[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]
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DEPARTMENT OF VETERANS AFFAIRS
38 CFR Part 17
RIN 2900-AN80
Medical Foster Homes
AGENCY: Department of Veterans Affairs.
ACTION: Final rule.
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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