Medical Foster Homes, 5186-5191 [2012-2063]
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Federal Register / Vol. 77, No. 22 / Thursday, February 2, 2012 / Rules and Regulations
Dated: January 20, 2012.
Waverly W. Gregory, Jr.,
Bridge Program Manager, Fifth Coast Guard
District.
[FR Doc. 2012–2282 Filed 2–1–12; 8:45 am]
BILLING CODE 9110–04–P
DEPARTMENT OF HOMELAND
SECURITY
Coast Guard
33 CFR Part 117
[Docket No. USCG–2011–1171]
Drawbridge Operation Regulation;
Northeast Cape Fear River,
Wilmington, NC
Coast Guard, DHS.
Notice of temporary deviation
from regulations.
AGENCY:
ACTION:
The Commander, Fifth Coast
Guard District, has issued a temporary
deviation from the regulations
governing the operation of the Isabel S.
Holmes Bridge across the Northeast
Cape Fear River, mile 1.0, at
Wilmington, NC. The deviation restricts
the operation of the draw span to
accommodate the 100 year Anniversary
of the Girl Scout Program Ceremonial
walk. The deviation allows the bridge to
remain in the closed position to vessels.
DATES: This deviation is effective from
10 a.m. until noon on March 10, 2012.
ADDRESSES: Documents mentioned in
this preamble as being available in the
docket USCG–2011–1171 and are
available online by going to https://www.
regulations.gov, inserting USCG–2011–
1171 in the ‘‘Keywords’’ box, and then
clicking ‘‘Search’’. This material is also
available for inspection or copying the
Docket Management Facility (M–30),
U.S. Department of Transportation,
West Building Ground Floor, Room
W12–140, 1200 New Jersey Avenue SE.,
Washington, DC 20590, between 9 a.m.
and 5 p.m., Monday through Friday,
except Federal Holidays.
FOR FURTHER INFORMATION CONTACT: If
you have questions on this rule, call or
email Mr. Jim Rousseau, Bridge
Management Specialist, Fifth Coast
Guard District, telephone (757) 398–
6557. Email James.L.Rousseau2@uscg.
mil. If you have questions on reviewing
the docket, call Renee V. Wright,
Program Manager, Docket Operations,
(202) 366–9826.
SUPPLEMENTARY INFORMATION: The Event
Director for the New Hanover County
Girl Scouts, with approval from the
North Carolina Department of
Transportation, owner of the
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drawbridge, has requested a temporary
deviation from the current operating
schedule to accommodate the 100 year
Anniversary of the Girl Scout Program
Ceremonial walk.
The Isabel S. Holmes Bridge operating
regulations are set out in 33 CFR
117.829(a). However on January 10,
2012 (77 FR 1406) the Coast Guard
granted a deviation from 33 CFR
117.829(a) to facilitate structural repair
on the bridge. Under the current
operating deviation schedule, the
drawbridge will be closed to navigation
from 7 a.m. on January 16, 2012 until
and including 11 p.m. on April 30,
2012; except that vessel openings will
be provided if at least three hours
advance notice is given to the bridge
tender at (910) 251–5774 or via marine
radio on channel 13 VHF. The Isabel S.
Holmes Bridge across the Northeast
Cape Fear River, mile 1.0,a bascule lift
Bridge, in Wilmington, NC, has a
vertical clearance in the closed position
of 40 feet, above mean high water.
Under this temporary deviation, the
drawbridge will be allowed to remain in
the closed-to-navigation position from
10 a.m. to noon on Saturday, March 10,
2012 to accommodate the 100 year
Anniversary of the Girl Scout Program
Ceremonial walk.
Vessels able to pass under the closed
span may transit under the drawbridge
while it is in the closed position.
Mariners are advised to proceed with
caution. The Coast Guard will inform
users of the waterway through our local
and broadcast Notices to Mariners of the
limited operating schedule for the
drawbridge so that vessels can arrange
their transits to minimize any impacts
caused by the temporary deviation.
There are no alternate routes for vessels
and the bridge will be able to open in
the event of an emergency.
In accordance with 33 CFR 117.35(e),
when applicable the draw must return
to its regular operating schedule
immediately at the end of the
designated time period. This deviation
from the operating regulations is
authorized under 33 CFR 117.35.
Dated: January 13, 2012.
Waverly W. Gregory, Jr.,
Bridge Program Manager, Fifth Coast Guard
District.
[FR Doc. 2012–2284 Filed 2–1–12; 8:45 am]
BILLING CODE 9110–04–P
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DEPARTMENT OF VETERANS
AFFAIRS
38 CFR Part 17
RIN 2900–AN80
Medical Foster Homes
Department of Veterans Affairs.
Final rule.
AGENCY:
ACTION:
This document amends the
Department of Veterans Affairs (VA)
‘‘Medical’’ regulations to add rules
relating to medical foster homes. Prior
to this final rule, VA’s medical foster
home program had, whenever possible
and appropriate, relied upon regulations
governing community residential care
facilities; however, those regulations did
not cover all aspects of medical foster
homes, which provide community
based care in a smaller, residential
facility and to a more medically
complex and disabled population. This
final rule reflects current VA policy and
practice, and generally conforms to
industry standards and expectations.
DATES: Effective date: March 5, 2012.
The Director of the Federal Register
approved the incorporation by reference
of certain publications listed in this rule
as of March 5, 2012.
FOR FURTHER INFORMATION CONTACT: Rick
Greene, Office of Patient Care Services
(114), Veterans Health Administration,
Department of Veterans Affairs, 810
Vermont Avenue NW., Washington, DC
20420, (202) 461–6786. (This is not a
toll free number.)
SUPPLEMENTARY INFORMATION: Many
veterans who are disabled due to
complex chronic disease or traumatic
injury may be unable to live safely and
independently, or may have health care
needs that exceed the capabilities of
their families. Many of these veterans
are placed in nursing homes. Others,
with the proper support, can continue to
live in a residential setting and delay, or
totally avoid, the need for nursing home
care. VA’s community residential care
program, specifically authorized by 38
U.S.C. 1730 and implemented at 38 CFR
17.61 through 17.72, has provided
health care supervision to these
veterans.
A medical foster home is a specific
type of community residential care
facility that provides home-based care to
a small number of residents with serious
chronic disease and disability. A
medical foster home provides a greater
level of care than a community
residential care facility (and in this
respect a medical foster home is more
analogous to a nursing home), while
allowing veterans to live in a home-like
SUMMARY:
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Federal Register / Vol. 77, No. 22 / Thursday, February 2, 2012 / Rules and Regulations
setting and maintain a greater degree of
independence. VA interprets 38 U.S.C.
1730 as authorizing a medical foster
home program, as a subset of the
community residential care program. In
particular, we believe medical foster
homes fit within the type of facility
authorized by section 1730(f), since they
provide ‘‘room and board and * * *
limited personal care.’’
In a document published in the
Federal Register on May 19, 2011 (76
FR 28917), VA proposed regulations to
govern medical foster homes. We
provided a 60 day comment period,
which ended on July 18, 2011. We
received one comment.
The commenter sought clarification
regarding whether a veteran would
‘‘have the option of receiving approved
care in their own home rather than
being forced into a local nursing home’’
if there were no approved medical foster
home in their area. The proposed rule
stated in § 17.73(a) that the purpose of
the medical foster home program is to
‘‘approve[] certain medical foster homes
for the placement of veterans’’ and that
placement in a medical foster home is
voluntary on the part of the veteran. If
the veteran is interested in this care
option, VA will try to refer the veteran
to a medical foster home as close to his
or her residence as possible.
However, VA is aware that a medical
foster home may not be located in the
immediate vicinity of the veteran’s
residence. If a veteran is unable or
unwilling to accept placement in a
medical foster home that is located
outside the immediate vicinity of the
veteran’s residence, VA offers several
alternate health care programs that may
better suit the veteran’s needs. These
alternate programs include home based
primary care, where the veteran receives
primary care in his home; community
residential care, which provides care
similar to that of the medical foster
home; and nursing home care. Home
Based Primary Care provides long-term
primary care to chronically ill veterans
in their own homes. Home Based
Primary Care is appropriate for veterans
with complex, chronic, and long-term
conditions that would make it difficult
to come to a VA facility for treatment.
A VA treatment team coordinates the
plan of care for each veteran and comes
to the veteran’s home to provide
services. Home Based Primary Care
provides primary care, palliative care,
therapy, disease management, and
coordination of care services.
The commenter noted that
§ 17.74(d)(3) requires the veteran to be
placed in a single-occupancy bedroom,
unless the veteran agrees to a multioccupant bedroom. The commenter
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asked whether the spouse of a married
veteran ‘‘[c]an * * * move into the
home with the veteran[,] or will the
couple be forced to live apart?’’ Nothing
in the regulation would preclude the
spouse of a veteran from living in the
same medical foster home as the
veteran. Such an arrangement would be
a matter of agreement between the
spouse of the veteran and the medical
foster home caregiver. If the spouse of
the veteran also requires medical care in
addition to lodging, then the spouse of
the veteran must be included in the total
number of residents receiving care in
the medical foster home, which
§ 17.73(b) limits to no more than three.
The medical foster home would not be
able to provide adequate care to all of
its residents if the total number of
residents receiving care exceeds three. If
VA recommends a medical foster home
that was unable to accommodate the
veteran and his or her spouse, VA could
provide the veteran an alternate location
that would accommodate the veteran
and the spouse’s needs. However, any
agreement between the medical foster
home caregiver for the lodging and/or
care of veteran’s spouse in such home
is beyond the scope of this rulemaking.
Also, as noted above, if the option of a
medical foster home does not
adequately address the veteran’s and the
veteran’s family’s needs, the veteran
may consider an alternate health care
option. Therefore, no veteran will be
‘‘forced to live apart’’ from his or her
spouse. Because the agreement for
lodging and/or medical care for the
spouse of the veteran is outside the
scope of this rulemaking, except where
it may impact compliance with
§ 17.73(b), we are not making any
changes based on this comment.
The commenter also stated that, in the
commenter’s view, the proposed rule
contained language that seemed to
indicate that only elderly veterans were
eligible to be placed in a medical foster
home. The commenter further stated
that ‘‘there are a growing number of
young military veterans who are
severely injured and in need of daily
medical assistance’’ and questioned
whether placement in a medical foster
home would be an option for these
veterans. We agree with the commenter
that placement in a medical foster home
should not be restricted based on the
age of the veteran, and this final
rulemaking does not place any such
restriction. Age is referenced only in the
proposed rulemaking in the
supplementary information discussing
§ 17.73(c)(2), where we discussed the
eligibility criteria for referral to a
medical foster home. We had stated that
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one criterion is the veteran’s enrollment
in either the VA Home Based Primary
Care or VA Spinal Cord Injury
Homecare program. The proposed rule
notice explained that ‘‘VA Home Based
Primary Care (HBPC) is a home care
program designed to meet the
longitudinal, primary care needs of an
aging veteran population with complex,
chronic, disabling disease.’’ However,
the HBPC program is not limited to
elderly veterans. The program is
designed to serve the chronically ill
through the months and years before
death, providing primary care, palliative
care, rehabilitation, disease management
and coordination of care services. The
proposed rulemaking did not place any
age restrictions on eligibility for
placement in a medical foster home
within the regulation text. We are,
therefore, not making any changes based
on this comment.
The proposed rule cited 38 U.S.C.
501, 1721, and as noted in specific
sections as the authority for 38 CFR part
17. However, the correct authority for
part 17 is 38 U.S.C. 501, and as noted
in specific sections. We are amending
the final rule to reflect the correct
authority for part 17.
Based on the rationale set forth in the
proposed rule and in this document, VA
adopts the proposed rule as a final rule,
with the above noted change.
Effect of Rulemaking
Title 38 of the Code of Federal
Regulations, as revised by this final rule,
represents VA’s implementation of its
legal authority on this subject. Other
than future amendments to this
regulation or governing statutes, no
contrary rules or procedures are
authorized. All existing or subsequent
VA guidance must be read to conform
with this final rule if possible or, if not
possible, such guidance is superseded
by this rulemaking.
Executive Orders 12866 and 13563
Executive Orders 12866 and 13563
direct agencies to assess the costs and
benefits of available regulatory
alternatives and, when regulation is
necessary, to select regulatory
approaches that maximize net benefits
(including potential economic,
environmental, public health and safety
effects, and other advantages;
distributive impacts; and equity).
Executive Order 13563 (Improving
Regulation and Regulatory Review)
emphasizes the importance of
quantifying both costs and benefits,
reducing costs, harmonizing rules, and
promoting flexibility. Executive Order
12866 (Regulatory Planning and
Review) defines a ‘‘significant
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Federal Register / Vol. 77, No. 22 / Thursday, February 2, 2012 / Rules and Regulations
regulatory action,’’ which requires
review by the Office of Management and
Budget (OMB), as ‘‘any regulatory action
that is likely to result in a rule that may:
(1) Have an annual effect on the
economy of $100 million or more or
adversely affect in a material way the
economy, a sector of the economy,
productivity, competition, jobs, the
environment, public health or safety, or
State, local, or tribal governments or
communities; (2) Create a serious
inconsistency or otherwise interfere
with an action taken or planned by
another agency; (3) Materially alter the
budgetary impact of entitlements,
grants, user fees, or loan programs or the
rights and obligations of recipients
thereof; or (4) Raise novel legal or policy
issues arising out of legal mandates, the
President’s priorities, or the principles
set forth in this Executive Order.
The economic, interagency,
budgetary, legal, and policy
implications of this regulatory action
have been examined and it has been
determined not to be a significant
regulatory action under Executive Order
12866.
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Unfunded Mandates
The Unfunded Mandates Reform Act
of 1995 requires, at 2 U.S.C. 1532, that
agencies prepare an assessment of
anticipated costs and benefits before
issuing any rule that may result in
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 final rule will have no
such effect on State, local, and 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.
In the proposed rule, we stated that
proposed § 17.74(q) contains collection
of information provisions under the
Paperwork Reduction Act of 1995 (44
U.S.C. 3501–3521), and that we had
requested public comment on those
provisions in the notice published in
the Federal Register on May 19, 2011
(76 FR 28917). We did not receive any
comments on the proposed collection of
information, which OMB has approved
without an expiration date, under
control number 2900–0777. Following
§ 17.74(q) in this final rule, we set out
an information collection approval
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parenthetical displaying OMB control
number 2900–0777.
Regulatory Flexibility Act
The Secretary hereby certifies that
this final rule will 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. In addition to
having an effect on individuals
(veterans), the final rule will have an
insignificant economic impact on a few
small entities. Most of the minimum
standards that will be established by
this rulemaking are already required by
state and local regulations, and medical
foster homes should already be in
compliance with those regulations or
with the current NFPA codes. Any
additional costs for compliance with
this final rule would constitute an
inconsequential amount of the
operational cost for most facilities.
Accordingly, pursuant to 5 U.S.C.
605(b), this final rule is exempt from the
initial and final regulatory flexibility
analysis requirements of sections 603
and 604.
Catalog of Federal Domestic Assistance
The Catalog of Federal Domestic
Assistance numbers and titles for the
programs affected by this document are
64.005, Grants to States for Construction
of State Home Facilities; 64.007, Blind
Rehabilitation Centers; 64.008, Veterans
Domiciliary Care; 64.009, Veterans
Medical Care Benefits; 64.010, Veterans
Nursing Home Care; 64.011, 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.
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 January 9, 2012, for
publication.
List of Subjects in 38 CFR Part 17
Administrative practice and
procedure, Alcohol abuse, Alcoholism,
Claims, Day care, Dental health, Drug
abuse, Foreign relations, Government
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contracts, Grant programs—health,
Grant programs—veterans, Health care,
Health facilities, Health professions,
Health records, Homeless, Incorporation
by reference, Medical and dental
schools, Medical devices, Medical
research, Mental health programs,
Nursing homes, Philippines, Reporting
and recordkeeping requirements,
Scholarships and fellowships, Travel
and transportation expenses, Veterans.
Dated: January 26, 2012.
Robert C. McFetridge,
Director of Regulation Policy and
Management, Office of the General Counsel,
Department of Veterans Affairs.
For the reasons stated in the
preamble, the Department of Veterans
Affairs amends 38 CFR part 17 as
follows:
PART 17—MEDICAL
1. The authority citation for part 17
continues to read as follows:
■
Authority: 38 U.S.C. 501, and as noted in
specific sections.
■
2. Revise § 17.1(b) to read as follows:
§ 17.1
Incorporation by reference.
*
*
*
*
*
(b) The following materials are
incorporated by reference into this part.
(1) NFPA 10, Standard for Portable
Fire Extinguishers (2010 edition),
Incorporation by Reference (IBR)
approved for §§ 17.63, 17.74, and 17.81.
(2) NFPA 101, Life Safety Code (2009
edition), IBR approved for §§ 17.63,
17.74 (chapters 1 through 11, 24, and
section 33.7), 17.81, and 17.82.
(3) NFPA 101A, Guide on Alternative
Approaches to Life Safety (2010
edition), IBR approved for § 17.63.
(4) NFPA 13, Standard for the
Installation of Sprinkler Systems (2010
edition), IBR approved for § 17.74.
(5) NFPA 13D, Standard for the
Installation of Sprinkler Systems in
One- and Two-Family Dwellings and
Manufactured Homes (2010 edition),
IBR approved for § 17.74.
(6) NFPA 13R, Standard for the
Installation of Sprinkler Systems in
Residential Occupancies Up To and
Including Four Stories in Height (2010
edition), IBR approved for § 17.74.
(7) NFPA 25, Standard for the
Inspection, Testing, and Maintenance of
Water-Based Fire Protection Systems
(2008 edition), IBR approved for § 17.74.
(8) NFPA 30, Flammable and
Combustible Liquids Code (2008
edition), IBR approved for § 17.74.
(9) NFPA 72, National Fire Alarm and
Signaling Code (2010 edition), IBR
approved for § 17.74.
(10) NFPA 720, Standard for the
Installation of Carbon Monoxide (CO)
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Detection and Warning Equipment
(2009 edition), IBR approved for § 17.74.
*
*
*
*
*
■ 3. Sections 17.73 and 17.74 are added
to read as follows:
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§ 17.73
Medical foster homes—general.
(a) Purpose. Through the medical
foster home program, VA recognizes and
approves certain medical foster homes
for the placement of veterans. The
choice to become a resident of a medical
foster home is a voluntary one on the
part of each veteran. VA’s role is limited
to referring veterans to approved
medical foster homes. When a veteran is
placed in an approved home, VA will
provide inspections to ensure that the
home continues to meet the
requirements of this part, as well as
oversight and medical foster home
caregiver training. If a medical foster
home does not meet VA’s criteria for
approval, VA will not refer any veteran
to the home or provide any of these
services. VA may also provide certain
medical benefits to veterans placed in
medical foster homes, consistent with
the VA program in which the veteran is
enrolled.
(b) Definitions. For the purposes of
this section and § 17.74:
Labeled means that the equipment or
materials have attached to them a label,
symbol, or other identifying mark of an
organization recognized as having
jurisdiction over the evaluation and
periodic inspection of such equipment
or materials, and by whose labeling the
manufacturer indicates compliance with
appropriate standards or performance.
Medical foster home means a private
home in which a medical foster home
caregiver provides care to a veteran
resident and:
(i) The medical foster home caregiver
lives in the medical foster home;
(ii) The medical foster home caregiver
owns or rents the medical foster home;
and
(iii) There are not more than three
residents receiving care (including
veteran and non-veteran residents).
Medical foster home caregiver means
the primary person who provides care to
a veteran resident in a medical foster
home.
Placement refers to the voluntary
decision by a veteran to become a
resident in an approved medical foster
home.
Veteran resident means a veteran
residing in an approved medical foster
home who meets the eligibility criteria
in paragraph (c) of this section.
(c) Eligibility. VA health care
personnel may assist a veteran by
referring such veteran for placement in
a medical foster home if:
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(1) The veteran is unable to live
independently safely or is in need of
nursing home level care;
(2) The veteran must be enrolled in,
or agree to be enrolled in, either a VA
Home Based Primary Care or VA Spinal
Cord Injury Homecare program, or a
similar VA interdisciplinary program
designed to assist medically complex
veterans living in the home; and
(3) The medical foster home has been
approved in accordance with paragraph
(d) of this section.
(d) Approval of medical foster homes.
Medical foster homes will be approved
by a VA Medical Foster Homes
Coordinator based on the report of a VA
inspection and on any findings of
necessary interim monitoring of the
medical foster home, if that home meets
the standards established in § 17.74. The
approval process is governed by the
process for approving community
residential care facilities under §§ 17.65
through 17.72 except as follows:
(1) Where §§ 17.65 through 17.72
reference § 17.63.
(2) Because VA does not physically
place veterans in medical foster homes,
VA also does not assist veterans in
moving out of medical foster homes as
we do for veterans in other community
residential care facilities under
§ 17.72(d)(2); however, VA will assist
such veterans in locating an approved
medical foster home when relocation is
necessary.
(e) Duties of Medical foster home
caregivers. The medical foster home
caregiver, with assistance from relief
caregivers, provides a safe environment,
room and board, supervision, and
personal assistance, as appropriate for
each veteran.
(Authority: 38 U.S.C. 501, 1730)
§ 17.74 Standards applicable to medical
foster homes.
(a) General. A medical foster home
must:
(1) Meet all applicable state and local
regulations, including construction,
maintenance, and sanitation regulations.
(2) Have safe and functioning systems
for heating, hot and cold water,
electricity, plumbing, sewage, cooking,
laundry, artificial and natural light, and
ventilation. Ventilation for cook stoves
is not required.
(3) Except as otherwise provided in
this section, meet the applicable
provisions of chapters 1 through 11 and
24, and section 33.7 of NFPA 101
(incorporated by reference, see § 17.1),
and the other codes and chapters
identified in this section, as applicable.
(b) Community residential care
facility standards applicable to medical
foster homes. Medical foster homes
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5189
must comply with § 17.63(c), (d), (f), (h),
(j) and (k).
(c) Activities. The facility must plan
and facilitate appropriate recreational
and leisure activities.
(d) Residents’ bedrooms. Each veteran
resident must have a bedroom:
(1) With a door that closes and
latches;
(2) That contains a suitable bed and
appropriate furniture; and
(3) That is single occupancy, unless
the veteran agrees to a multi-occupant
bedroom.
(e) Windows. VA may grant
provisional approval for windows used
as a secondary means of escape that do
not meet the minimum size and
dimensions required by chapter 24 of
NFPA 101 (incorporated by reference,
see § 17.1) if the windows are a
minimum of 5.0 square feet (and at least
20 inches wide and at least 22 inches
high). The secondary means of escape
must be brought into compliance with
chapter 24 no later than 60 days after a
veteran resident is placed in the home.
(f) Special locking devices. Special
locking devices that do not comply with
section 7.2.1.5 of NFPA 101
(incorporated by reference, see § 17.1)
are permitted where the clinical needs
of the veteran resident require
specialized security measures and with
the written approval of:
(1) The responsible VA clinician; and
(2) The VA fire/safety specialist or the
Director of the VA Medical Center of
jurisdiction.
(g) Smoke and carbon monoxide (CO)
detectors and smoke and CO alarms.
Medical foster homes must comply with
this paragraph (g) no later than 60 days
after the first veteran is placed in the
home. Prior to compliance, VA
inspectors will provisionally approve a
medical foster home for the duration of
this 60-day period if the medical foster
home mitigates risk through the use of
battery-operated single station alarms,
provided that the alarms are installed
before any veteran is placed in the
home.
(1) Smoke detectors or smoke alarms
must be provided in accordance with
sections 24.3.4.1 or 24.3.4.2 of NFPA
101 (incorporated by reference, see
§ 17.1); section 24.3.4.3 of NFPA 101
will not be used. In addition, smoke
alarms must be interconnected so that
the operation of any smoke alarm causes
an alarm in all smoke alarms within the
medical foster home. Smoke detectors or
smoke alarms must not be installed in
the kitchen or any other location subject
to causing false alarms.
(2) CO detectors or CO alarms must be
installed in any medical foster home
with a fuel-burning appliance, fireplace,
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or an attached garage, in accordance
with NFPA 720 (incorporated by
reference, see § 17.1).
(3) Combination CO/smoke detectors
and combination CO/smoke alarms are
permitted.
(4) Smoke detectors and smoke alarms
must initiate a signal to a remote
supervising station to notify emergency
forces in the event of an alarm.
(5) Smoke and/or CO alarms and
smoke and/or CO detectors, and all
other elements of a fire alarm system,
must be inspected, tested, and
maintained in accordance with NFPA
72 (incorporated by reference, see
§ 17.1) and NFPA 720 (incorporated by
reference, see § 17.1).
(h) Sprinkler systems. (1) If a sprinkler
system is installed, it must be inspected,
tested, and maintained in accordance
with NFPA 25 (incorporated by
reference, see § 17.1), unless the
sprinkler system is installed in
accordance with NFPA 13D
(incorporated by reference, see § 17.1). If
a sprinkler system is installed in
accordance with NFPA 13D, it must be
inspected annually by a competent
person.
(2) If sprinkler flow or pressure
switches are installed, they must
activate notification appliances in the
medical foster home, and must initiate
a signal to the remote supervising
station.
(i) Fire extinguishers. At least one 2–
A:10–B:C rated fire extinguisher must be
visible and readily accessible on each
floor, including basements, and must be
maintained in accordance with the
manufacturer’s instructions. Portable
fire extinguishers must be inspected,
tested, and maintained in accordance
with NFPA 10 (incorporated by
reference, see § 17.1).
(j) Emergency lighting. Each occupied
floor must have at least one plug-in
rechargeable flashlight, operable and
readily accessible, or other approved
emergency lighting. Such emergency
lighting must be tested monthly and
replaced if not functioning.
(k) Fireplaces. A non-combustible
hearth, in addition to protective glass
doors or metal mesh screens, is required
for fireplaces. Hearths and protective
devices must meet all applicable state
and local fire codes.
(l) Portable heaters. Portable heaters
may be used if they are maintained in
good working condition and:
(1) The heating elements of such
heaters do not exceed 212 degrees
Fahrenheit (100 degrees Celsius);
(2) The heaters are labeled; and
(3) The heaters have tip-over
protection.
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(m) Oxygen safety. Any area where
oxygen is used or stored must not be
near an open flame and must have a
posted ‘‘No Smoking’’ sign. Oxygen
cylinders must be adequately secured or
protected to prevent damage to
cylinders. Whenever possible,
transfilling of liquid oxygen must take
place outside of the living areas of the
home.
(n) Smoking. Smoking must be
prohibited in all sleeping rooms,
including sleeping rooms of non-veteran
residents. Ashtrays must be made of
noncombustible materials.
(o) Special/other hazards. (1)
Extension cords must be three-pronged,
grounded, sized properly, and not
present a hazard due to inappropriate
routing, pinching, damage to the cord,
or risk of overloading an electrical panel
circuit.
(2) Flammable or combustible liquids
and other hazardous material must be
safely and properly stored in either the
original, labeled container or a safety
can as defined by section 3.3.44 of
NFPA 30 (incorporated by reference, see
§ 17.1).
(p) Emergency egress and relocation
drills. Operating features of the medical
foster home must comply with section
33.7 of NFPA 101 (incorporated by
reference, see § 17.1), except that section
33.7.3.6 of NFPA 101 does not apply.
Instead, VA will enforce the following
requirements:
(1) Before placement in a medical
foster home, the veteran will be
clinically evaluated by VA to determine
whether the veteran is able to
participate in emergency egress and
relocation drills. Within 24 hours after
arrival, each veteran resident must be
shown how to respond to a fire alarm
and evacuate the medical foster home,
unless the veteran resident is unable to
participate.
(2) The medical foster home caregiver
must demonstrate the ability to evacuate
all occupants within three minutes to a
point of safety outside of the medical
foster home that has access to a public
way, as defined in NFPA 101
(incorporated by reference, see § 17.1).
(3) If all occupants are not evacuated
within three minutes or if a veteran
resident is either permanently or
temporarily unable to participate in
drills, then the medical foster home will
be given a 60-day provisional approval,
after which time the home must have
established one of the following
remedial options or VA will terminate
the approval in accordance with § 17.65.
(i) The home is protected throughout
with an automatic sprinkler system in
accordance with section 9.7 of NFPA
101 (incorporated by reference, see
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§ 17.1) and whichever of the following
apply: NFPA 13 (incorporated by
reference, see § 17.1); NFPA 13R
(incorporated by reference, see § 17.1);
or NFPA 13D (incorporated by
reference, see § 17.1).
(ii) Each veteran resident who is
permanently or temporarily unable to
participate in a drill or who fails to
evacuate within three minutes must
have a bedroom located at the ground
level with direct access to the exterior
of the home that does not require travel
through any other portion of the
residence, and access to the ground
level must meet the requirements of the
Americans with Disabilities Act. The
medical foster home caregiver’s
bedroom must also be on ground level.
(4) The 60-day provisional approval
under paragraph (p)(3) of this section
may be contingent upon increased fire
prevention measures, including but not
limited to prohibiting smoking or use of
a fireplace. However, each veteran
resident who is temporarily unable to
participate in a drill will be permitted
to be excused from up to two drills
within one 12-month period, provided
that the two excused drills are not
consecutive, and this will not be a cause
for VA to not approve the home.
(5) For purposes of paragraph (p), the
term all occupants means every person
in the home at the time of the
emergency egress and relocation drill,
including non-residents.
(q) Records of compliance with this
section. The medical foster home must
comply with § 17.63(i) regarding facility
records, and must document all
inspection, testing, drills and
maintenance activities required by this
section. Such documentation must be
maintained for 3 years or for the period
specified by the applicable NFPA
standard, whichever is longer.
Documentation of emergency egress and
relocation drills must include the date,
time of day, length of time to evacuate
the home, the name of each medical
foster home caregiver who participated,
the name of each resident, whether the
resident participated, and whether the
resident required assistance.
(r) Local permits and emergency
response. Where applicable, a permit or
license must be obtained for occupancy
or business by the medical foster home
caregiver from the local building or
business authority. When there is a
home occupant who is incapable of selfpreservation, the local fire department
or response agency must be notified by
the medical foster home within 7 days
of the beginning of the occupant’s
residency.
(s) Equivalencies. Any equivalencies
to VA requirements must be in
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accordance with section 1.4.3 of NFPA
101 (incorporated by reference, see
§ 17.1), and must be approved in writing
by the appropriate Veterans Health
Administration, Veterans Integrated
Service Network (VISN) Director. A
veteran living in a medical foster home
when the equivalency is granted or who
is placed there after it is granted must
be notified in writing of the
equivalencies and that he or she must be
willing to accept such equivalencies.
The notice must describe the exact
nature of the equivalency, the
requirements of this section with which
the medical foster home is unable to
comply, and explain why the VISN
Director deemed the equivalency
necessary. Only equivalencies that the
VISN Director determines do not pose a
risk to the health or safety of the veteran
may be granted. Also, equivalencies
may only be granted when technical
requirements of this section cannot be
complied with absent undue expense,
there is no other nearby home which
can serve as an adequate alternative,
and the equivalency is in the best
interest of the veteran.
(t) Cost of medical foster homes.
(1) Payment for the charges to veterans
for the cost of medical foster home care
is not the responsibility of the United
States Government.
(2) The resident or an authorized
personal representative and a
representative of the medical foster
home facility must agree upon the
charge and payment procedures for
medical foster home care.
(3) The charges for medical foster
home care must be comparable to prices
charged by other assisted living and
nursing home facilities in the area based
on the veteran’s changing care needs
and local availability of medical foster
homes. (The Office of Management and
Budget has approved the information
collection requirements in this section
under control number 2900–0777.)
(Authority: 38 U.S.C. 501, 1730)
[FR Doc. 2012–2063 Filed 2–1–12; 8:45 am]
ENVIRONMENTAL PROTECTION
AGENCY
40 CFR Part 52
tkelley on DSK3SPTVN1PROD with RULES
[EPA–R03–OAR–2011–0913; FRL–9625–5]
Approval and Promulgation of Air
Quality Implementation Plans; District
of Columbia; Regional Haze State
Implementation Plan
Environmental Protection
Agency (EPA).
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Final rule.
EPA is approving the District
of Columbia Regional Haze Plan, a
revision to the District of Columbia
State Implementation Plan (SIP)
addressing Clean Air Act (CAA)
requirements and EPA’s rules for states
to prevent and remedy future and
existing anthropogenic impairment of
visibility in mandatory Class I areas
through a regional haze program. EPA is
also approving this revision since it
meets the infrastructure requirements
relating to visibility protection for the
1997 8-hour ozone National Ambient
Air Quality Standard (NAAQS) and the
1997 and 2006 fine particulate matter
(PM2.5) NAAQS.
DATES: Effective Date: This final rule is
effective on March 5, 2012.
ADDRESSES: EPA has established a
docket for this action under Docket ID
Number EPA–R03–OAR–2011–0913. All
documents in the docket are listed in
the www.regulations.gov Web site.
Although listed in the electronic docket,
some information is not publicly
available, i.e., confidential business
information (CBI) or other information
whose disclosure is restricted by statute.
Certain other material, such as
copyrighted material, is not placed on
the Internet and will be publicly
available only in hard copy form.
Publicly available docket materials are
available either electronically through
www.regulations.gov or in hard copy for
public inspection during normal
business hours at the Air Protection
Division, U.S. Environmental Protection
Agency, Region III, 1650 Arch Street,
Philadelphia, Pennsylvania 19103.
Copies of the State submittal are
available at the District Department of
the Environment, 1200 First Street NE.,
Washington, DC 20002.
FOR FURTHER INFORMATION CONTACT:
Jacqueline Lewis, (215) 814–2037, or by
email at lewis.jacqueline@epa.gov.
SUPPLEMENTARY INFORMATION:
SUMMARY:
I. Background
BILLING CODE 8320–01–P
AGENCY:
ACTION:
Throughout this document, whenever
‘‘we,’’ ‘‘us,’’ or ‘‘our’’ is used, we mean
EPA. On November 16, 2011 (76 FR
70929), EPA published a notice of
proposed rulemaking (NPR) for the
District of Columbia. The NPR proposed
approval of the District of Columbia’s
regional haze plan for the first
implementation period, through 2018.
EPA proposed to approve this revision
since it assures reasonable progress
toward the national goal of achieving
natural visibility conditions in Class I
areas for the first implementation
period. This revision also meets the
PO 00000
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5191
infrastructure requirements of
110(a)(2)(D)(i)(II) and 110 (a)(2)(J),
relating to visibility protection for the
1997 8-hour ozone NAAQS and the
1997 and 2006 PM2.5 NAAQS.
II. Summary of SIP Revision
The revision includes a long term
strategy with enforceable measures
ensuring reasonable progress towards
meeting the reasonable progress goals
for the first planning period, through
2018. The District of Columbia’s
Regional Haze Plan contains the
emission reductions needed to achieve
the District of Columbia’s share of
emission reductions agreed upon
through the regional planning process.
Other specific requirements of the CAA
and EPA’s Regional Haze Rule and the
rationale for EPA’s proposed action are
explained in the NPR and will not be
restated here. No public comments were
received on the NPR.
III. Final Action
EPA is approving a revision to the
District of Columbia State
Implementation Plan submitted by the
District of Columbia, through the
District Department of the Environment
(DDOE), on October 27, 2011, that
addresses regional haze for the first
implementation period. EPA is making
a determination that the District of
Columbia Regional Haze SIP contains
the emission reductions needed to
achieve the District of Columbia’s share
of emission reductions agreed upon
through the regional planning process.
Furthermore, the District of Columbia’s
Regional Haze Plan ensures that
emissions from the District will not
interfere with the reasonable progress
goals for neighboring states’ Class I
areas. In addition, EPA is approving this
revision because it meets the applicable
visibility related requirements of the
CAA section 110(a)(2) including, but not
limited to 110(a)(2)(D)(i)(II) and
110(a)(2)(J), relating to visibility
protection for the 1997 8-hour ozone
NAAQS and the 1997 and 2006 PM2.5
NAAQS.
IV. Statutory and Executive Order
Reviews
A. General Requirements
Under the CAA, the Administrator is
required to approve a SIP submission
that complies with the provisions of the
CAA and applicable Federal regulations.
42 U.S.C. 7410(k); 40 CFR 52.02(a).
Thus, in reviewing SIP submissions,
EPA’s role is to approve state choices,
provided that they meet the criteria of
the CAA. Accordingly, this action
merely approves state law as meeting
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]]>Agencies
[Federal Register Volume 77, Number 22 (Thursday, February 2, 2012)]
[Rules and Regulations]
[Pages 5186-5191]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-2063]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF VETERANS AFFAIRS
38 CFR Part 17
RIN 2900-AN80
Medical Foster Homes
AGENCY: Department of Veterans Affairs.
ACTION: Final rule.
-----------------------------------------------------------------------
SUMMARY: This document amends the Department of Veterans Affairs (VA)
``Medical'' regulations to add rules relating to medical foster homes.
Prior to this final rule, VA's medical foster home program had,
whenever possible and appropriate, relied upon regulations governing
community residential care facilities; however, those regulations did
not cover all aspects of medical foster homes, which provide community
based care in a smaller, residential facility and to a more medically
complex and disabled population. This final rule reflects current VA
policy and practice, and generally conforms to industry standards and
expectations.
DATES: Effective date: March 5, 2012.
The Director of the Federal Register approved the incorporation by
reference of certain publications listed in this rule as of March 5,
2012.
FOR FURTHER INFORMATION CONTACT: Rick Greene, Office of Patient Care
Services (114), Veterans Health Administration, Department of Veterans
Affairs, 810 Vermont Avenue NW., Washington, DC 20420, (202) 461-6786.
(This is not a toll free number.)
SUPPLEMENTARY INFORMATION: Many veterans who are disabled due to
complex chronic disease or traumatic injury may be unable to live
safely and independently, or may have health care needs that exceed the
capabilities of their families. Many of these veterans are placed in
nursing homes. Others, with the proper support, can continue to live in
a residential setting and delay, or totally avoid, the need for nursing
home care. VA's community residential care program, specifically
authorized by 38 U.S.C. 1730 and implemented at 38 CFR 17.61 through
17.72, has provided health care supervision to these veterans.
A medical foster home is a specific type of community residential
care facility that provides home-based care to a small number of
residents with serious chronic disease and disability. A medical foster
home provides a greater level of care than a community residential care
facility (and in this respect a medical foster home is more analogous
to a nursing home), while allowing veterans to live in a home-like
[[Page 5187]]
setting and maintain a greater degree of independence. VA interprets 38
U.S.C. 1730 as authorizing a medical foster home program, as a subset
of the community residential care program. In particular, we believe
medical foster homes fit within the type of facility authorized by
section 1730(f), since they provide ``room and board and * * * limited
personal care.''
In a document published in the Federal Register on May 19, 2011 (76
FR 28917), VA proposed regulations to govern medical foster homes. We
provided a 60 day comment period, which ended on July 18, 2011. We
received one comment.
The commenter sought clarification regarding whether a veteran
would ``have the option of receiving approved care in their own home
rather than being forced into a local nursing home'' if there were no
approved medical foster home in their area. The proposed rule stated in
Sec. 17.73(a) that the purpose of the medical foster home program is
to ``approve[] certain medical foster homes for the placement of
veterans'' and that placement in a medical foster home is voluntary on
the part of the veteran. If the veteran is interested in this care
option, VA will try to refer the veteran to a medical foster home as
close to his or her residence as possible.
However, VA is aware that a medical foster home may not be located
in the immediate vicinity of the veteran's residence. If a veteran is
unable or unwilling to accept placement in a medical foster home that
is located outside the immediate vicinity of the veteran's residence,
VA offers several alternate health care programs that may better suit
the veteran's needs. These alternate programs include home based
primary care, where the veteran receives primary care in his home;
community residential care, which provides care similar to that of the
medical foster home; and nursing home care. Home Based Primary Care
provides long-term primary care to chronically ill veterans in their
own homes. Home Based Primary Care is appropriate for veterans with
complex, chronic, and long-term conditions that would make it difficult
to come to a VA facility for treatment. A VA treatment team coordinates
the plan of care for each veteran and comes to the veteran's home to
provide services. Home Based Primary Care provides primary care,
palliative care, therapy, disease management, and coordination of care
services.
The commenter noted that Sec. 17.74(d)(3) requires the veteran to
be placed in a single-occupancy bedroom, unless the veteran agrees to a
multi-occupant bedroom. The commenter asked whether the spouse of a
married veteran ``[c]an * * * move into the home with the veteran[,] or
will the couple be forced to live apart?'' Nothing in the regulation
would preclude the spouse of a veteran from living in the same medical
foster home as the veteran. Such an arrangement would be a matter of
agreement between the spouse of the veteran and the medical foster home
caregiver. If the spouse of the veteran also requires medical care in
addition to lodging, then the spouse of the veteran must be included in
the total number of residents receiving care in the medical foster
home, which Sec. 17.73(b) limits to no more than three. The medical
foster home would not be able to provide adequate care to all of its
residents if the total number of residents receiving care exceeds
three. If VA recommends a medical foster home that was unable to
accommodate the veteran and his or her spouse, VA could provide the
veteran an alternate location that would accommodate the veteran and
the spouse's needs. However, any agreement between the medical foster
home caregiver for the lodging and/or care of veteran's spouse in such
home is beyond the scope of this rulemaking. Also, as noted above, if
the option of a medical foster home does not adequately address the
veteran's and the veteran's family's needs, the veteran may consider an
alternate health care option. Therefore, no veteran will be ``forced to
live apart'' from his or her spouse. Because the agreement for lodging
and/or medical care for the spouse of the veteran is outside the scope
of this rulemaking, except where it may impact compliance with Sec.
17.73(b), we are not making any changes based on this comment.
The commenter also stated that, in the commenter's view, the
proposed rule contained language that seemed to indicate that only
elderly veterans were eligible to be placed in a medical foster home.
The commenter further stated that ``there are a growing number of young
military veterans who are severely injured and in need of daily medical
assistance'' and questioned whether placement in a medical foster home
would be an option for these veterans. We agree with the commenter that
placement in a medical foster home should not be restricted based on
the age of the veteran, and this final rulemaking does not place any
such restriction. Age is referenced only in the proposed rulemaking in
the supplementary information discussing Sec. 17.73(c)(2), where we
discussed the eligibility criteria for referral to a medical foster
home. We had stated that one criterion is the veteran's enrollment in
either the VA Home Based Primary Care or VA Spinal Cord Injury Homecare
program. The proposed rule notice explained that ``VA Home Based
Primary Care (HBPC) is a home care program designed to meet the
longitudinal, primary care needs of an aging veteran population with
complex, chronic, disabling disease.'' However, the HBPC program is not
limited to elderly veterans. The program is designed to serve the
chronically ill through the months and years before death, providing
primary care, palliative care, rehabilitation, disease management and
coordination of care services. The proposed rulemaking did not place
any age restrictions on eligibility for placement in a medical foster
home within the regulation text. We are, therefore, not making any
changes based on this comment.
The proposed rule cited 38 U.S.C. 501, 1721, and as noted in
specific sections as the authority for 38 CFR part 17. However, the
correct authority for part 17 is 38 U.S.C. 501, and as noted in
specific sections. We are amending the final rule to reflect the
correct authority for part 17.
Based on the rationale set forth in the proposed rule and in this
document, VA adopts the proposed rule as a final rule, with the above
noted change.
Effect of Rulemaking
Title 38 of the Code of Federal Regulations, as revised by this
final rule, represents VA's implementation of its legal authority on
this subject. Other than future amendments to this regulation or
governing statutes, no contrary rules or procedures are authorized. All
existing or subsequent VA guidance must be read to conform with this
final rule if possible or, if not possible, such guidance is superseded
by this rulemaking.
Executive Orders 12866 and 13563
Executive Orders 12866 and 13563 direct agencies to assess the
costs and benefits of available regulatory alternatives and, when
regulation is necessary, to select regulatory approaches that maximize
net benefits (including potential economic, environmental, public
health and safety effects, and other advantages; distributive impacts;
and equity). Executive Order 13563 (Improving Regulation and Regulatory
Review) emphasizes the importance of quantifying both costs and
benefits, reducing costs, harmonizing rules, and promoting flexibility.
Executive Order 12866 (Regulatory Planning and Review) defines a
``significant
[[Page 5188]]
regulatory action,'' which requires review by the Office of Management
and Budget (OMB), as ``any regulatory action that is likely to result
in a rule that may: (1) Have an annual effect on the economy of $100
million or more or adversely affect in a material way the economy, a
sector of the economy, productivity, competition, jobs, the
environment, public health or safety, or State, local, or tribal
governments or communities; (2) Create a serious inconsistency or
otherwise interfere with an action taken or planned by another agency;
(3) Materially alter the budgetary impact of entitlements, grants, user
fees, or loan programs or the rights and obligations of recipients
thereof; or (4) Raise novel legal or policy issues arising out of legal
mandates, the President's priorities, or the principles set forth in
this Executive Order.
The economic, interagency, budgetary, legal, and policy
implications of this regulatory action have been examined and it has
been determined not to be a significant regulatory action under
Executive Order 12866.
Unfunded Mandates
The Unfunded Mandates Reform Act of 1995 requires, at 2 U.S.C.
1532, that agencies prepare an assessment of anticipated costs and
benefits before issuing any rule that may result in 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 final rule will have no such effect
on State, local, and 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.
In the proposed rule, we stated that proposed Sec. 17.74(q)
contains collection of information provisions under the Paperwork
Reduction Act of 1995 (44 U.S.C. 3501-3521), and that we had requested
public comment on those provisions in the notice published in the
Federal Register on May 19, 2011 (76 FR 28917). We did not receive any
comments on the proposed collection of information, which OMB has
approved without an expiration date, under control number 2900-0777.
Following Sec. 17.74(q) in this final rule, we set out an information
collection approval parenthetical displaying OMB control number 2900-
0777.
Regulatory Flexibility Act
The Secretary hereby certifies that this final rule will 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. In addition to having an effect on individuals (veterans), the
final rule will have an insignificant economic impact on a few small
entities. Most of the minimum standards that will be established by
this rulemaking are already required by state and local regulations,
and medical foster homes should already be in compliance with those
regulations or with the current NFPA codes. Any additional costs for
compliance with this final rule would constitute an inconsequential
amount of the operational cost for most facilities. Accordingly,
pursuant to 5 U.S.C. 605(b), this final rule is exempt from the initial
and final regulatory flexibility analysis requirements of sections 603
and 604.
Catalog of Federal Domestic Assistance
The Catalog of Federal Domestic Assistance numbers and titles for
the programs affected by this document are 64.005, Grants to States for
Construction of State Home Facilities; 64.007, Blind Rehabilitation
Centers; 64.008, Veterans Domiciliary Care; 64.009, Veterans Medical
Care Benefits; 64.010, Veterans Nursing Home Care; 64.011, 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.
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 January 9, 2012, for publication.
List of Subjects in 38 CFR Part 17
Administrative practice and procedure, 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, Incorporation by reference, Medical and dental schools,
Medical devices, Medical research, Mental health programs, Nursing
homes, Philippines, Reporting and recordkeeping requirements,
Scholarships and fellowships, Travel and transportation expenses,
Veterans.
Dated: January 26, 2012.
Robert C. McFetridge,
Director of Regulation Policy and Management, Office of the General
Counsel, Department of Veterans Affairs.
For the reasons stated in the preamble, the Department of Veterans
Affairs amends 38 CFR part 17 as follows:
PART 17--MEDICAL
0
1. The authority citation for part 17 continues to read as follows:
Authority: 38 U.S.C. 501, and as noted in specific sections.
0
2. Revise Sec. 17.1(b) to read as follows:
Sec. 17.1 Incorporation by reference.
* * * * *
(b) The following materials are incorporated by reference into this
part.
(1) NFPA 10, Standard for Portable Fire Extinguishers (2010
edition), Incorporation by Reference (IBR) approved for Sec. Sec.
17.63, 17.74, and 17.81.
(2) NFPA 101, Life Safety Code (2009 edition), IBR approved for
Sec. Sec. 17.63, 17.74 (chapters 1 through 11, 24, and section 33.7),
17.81, and 17.82.
(3) NFPA 101A, Guide on Alternative Approaches to Life Safety (2010
edition), IBR approved for Sec. 17.63.
(4) NFPA 13, Standard for the Installation of Sprinkler Systems
(2010 edition), IBR approved for Sec. 17.74.
(5) NFPA 13D, Standard for the Installation of Sprinkler Systems in
One- and Two-Family Dwellings and Manufactured Homes (2010 edition),
IBR approved for Sec. 17.74.
(6) NFPA 13R, Standard for the Installation of Sprinkler Systems in
Residential Occupancies Up To and Including Four Stories in Height
(2010 edition), IBR approved for Sec. 17.74.
(7) NFPA 25, Standard for the Inspection, Testing, and Maintenance
of Water-Based Fire Protection Systems (2008 edition), IBR approved for
Sec. 17.74.
(8) NFPA 30, Flammable and Combustible Liquids Code (2008 edition),
IBR approved for Sec. 17.74.
(9) NFPA 72, National Fire Alarm and Signaling Code (2010 edition),
IBR approved for Sec. 17.74.
(10) NFPA 720, Standard for the Installation of Carbon Monoxide
(CO)
[[Page 5189]]
Detection and Warning Equipment (2009 edition), IBR approved for Sec.
17.74.
* * * * *
0
3. Sections 17.73 and 17.74 are added to read as follows:
Sec. 17.73 Medical foster homes--general.
(a) Purpose. Through the medical foster home program, VA recognizes
and approves certain medical foster homes for the placement of
veterans. The choice to become a resident of a medical foster home is a
voluntary one on the part of each veteran. VA's role is limited to
referring veterans to approved medical foster homes. When a veteran is
placed in an approved home, VA will provide inspections to ensure that
the home continues to meet the requirements of this part, as well as
oversight and medical foster home caregiver training. If a medical
foster home does not meet VA's criteria for approval, VA will not refer
any veteran to the home or provide any of these services. VA may also
provide certain medical benefits to veterans placed in medical foster
homes, consistent with the VA program in which the veteran is enrolled.
(b) Definitions. For the purposes of this section and Sec. 17.74:
Labeled means that the equipment or materials have attached to them
a label, symbol, or other identifying mark of an organization
recognized as having jurisdiction over the evaluation and periodic
inspection of such equipment or materials, and by whose labeling the
manufacturer indicates compliance with appropriate standards or
performance.
Medical foster home means a private home in which a medical foster
home caregiver provides care to a veteran resident and:
(i) The medical foster home caregiver lives in the medical foster
home;
(ii) The medical foster home caregiver owns or rents the medical
foster home; and
(iii) There are not more than three residents receiving care
(including veteran and non-veteran residents).
Medical foster home caregiver means the primary person who provides
care to a veteran resident in a medical foster home.
Placement refers to the voluntary decision by a veteran to become a
resident in an approved medical foster home.
Veteran resident means a veteran residing in an approved medical
foster home who meets the eligibility criteria in paragraph (c) of this
section.
(c) Eligibility. VA health care personnel may assist a veteran by
referring such veteran for placement in a medical foster home if:
(1) The veteran is unable to live independently safely or is in
need of nursing home level care;
(2) The veteran must be enrolled in, or agree to be enrolled in,
either a VA Home Based Primary Care or VA Spinal Cord Injury Homecare
program, or a similar VA interdisciplinary program designed to assist
medically complex veterans living in the home; and
(3) The medical foster home has been approved in accordance with
paragraph (d) of this section.
(d) Approval of medical foster homes. Medical foster homes will be
approved by a VA Medical Foster Homes Coordinator based on the report
of a VA inspection and on any findings of necessary interim monitoring
of the medical foster home, if that home meets the standards
established in Sec. 17.74. The approval process is governed by the
process for approving community residential care facilities under
Sec. Sec. 17.65 through 17.72 except as follows:
(1) Where Sec. Sec. 17.65 through 17.72 reference Sec. 17.63.
(2) Because VA does not physically place veterans in medical foster
homes, VA also does not assist veterans in moving out of medical foster
homes as we do for veterans in other community residential care
facilities under Sec. 17.72(d)(2); however, VA will assist such
veterans in locating an approved medical foster home when relocation is
necessary.
(e) Duties of Medical foster home caregivers. The medical foster
home caregiver, with assistance from relief caregivers, provides a safe
environment, room and board, supervision, and personal assistance, as
appropriate for each veteran.
(Authority: 38 U.S.C. 501, 1730)
Sec. 17.74 Standards applicable to medical foster homes.
(a) General. A medical foster home must:
(1) Meet all applicable state and local regulations, including
construction, maintenance, and sanitation regulations.
(2) Have safe and functioning systems for heating, hot and cold
water, electricity, plumbing, sewage, cooking, laundry, artificial and
natural light, and ventilation. Ventilation for cook stoves is not
required.
(3) Except as otherwise provided in this section, meet the
applicable provisions of chapters 1 through 11 and 24, and section 33.7
of NFPA 101 (incorporated by reference, see Sec. 17.1), and the other
codes and chapters identified in this section, as applicable.
(b) Community residential care facility standards applicable to
medical foster homes. Medical foster homes must comply with Sec.
17.63(c), (d), (f), (h), (j) and (k).
(c) Activities. The facility must plan and facilitate appropriate
recreational and leisure activities.
(d) Residents' bedrooms. Each veteran resident must have a bedroom:
(1) With a door that closes and latches;
(2) That contains a suitable bed and appropriate furniture; and
(3) That is single occupancy, unless the veteran agrees to a multi-
occupant bedroom.
(e) Windows. VA may grant provisional approval for windows used as
a secondary means of escape that do not meet the minimum size and
dimensions required by chapter 24 of NFPA 101 (incorporated by
reference, see Sec. 17.1) if the windows are a minimum of 5.0 square
feet (and at least 20 inches wide and at least 22 inches high). The
secondary means of escape must be brought into compliance with chapter
24 no later than 60 days after a veteran resident is placed in the
home.
(f) Special locking devices. Special locking devices that do not
comply with section 7.2.1.5 of NFPA 101 (incorporated by reference, see
Sec. 17.1) are permitted where the clinical needs of the veteran
resident require specialized security measures and with the written
approval of:
(1) The responsible VA clinician; and
(2) The VA fire/safety specialist or the Director of the VA Medical
Center of jurisdiction.
(g) Smoke and carbon monoxide (CO) detectors and smoke and CO
alarms. Medical foster homes must comply with this paragraph (g) no
later than 60 days after the first veteran is placed in the home. Prior
to compliance, VA inspectors will provisionally approve a medical
foster home for the duration of this 60-day period if the medical
foster home mitigates risk through the use of battery-operated single
station alarms, provided that the alarms are installed before any
veteran is placed in the home.
(1) Smoke detectors or smoke alarms must be provided in accordance
with sections 24.3.4.1 or 24.3.4.2 of NFPA 101 (incorporated by
reference, see Sec. 17.1); section 24.3.4.3 of NFPA 101 will not be
used. In addition, smoke alarms must be interconnected so that the
operation of any smoke alarm causes an alarm in all smoke alarms within
the medical foster home. Smoke detectors or smoke alarms must not be
installed in the kitchen or any other location subject to causing false
alarms.
(2) CO detectors or CO alarms must be installed in any medical
foster home with a fuel-burning appliance, fireplace,
[[Page 5190]]
or an attached garage, in accordance with NFPA 720 (incorporated by
reference, see Sec. 17.1).
(3) Combination CO/smoke detectors and combination CO/smoke alarms
are permitted.
(4) Smoke detectors and smoke alarms must initiate a signal to a
remote supervising station to notify emergency forces in the event of
an alarm.
(5) Smoke and/or CO alarms and smoke and/or CO detectors, and all
other elements of a fire alarm system, must be inspected, tested, and
maintained in accordance with NFPA 72 (incorporated by reference, see
Sec. 17.1) and NFPA 720 (incorporated by reference, see Sec. 17.1).
(h) Sprinkler systems. (1) If a sprinkler system is installed, it
must be inspected, tested, and maintained in accordance with NFPA 25
(incorporated by reference, see Sec. 17.1), unless the sprinkler
system is installed in accordance with NFPA 13D (incorporated by
reference, see Sec. 17.1). If a sprinkler system is installed in
accordance with NFPA 13D, it must be inspected annually by a competent
person.
(2) If sprinkler flow or pressure switches are installed, they must
activate notification appliances in the medical foster home, and must
initiate a signal to the remote supervising station.
(i) Fire extinguishers. At least one 2-A:10-B:C rated fire
extinguisher must be visible and readily accessible on each floor,
including basements, and must be maintained in accordance with the
manufacturer's instructions. Portable fire extinguishers must be
inspected, tested, and maintained in accordance with NFPA 10
(incorporated by reference, see Sec. 17.1).
(j) Emergency lighting. Each occupied floor must have at least one
plug-in rechargeable flashlight, operable and readily accessible, or
other approved emergency lighting. Such emergency lighting must be
tested monthly and replaced if not functioning.
(k) Fireplaces. A non-combustible hearth, in addition to protective
glass doors or metal mesh screens, is required for fireplaces. Hearths
and protective devices must meet all applicable state and local fire
codes.
(l) Portable heaters. Portable heaters may be used if they are
maintained in good working condition and:
(1) The heating elements of such heaters do not exceed 212 degrees
Fahrenheit (100 degrees Celsius);
(2) The heaters are labeled; and
(3) The heaters have tip-over protection.
(m) Oxygen safety. Any area where oxygen is used or stored must not
be near an open flame and must have a posted ``No Smoking'' sign.
Oxygen cylinders must be adequately secured or protected to prevent
damage to cylinders. Whenever possible, transfilling of liquid oxygen
must take place outside of the living areas of the home.
(n) Smoking. Smoking must be prohibited in all sleeping rooms,
including sleeping rooms of non-veteran residents. Ashtrays must be
made of noncombustible materials.
(o) Special/other hazards. (1) Extension cords must be three-
pronged, grounded, sized properly, and not present a hazard due to
inappropriate routing, pinching, damage to the cord, or risk of
overloading an electrical panel circuit.
(2) Flammable or combustible liquids and other hazardous material
must be safely and properly stored in either the original, labeled
container or a safety can as defined by section 3.3.44 of NFPA 30
(incorporated by reference, see Sec. 17.1).
(p) Emergency egress and relocation drills. Operating features of
the medical foster home must comply with section 33.7 of NFPA 101
(incorporated by reference, see Sec. 17.1), except that section
33.7.3.6 of NFPA 101 does not apply. Instead, VA will enforce the
following requirements:
(1) Before placement in a medical foster home, the veteran will be
clinically evaluated by VA to determine whether the veteran is able to
participate in emergency egress and relocation drills. Within 24 hours
after arrival, each veteran resident must be shown how to respond to a
fire alarm and evacuate the medical foster home, unless the veteran
resident is unable to participate.
(2) The medical foster home caregiver must demonstrate the ability
to evacuate all occupants within three minutes to a point of safety
outside of the medical foster home that has access to a public way, as
defined in NFPA 101 (incorporated by reference, see Sec. 17.1).
(3) If all occupants are not evacuated within three minutes or if a
veteran resident is either permanently or temporarily unable to
participate in drills, then the medical foster home will be given a 60-
day provisional approval, after which time the home must have
established one of the following remedial options or VA will terminate
the approval in accordance with Sec. 17.65.
(i) The home is protected throughout with an automatic sprinkler
system in accordance with section 9.7 of NFPA 101 (incorporated by
reference, see Sec. 17.1) and whichever of the following apply: NFPA
13 (incorporated by reference, see Sec. 17.1); NFPA 13R (incorporated
by reference, see Sec. 17.1); or NFPA 13D (incorporated by reference,
see Sec. 17.1).
(ii) Each veteran resident who is permanently or temporarily unable
to participate in a drill or who fails to evacuate within three minutes
must have a bedroom located at the ground level with direct access to
the exterior of the home that does not require travel through any other
portion of the residence, and access to the ground level must meet the
requirements of the Americans with Disabilities Act. The medical foster
home caregiver's bedroom must also be on ground level.
(4) The 60-day provisional approval under paragraph (p)(3) of this
section may be contingent upon increased fire prevention measures,
including but not limited to prohibiting smoking or use of a fireplace.
However, each veteran resident who is temporarily unable to participate
in a drill will be permitted to be excused from up to two drills within
one 12-month period, provided that the two excused drills are not
consecutive, and this will not be a cause for VA to not approve the
home.
(5) For purposes of paragraph (p), the term all occupants means
every person in the home at the time of the emergency egress and
relocation drill, including non-residents.
(q) Records of compliance with this section. The medical foster
home must comply with Sec. 17.63(i) regarding facility records, and
must document all inspection, testing, drills and maintenance
activities required by this section. Such documentation must be
maintained for 3 years or for the period specified by the applicable
NFPA standard, whichever is longer. Documentation of emergency egress
and relocation drills must include the date, time of day, length of
time to evacuate the home, the name of each medical foster home
caregiver who participated, the name of each resident, whether the
resident participated, and whether the resident required assistance.
(r) Local permits and emergency response. Where applicable, a
permit or license must be obtained for occupancy or business by the
medical foster home caregiver from the local building or business
authority. When there is a home occupant who is incapable of self-
preservation, the local fire department or response agency must be
notified by the medical foster home within 7 days of the beginning of
the occupant's residency.
(s) Equivalencies. Any equivalencies to VA requirements must be in
[[Page 5191]]
accordance with section 1.4.3 of NFPA 101 (incorporated by reference,
see Sec. 17.1), and must be approved in writing by the appropriate
Veterans Health Administration, Veterans Integrated Service Network
(VISN) Director. A veteran living in a medical foster home when the
equivalency is granted or who is placed there after it is granted must
be notified in writing of the equivalencies and that he or she must be
willing to accept such equivalencies. The notice must describe the
exact nature of the equivalency, the requirements of this section with
which the medical foster home is unable to comply, and explain why the
VISN Director deemed the equivalency necessary. Only equivalencies that
the VISN Director determines do not pose a risk to the health or safety
of the veteran may be granted. Also, equivalencies may only be granted
when technical requirements of this section cannot be complied with
absent undue expense, there is no other nearby home which can serve as
an adequate alternative, and the equivalency is in the best interest of
the veteran.
(t) Cost of medical foster homes. (1) Payment for the charges to
veterans for the cost of medical foster home care is not the
responsibility of the United States Government.
(2) The resident or an authorized personal representative and a
representative of the medical foster home facility must agree upon the
charge and payment procedures for medical foster home care.
(3) The charges for medical foster home care must be comparable to
prices charged by other assisted living and nursing home facilities in
the area based on the veteran's changing care needs and local
availability of medical foster homes. (The Office of Management and
Budget has approved the information collection requirements in this
section under control number 2900-0777.)
(Authority: 38 U.S.C. 501, 1730)
[FR Doc. 2012-2063 Filed 2-1-12; 8:45 am]
BILLING CODE 8320-01-P
