Assistance to States in Hiring and Retaining Nurses at State Veterans Homes, 19785-19789 [E8-7641]
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Federal Register / Vol. 73, No. 71 / Friday, April 11, 2008 / Proposed Rules
Department of Veterans Affairs.
Proposed rule.
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.
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),
Definitions
Definitions applicable to the proposed
regulations are set forth at § 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,
comply with the instructions of the
COTP or his/her authorized
representative.
Dated: March 26, 2008.
T.V. Skuby,
Captain, U.S. Coast Guard, Acting
Commander, First Coast Guard District.
[FR Doc. E8–7676 Filed 4–10–08; 8:45 am]
BILLING CODE 4910–15–P
DEPARTMENT OF VETERANS
AFFAIRS
38 CFR Part 53
RIN 2900–AM26
Assistance to States in Hiring and
Retaining Nurses at State Veterans
Homes
AGENCY:
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ACTION:
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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 § 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 § 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 § 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
§ 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
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incentive program’’ would not include
standard employee benefits.
Proposed § 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 § 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 § 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 shortterm 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.
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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
§ 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 § 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 § 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 nonVA 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
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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 § 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 § 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 § 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 § 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 § 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 § 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
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receives payments in excess of the
amount allowed under § 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 § 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.
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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
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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 §§ 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.
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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 programsveterans, 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.
§ 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).
§ 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).
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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).
§ 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).
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§ 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 § 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:
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(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 3year 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 § 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).
§ 53.20
Application requirements.
(a) To apply for payments during a
fiscal year, a State representative must
submit to VA, in accordance with
§ 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 https://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
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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).
§ 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
E:\FR\FM\11APP1.SGM
11APP1
Federal Register / Vol. 73, No. 71 / Friday, April 11, 2008 / Proposed Rules
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.
DEPARTMENT OF COMMERCE
National Oceanic and Atmospheric
Administration
50 CFR Part 216
(Authority: 38 U.S.C. 101, 501, 1744).
[Docket No. 080220219–8445–02]
§ 53.31
RIN 0648–AT77
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).
§ 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).
§ 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).
§ 53.41
Notification of Funding Decision.
ebenthall on PRODPC61 with PROPOSALS
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
VerDate Aug<31>2005
15:24 Apr 10, 2008
Jkt 214001
Taking and Importing Marine
Mammals; Taking Marine Mammals
Incidental to a U.S. Navy Shock Trial
National Marine Fisheries
Service (NMFS), National Oceanic and
Atmospheric Administration (NOAA),
Commerce.
ACTION: Proposed rule; request for
comments and information.
AGENCY:
SUMMARY: NMFS has received a request
from the U.S. Navy (Navy) for an
authorization for the taking of marine
mammals incidental to conducting a
Full Ship Shock Trial (FSST) of the
MESA VERDE (LPD 19) in the offshore
waters of the Atlantic Ocean off
Mayport, FL. By this document, NMFS
is proposing regulations to govern that
take. In order to issue final regulations
governing the take and Letters of
Authorization (LOAs) thereunder,
NMFS must determine that the total
taking will have a negligible impact on
the affected species or stocks of marine
mammals. NMFS regulations must set
forth the permissible methods of take
and other means of effecting the least
practicable adverse impact on the
affected species or stocks of marine
mammals and their habitat, as well as
monitoring and reporting requirements.
NMFS invites comment on the proposed
regulations and findings.
DATES: Comments and information must
be received by May 12, 2008.
ADDRESSES: You may submit comments
on the application and proposed rule,
using the identifier 0648–AT77, by any
of the following methods:
Electronic Submissions: Submit all
electronic public comments via the
Federal e-Rulemaking Portal: https://
www.regulations.gov.
Fax: 301–427–2521 (using the
identifier: 0648–AT77).
Mail: paper, disk, or CD-ROM
comments should be addressed to: Mr.
P. Michael Payne, Chief, Permits,
Conservation and Education Division,
Office of Protected Resources, National
Marine Fisheries Service, 1315 EastWest Highway, Silver Spring, MD
20910–3225.
Instructions: All comments received
are a part of the public record and will
generally be posted to https://
www.regulations.gov without change.
PO 00000
Frm 00041
Fmt 4702
Sfmt 4702
19789
All Personal Identifying Information (for
example, name, address, etc) voluntarily
submitted by the commenter may be
publicly accessible. Do not submit
Confidential Business Information or
otherwise sensitive or protected
information.
NMFS will accept anonymous
comments. Attachments to electronic
comments will be accepted in Microsoft
Word, Excel, WordPerfect, or Adobe
PDF file formats only.
A copy of the application, containing
a list of references used in this
document, and other documents cited
herein, may be obtained by writing to
the above address, by telephoning one
of the contacts listed under FOR FURTHER
INFORMATION CONTACT, or at: https://
www.nmfs.noaa.gov/pr/permits/
incidental.htm.
A copy of the Navy’s documents cited
in this proposed rule may also be
viewed, by appointment, during regular
business hours at this address.
FOR FURTHER INFORMATION CONTACT: Ken
Hollingshead Office of Protected
Resources, NMFS, (301) 713–2289, ext.
128.
SUPPLEMENTARY INFORMATION:
Background
Sections 101(a)(5)(A) and (D) of the
MMPA (16 U.S.C. 1361 et seq.) direct
the Secretary of Commerce (Secretary)
to allow, upon request, the incidental,
but not intentional taking of marine
mammals by U.S. citizens who engage
in a specified activity (other than
commercial fishing) if certain findings
are made and regulations are issued or,
if the taking is limited to harassment,
notice of a proposed authorization is
provided to the public for review.
Authorization for incidental takings
may be granted if NMFS finds that the
taking will have no more than a
negligible impact on the species or
stock(s), and will not have an
unmitigable adverse impact on the
availability of the species or stock(s) for
subsistence uses (where relevant), and if
the permissible methods of taking and
requirements pertaining to the
mitigation, monitoring and reporting of
such taking are set forth.
NMFS has defined ‘‘negligible
impact’’ in 50 CFR 216.103 as: ‘‘an
impact resulting from the specified
activity that cannot be reasonably
expected to, and is not reasonably likely
to, adversely affect the species or stock
through effects on annual rates of
recruitment or survival.’’
With respect to military readiness
activities, the MMPA defines
‘‘harassment’’ as:
(i) any act that injures or has the significant
potential to injure a marine mammal or
E:\FR\FM\11APP1.SGM
11APP1
]]>Agencies
[Federal Register Volume 73, Number 71 (Friday, April 11, 2008)]
[Proposed Rules]
[Pages 19785-19789]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E8-7641]
-----------------------------------------------------------------------
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.
-----------------------------------------------------------------------
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
https://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
