State Veterans' Homes--Opportunities To Reduce VA and State Costs and Improve Program Management
HRD-82-7
Published: Oct 22, 1981. Publicly Released: Nov 23, 1981.
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Highlights
State homes provide hospital, nursing home, and domiciliary care to needy, disabled veterans. The Veterans Administration (VA) helps states defray the costs of operating and constructing state homes through per diem payments and construction grants. GAO reviewed the state home program to find out if: (1) VA was effectively administering the program; (2) if the method used to help states pay for the care provided should be changed; and (3) the homes were capable of providing quality care.
Recommendations
Matter for Congressional Consideration
| Matter | Status | Comments |
|---|---|---|
| Congress should consider amending 38 U.S.C. 3203 to extend the pension reduction criteria to cover care being furnished in state homes and to authorize VA to transfer the money withheld to the states to help pay for the veterans' care. |
Closed – Not Implemented
|
Although Congress may amend 38 U.S.C. 3203 in the future, its action would be based on more current information than the 1981 GAO report. |
| In any deliberations on legislative proposals to change the reimbursement method to increase VA funding, Congress should consider the extent to which the states are taking advantage of the alternative sources of revenue identified by GAO. |
Closed – Implemented
|
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information. |
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Veterans Administration | The Administrator of Veterans Affairs, through the Chief Medical Director, should determine the need for state home construction projects before approving their construction. |
Closed – Implemented
Construction requests were coordinated with internal planning.
|
| Veterans Administration | The Administrator of Veterans Affairs, through the Chief Medical Director, should establish, in coordination with state and local planning agencies, and the National Association of State Veterans Homes, more realistic medical district plans for the construction and/or use of VA, community, and state nursing homes to provide care to veterans. |
Closed – Implemented
Planning will include recommended coordination and will be included in the 5-year plan.
|
| Veterans Administration | The Administrator of Veterans Affairs, through the Chief Medical Director, should encourage state homes to collect from veterans receiving pensions an amount equal to the reduction that would occur if the veterans obtained care in a VA facility. |
Closed – Implemented
VA recommended this action in a letter to the National Association of State Veterans Homes.
|
| Veterans Administration | The Administrator of Veterans Affairs, through the Chief Medical Director, should follow up on inspection reports to ensure that compliance with all standards is assessed. |
Closed – Implemented
VA made this a part of its annual review process.
|
| Veterans Administration | The Administrator of Veterans Affairs, through the Chief Medical Director, should revise state home standards to provide specificity and guidance, such as that provided in the Joint Commission on Accreditation of Hospitals and Department of Health and Human Services (HHS) standards. |
Closed – Implemented
Standards were published on October 1, 1984.
|
| Veterans Administration | The Administrator of Veterans Affairs, through the Chief Medical Director, should develop standards on surgical care and related services as part of the state home hospital standards. |
Closed – Not Implemented
Legislation was introduced which could eliminate hospital care from the state home program. VA has no further plans to develop surgical standards.
|
| Veterans Administration | The Administrator of Veterans Affairs, through the Chief Medical Director, should encourage state homes to convert hospital beds, other than those needed to meet the short-term acute-care needs of home patients, to nursing home beds. |
Closed – Not Implemented
VA plans no action to implement this recommendation. It feels that the limited hospital per diem discourages state homes from operating hospital beds.
|
| Veterans Administration | The Administrator of Veterans Affairs, through the Chief Medical Director, should direct VA medical centers that are clinics of jurisdiction for the state home program to review the appropriateness of the per diem rates paid for veterans already in state homes and adjust per diem payments as necessary. The appropriateness of per diem rates should be determined by a VA physician using the level of care definitions in the state home manual. |
Closed – Implemented
A circular was issued on June 28, 1982.
|
| Veterans Administration | The Administrator of Veterans Affairs, through the Chief Medical Director, should inform VA physicians of their options to request additional data from the state home to justify the requested level of care and to authorize payment of per diem at a rate other than that requested. |
Closed – Implemented
VA addressed this in a conference call to all medical center directors.
|
| Veterans Administration | The Administrator of Veterans Affairs, through the Chief Medical Director, should reemphasize to VA physicians the importance of independently verifying the needed level of care of veterans admitted to state homes. |
Closed – Implemented
VA addressed this in a conference call to all medical center directors and in a Geriatrics and Extended Care letter.
|
| Veterans Administration | The Administrator of Veterans Affairs, through the Chief Medical Director, should direct VA physicians to approve payment of the hospital per diem rate only if the patient needs acute hospital care. |
Closed – Not Implemented
Congress changed the per diem reimbursement for hospital care, making it less than the reimbursement for nonacute nursing home care.
|
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Topics
Construction costsstate relationsHealth care costsHealth care servicesHealth insurance cost controlMonitoringPlanningProposed legislationVeterans hospitalsVeterans pensions