giver at least a majority of the time (e.g., this would generally 
not include an individual acting in the capacity of an advance practice 
nurse, an administrative nurse, or a director of nursing) (the terms 
nurses and nursing shall be construed consistent with this definition).

[[Page 19788]]

    State means each of the several States, Territories, and 
possessions of the United States, the District of Columbia, and the 
Commonwealth of Puerto Rico.
    State representative means the official designated in accordance 
with State authority with responsibility for matters relating to 
payments under this part.
    State Veterans Home (SVH) means a home approved by the Department 
of Veterans Affairs (VA) which a State established primarily for 
veterans disabled by age, disease, or otherwise, who by reason of such 
disability are incapable of earning a living. A SVH may provide 
domiciliary care, nursing home care, adult day health care, and 
hospital care. Hospital care may be provided only when the SVH also 
provides domiciliary and/or nursing home care.

(Authority: 38 U.S.C. 101, 501, 1744).

Sec.  53.10  Decision makers, notifications, and additional 
information.

    The Chief Consultant, Geriatrics and Extended Care, will make all 
determinations regarding payments under this part, and will provide 
written notice to affected State representatives of approvals, denials, 
or requests for additional information under this part.

(Authority: 38 U.S.C. 101, 501, 1744).

Sec.  53.11  General requirements for payments.

    (a) VA will make payment under this part to a State for an employee 
incentive program to reduce the shortage of nurses at the SVH, when the 
following conditions are met:
    (1) The State representative applies for payment in accordance with 
the provisions of Sec.  53.20,
    (2) The SVH receives per diem payments from VA under the provisions 
of 38 U.S.C. 1741 for one or more of the following: adult day health 
care, domiciliary care, hospital care, or nursing home care,
    (3) The SVH has a nursing shortage that is documented by credible 
evidence, including but not limited to SVH records showing nursing 
vacancies, SVH records showing nurse overtime use, and reports 
documenting that nurses are difficult to hire in the local area and 
difficult to retain as employees at the SVH,
    (4) The SVH does not use payments to pay for all or part of a 
nurse's standard employee benefits, such as salary, health insurance, 
or retirement plan,
    (5) The SVH provides to the Chief Consultant, Geriatrics and 
Extended Care, documentation establishing that it has an employee 
incentive program that:
    (i) Is likely to be effective in promoting the hiring and retention 
of nurses for the purpose of reducing nursing shortages at that home, 
and
    (ii) Is in operation or ready for immediate implementation if VA 
payments are made under this part,
    (6) The payment amount applied for by the State is no more than 50 
percent of the funding for the employee incentive program during the 
fiscal year,
    (7) The SVH employee incentive program includes a mechanism to 
ensure that an individual receiving benefits under the program works at 
the SVH as a nurse for a period commensurate with the benefits 
provided, and, insofar as possible, the program is designed to 
eliminate any nursing shortage at the SVH within a 3-year period from 
the initiation of VA payments,
    (8) The SVH, if it received payments under this part during a 
previous fiscal year, has met the reporting requirements of Sec.  
53.31(a) regarding such payments, and
    (9) The SVH credits to its employee incentive program any funds 
refunded to the SVH by an employee because the employee was in breach 
of an agreement for employee assistance funded with payments made under 
this part and the SVH credits the amount returned as a non-Federal 
funding source.
    (b) VA intends to allow flexibility and innovation in determining 
the types of employee incentive programs at SVHs eligible for payments. 
Programs could include such things as the provision of short-term 
scholarships for continuing nursing education, sign-on bonuses for 
nurses, and improvements to working conditions. In determining whether 
an employee incentive program is likely to be effective, VA will 
consider any information available, including past performance of the 
SVH's program funded by payments made under this part.

(Authority: 38 U.S.C. 101, 501, 1744).

Sec.  53.20  Application requirements.

    (a) To apply for payments during a fiscal year, a State 
representative must submit to VA, in accordance with Sec.  53.40, a 
completed VA Form 10-0430 and documentation specified by the form (VA 
Form 10-0430 is available at VA medical centers and on the Internet at 
http://www1.va.gov/geriatricsshg/ or may be obtained by notifying the 
Geriatrics and Extended Care Office (114) at 202-461-6750, VHA 
Headquarters, 810 Vermont Avenue, NW., Washington, DC 20420. The 
submission must be made to VA during the first quarter (October 1-
December 31) of the fiscal year in which the VA payments are sought. 
The State must submit a new application for each fiscal year that the 
State seeks payments for an incentive program.
    (b) As part of the application, the State representative must 
submit to VA evidence that the State has sufficient funding, when 
combined with the VA payments, to fully operate its employee incentive 
program through the end of the fiscal year. To meet this requirement, 
the State representative must provide to VA a letter from an authorized 
State official certifying that, if VA were to approve payments under 
this part, the non-VA share of the funds for the program would be by a 
date or dates specified in the certification, available for the 
employee incentive program without further State action to make such 
funds available. If the certification is based on a State law 
authorizing funds for the employee incentive program, a copy of the 
State law must be submitted with the certification.
    (c) If an application does not contain sufficient information for a 
determination under this part, the State representative will be 
notified in writing of any additional submission required and that the 
State has 30 calendar days from the date of the notice to submit such 
additional information or no further action will be taken. If the State 
representative does not submit all of the required information or 
demonstrate that he or she has good cause for failing to provide the 
information within 30 calendar days of the notice (which may extend 
beyond the first quarter of the Federal fiscal year), then the State 
applicant will be notified in writing that the application for VA 
assistance will be deemed withdrawn and no further action will be 
taken.

(Authority: 38 U.S.C. 101, 501, 1744).

Sec.  53.30  Payments.

    (a) The amount of payments awarded under this part during a fiscal 
year will be the amount requested by the State and approved by VA in 
accordance with this part. Payments may not exceed 50 percent of the 
cost of the employee incentive program for that fiscal year and may not 
exceed 2 percent of the amount of the total per diem payments estimated 
by VA to be made to the State for that SVH during that fiscal year for 
adult day health care, domiciliary care, hospital care, and nursing 
home care, under 38 U.S.C. 1741.
    (b) Payments will be made by lump sum or installment as deemed 
appropriate by the Chief Consultant, Geriatrics and Extended Care.
    (c) Payments will be made to the State or, if designated by the 
State

[[Page 19789]]

representative, the SVH conducting the employee incentive program.
    (d) Payments made under this part for a specific employee incentive 
program shall be used solely for that purpose.

(Authority: 38 U.S.C. 101, 501, 1744).

Sec.  53.31  Annual report.

    (a) A State receiving payment under this part shall provide to VA a 
report setting forth in detail the use of the funds, including a 
descriptive analysis of how effective the employee incentive program 
has been in improving nurse staffing in the SVH. The report shall be 
provided to VA within 60 days of the close of the Federal fiscal year 
(September 30) in which payment was made and shall be subject to audit 
by VA.
    (b) A State receiving payment under this part shall also prepare 
audit reports as required by the Single Audit Act of 1984 (see 38 CFR 
part 41) and submit them to VA.

(Authority: 38 U.S.C. 101, 501, 1744).

Sec.  53.32  Recapture provisions.

    If a State fails to use the funds provided under this part for the 
purpose for which payment was made or receives more than is allowed 
under this part, the United States shall be entitled to recover from 
the State the amount not used for such purpose or the excess amount 
received.

(Authority: 38 U.S.C. 101, 501, 1744).

Sec.  53.40  Submissions of information and documents.

    All submissions of information and documents required to be 
presented to VA must be made to the Chief Consultant, Geriatrics and 
Extended Care (114), VHA Headquarters, 810 Vermont Avenue, NW., 
Washington, DC 20420.

(Authority: 38 U.S.C. 101, 501, 1744).

Sec.  53.41  Notification of Funding Decision.

    If the Chief Consultant, Geriatrics and Extended Care, determines 
that a submission from a State fails to meet the requirements of this 
part for funding, the Chief Consultant shall provide written notice of 
the decision and the reasons for the decision.

(Authority: 38 U.S.C. 101, 501, 1744).


 [FR Doc. E8-7641 Filed 4-10-08; 8:45 am]
BILLING CODE 8320-01-P