Health Care for Homeless Veterans Program, 79323-79327 [2010-31780]

Agencies

• DEPARTMENT OF VETERANS AFFAIRS

[Federal Register Volume 75, Number 243 (Monday, December 20, 2010)]
[Proposed Rules]
[Pages 79323-79327]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2010-31780]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 63

RIN 2900-AN73


Health Care for Homeless Veterans Program

AGENCY: Department of Veterans Affairs.

ACTION: Proposed rule.

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SUMMARY: This proposed rule would establish regulations for contracting 
with community-based treatment facilities in the Health Care for 
Homeless Veterans (HCHV) program of the Department of Veterans Affairs 
(VA). It would formalize VA's policies and procedures in connection 
with this program, which is designed to assist certain homeless 
veterans in obtaining treatment from non-VA community-based providers. 
It would also clarify that veterans with substance use disorders may 
qualify for the program.

DATES: Comments on the proposed rule, including comments on the 
information collection provisions, must be received on or before 
February 18, 2011.

ADDRESSES: Written comments may be submitted through https://www.Regulations.gov; by mail or hand delivery to the Director, 
Regulations 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-AN73, Health Care for Homeless Veterans Program.'' 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 (FDMS) at 
https://www.Regulations.gov.

FOR FURTHER INFORMATION CONTACT: Robert Hallett, Healthcare for 
Homeless Veterans Manager, c/o Bedford VA Medical Center, 200 Springs 
Road, Bldg. 12, Bedford, MA 01730; (781) 687-3187 (this is not a toll 
free number).

SUPPLEMENTARY INFORMATION: The HCHV program is authorized by 38 U.S.C. 
2031, under which VA may provide outreach as well as ``care, treatment, 
and rehabilitative services (directly or by contract in community-based 
treatment facilities, including halfway houses)'' to ``veterans 
suffering from serious mental illness, including veterans who are 
homeless.'' One of VA's national priorities is a renewed effort to end 
homelessness for veterans. For this reason, we are proposing to 
establish regulations that are consistent with the current 
administration of this program.
    The primary mission of the HCHV program is to use outreach efforts 
to contact and engage veterans who are homeless and suffering from 
serious mental illness or a substance use disorder. Many of the 
veterans for whom the HCHV program is designed have not previously used 
VA medical services or been enrolled in the VA health care system.
    Through the HCHV program, VA identifies homeless veterans with 
serious mental illness and/or substance use disorder, usually through 
medical intervention, and offers community-based care to those whose 
conditions are determined, clinically, to be managed sufficiently that 
the individuals can participate in such care. We have assisted homeless 
veterans with substance use disorders through this program because, 
based on our practical understanding and experience, the vast majority 
of homeless veterans have substance use disorders. Treating substance 
use as a mental disorder is consistent with the generally accepted 
``disease model'' of alcoholism and drug addiction treatment, as well 
as the modern use of medical intervention to treat the condition. We 
believe that if a substance use disorder is a contributing cause of 
homelessness, then that disorder is serious; therefore, it is 
consistent to include such veterans in a program designed for 
``veterans suffering from serious mental illness, including veterans 
who are homeless.'' 38 U.S.C. 2031(a).
    Veterans who are identified and who choose to participate in this 
form of care as part of their treatment plan are then referred by VA to 
an appropriate non-VA community-based provider. In some cases, VA will 
continue to actively medically manage the veteran's condition, while in 
other cases a VA clinician may determine that a veteran can be 
sufficiently managed through utilization of non-medical resources, such 
as 12-step programs.
    To provide the community-based care, VA contracts, via the HCHV 
program, with non-VA community-based providers, such as halfway houses, 
to provide to these veterans housing and mental health and/or substance 
use disorder treatment. VA provides per diem payments to these non-VA 
community-based providers for the services provided to veterans. 
Service provision within these contracts is typically short-term, 
because during their stay veteran-participants are connected with other 
resources designed to provide longer-term housing. These contracts, and 
the per diem payment, are governed by the Federal Acquisition 
Regulations, and the VA supplements thereto contained in the Veterans 
Affairs Acquisition Regulations at chapter 8 of title 48, CFR. These 
are the rules that specifically govern requirements exclusive to VA 
contracting actions.
    We propose to establish a new 38 CFR part 63 for the HCHV program 
because the program is unique and the proposed rule would not apply to 
therapeutic housing or other VA programs designed to end homelessness. 
The primary purposes of this rulemaking are to establish eligibility 
criteria for veterans

[[Page 79324]]

and set forth the parameters for selection of non-VA community-based 
providers. In addition, the proposed rule would clarify that HCHV 
contract residential treatment may be provided to homeless veterans 
with substance use disorders, which, as discussed above, are serious 
mental disorders when they cause or contribute to homelessness. 
Finally, we note that the proposed rule would be consistent with VA's 
overall, renewed efforts to end homelessness for our Nation's veterans.
    After a general description of the purpose and scope of the HCHV 
program in proposed Sec.  63.1, we would set forth in Sec.  63.2 a few 
definitions applicable to these regulations.
    We would define a ``clinician'' as a physician, physician 
assistant, nurse practitioner, psychiatrist, psychologist, or other 
independent licensed practitioner. This is consistent with the common 
understanding of the term and with the definition set forth in 38 CFR 
70.2.
    We would define ``homeless'' consistent with 38 U.S.C. 2002(1), 
which defines a ``homeless veteran'' as ``a veteran who is homeless (as 
that term is defined in section 103(a) of the McKinney-Vento Homeless 
Assistance Act (42 U.S.C. 11302(a)).'' Under 42 U.S.C. 11302(a), 
``homeless'' means ``(1) an individual who lacks a fixed, regular, and 
adequate nighttime residence; and (2) an individual who has a primary 
nighttime residence that is (A) A supervised publicly or privately 
operated shelter designed to provide temporary living accommodations 
(including welfare hotels, congregate shelters, and transitional 
housing for the mentally ill); (B) an institution that provides a 
temporary residence for individuals intended to be institutionalized; 
or (C) a public or private place not designed for, or ordinarily used 
as, a regular sleeping accommodation for human beings.'' We interpret 
section 2002(1) to mean Congress intended that, for purposes of VA 
benefits for homeless veterans, we would define ``homeless'' consistent 
with the homeless assistance statutes administered by the Department of 
Health and Human Services, to include any future amendment of the 
definition of ``homeless'' in section 11302(a). We therefore propose to 
define ``homeless'' by cross-referencing section 11302(a).
    In order to be eligible for the HCHV program, a veteran must have a 
serious mental illness and/or a substance use disorder. This is a 
clinical determination made in the veteran's medical record. The 
condition must also be a cause, or potential cause, of the veteran's 
homelessness. We propose to define ``serious mental illness'' and 
``substance use disorder'' as diagnosed illnesses that actually or 
potentially contribute to a veteran's homelessness. By requiring a 
connection between a clinical diagnosis and homelessness, we intend to 
address only those disorders that cause or contribute to a veteran's 
homelessness. This is consistent with the overall purpose of 38 U.S.C. 
2031, and the focus of the HCHV program on eradicating the causes of 
homelessness.
    We would define ``non-VA community-based provider'' as ``a facility 
in a community that provides temporary, short-term housing (generally 
up to 6 months) for the homeless, as well as services such as 
rehabilitation services, community outreach, and basic mental-health 
services.'' This definition will cover the types of facilities that 
cater to the population served by the HCHV program. Persons who need 
long-term housing, or who are homeless but do not require services, are 
not targeted by this program. This definition is consistent with the 
use of this term in existing HCHV contracts.
    We would define ``participant'' as ``an eligible veteran under 
Sec.  63.3 for whom VA is paying per diem to a non-VA community-based 
provider.'' This definition is logical because the term refers to 
veterans who are participating in the program. It is also consistent 
with the use of this term in existing HCHV contracts.
    Under Sec.  63.3(a), we would premise eligibility for per diem 
payments on the non-VA community-based provider's servicing of a 
veteran who is homeless, eligible for VA medical care, and has a 
serious mental illness or substance use disorder that is being 
clinically managed. A finding by a VA clinician that a veteran's 
condition is clinically managed generally represents the determination 
that the condition is in a sufficiently stable and managed state to 
allow participation in the program. We would generally require that the 
veteran be enrolled in the VA health care system, but would not so 
require if the veteran is eligible for VA health care under 38 CFR 
17.36 regarding care provided to veterans enrolled in the VA health 
care system or Sec.  17.37 regarding care provided to veterans who are 
not enrolled in the system. Requiring that the veteran's mental illness 
or substance use disorder be clinically managed is also consistent with 
the goals of the HCHV Program, as well as 38 U.S.C. 2031, because non-
VA community-based providers are generally not equipped to deal with 
veterans who have acute, unstable, or untreated mental health issues. 
Generally, such veterans who are identified through HCHV outreach 
services should be treated or stabilized at facilities that emphasize 
medical treatment.
    In Sec.  63.3(b), we would establish certain preferences. Because 
per diem funds are not unlimited, we need to ensure that these funds 
are used first to assist those veterans who we believe can benefit the 
most from the HCHV program. We would give first preference to veterans 
who are new to the VA health care system as a result of VA outreach, or 
who were referred by community outreach programs, because the HCHV 
program was established to help get these hard-to-reach populations 
actively involved in the VA health care system.
    Proposed Sec.  63.3(c) clarifies that determinations of eligibility 
and priority are made by VA and not by non-VA community-based 
providers.
    In Sec.  63.10, we would describe our method of selecting non-VA 
community-based providers. Under proposed paragraph (a), we would 
accept applications from facilities that ``provide temporary 
residential assistance for homeless persons with serious mental 
illness, and/or substance use disorders, and who can provide the 
specific services and meet the standards identified in Sec.  63.15 and 
elsewhere in this part.'' This statement conforms to the basic 
definition of a non-VA community-based provider that we propose in 
Sec.  63.2.
    In Sec.  63.10(b), we would establish that the general principles 
governing the award of VA contracts apply to the award of HCHV program 
contracts. Contracts awarded through the HCHV program are between VA 
and non-VA community-based providers for short periods of time, and 
usually do not involve large amounts of money. In this regard, these 
contracts are similar to contracts for outpatient services made under 
38 CFR 17.81 and 17.82. Hence, paragraph (b) is similar to the contract 
requirements established in those sections. We also note that, under 
Sec.  63.15(a), the safety requirements applicable to non-VA community-
based providers would be identical to those required under Sec.  17.81.
    Paragraph (c) would establish the national standards for certain 
contract terms, but would allow for local, contract-specific rates and 
contract-lengths. The per diem rate, under paragraph (c)(1), would be 
established in individual contracts, but would have to be ``based on 
local community needs, standards, and practices.'' This would allow 
local VA staff to seek competitive contracts, and to provide per diem 
at a rate comparable to what the facility

[[Page 79325]]

would expect to receive from a private entity.
    Paragraph (c)(2) would prescribe similar provisions regarding the 
length of time for which VA may pay per diem based on a specific 
veteran. We would provide that contracts should generally not authorize 
the payment of per diem for a single veteran for a period of longer 
than 6 months; however, this term will ultimately be subject to the 
needs of veterans in a specific community. Paragraph (c)(2) would 
simply attempt to provide guidance in this regard.
    In Sec.  63.15, we propose to establish the duties of, and 
standards applicable to, non-VA community-based providers. These 
standards would also be set forth in specific contracts. Under the 
Federal Acquisition Regulations we have authority to require non-VA 
community-based providers to meet specified standards. These duties and 
standards are consistent with current practice in the HCHV program, and 
are generally standard industry practice for the types of non-VA 
community-based providers that would be affected by this rulemaking. 
Thus, most providers seeking per diem contracts would already meet 
these standards. Adherence to these standards is necessary to protect 
the health, safety, and rehabilitation of this vulnerable population of 
veterans.
    Because group activities and social and community interaction have 
been shown to be invaluable in the rehabilitation of those suffering 
from serious mental illnesses or substance use disorders, we would 
require that the programs of non-VA community-based providers include 
structured group activities in Sec.  63.15(b)(1), an environment 
conducive to social interaction in Sec.  63.15(c)(2), and a program 
which includes community involvement in Sec.  63.15(c)(6).
    Because most veterans who qualify for this program will lack their 
own means of transportation, proposed Sec.  63.15(c)(5) states that a 
facility in an area offering either public transportation or nearby 
employment that requires no transit will receive preference over 
facilities in more remote locations.
    In order to ensure that the standards outlined in Sec.  63.15 are 
adhered to, paragraph (e) would provide for inspections, without prior 
notice, of facilities to receive the per-diem payment both prior to the 
contract period and during performance. Any failure to meet the 
standards in Sec.  63.15 must be remedied to the satisfaction of the 
inspector before a contract may be awarded or renewed.

Paperwork Reduction Act

    This proposed rule includes a provision, Sec.  63.15(e)(3), which 
constitutes a collection of information under the Paperwork Reduction 
Act (44 U.S.C. 3501-3521) that requires approval by the Office of 
Management and Budget (OMB). Accordingly, under section 3507(d) of the 
Act, VA has submitted a copy of this rulemaking to OMB for review. 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. If OMB does not approve the collection of information 
as requested, VA will immediately remove the provision containing a 
collection of information or take such other action as is directed by 
OMB.
    Comments on the collection of information contained in this 
proposed rule should be submitted to the Office of Management and 
Budget, Attention: Desk Officer for the Department of Veterans Affairs, 
Office of Information and Regulatory Affairs, Washington, DC 20503, 
with copies sent by mail or hand delivery to: Director, Office of 
Regulation Policy and Management (02REG), Department of Veterans 
Affairs, 810 Vermont Ave., NW., Room 1068, Washington, DC 20420; fax to 
(202) 273-9026; or through https://www.Regulations.gov. Comments should 
indicate that they are submitted in response to ``RIN 2900-AN73, Health 
Care for Homeless Veterans Program.''
    OMB is required to make a decision concerning the collection of 
information contained in this proposed rule between 30 and 60 days 
after publication of this document in the Federal Register. Therefore, 
a comment to OMB is best assured of having its full effect if OMB 
receives it within 30 days of publication. This does not affect the 
deadline for the public to comment on the proposed rule.
    VA considers comments by the public on proposed collections of 
information in--
     Evaluating whether the proposed collections of information 
are necessary for the proper performance of the functions of VA, 
including whether the information will have practical utility;
     Evaluating the accuracy of VA's estimate of the burden of 
the proposed collections of information, including the validity of the 
methodology and assumptions used;
     Enhancing the quality, usefulness, and clarity of the 
information to be collected; and
     Minimizing the burden of the collections of information on 
those who are to respond, including through the use of appropriate 
automated, electronic, mechanical, or other technological collection 
techniques or other forms of information technology, e.g., permitting 
electronic submission of responses.
    The proposed amendments to title 38, CFR chapter I contain a 
collection of information under the Paperwork Reduction Act for which 
we are requesting approval by OMB. This collection of information is 
described immediately following this paragraph.
    Title: HCHV program.
    Summary of collection of information: The proposed rule at Sec.  
63.15(e)(3) requires the facility to keep, and provide to VA facility 
inspectors, documentary evidence sufficient to verify that the facility 
meets the applicable standards of part 63.
    Description of the need for information and proposed use of 
information: This information is needed for VA to evaluate the 
facilities and programs of non-VA community-based providers and 
determine whether the requirements of this part are met.
    Description of likely respondents: Non-VA community-based 
providers.
    Estimated number of respondents per year: Approximately 300 non-VA 
community-based providers, as, historically, each VA Medical Center 
awards two contracts per year.
    Estimated frequency of responses per year: 1.
    Estimated total annual reporting and recordkeeping burden: For non-
VA community-based providers, 150 hours.

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 OMB unless OMB waives such a 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

[[Page 79326]]

a serious inconsistency or otherwise interfere with an action planned 
or taken 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, economic, legal, and policy implications 
of this proposed rule have been examined and it has been determined to 
not be a significant regulatory action under Executive Order 12866.

Regulatory Flexibility Act

    The Secretary hereby certifies that this proposed regulatory 
amendment 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 amendment would not 
cause a significant economic impact on health care providers, 
suppliers, or similar entities since only a small portion of the 
business of affected entities concerns VA beneficiaries. Therefore, 
pursuant to 5 U.S.C. 605(b), this proposed amendment is exempt from the 
initial and final regulatory flexibility analysis requirements of 
sections 603 and 604.

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 proposed rule that may result in an 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 
given 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 Program

    The Catalog of Federal Domestic Assistance numbers and titles for 
the programs affected by this document are: 64.007, Blind 
Rehabilitation Centers; 64.009, Veterans Medical Care Benefits; 64.019, 
Veterans Rehabilitation Alcohol and Drug Dependence.

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 December 10, 2010, for publication.

List of Subjects in 38 CFR Part 63

    Administrative practice and procedure, Day care, Disability 
benefits, Government contracts, Health care, Homeless, Housing, 
Individuals with disabilities, Low and moderate income housing, Public 
assistance programs, Public housing, Relocation assistance, Reporting 
and recordkeeping requirements, Veterans.

    Dated: December 14, 2010.
Robert C. McFetridge,
Director, 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 
chapter I to add a new part 63 to read as follows:

PART 63--HEALTH CARE FOR HOMELESS VETERANS (HCHV) PROGRAM

Sec.
63.1 Purpose and scope.
63.2 Definitions.
63.3 Eligible veterans.
63.10 Selection of non-VA community-based providers.
63.15 Duties of, and standards applicable to, non-VA community-based 
providers.

    Authority:  38 U.S.C. 501, 2031, and as noted in specific 
sections.


Sec.  63.1  Purpose and scope.

    This part implements the Health Care for Homeless Veterans (HCHV) 
Program. This program provides per diem payments to non-VA community-
based facilities that provide housing, as well as care, treatment and/
or rehabilitative services, to homeless veterans who are seriously 
mentally ill or have a substance use disorder.

(Authority: 38 U.S.C. 501, 2031(a)(2))

Sec.  63.2  Definitions.

    For the purposes of this part:
    Clinician means a physician, physician assistant, nurse 
practitioner, psychiatrist, psychologist, or other independent licensed 
practitioner.
    Homeless has the meaning given that term in section 103 of the 
McKinney-Vento Homeless Assistance Act (42 U.S.C. 11302(a)).
    Non-VA community-based provider means a facility in a community 
that provides temporary, short-term housing (generally up to 6 months) 
for the homeless, as well as services such as rehabilitation services, 
community outreach, and basic mental-health services.
    Participant means an eligible veteran under Sec.  63.3 for whom VA 
is paying per diem to a non-VA community-based provider.
    Serious mental illness means diagnosed mental illness that actually 
or potentially contributes to a veteran's homelessness.
    Substance use disorder means alcoholism or addiction to a drug that 
actually or potentially contributes to a veteran's homelessness.

(Authority: 501, 2002, 2031)

Sec.  63.3  Eligible veterans.

    (a) Eligibility. In order to serve as the basis for a per diem 
payment through the HCHV program, a veteran served by the non-VA 
community-based provider must be:
    (1) Homeless;
    (2) Enrolled in the VA health care system, or eligible for VA 
health care under 38 CFR 17.36 or 17.37; and
    (3) Have a serious mental illness and/or substance use disorder,
    (i) That has been diagnosed by a VA clinician,
    (ii) Is ``clinically managed'' as determined by a VA clinician 
(clinical management of a condition may be achieved through non-medical 
intervention such as participation in a 12-step program), and
    (iii) Impacts the veteran's ability for self-care and/or management 
of financial affairs as determined by a VA caseworker (i.e., a 
clinician, social worker, or addiction specialist).
    (b) Priority veterans. In allocating HCHV program resources, VA 
will give priority to veterans, in the following order, who:
    (1) Are new to the VA health care system as a result of VA outreach 
efforts, and to those referred to VA by community agencies that 
primarily serve the homeless population, such as shelters, homeless day 
centers, and soup kitchens.
    (2) Have service-connected disabilities.
    (3) All other veterans.
    (c) VA will refer a veteran to a non-VA community-based provider 
after VA determines the veteran's eligibility and priority.

(Authority: 501, 2031)

Sec.  63.10  Selection of non-VA community-based providers.

    (a) Who can apply. VA may award per diem contracts to non-VA 
community-based providers who provide temporary residential assistance 
for homeless persons with serious mental illness, and/or substance use 
disorders, and

[[Page 79327]]

who can provide the specific services and meet the standards identified 
in Sec.  63.15 and elsewhere in this part.
    (b) Awarding contracts. Contracts for services authorized under 
this section will be awarded in accordance with applicable VA and 
Federal procurement procedures in 48 CFR chapter 8. Such contracts will 
be awarded only after the quality, effectiveness and safety of the 
applicant's program and facilities have been ascertained to VA's 
satisfaction, and then only to applicants determined by VA to meet the 
requirements of this part.
    (c) Per diem rates and duration of contract periods.
    (1) Per diem rates are to be negotiated as a contract term between 
VA and the non-VA community-based provider; however, the negotiated 
rate must be based on local community needs, standards, and practices.
    (2) Contracts with non-VA community-based providers will establish 
the length of time for which VA may pay per diem based on an individual 
veteran; however, VA will not authorize the payment of per diem for an 
individual veteran for a period of more than 6 months absent 
extraordinary circumstances.

(Authority: 38 U.S.C. 501, 2031)

Sec.  63.15  Duties of, and standards applicable to, non-VA community-
based providers.

    A non-VA community-based provider must meet all of the standards 
and provide the appropriate services identified in this section, as 
well as any additional requirements set forth in a specific contract.
    (a) Facility safety requirements. The facility must meet all 
applicable safety requirements set forth in 38 CFR 17.81(a).
    (b) Treatment plans and therapeutic/rehabilitative services. 
Individualized treatment plans are to be developed through a joint 
effort of the veteran, non-VA community-based provider staff and VA 
clinical staff. Therapeutic and rehabilitative services must be 
provided by the non-VA community-based provider as described in the 
treatment plan. In some cases, VA may complement the non-VA community-
based provider's program with added treatment services such as 
participation in VA outpatient programs. Services provided by the non-
VA community-based provider generally should include, as appropriate:
    (1) Structured group activities such as group therapy, social 
skills training self-help group meetings or peer counseling.
    (2) Professional counseling, including counseling on self care 
skills, adaptive coping skills and, as appropriate, vocational 
rehabilitation counseling, in collaboration with VA programs and 
community resources.
    (c) Quality of life, room and board.
    (1) The non-VA community-based provider must provide residential 
room and board in an environment that promotes a lifestyle free of 
substance abuse.
    (2) The environment must be conducive to social interaction, 
supportive of recovery models and the fullest development of the 
resident's rehabilitative potential.
    (3) Residents must be assisted in maintaining an acceptable level 
of personal hygiene and grooming.
    (4) Residential programs must provide laundry facilities.
    (5) VA will give preference to facilities located close to public 
transportation and/or areas that provide employment.
    (6) The program must promote community interaction, as demonstrated 
by the nature of scheduled activities or by information about resident 
involvement with community activities, volunteers, and local consumer 
services.
    (7) Adequate meals must be provided in a setting that encourages 
social interaction; nutritious snacks between meals and before bedtime 
must be available.
    (d) Staffing. The non-VA community-based provider must employ 
sufficient professional staff and other personnel to carry out the 
policies and procedures of the program. There will be at a minimum, an 
employee on duty on the premises, or residing at the program and 
available for emergencies, 24 hours a day, 7 days a week. Staff 
interaction with residents should convey an attitude of genuine concern 
and caring.
    (e) Inspections. (1) VA must be permitted to conduct an initial 
inspection prior to the award of the contract and follow-up inspections 
of the non-VA community-based provider's facility and records. At 
inspections, the non-VA community-based provider must make available 
the documentation described in paragraph (e)(3) of this section.
    (2) If problems are identified as a result of an inspection, VA 
will establish a plan of correction and schedule a follow-up inspection 
to ensure that the problems are corrected. Contracts will not be 
awarded or renewed until noted deficiencies have been eliminated to the 
satisfaction of the inspector.
    (3) Non-VA community-based providers must keep sufficient 
documentation to support a finding that they comply with this section, 
including accurate records of participants' lengths of stay, and these 
records must be made available at all VA inspections.
    (4) Inspections under this section may be conducted without prior 
notice.
    (f) Rights of veteran participants. The non-VA community-based 
provider must comply with all applicable patients' rights provisions 
set forth in 38 CFR 17.33.
    (g) Services and supplies. VA per diem payments under this part 
will include the services specified in the contract and any other 
services or supplies normally provided without extra charge to other 
participants in the non-VA community-based provider's program.

(Authority: 38 U.S.C. 501, 2031)


(The Office of Management and Budget has approved the information 
collection requirement in this section under control number 2900-
0091.)

[FR Doc. 2010-31780 Filed 12-17-10; 8:45 am]
BILLING CODE 8320-01-P