[Federal Register Volume 80, Number 160 (Wednesday, August 19, 2015)]
[Notices]
[Pages 50382-50383]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-20458]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0160]


Agency Information Collection: (Per Diem for Nursing Home Care of 
Veterans in State Homes; Per Diem for Domiciliary Adult Day Health Care 
of Veterans in State Homes)

AGENCY: Veterans Health Administration, Department of Veterans Affairs.

ACTION: Notice.

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SUMMARY: The Veterans Health Administration (VHA), Department of 
Veterans Affairs (VA), is announcing an opportunity for public comment 
on the proposed collection of certain information by the agency. Under 
the Paperwork Reduction Act (PRA) of 1995, Federal agencies are 
required to publish notice in the Federal Register concerning each 
proposed collection of information and allow 60 days for public comment 
in response to the notice. This notice solicits comments on the 
information needed to provide payment of per diem to State homes that 
provide nursing home care to eligible

[[Page 50383]]

veterans and payment of per diem to State homes that provide adult day 
health care to eligible veterans. The intended effect of these 
provisions was to ensure that veterans receive high quality care in 
State Homes.

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before October 19, 2015.

ADDRESSES: Submit written comments on the collection of information 
through Federal Docket Management System (FDMS) at www.Regulations.gov; 
or Colette Alvarez, Chief Business Office, Purchased Care, Veterans 
Health Administration (10N21R), Department of Veterans Affairs, 810 
Vermont Avenue NW., Washington, DC 20420 or email: 
[email protected]. Please refer to ``Per Diem for Nursing Home 
Care of Veterans in State Homes; Per Diem for Domiciliary and Adult Day 
Health Care of Veterans in State Homes, OMB Control No. 2900-0160'' in 
any correspondence. During the comment period, comments may be viewed 
online through the FDMS.

FOR FURTHER INFORMATION CONTACT: Colette Alvarez at (775) 842-5755.

SUPPLEMENTARY INFORMATION: Under the PRA of 1995 (Pub. L. 104-13; 44 
U.S.C. 3501-3521), Federal agencies must obtain approval from the 
Office of Management and Budget (OMB) for each collection of 
information they conduct or sponsor. This request for comment is being 
made pursuant to section 3506(c)(2)(A) of the PRA.
    With respect to the following collection of information, VHA 
invites comments on: (1) Whether the proposed collection of information 
is necessary for the proper performance of VHA's functions, including 
whether the information will have practical utility; (2) the accuracy 
of VHA's estimate of the burden of the proposed collection of 
information; (3) ways to enhance the quality, utility, and clarity of 
the information to be collected; and (4) ways to minimize the burden of 
the collection of information on respondents, including through the use 
of automated collection techniques or the use of other forms of 
information technology.
    Titles: (Per Diem for Nursing Home Care of Veterans in State Homes; 
Per Diem for Domiciliary Adult Day Health Care of Veterans in State 
Homes).
    a. Title 38, CFR parts 51 and 52, State Home Programs.
    b. State Home Inspection--Staffing Profile, VA Form 10-3567.
    c. State Home Report and Statement of Federal Aid Claimed, VA Form 
10-5588.
    d. Claim for Payment for Nursing Home Care Provided to Veterans 
Awarded Retroactive Service Connection, VA Form 10-5588A.
    e. State Home Program Application for Veteran Care--Medical 
Certification, VA Form 10-10SH.
    f. Department of Veterans Affairs Certification Regarding Drug-Free 
Workplace Requirements for Grantees Other Than Individuals, VA Form 10-
0143.
    g. Statement of Assurance of Compliance with Section 504 of the 
Rehabilitation Act of 1973, VA Form 10-0143a.
    h. Certification Regarding Lobbying, VA Form 10-0144.
    i. Statement of Assurance of Compliance with Equal Opportunity 
Laws, VA Form 10-0144a.
    j. Request for Prescription Drugs from an Eligible Veteran in a 
State Home, VA Form 10-0460.
    OMB Control Number: 2900-0160.
    Type of Review: Revision of a currently approved collection.
    Abstract: VA pays per diem to State Veterans Homes (SVHs) providing 
nursing home, domiciliary and adult day health services care to 
eligible Veterans. VA pays per diem to SVHs for the care of Veterans 
irrespective of whether the Veteran has wartime or peacetime service.
    VA processes two different types of state nursing home per diem 
payments. Each is determined by a Veteran's eligibility. One is a 
higher per diem or prevailing rate for certain Veterans who have 
service-connected disabilities. The other is a basic rate that is paid 
to Veterans who are not eligible for the higher rate. VA also ensures 
that SVHs meet VA standards through surveys, audits, and reconciliation 
of records. VA requires facilities providing nursing home, domiciliary 
and adult day health care to furnish an application for recognition 
based on certification; appeal information, application and 
justification for payment; records and reports which facility 
management must maintain regarding activities of residents or 
participants; information relating to whether the facility meets 
standards concerning residents' rights and responsibilities prior to 
admission or enrollment, during admission or enrollment, and upon 
discharge; the records and reports which facilities management and 
health care professionals must maintain regarding residents or 
participants and employees; documents pertain to the management of the 
facilities; food menu planning; pharmaceutical records; and life safety 
documentation. Without access to such information, VA would not be able 
to determine whether high quality care is being provided to Veterans.
    For an eligible Veteran to be considered for per diem payments for 
nursing home, domiciliary or ADHC, two forms are required to be 
submitted to the VA medical center of jurisdiction for each Veteran, at 
the time of the Veteran's admission to a SVH (VA Form 10-10EZ, 
Application for Health Benefits or 10-10EZR, Health Benefits Renewal 
Form) and VA Form 10-10SH, State Home Program Application for Veteran 
Care Medical Certification).
    Affected Public: State, Local or Private Government.
    Estimated Annual Burden: 6,818 hours.
    Home Programs:
    a. State Home Inspection Staffing Profile, VA Form 10-3567--69.5 
hrs.
    b. State Home Report and State of Federal Aid Claimed, VA Form 10-
5588--834 hrs.
    c. Claim for Payment for Nursing Home Care Provided to Veterans 
Awarded Retroactive Service Connection, VA Form 10-5588A--180 hrs.
    d. State Home Program Application for Veteran Care--Medical 
Certification, VA Form 10-10SH--3,802 hrs.
    e. Department of Veterans Affairs Certification Regarding Drug-Free 
Workplace Requirements for Grantees Other Than Individuals, VA Form 10-
0143--12 hrs.
    f. Statement of Assurance of Compliance with Section 504 of the 
Rehabilitation Act of 1973, VA Form 10-1043a--12 hrs.
    g. Certification Regarding Lobbying, VA Form 10-0144--12 hrs.
    h. Statement of Assurance of Compliance with Equal Opportunity 
Laws, VA Form 10-0460--12 hrs.
    i. Request for Prescription Drugs from an Eligible Veteran in a 
State Home, VA Form 10-0144a--12 hrs.
    j. Application for Recognition (Letter to Under Secretary for 
Health)--2 hrs.
    k. Recognition & Certification (Sections 51.30 and 52.30)--120 hrs.
    l. Quality of Life (Sections 51.100 and 52.100)--350 hrs.
    m. Section, Administration and (Section 51.210 and 52.210)--1,400.
    Estimated Average Burden per Respondent:
    Frequency of Response: On Occasion.
    Estimated Number of Respondents: 12,884.

    By direction of the Secretary.
Kathleen M. Manwell,
Program Analyst, VA Privacy Service, Office of Privacy and Records 
Management, Department of Veterans Affairs.
[FR Doc. 2015-20458 Filed 8-18-15; 8:45 am]
 BILLING CODE 8320-01-P