[Federal Register Volume 77, Number 52 (Friday, March 16, 2012)]
[Proposed Rules]
[Pages 15650-15656]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-6397]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 60

RIN 2900-AN79


Fisher House and Other Temporary Lodging

AGENCY: Department of Veterans Affairs.

ACTION: Proposed rule.

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SUMMARY: The Department of Veterans Affairs (VA) proposes to amend its 
regulations concerning Fisher House and other temporary lodging 
furnished by VA while a veteran is experiencing an episode of care at a 
VA medical facility. We intend that the proposed rule would update 
current regulations to better describe the application process for this 
assistance and clarify the distinctions between Fisher House and other 
temporary lodging provided by VA. The proposed rule generally reflects 
current VA policy and practice, and conforms to industry standards and 
expectations.

DATES: Comments must be received by VA on or before May 15, 2012.

ADDRESSES: Written comments may be submitted through http://www.regulations.gov; by mail or hand delivery to the Director, 
Regulation Policy and Management (02REG), 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-AN79, Fisher House and Other Temporary 
Lodging''. 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 (this is not a toll-free 
number) for an appointment. In addition, during the comment period, 
comments may be viewed online through the Federal Docket Management 
System at http://www.regulations.gov.

FOR FURTHER INFORMATION CONTACT: Deborah Amdur, Chief Consultant, Care 
Management and Social Work Service (11SW), Veterans Health 
Administration, Department of Veterans Affairs, 810 Vermont Avenue NW., 
Washington, DC 20420, (202) 461-6780. (This is not a toll free number).

SUPPLEMENTARY INFORMATION: Under the provisions of 38 U.S.C. 1708, VA 
``may furnish [certain] persons * * * with temporary lodging in a 
Fisher [H]ouse or other appropriate facility in connection with the 
examination, treatment, or care of a veteran under [chapter 17].'' This 
authority to provide temporary lodging assists VA in providing 
appropriate treatment and care to veterans. Individuals receiving such 
treatment or care often respond better when they are accompanied by 
relatives, close friends, or caregivers. Thus, the provision of 
temporary lodging can be an important element of the veteran's 
treatment. VA implemented its authority under section 1708 in current 
38 CFR part 60. However, we have determined that the current rules can 
be improved to better distinguish between Fisher House and other types 
of temporary lodging, and to describe the application process in 
greater detail. This proposed rule would provide such clarification, 
adding details where necessary.

Section 60.1 Purpose and scope.

    Proposed Sec.  60.1 would state that part 60 applies to the use of 
Fisher House and other temporary lodging furnished by VA while a 
veteran is experiencing an episode of care at a VA health care 
facility.

Section 60.2 Definitions.

    Proposed Sec.  60.2 would set forth definitions applicable to part 
60. For the purpose of receiving temporary lodging from VA, current 
regulations use the terms ``eligible persons,'' ``a member of the 
family,'' people who ``provide the equivalent of family support,'' and 
``caregivers,'' to refer to individuals permitted to accompany veterans 
during their episode of care. However, VA Form 10-0408A, the 
application form for Fisher House or other temporary lodging, uses the 
term ``accompanying individual'' to refer to such persons. For 
consistency of terms and to eliminate any ambiguity as to whether 
applicants must be related to the veteran, we propose to uniformly use 
the term ``accompanying individual.'' We propose to define the term to 
mean ``an individual seeking Fisher House or other temporary lodging, 
who provides familial support or the equivalent of familial support, to 
a veteran while the veteran is experiencing an episode of care.'' The 
regulation would specifically explain that the term is ``defined 
broadly to include relatives, close friends, and caregivers.'' This 
proposed definition would therefore provide for a broader class of 
individuals permitted to accompany veterans during an episode of care.
    Current Sec.  60.2 defines the term ``C&P examination.'' C&P is the 
acronym

[[Page 15651]]

commonly used to refer to VA's compensation and pension programs. We 
propose to use the term ``compensation and pension examinations'' 
instead of using the acronym. However, the proposed definition for 
``compensation and pension'' examinations would be substantively 
identical to the definition in current Sec.  60.2.
    We also propose to utilize the term ``episode of care'' in lieu of 
``VA medical or compensation and pension examinations.'' We propose to 
define an ``episode of care'' as ``a course of outpatient treatment, or 
a period of hospitalization, during which a veteran receives health 
care under 38 U.S.C. chapter 17, or 38 U.S.C. 8111 or 8153.'' Although 
this would be a new term in part 60, it is well recognized in the 
medical community and it is generally accepted, used, and understood by 
the medical community and by managers working in the Fisher House and 
other temporary lodging programs. Further, using the term ``episode of 
care'' in our regulations would be clearer than repeatedly attempting 
to describe the types of care for which VA may provide lodging 
assistance, which is how this concept is set forth in the current 
regulations.
    For purposes of further clarification regarding the definition of 
``episode of care,'' we propose to provide a non-exclusive list of 
examples of episodes of care. The first would be ``[a]n appointment at 
a VA health care facility to receive health care or a compensation and 
pension examination.'' This is consistent with our current regulations. 
See 38 CFR 60.1 (explaining that part 60 ``sets forth requirements 
regarding the use of Fisher Houses and other temporary lodging by 
veterans receiving * * * [compensation and pension] examinations * * 
*.''); see also 38 CFR 60.3(a) (explaining that veterans with an 
appointment at a VA health care facility for the purpose of receiving 
health care or a compensation and pension examination are eligible to 
stay in temporary lodging).
    The second example would be as follows: ``Extended outpatient 
treatment, such as treatment associated with organ transplant, 
chemotherapy, or radiation.'' The use of Fisher House or other 
temporary lodging for such treatment is addressed in current Sec.  
60.7. These examples represent the most common episodes of care 
associated with applications for lodging, and the examples are 
consistent with current Sec.  60.3.
    The third example concerns hospitalizations for a critical injury 
or where death is imminent. In such cases, it can be helpful to the 
veteran to have friends or family present. The example would also 
include hospitalization ``where a veteran is unable to make medical 
decisions for him/herself and the accompanying individual is authorized 
to make such decisions on the veteran's behalf.'' In such cases, VA 
would consider an application for lodging by an accompanying individual 
who is authorized to make decisions for the veteran. We note that in 
most cases, such hospitalizations would also be considered 
hospitalizations for critical injury or illness. The purpose of this 
last example is to clarify that lodging may be provided for 
compassionate reasons, as well as logistically, medically, or legally 
necessary reasons.
    We also propose to define ``Fisher House'' as ``a housing facility 
that is located at or near a VA health care facility and was 
constructed by and donated to VA by the Fisher House Foundation 
(formerly the Zachary and Elizabeth M. Fisher Armed Services 
Foundation).'' This definition would be consistent with the definition 
of the term in current 38 CFR 60.2. However, we would add that the term 
includes ``a facility that is treated as if it were Fisher House 
lodging under Sec.  60.3.'' We discuss this proposed addition below 
under proposed Sec.  60.3.
    The definition of ``other temporary lodging'' would be slightly 
more detailed than the definition in current Sec.  60.2, but it would 
not be substantively different. The definition conforms to current 
usage and practice.
    ``VA'' would be defined as ``the Department of Veterans Affairs.''

Section 60.3 Other donated temporary lodging.

    Proposed Sec.  60.3 would establish that ``[w]henever VA receives, 
from a source other than the Fisher House Foundation, an undesignated 
donation of lodging to be used on a temporary basis, the lodging will 
be designated as if it were Fisher House lodging or be treated as other 
temporary lodging based upon the types of lodging available in the 
area.'' Under 38 U.S.C. 8103(a)(2), the Secretary of Veterans Affairs 
(Secretary) may accept donations of ``any facility * * * that the 
Secretary considers necessary for use as a medical facility.'' See also 
38 U.S.C. 8104(e) (authorizing VA to accept donations of medical 
facilities). 38 U.S.C. 8101(3) defines a ``medical facility'' as a 
facility used for the provision of health-care services and including 
any necessary associated buildings. We interpret this definition of 
``medical facility'' as including lodging to be used on a temporary 
basis in connection with VA health care since the provision of 
temporary lodging can be an important element of a veteran's treatment.
    Under proposed Sec.  60.3, if the Secretary accepts a gift that 
specifies the terms of lodging to be provided, then the lodging would 
be used in the manner specified by the grantor of the gift. However, if 
no terms are specified, the Secretary would designate, based on 
consideration of the types of lodging available in the area, whether 
the gift would be treated as ``other temporary lodging'' or as if it 
were donated by the Fisher House Foundation. This is consistent with 
current VA practice.

Section 60.10 Eligibility criteria for Fisher House or other temporary 
lodging.

    Proposed Sec.  60.10 would set forth the eligibility criteria for 
lodging under part 60. It would include provisions from several current 
regulations. However, we propose to reorganize the information for 
clarity.
    Proposed paragraph (a) would establish the general rule that 
``[w]hile a veteran is undergoing an episode of care, VA may provide 
either Fisher House or other temporary lodging, as appropriate, if the 
application meets the requirements of this part 60. These are the only 
types of lodging provided by VA under this part.'' Proposed paragraph 
(a) is consistent with current Sec.  60.3. We would also add a new note 
to paragraph (a), which would clarify that ``[l]odging provided for 
under this part will not be used by a person participating in a VA 
residential treatment program, or as a substitute for participation in 
such a program.'' This note would help ensure that temporary lodging is 
properly used for its intended purposes, and not as an alternative to 
proper residential care.
    There are currently active duty servicemembers who receive care at 
VA facilities under the authority of 38 U.S.C. 8111. Under these 
circumstances we provide lodging in the same manner that lodging is 
provided for veterans and their accompanying individuals. 
Servicemembers would be subject to the same rules as veterans and they 
would be required to meet the same eligibility requirements concerning 
episodes of care.
    Proposed paragraph (b) would set forth the general requirements for 
Fisher House and other temporary lodging. Further, proposed paragraph 
(b) would clarify the major distinction between Fisher House lodging 
and other temporary lodging. We have determined that current 
regulations lack sufficient clarity regarding these two different types 
of lodging. The primary

[[Page 15652]]

distinction is that Fisher House lodging is generally limited to 
accompanying individuals. It is not available for unaccompanied 
veterans.
    Also, we propose to add a note to paragraph (b) to clarify that 
``VA does not impose a general limit on the number of persons who may 
accompany a veteran, but VA may in specific cases provide lodging to 
only a specific number of persons due to space or resource 
limitations.'' This is consistent with VA's current general practice, 
which is to allocate lodging on a space-available basis.
    Concerning the differences between Fisher House lodging and other 
temporary lodging provided by VA, proposed paragraph (b)(1) would 
clarify that Fisher House lodging is not used to lodge unaccompanied 
veterans or individuals in need of transitional or permanent housing. 
This distinction is essential to preserve the intent of the Fisher 
House Foundation, which is to provide support for families while a 
veteran experiences an episode of care. Because the purpose of Fisher 
House lodging is to provide a retreat for accompanying individuals from 
the medical care environment, Fisher House lodging is available only to 
accompanying individuals and, in limited circumstances of immediate 
need and no alternative temporary lodging, to veterans with 
accompanying individuals.
    Proposed paragraph (b)(2) would discuss other temporary lodging. We 
would clarify in this paragraph that for an accompanying individual to 
stay in other temporary lodging, the veteran must also be staying in 
temporary lodging. We would further specify in a note to this paragraph 
that VA may, due to space restrictions, impose a limit on the number of 
accompanying individuals.
    Proposed paragraph (c) would restate the requirement in current 
Sec.  60.4(h) that the veteran be medically stable and capable of self-
care or be accompanied by an individual who is able to provide all 
necessary care. The proposed rule would clearly state that this 
requirement applies to both Fisher House lodging and other temporary 
lodging. The current rule is ambiguous in this regard. The capacity for 
self-care is required because neither Fisher House lodging nor other 
temporary lodging is intended to be substitutes for, or supplements to, 
medical care.
    Proposed Sec.  60.10(d) would restate the existing travel time/
distance requirement in current Sec.  60.5, but would clarify that the 
distance requirement applies to both Fisher House and other temporary 
lodging. The current rule is ambiguous in this regard. Proposed 
paragraph (d) would permit the travel time/distance requirement to be 
applicable to ``the applicant,'' allowing this requirement to be 
considered for an accompanying individual as well as for a veteran. 
This is current VA practice when considering Fisher House applications 
from non-veterans accompanying veterans. It would also clarify that VA 
may waive the time/distance requirement under exceptional circumstances 
that apply to either the accompanying individual or the veteran.
    In proposed paragraph (e) we would prescribe special consideration 
for organ donors and their accompanying individuals. Specifically, 
regarding individuals who wish to donate an organ to a veteran, we 
would explain that ``VA may provide Fisher House or other temporary 
lodging for individuals who must be present on site for evaluation, 
donation, and care related to their status as an organ donor for a 
veteran. VA may also provide Fisher House or other temporary lodging 
for the donor's accompanying individuals at all phases of the 
transplant process.'' This provision is based on clinical need pursuant 
to 38 U.S.C. 1710(a) regarding eligibility for hospital care and 
medical services and not on our temporary lodging authority under 
section 1708. Outcomes of transplantation are linked directly to the 
presence and competence of accompanying individuals who support the 
organ donor at all phases of the transplant process. In addition, this 
paragraph would recognize VA's obligations to living donors who give 
veterans the gift of life.

Section 60.15 Application process.

    Proposed Sec.  60.15 would prescribe the application process for 
Fisher House or other temporary lodging. Under current Sec.  60.4, 
applications for lodging may be submitted by mail, telephone, 
facsimile, in person, or electronically. We intend to continue to 
provide for the same means of submissions. Proposed Sec.  60.15(a) 
would simply restate a portion of current Sec.  60.4. Under proposed 
Sec.  60.15(a), we would refer to VA Form 10-0408A as the application 
and provide information about where to obtain the form. We would also 
specify where to submit the completed form. This additional information 
is intended to assist applicants. We do not intend any changes in the 
current application process.
    In proposed paragraph (b), which is based upon current Sec.  60.8 
and 60.9, we would describe how VA processes applications and makes 
decisions to grant temporary lodging. However, we propose to add detail 
for purposes of clarification.
    Paragraph (b)(1) would state that applications ``are generally 
processed in the order that they are received by VA, and temporary 
lodging is then granted on a first-come, first-served basis; however, 
in extraordinary circumstances, such as imminent death, critical 
injury, or organ donation applications may be processed out of order.'' 
The general rule that applications would be processed in the order 
received would be based upon the last sentence of current Sec.  60.8, 
which prescribes, ``[t]emporary lodging will be provided on a first-
come, first-served basis.'' However, the proposed exceptions for 
circumstances involving imminent death, critical injury, or organ 
donation are new and we propose the exceptions because in these 
circumstances, we believe that family members and loved ones should be 
given every opportunity to be with the veteran and, likewise, that the 
veteran should be accompanied by such people.
    Proposed paragraph (b)(2) would state that ``[t]emporary lodging is 
granted on a space-available basis, with some consideration given to 
the compatibility of the applicant(s) and the room(s) available.'' This 
general rule would be based upon current Sec.  60.8. The proposed 
paragraph would provide, by way of example, that ``although VA may 
require an applicant to share a room with another veteran's 
accompanying individual, VA would not do so if the persons affected are 
not the same gender.''
    Proposed paragraph (b)(3) would essentially restate the second 
sentence of current Sec.  60.8. It is important that grants of 
temporary lodging at a VA health care facility, usually in non-utilized 
beds, be subject to the approval of the Director of the health care 
facility in order to avoid any negative impact on patient care. For 
example, a non-utilized bed that might not be provided to an 
accompanying individual could include a bed located in an intensive 
care unit or in an area of the hospital from which visitors are limited 
or barred. In addition, the proposed rule would add that ``[n]on-
utilized beds provided to accompanying individuals must be reassigned 
to VA patients when necessary.'' If a patient needs to use a bed that 
was previously non-utilized and was provided to an accompanying 
individual, the patient would take priority over the accompanying 
individual and the bed would no longer be considered ``non-utilized.'' 
In such cases, VA would make every effort to relocate the accompanying 
individual into other temporary lodging.

[[Page 15653]]

    Proposed paragraph (b)(4) would restate the funding limitation 
prescribed in current Sec.  60.8, without substantive change.
    Proposed paragraph (b)(5) would state that ``[s]ubject to all 
criteria provided in this part, the person responsible for coordinating 
the Fisher House and other temporary lodging program(s) at the VA 
health care facility of jurisdiction is responsible for making 
decisions to grant temporary lodging. These decisions are considered to 
be final VA decisions concerning individual medical treatment plans and 
the scheduling and use of VA lodging facilities, and they are not 
appealable to the Board of Veterans' Appeals.'' This general rule would 
be based upon current Sec.  60.9, and would reflect current VA policy 
and practice. The Fisher House program is a unique private-public 
partnership between The Fisher House Foundation, Inc., and the 
Secretary of Veterans Affairs to provide temporary lodging for 
individuals who accompany a veteran during the veteran's 
hospitalization for an illness, disease, or injury. Fisher Houses are 
given to the U.S. Government as gifts, and VA subsequently is 
responsible for the operation and maintenance of Fisher Houses. Lodging 
in Fisher Houses and other facilities is not a VA benefit, but rather a 
temporary resource made available to veterans on a first-come first-
serve basis, when necessary criteria under the rule are met. Section 
1708 gives VA discretion to provide such lodging when appropriate and 
available, but does not establish a right to such lodging as a VA 
``benefit.'' VA does not guarantee accommodations in VA Fisher Houses 
or in other temporary lodging facilities, and completion of the 
application process as described in the rule does not ensure temporary 
lodging would be provided. VA's determinations in providing such 
lodging are based in part on medical judgment regarding the course of a 
veteran's treatment and in part on administrative scheduling matters 
concerning the availability of space. These types of determinations 
generally are not subject to appellate review, nor could such review 
ordinarily be accompanied within the timeframes relevant to 
administering temporary lodging. Therefore, we do not interpret section 
1708 as creating any benefit entitlement within the jurisdiction of the 
Board of Veterans' Appeals. Rather, lodging decisions made under this 
proposed rule would be final VA decisions.
    Proposed paragraphs (b)(6) and (7) would reflect current practice 
not prescribed in current regulations. These paragraphs would explain 
that when VA cannot grant an application for one type of lodging, we 
would consider whether the applicant could qualify for the other type 
of lodging, regardless of any selection on the application. If the 
application cannot be granted for either type of lodging, we would send 
the application to a VA social worker to see if other arrangements can 
be made to assist the applicant.
    Proposed paragraph (c) would restate current Sec.  60.10, without 
substantive revision.
    As indicated throughout this preamble, VA Form 10-0408A has been 
designated as the application form for Fisher House and Other Temporary 
Lodging. Current regulations do not refer specifically to VA Form 10-
0408A. However, the form was approved by the Office of Management and 
Budget (OMB). Therefore, we intend to note in a parenthetical at the 
end of proposed Sec.  60.15 that OMB has approved the collection of 
information under control number 2900-0630.

Section 60.20 Duration of Fisher House or other temporary lodging.

    Proposed Sec.  60.20 would be the final section in part 60 and it 
would concern the duration of lodging provided by VA under part 60. 
Substantively, proposed paragraphs (a) and (b) would be similar to 
current Sec.  60.7, except that the proposed rule would use the term 
``episode of care'' rather than describe specific types of medical 
treatment.
    Proposed Sec.  60.20(c) would permit an extension of a previous 
period of lodging. The duration of a period of lodging would be 
specific to each situation set forth on the application and, therefore, 
would generally be defined by the terms of the granted application. 
However, in certain cases we might need to provide exceptions, such as 
when a medical emergency occurs during a scheduled episode of care or 
when weather changes prevent departure from the lodging provided by VA.
    Proposed paragraph (d) would authorize an indefinite period of 
lodging for individuals accompanying a veteran who is hospitalized for 
an indefinite period based on the treatment or rehabilitation needs of 
the veteran as determined by the veteran's health care team and based 
on the availability of Fisher House lodging or of funding for other 
temporary lodging. Lodging in non-utilized VA hospital beds would not 
be authorized for an indefinite period due to the administrative and 
medical needs of VA medical facilities.
    Proposed paragraphs (e) and (f) would be consistent with current 
Sec.  60.7. These paragraphs would restrict awards of temporary lodging 
to veterans who are unable to arrive for a scheduled appointment at the 
health care facility if they left their home after 8 a.m. or who would 
be unable to return home before 7 p.m. We believe that travel before 8 
a.m. or after 7 p.m. may be more difficult or dangerous than travel 
during regular daylight hours.

Effect of Rulemaking

    Title 38 of the Code of Federal Regulations, as proposed to be 
revised by this proposed rulemaking, would represent VA's 
implementation of its exclusive legal authority on this subject. Other 
than future amendments to this regulation or governing statutes, no 
contrary rules or procedures would be authorized. All existing and 
subsequent VA guidance would be read to conform with this proposed 
rulemaking if possible or, if not possible, such guidance would be 
superseded by this rulemaking.

Paperwork Reduction Act

    Although this document contains provisions constituting collections 
of information under the provisions of the Paperwork Reduction Act (44 
U.S.C. 3501-3521), no new or proposed revised collections of 
information are associated with this proposed rule. The information 
collection provisions for this section are approved by OMB and have 
been assigned OMB control number 2900-0630.

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. This proposed rule would not cause a significant 
economic impact on health care providers, suppliers, or entities 
because the proposed rule would apply only to patients receiving care 
at VA facilities. Also, this proposed rule might have an insignificant 
impact on small entities involved in the lodging industry. However, any 
effect would be minuscule. Therefore, under 5 U.S.C. 605(b), this 
proposed rule is exempt from the initial and final regulatory 
flexibility analyses requirements of 5 U.S.C. 603 and 604.

Executive Orders 12866 and 13563

    Executive Orders 12866 and 13563 direct agencies to assess the 
costs and benefits of available regulatory alternatives and, when 
regulation is necessary, to select regulatory approaches that maximize 
net benefits

[[Page 15654]]

(including potential economic, environmental, public health and safety 
effects, and other advantages; distributive impacts; and equity). 
Executive Order 13563 (Improving Regulation and Regulatory Review) 
emphasizes the importance of quantifying both costs and benefits, 
reducing costs, harmonizing rules, and promoting flexibility. Executive 
Order 12866 (Regulatory Planning and Review) classifies a ``significant 
regulatory action,'' requiring review by 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 this Executive 
Order.''
    The economic, interagency, budgetary, legal, and policy 
implications of this proposed rule have been examined and it has been 
determined not to be a significant regulatory action under Executive 
Order 12866.

Unfunded Mandates

    The Unfunded Mandates Reform Act of 1995 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 the expenditure by 
State, local, and tribal governments, in the aggregate, or by the 
private sector, of $100 million or more (adjusted annually for 
inflation) in any year. This proposed rule would have no such effect on 
State, local, and tribal governments, or on the private sector.

Catalog of Federal Domestic Assistance

    The Catalog of Federal Domestic Assistance program number and title 
for this rule are as follows: 64.005, Grants to States for Construction 
of State Home Facilities; 64.007, Blind Rehabilitation Centers; 64.008, 
Veterans Domiciliary Care; 64.009, Veterans Medical Care Benefits; 
64.010, Veterans Nursing Home Care; 64.014, Veterans State Domiciliary 
Care; 64.015, Veterans State Nursing Home Care; 64.018, Sharing 
Specialized Medical Resources; 64.019, Veterans Rehabilitation Alcohol 
and Drug Dependence; 64.022, Veterans Home Based Primary Care; and 
64.024, VA Homeless Providers Grant and Per Diem Program.

Signing Authority

    The Secretary of Veterans Affairs, or designee, approved this 
document and authorized the undersigned to sign and submit the document 
to the Office of the Federal Register for publication electronically as 
an official document of the Department of Veterans Affairs. John R. 
Gingrich, Chief of Staff, Department of Veterans Affairs, approved this 
document on March 8, 2012, for publication.

List of Subjects in 38 CFR Part 60

    Health care, Health facilities, Health records, Reporting and 
recordkeeping requirements, Housing, Travel, Veterans.

    Dated: March 13, 2012.
Robert C. McFetridge,
Director of Regulation Policy and Management, Office of the General 
Counsel, Department of Veterans Affairs.

    For the reasons stated in the preamble, VA proposes to amend 38 CFR 
part 60 as follows:

PART 60--FISHER HOUSES AND OTHER TEMPORARY LODGING

    1. The authority citation for part 60 continues to read as follows:

    Authority: 38 U.S.C. 501, 1708.

    2. Part 60 is revised to read as follows:

Sec.
60.1 Purpose and scope.
60.2 Definitions.
60.3 Other donated temporary lodging.
60.10 Eligibility criteria for Fisher House or other temporary 
lodging.
60.15 Application process.
60.20 Duration of Fisher House or other temporary lodging.


Sec.  60.1  Purpose and scope.

    This part applies to Fisher House and other temporary lodging 
furnished by VA while a veteran is experiencing an episode of care at a 
VA health care facility.

(Authority: 38 U.S.C. 501, 1708).

Sec.  60.2  Definitions.

    For the purposes of this part:
    Accompanying individual means an individual seeking Fisher House or 
other temporary lodging, who provides familial support or the 
equivalent of familial support, to a veteran while the veteran is 
experiencing an episode of care. This term is defined broadly to 
include relatives, close friends, and caregivers.
    Compensation and pension examination means an examination requested 
by VA's Veterans Benefits Administration to be conducted at a VA health 
care facility for the purpose of evaluating a veteran's claim.
    Episode of care means a course of outpatient treatment, or a period 
of hospitalization, during which a veteran receives health care under 
38 U.S.C. chapter 17, or 38 U.S.C. 8111 or 8153. Examples of episodes 
of care include (but are not limited to) the following:
    (1) An appointment at a VA health care facility to receive health 
care or a compensation and pension examination.
    (2) Extended outpatient treatment, such as treatment associated 
with organ transplant, chemotherapy, or radiation.
    (3) Hospitalization for a critical injury or illness; where death 
is imminent; or where a veteran is unable to make medical decisions for 
him/herself and the accompanying individual is authorized to make such 
decisions on the veteran's behalf.
    Fisher House means a housing facility that is located at or near a 
VA health care facility and was constructed by and donated to VA by the 
Fisher House Foundation (formerly the Zachary and Elizabeth M. Fisher 
Armed Services Foundation), or a facility that is treated as if it were 
Fisher House lodging under Sec.  60.3.
    Other temporary lodging includes:
    (1) Lodging at a temporary lodging facility, other than a Fisher 
House, located at a VA health care facility (generally referred to as a 
``hoptel'');
    (2) A hotel or motel;
    (3) Non-utilized beds at a VA health care facility designated as 
lodging beds; and
    (4) Other donated lodging to be used on a temporary basis in 
accordance with 38 U.S.C. 1708.
    VA means the Department of Veterans Affairs.

(Authority: 38 U.S.C. 501, 1708)

Sec.  60.3  Other donated temporary lodging.

    Whenever VA receives, from a source other than the Fisher House 
Foundation, an undesignated donation of lodging to be used on a 
temporary basis, the lodging will be designated as if it were Fisher 
House lodging or be treated as other temporary lodging based upon the 
types of lodging available in the area. If VA receives a gift that 
specifies the terms of the lodging provided, VA will use the lodging 
provided in the manner specified by the donor.

(Authority: 38 U.S.C. 501, 1708, 8103, 8104)


[[Page 15655]]




Sec.  60.10  Eligibility criteria for Fisher House or other temporary 
lodging.

    (a) General. While a veteran is undergoing an episode of care, VA 
may provide either Fisher House or other temporary lodging, as 
appropriate, if the application meets the requirements of this part 60. 
These are the only types of lodging provided by VA under this part.  
Note: Lodging provided for under this part will not be used by a person 
participating in a VA residential treatment program, or as a substitute 
for participation in such a program.
    (b) Eligible persons. (1) Fisher House. VA may provide Fisher House 
lodging to accompanying individual(s) and, in limited circumstances of 
immediate need and no alternative temporary lodging, to a veteran with 
one or more accompanying individual(s). Fisher House lodging will not 
be used to lodge unaccompanied veterans or individuals in need of 
transitional or permanent housing. Note: VA does not impose a general 
limit on the number of persons who may accompany a veteran, but VA may 
in specific cases provide lodging to only a specific number of persons 
due to space or resource limitations.
    (2) Other temporary lodging. VA may provide other temporary lodging 
to a veteran or to a veteran and his or her accompanying individual(s). 
Accompanying individuals may not stay in other temporary lodging unless 
the veteran is also staying in temporary lodging. Note: VA does not 
impose a general limit on the number of persons who may accompany a 
veteran, but VA may in specific cases provide lodging to only a 
specific number of persons due to space or resource limitations.
    (c) Condition of the veteran. Fisher House or other temporary 
lodging will not be provided to a veteran unless the VA official 
reviewing the application determines, based on the application and on 
any necessary clinical information, that the veteran is:
    (1) Medically stable and capable of self-care; or
    (2) Accompanied by an individual who is able to provide all 
necessary care.
    (d) Travel time/distance requirement. Fisher House or other 
temporary lodging may be provided only if the applicant seeking lodging 
must travel at least 50 miles, or for 2 hours, from his or her home to 
the VA health care facility. VA may waive these requirements based on 
exceptional circumstances, such as when the physical condition of an 
accompanying individual and/or the veteran, inclement weather, road 
conditions, or the mode of transportation, make it difficult or 
dangerous to travel to or return from the VA health care facility 
without an overnight stay.
    (e) Special authority for organ transplant cases. Notwithstanding 
any other provision of this part, VA may provide Fisher House or other 
temporary lodging for individuals who must be present on site for 
evaluation, donation, and care related to their status as an organ 
donor for a veteran. VA may also provide Fisher House or other 
temporary lodging for the donor's accompanying individuals at all 
phases of the transplant process.

(Authority: 38 U.S.C. 501, 1708, 1710(a))

Sec.  60.15  Application process.

    (a) Obtaining and submitting the application. VA Form 10-0408A is 
the application for Fisher House and other temporary lodging. 
Applications may be submitted by mail, telephone, facsimile, in person, 
or electronically. VA Form 10-0408A is available from any VA medical 
center or may be obtained online at http://vaww4.va.gov/vaforms/medical/pdf/vha-10-0408A-fill.pdf. The completed application must be 
submitted as follows:
    (1) For Fisher House lodging, to the Fisher House Manager at the VA 
medical center of jurisdiction.
    (2) For other temporary lodging, to the temporary lodging program 
coordinator at the VA medical center of jurisdiction.
    (b) Processing applications. (1) Applications are generally 
processed in the order that they are received by VA, and temporary 
lodging is then granted on a first come first serve basis; however, in 
extraordinary circumstances, such as imminent death, critical injury, 
or organ donation applications may be processed out of order.
    (2) Temporary lodging is granted on a space-available basis, with 
some consideration given to the compatibility of the applicant(s) and 
the room(s) available. For example, although VA may require an 
applicant to share a room with another veteran's accompanying 
individual, VA would not do so if the persons affected are not the same 
gender.
    (3) Temporary lodging at a VA health care facility, such as non-
utilized beds in a VA medical facility, may be made available only if 
not barred by law and if the Director of the medical facility 
determines that such action would not have a negative impact on patient 
care. Non-utilized beds provided to accompanying individuals must be 
reassigned to VA patients when necessary.
    (4) The Director of the VA Medical Center of jurisdiction will 
determine whether local funding is sufficient to allow the use of 
temporary lodging in hotels and motels.
    (5) Subject to all criteria provided in this part, the person 
responsible for coordinating the Fisher House and other temporary 
lodging program(s) at the VA health care facility of jurisdiction is 
responsible for making decisions to grant temporary lodging. These 
decisions are considered to be final VA decisions concerning individual 
medical treatment plans and the scheduling and use of VA lodging 
facilities, and they are not appealable to the Board of Veterans' 
Appeals.
    (6) If VA denies an application for one type of lodging, such as at 
a Fisher House, the application will be considered for other temporary 
lodging and vice versa, if the applicant is eligible.
    (7) If VA denies the application for all types of temporary 
lodging, VA will refer the application to a VA social worker at the VA 
medical center of jurisdiction to determine if other arrangements can 
be made.
    (c) Costs for Fisher House and other temporary lodging under this 
part are borne by VA.

(Authority: 38 U.S.C. 501, 1708)



(The Office of Management and Budget has approved the information 
collection requirements in this section under OMB control number 2900-
0630)


Sec.  60.20  Duration of Fisher House or other temporary lodging.

    Fisher House or other temporary lodging may be awarded for the 
following periods:
    (a) While the veteran is undergoing an episode of care.
    (b) While the veteran is hospitalized, if the veteran is admitted 
to a VA medical facility while undergoing an outpatient episode of care 
for which temporary lodging was already provided.
    (c) As extended by the appropriate VA clinician or social worker 
based on an emergency situation or unforeseen circumstances.
    (d) For an indefinite period for accompanying individuals who are 
visiting veterans hospitalized for an indefinite period, provided that 
the accompanying individual is not using a VA medical facility bed. 
Whether a veteran is hospitalized for an indefinite period will be 
based upon the treatment or rehabilitation needs of the veteran as 
determined by the veteran's health care team.
    (e) Temporary lodging may be furnished the night before the day of 
a scheduled appointment if, the veteran leaving home after 8 a.m., 
would be

[[Page 15656]]

unable to arrive at the health care facility by the time of the 
scheduled appointment.
    (f) Temporary lodging may be furnished the night of the scheduled 
appointment if, after the appointment, the veteran would be unable to 
return home before 7 p.m. When a veteran is undergoing outpatient 
treatment or procedures the veteran and accompanying individual(s) may 
be furnished temporary lodging for the duration of the episode of care 
subject to limitations described in this section.

(Authority: 38 U.S.C. 501, 1708)


[FR Doc. 2012-6397 Filed 3-15-12; 8:45 am]
BILLING CODE 8320-01-P