Nursing home care, adult day health care, and medications for veterans with service-connected disabilities

38 U.S.C. § 1745
in effect
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(a)(1) The Secretary shall enter into a contract (or an agreement) with each State home for payment by the Secretary for nursing home care provided in the home, in any case in which such care is provided to any veteran as follows:(A) Any veteran in need of such care for a service-connected disability. (B) Any veteran who—(i) has a service-connected disability rated at 70 percent or more; and (ii) is in need of such care. (2) Payment under each contract (or agreement) between the Secretary and a State home under paragraph (1) shall be based on a methodology, developed by the Secretary in consultation with the State home, to adequately reimburse the State home for the care provided by the State home under the contract (or agreement). (3) Payment by the Secretary under paragraph (1) to a State home for nursing home care provided to a veteran described in that paragraph constitutes payment in full to the State home for such care furnished to that veteran. (4)(A) An agreement under this section may be authorized by the Secretary or any Department official authorized by the Secretary, and any such action is not an award for purposes of such laws that would otherwise require the use of competitive procedures for the furnishing of hospital care, medical services, and extended care services. (B)(i) Except as provided in the agreement itself, in clause (ii), and unless otherwise provided in this section or regulations prescribed pursuant to this section, a State home that enters into an agreement under this section is not subject to, in the carrying out of the agreement, any provision of law to which providers of services and suppliers under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) are not subject. (ii) A State home that enters into an agreement under this section is subject to—(I) all provisions of law regarding integrity, ethics, or fraud, or that subject a person to civil or criminal penalties; (II) all provisions of law that protect against employment discrimination or that otherwise ensure equal employment opportunities; and (III) all provisions in this subchapter. (iii) Notwithstanding subparagraph (B)(ii)(I), a State home that enters into an agreement under this section may not be treated as a Federal contractor or subcontractor for purposes of chapter 67 of title 41 (known as the “McNamara-O’Hara Service Contract Act of 1965”). (b) The Secretary shall furnish such drugs and medicines as may be ordered on prescription of a duly licensed physician as specific therapy in the treatment of illness or injury to any veteran as follows:(1) Any veteran who—(A) is not being provided nursing home care for which payment is payable under subsection (a); and (B) is in need of such drugs and medicines for a service-connected disability. (2) Any veteran who—(A) has a service-connected disability rated at 50 percent or more; (B) is not being provided nursing home care for which payment is payable under subsection (a); and (C) is in need of such drugs and medicines. (3) Any veteran who has been determined by the Secretary to be catastrophically disabled, as defined in section 17.36(e) of title 38, Code of Federal Regulations, or successor regulations, and on whose behalf the Secretary is paying a per diem for nursing home or domiciliary care in a State home under this chapter. (c) Any State home that requests payment or reimbursement for services provided to a veteran under this section shall provide to the Secretary such information as the Secretary considers necessary to identify each individual veteran eligible for payment under such section. (d)(1) The Secretary shall enter into an agreement with each State home for payment by the Secretary for medical supervision model adult day health care provided to a veteran described in subsection (a)(1) on whose behalf the State home is not in receipt of payment for nursing home care from the Secretary. (2)(A) Payment under each agreement between the Secretary and a State home under paragraph (1) for each veteran who receives medical supervision model adult day health care under such agreement shall be made at a rate established through regulations prescribed by the Secretary to adequately reimburse the State home for the care provided by the State home, including necessary transportation expenses. (B) The Secretary shall consult with the State homes in prescribing regulations under subparagraph (A). (C) The rate established through regulations under subparagraph (A) shall not take effect until the date that is 30 days after the date on which those regulations are published in the Federal Register. (3) Payment by the Secretary under paragraph (1) to a State home for medical supervision model adult day health care provided to a veteran described in that paragraph constitutes payment in full to the State home for such care furnished to that veteran. (4) In this subsection, the term “medical supervision model adult day health care” means adult day health care that includes the coordination of physician services, dental services, nursing services, the administration of drugs, and such other requirements as determined appropriate by the Secretary.

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