[Federal Register Volume 73, Number 233 (Wednesday, December 3, 2008)]
[Rules and Regulations]
[Pages 73558-73562]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E8-28542]
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DEPARTMENT OF VETERANS AFFAIRS
38 CFR Part 53
RIN 2900-AM26
Assistance to States in Hiring and Retaining Nurses at State
Veterans Homes
AGENCY: Department of Veterans Affairs.
ACTION: Final rule.
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SUMMARY: The Department of Veterans Affairs (VA) hereby establishes a
final rule setting forth a mechanism for States to obtain payments from
VA to assist a State veterans home in the hiring and retention of
nurses for the purpose of reducing nursing shortages at the home. This
rule implements provisions of the Veterans Health Programs Improvement
Act of 2004.
DATES: Effective Date: This final rule is effective January 2, 2009.
FOR FURTHER INFORMATION CONTACT: Jacquelyn Bean, Chief, State Veterans
Home Per Diem Program, at (202) 461-6771, or Christa M. Hojlo, PhD,
Director, State Veterans Home Clinical and Survey Oversight, at (202)
461-6779; Veterans Health Administration (114), Department of Veterans
Affairs, 810 Vermont Avenue, NW., Washington, DC 20420. (These are not
toll-free numbers.)
SUPPLEMENTARY INFORMATION: In a document published in the Federal
Register (73 FR 19785) on April 11, 2008, we proposed to establish a
new 38 CFR part 53 consisting of regulations captioned ``PAYMENTS TO
STATES FOR PROGRAMS TO PROMOTE THE HIRING AND RETENTION OF NURSES AT
STATE VETERANS HOMES'' (referred to below as the proposed regulations).
This document adopts as a final rule, with changes discussed below,
those proposed regulations. This final rule sets forth a mechanism and
criteria for a State to obtain payments from VA to assist a State
Veterans Home (SVH) in the hiring and retention of nurses for the
purpose of reducing nursing shortages at that home. The final rule
establishes regulations concerning provisions in section 201 of the
Veterans Health Programs Improvement Act of 2004 (Pub. L. 108-422),
which are codified at 38 U.S.C. 1744.
We provided a 60-day comment period that ended June 10, 2008. We
received four submissions containing a number of comments that are all
discussed below.
Definition of Nurse
The proposed regulations at Sec. 53.02 defined the term ``nurse''
to include only those who are bedside care givers at least a majority
of the time. Consequently, the proposed regulations would allow
payments only to promote the hiring and retention of those nurses
licensed or certified, as described in the proposed definition, and who
are bedside care givers at least a majority of the time. In support of
this definition, the proposed rule noted that the applicable
legislative history (H. Rep. No. 108-538 at 5 (2004)) indicates that
the statutory provisions were intended to assist State homes ``in
hiring nurses to care for veterans.'' Two commenters asserted that VA
has misinterpreted 38 U.S.C. 1744 and its legislative history. With
respect to the statute, the comments specifically discussed paragraphs
(a) and (b), and the final sentence of paragraph (c), which states that
when prescribing criteria for programs to be funded, the Secretary
shall ``take into consideration the need for flexibility and
innovation.'' They asserted that the proposed definition of nurse
should be changed to remove its restriction to those who are bedside
care givers at least a majority of the time, and should not generally
exclude such individuals as those acting in the capacity of an advance
practice nurse, an administrative nurse, or a director of nursing. We
made no changes based on these comments.
Even if the statute and its legislative history are viewed as
permitting VA to establish a more expansive definition of the term
``nurse'' than we proposed, we do not agree with the commenters'
argument that the proposed definition is not a permissible one under
the statute. The provisions of 38 U.S.C. 1744(c) and (j) authorize VA
to establish criteria for the award of payments and we believe that VA
therefore has authority for the provisions in the proposed rule that,
through the definition of ``nurse,'' limit the nurses for whom VA
assistance may be provided. The greatest need for nurses is for those
who are bedside care givers at least a majority of the time and we have
determined that we can best use the available funding for recruiting
and retaining such nurses. In establishing criteria for programs to be
awarded payments, the need for flexibility and innovation is not the
only permissible consideration. Our consideration of the need for
flexibility and innovation has been reflected in the preambles and text
of the proposed rule and of this final rule.
Credible Evidence
The provisions of proposed Sec. 53.11(a)(3) would require, as a
condition of receiving assistance, that the State applicant document by
credible evidence that an individual SVH has a nursing shortage. One
commenter raised a number of issues regarding the submission of such
evidence.
The commenter questioned whether a State applicant would
necessarily have to provide an application for each
[[Page 73559]]
individual SVH within the State or whether general documentation could
be used for groups of SVHs within the State. We made no changes based
on this comment. The provisions of 38 U.S.C. 1744(e) require that
documentation be provided for each SVH (``Any such application shall
describe the nursing shortage at the State home. * * *'')
The commenter asserted that general criteria that set thresholds
for defining a nursing shortage would be preferable to the proposed
rule's provisions in Sec. 53.11 for documentation of a nursing
shortage, and that any SVH meeting the criteria should be able to
submit an application. We made no changes based on this comment as each
SVH could have a distinct factual scenario that would be subjected to
specific criteria in Sec. 53.11.
The commenter asked, what is the acceptable standard for ``credible
evidence;'' and further questioned whether the States would need to
hire an independent consultant to prepare their submission. We made no
changes based on these comments. The proposed regulations at Sec.
53.11(a)(3) provided a list of types of evidence that could be
submitted to establish a nursing shortage, i.e., ``including but not
limited to SVH records showing nursing vacancies, SVH records showing
nurse overtime use, and reports documenting that nurses are difficult
to hire in the local area and difficult to retain as employees at the
SVH.'' A State could certainly choose to utilize consultants to gain
information, but this is not a requirement.
Programs With No Experience
The provisions of proposed Sec. 53.11(a)(5) would require, as a
condition of receiving assistance, that the SVH submit documentation
establishing that it has an employee incentive program that (i) is
likely to be effective in promoting the hiring and retention of nurses
for the purpose of reducing nursing shortages at that home, and (ii) is
in operation or ready for immediate implementation upon receipt of
payments. One commenter asked what evidence would be necessary to show
likely effectiveness of a new program for which there is no experience
upon which to document success. We made no changes based on this
comment. To determine whether this condition has been satisfied, we
would review all relevant information provided, including information
about the program's design and the applicant's description of how the
program would eliminate the nursing shortage, as well as how long it
would take to do so. We would also use similar experiences with other
programs and apply our expertise to analyze such programs in
determining whether they are likely to be effective.
Existing Projects
One commenter interpreted the term ``improvements to working
conditions'' in proposed Sec. 53.11(b) to permit an employee incentive
project to improve ``working areas.'' The commenter asked whether a
project to improve working areas could qualify under a State home
construction grant and also qualify for payment under the hiring and
retention program. The commenter also asked whether such projects would
be reviewed in a manner similar to that used for SVH construction
grants. The statutory authority for the nurse hiring and retention
program does not contemplate providing funds for construction projects.
In addition, VA already has separate statutory authority that permits
funding projects to remodel or alter working areas, under 38 U.S.C.
8131-8137. We interpret these statutory authorities to require that
State applications for VA funding of all such construction projects be
submitted under the State home construction grant program. Based on
this comment, the final rule makes changes from the proposed regulation
in Sec. 53.11(a) by adding a new paragraph, Sec. 53.11(a)(10), to
provide that payments will not be made for projects that involve
constructing, acquiring, expanding, remodeling, or altering State
homes.
Funding Projects
One commenter asserted that ``the proposed program is looking at a
three-year window for an incentive program to be successful with
funding coming on an annual basis'' and suggested that VA provide
assurance that, if appropriations are made by Congress, VA would not
for other reasons refrain from continuing to fund a program that would
take 3 years to complete. We made no changes based on this comment. VA
needs to be able consider other factors in addition to appropriations
in determining whether to again fund a particular program.
Eliminating Nurse Shortages Within 3 Years
Under the provisions of proposed Sec. 53.11(a)(7), as a condition
of receiving assistance the SVH program must ``insofar as possible'' be
designed to eliminate any nursing shortage at the SVH within a 3-year
period from the initiation of VA payments. One commenter asserted that
``the requirement to put a plan in place that will eliminate all
nursing shortages in 3 years is not feasible.'' We made no changes
based on this comment. We note that this was not an absolute since the
text included the language ``insofar as possible.'' It certainly may
not always be possible to eliminate a nursing shortage within this 3-
year period, but we believe that such plans should, insofar as
possible, be designed in accordance with this 3-year target.
Student Forgiveness Programs
The proposed regulations at Sec. 53.11(b) stated that VA intends
to allow flexibility and innovation in determining the types of
employee incentive programs at SVHs eligible for payments. This
paragraph further stated that programs could include such things as the
provision of short-term scholarships for continuing nursing education,
sign-on bonuses for nurses, and improvements to working conditions. One
commenter asserted that the regulations should specifically state that
the regulations allow student forgiveness programs. We agree that the
student forgiveness programs could effectively help eliminate nursing
shortages and in the final rule we are adding it to the list of
examples.
Application Submissions
Under the provisions of proposed Sec. 53.20(a), applications must
be submitted during the first quarter of the fiscal year in which VA
payments are sought. One commenter asserted that the application window
should be changed to the last quarter of the preceding Federal Fiscal
Year (FFY) so that approved expenditures can begin with the start of
the FFY in which funds are to be expended. We agree with the suggested
change and the rationale for the change. In the final rule, we changed
the provisions of Sec. 53.20(a), and a related reference to that
quarter in Sec. 53.20(c), accordingly. We have also added ``Federal''
in this section and elsewhere to clarify references to ``fiscal year''.
Insufficient Information
Under the provisions of proposed Sec. 53.20(c), if an application
does not contain sufficient information, VA would notify the State
representative in writing that the State has 30 calendar days from the
date of the notice to submit such additional information or no further
action would be taken. These provisions also contain a mechanism for
extending the 30-day period based on good cause. One commenter asserted
that the time might be sufficient if the notice was provided
electronically but it may not be sufficient if provided by mail. We are
making a change in the
[[Page 73560]]
final rule in Sec. 53.20(c) to specify that such notice be given ``in
writing (electronically and by mail).'' We agree with the commenter
that it would be appropriate to provide electronic notice and that this
would enable the SVH to have more time to reply. We agree for the
reason stated by the commenter and have made appropriate changes to
Sec. 53.20(c). The commenter also asserted that there should be
provision to allow an extension beyond the 30 days if the information
required by VA will take longer than 30 days to obtain and submit. We
made no changes based on this comment. The proposed regulations at
Sec. 53.20(c) already would provide for extensions based on good
cause.
Nurse Training Costs; Nurses From Other Countries
One commenter asked why we are ``allowing the situation with the
very high tuition for nursing school to go unchanged'' and asserted
that if nurses were trained on the job at hospitals the market could be
flooded with nurses. The commenter also indicated her opposition to
``importing nurses from other countries.'' We made no changes based on
this comment. The substance of the comment is outside the scope of our
authority for this rulemaking proceeding. However, we note that the
final rule does make a change to list student forgiveness programs as
one of the types of incentives permitted.
The final rule also differs from the proposed rule by adding
parentheticals displaying the information collection control number
assigned by the Office of Management and Budget (OMB) following the
sections that contain information collection provisions. In addition,
the final rule differs from the proposed rule due by making
nonsubstantive clarifying or technical changes.
Based on the rationale in the proposed rule and in this document,
the provisions of the proposed rule are adopted as a final rule with
changes discussed in this preamble.
Executive Order 12866
Executive Order 12866 directs agencies to assess all costs and
benefits of available regulatory alternatives, and when regulation is
necessary, to select regulatory approaches that maximize net benefits
(including potential economic, environmental, public health and safety,
and other advantages; distributive impacts; and equity). The Executive
Order classifies a regulatory action as a ``significant regulatory
action,'' requiring review by OMB unless OMB waives such review, if it
is a regulatory action that is likely to result in a rule that may: (1)
Have an annual effect on the economy of $100 million or more or
adversely affect in a material way the economy, a sector of the
economy, productivity, competition, jobs, the environment, public
health or safety, or State, local, or tribal governments or
communities; (2) create a serious inconsistency or otherwise interfere
with an action taken or planned by another agency; (3) materially alter
the budgetary impact of entitlements, grants, user fees, or loan
programs or the rights and obligations of recipients thereof; or (4)
raise novel legal or policy issues arising out of legal mandates, the
President's priorities, or the principles set forth in the Executive
Order.
The economic, interagency, budgetary, legal, and policy
implications of this rule have been examined and it has been determined
to be a significant regulatory action under Executive Order 12866.
Unfunded Mandates
The Unfunded Mandates Reform Act requires, at 2 U.S.C. 1532, that
agencies prepare an assessment of anticipated costs and benefits before
issuing any rule that may result in expenditure by State, local, or
tribal governments, in the aggregate, or by the private sector, of $100
million or more (adjusted annually for inflation) in any given year.
This rule would have no such effect on State, local, or tribal
governments, or on the private sector.
Paperwork Reduction Act of 1995
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. Sec. 53.11,
53.20, 53.31, and 53.40 contain 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 notices
published in the Federal Register. Those notices were published on
April 2, 2007 (72 FR 15763), and June 27, 2007 (72 FR 35303). We did
not receive any comments on the proposed collections of information,
which OMB has approved through February 28, 2011, under control number
2900-0709. Following each of those sections in this final rule, we set
out an information collection approval parenthetical displaying OMB
control number 2900-0709.
Regulatory Flexibility Act
The Secretary hereby certifies that this rule would not have a
significant economic impact on a substantial number of small entities
as they are defined in the Regulatory Flexibility Act, 5 U.S.C. 601-
612. The funding for this program would be made by the Federal
government. The amount contributed by a SVH to fund an incentive
program would be an insignificant amount of the costs for operating the
SVH. Therefore, pursuant to 5 U.S.C. 605(b), this 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; and 64.026, Veterans State Adult Day Health Care.
List of Subjects in 38 CFR Part 53
Administrative practice and procedure, Adult day health care,
Alcohol abuse, Alcoholism, Claims, Day care, Dental health, Drug abuse,
Foreign relations, Government contracts, Grant programs--health, Grant
programs--veterans, Health care, Health facilities, Health professions,
Health records, Homeless, Medical and Dental schools, Medical devices,
Medical research, Mental health programs, Nursing homes, Philippines,
Reporting and recordkeeping requirements, Scholarships and fellowships,
Travel and transportation expenses, Veterans.
Approved: September 9, 2008.
Gordon H. Mansfield,
Deputy Secretary of Veterans.
0
For the reasons set forth in the preamble, the Department of Veterans
Affairs amends 38 CFR chapter I by adding part 53 to read as follows:
[[Page 73561]]
PART 53--PAYMENTS TO STATES FOR PROGRAMS TO PROMOTE THE HIRING AND
RETENTION OF NURSES AT STATE VETERANS HOMES
Sec.
53.1 Purpose and scope.
53.2 Definitions.
53.10 Decision makers, notifications, and additional information.
53.11 General requirements for payments.
53.20 Application requirements.
53.30 Payments.
53.31 Annual report.
53.32 Recapture provisions.
53.40 Submissions of information and documents.
53.41 Notification of funding decision.
Authority: 38 U.S.C. 101, 501, 1744.
Sec. 53.1 Purpose and scope.
In accordance with the provisions of 38 U.S.C. 1744, this part sets
forth the mechanism for a State to obtain payments to assist a State
Veterans Home (SVH) in the hiring and retention of nurses for the
purpose of reducing nursing shortages at that SVH.
(Authority: 38 U.S.C. 101, 501, 1744)
Sec. 53.2 Definitions.
For the purpose of this part:
Nurse means an individual who is a registered nurse, a licensed
practical nurse, a licensed vocational nurse, or a nursing assistant
certified in the State in which payment is made and who is a bedside
caregiver at least a majority of the time (e.g., this would generally
not include an individual acting in the capacity of an advance practice
nurse, an administrative nurse, or a director of nursing) (the terms
nurses and nursing shall be construed consistent with this definition).
State means each of the several States, Territories, and
possessions of the United States, the District of Columbia, and the
Commonwealth of Puerto Rico.
State representative means the official designated in accordance
with State authority with responsibility for matters relating to
payments under this part.
State Veterans Home (SVH) means a home approved by the Department
of Veterans Affairs (VA) which a State established primarily for
veterans disabled by age, disease, or otherwise, who by reason of such
disability are incapable of earning a living. A SVH may provide
domiciliary care, nursing home care, adult day health care, and
hospital care. Hospital care may be provided only when the SVH also
provides domiciliary and/or nursing home care.
(Authority: 38 U.S.C. 101, 501, 1744)
Sec. 53.10 Decision makers, notifications, and additional
information.
The Chief Consultant, Geriatrics and Extended Care, will make all
determinations regarding payments under this part, and will provide
written notice to affected State representatives of approvals, denials,
or requests for additional information under this part.
(Authority: 38 U.S.C. 101, 501, 1744)
Sec. 53.11 General requirements for payments.
(a) VA will make payment under this part to a State for an employee
incentive program to reduce the shortage of nurses at the SVH, when the
following conditions are met:
(1) The State representative applies for payment in accordance with
the provisions of Sec. 53.20;
(2) The SVH receives per diem payments from VA under the provisions
of 38 U.S.C. 1741 for one or more of the following: Adult day health
care, domiciliary care, hospital care, or nursing home care;
(3) The SVH has a nursing shortage that is documented by credible
evidence, including but not limited to SVH records showing nursing
vacancies, SVH records showing nurse overtime use, and reports
documenting that nurses are difficult to hire in the local area and
difficult to retain as employees at the SVH;
(4) The SVH does not use payments under this part to pay for all or
part of a nurse's standard employee benefits, such as salary, health
insurance, or retirement plan;
(5) The SVH provides to the Chief Consultant, Geriatrics and
Extended Care, documentation establishing that it has an employee
incentive program that:
(i) Is likely to be effective in promoting the hiring and retention
of nurses for the purpose of reducing nursing shortages at that home,
and
(ii) Is in operation or ready for immediate implementation if VA
payments are made under this part;
(6) The payment amount applied for by the State is no more than 50
percent of the funding for the employee incentive program during the
Federal fiscal year;
(7) The SVH employee incentive program includes a mechanism to
ensure that an individual receiving benefits under the program works at
the SVH as a nurse for a period commensurate with the benefits
provided, and, insofar as possible, the program is designed to
eliminate any nursing shortage at the SVH within a 3-year period from
the initiation of VA payments;
(8) The SVH, if it received payments under this part during a
previous Federal fiscal year, has met the reporting requirements of
Sec. 53.31(a) regarding such payments;
(9) The SVH credits to its employee incentive program any funds
refunded to the SVH by an employee because the employee was in breach
of an agreement for employee assistance funded with payments made under
this part and the SVH credits the amount returned as a non-Federal
funding source; and
(10) The project does not involve the construction, acquisition,
expansion, remodeling or alteration of the SVH.
(b) VA intends to allow flexibility and innovation in determining
the types of employee incentive programs at SVHs eligible for payments.
Programs could include such things as the provision of short-term
scholarships for continuing nursing education, sign-on bonuses for
nurses, student loan forgiveness programs, and improvements to working
conditions. In determining whether an employee incentive program is
likely to be effective, VA will consider any information available,
including past performance of the SVH's program funded by payments made
under this part.
(Authority: 38 U.S.C. 101, 501, 1744)
(The Office of Management and Budget has approved the
information collection provisions in this section under control
number 2900-0709.)
Sec. 53.20 Application requirements.
(a) To apply for payments during a Federal fiscal year, a State
representative must submit to VA, in accordance with Sec. 53.40, a
completed VA Form 10-0430 and documentation specified by the form (VA
Form 10-0430 is available at VA medical centers and on the Internet at
http://www1.va.gov/geriatricsshg/ or may be obtained by contacting the
Geriatrics and Extended Care Office (114) at 202-461-6750, VHA
Headquarters, 810 Vermont Avenue, NW., Washington, DC 20420). The
submission for payments for a fiscal year must be received by VA during
the last quarter (July 1-September 30) of the preceding fiscal year.
The State must submit a new application for each fiscal year that the
State seeks payments for an incentive program.
(b) As part of the application, the State representative must
submit to VA evidence that the State has sufficient funding, when
combined with the VA payments, to fully operate its employee incentive
program through the end of the fiscal year. To meet this requirement,
the State representative must provide to VA a letter from an
[[Page 73562]]
authorized State official certifying that, if VA were to approve
payments under this part, the non-VA share of the funds for the program
would be by a date or dates specified in the certification, available
for the employee incentive program without further State action to make
such funds available. If the certification is based on a State law
authorizing funds for the employee incentive program, a copy of the
State law must be submitted with the certification.
(c) If an application does not contain sufficient information for a
determination under this part, the State representative will be
notified in writing (electronically and by mail) of any additional
submission required and that the State has 30 calendar days from the
date of the notice to submit such additional information or no further
action will be taken. If the State representative does not submit all
of the required information or demonstrate that he or she has good
cause for failing to provide the information within 30 calendar days of
the notice (which may extend beyond the last quarter of the preceding
Federal fiscal year), then the State applicant will be notified in
writing that the application for VA assistance will be deemed withdrawn
and no further action will be taken.
(Authority: 38 U.S.C. 101, 501, 1744)
(The Office of Management and Budget has approved the
information collection provisions in this section under control
number 2900-0709.)
Sec. 53.30 Payments.
(a) The amount of payments awarded under this part during a Federal
fiscal year will be the amount requested by the State and approved by
VA in accordance with this part. Payments may not exceed 50 percent of
the cost of the employee incentive program for that fiscal year and may
not exceed 2 percent of the amount of the total per diem payments
estimated by VA to be made under 38 U.S.C. 1741 to the State for that
SVH during that fiscal year for adult day health care, domiciliary
care, hospital care, and nursing home care.
(b) Payments will be made by lump sum or installment as deemed
appropriate by the Chief Consultant, Geriatrics and Extended Care.
(c) Payments will be made to the State or, if designated by the
State representative, the SVH conducting the employee incentive
program.
(d) Payments made under this part for a specific employee incentive
program shall be used solely for that purpose.
(Authority: 38 U.S.C. 101, 501, 1744)
Sec. 53.31 Annual report.
(a) A State receiving payment under this part shall provide to VA a
report setting forth in detail the use of the funds, including a
descriptive analysis of how effective the employee incentive program
has been in improving nurse staffing in the SVH. The report shall be
provided to VA within 60 days of the close of the Federal fiscal year
(September 30) in which payment was made and shall be subject to audit
by VA.
(b) A State receiving payment under this part shall also prepare
audit reports as required by the Single Audit Act of 1984 (see 38 CFR
part 41) and submit them to VA.
(Authority: 38 U.S.C. 101, 501, 1744)
(The Office of Management and Budget has approved the
information collection provisions in this section under control
number 2900-0709.)
Sec. 53.32 Recapture provisions.
If a State fails to use the funds provided under this part for the
purpose for which payment was made or receives more than is allowed
under this part, the United States shall be entitled to recover from
the State the amount not used for such purpose or the excess amount
received.
(Authority: 38 U.S.C. 101, 501, 1744)
Sec. 53.40 Submissions of information and documents.
All submissions of information and documents required to be
presented to VA must be made to the Chief Consultant, Geriatrics and
Extended Care (114), VHA Headquarters, 810 Vermont Avenue, NW.,
Washington, DC 20420.
(Authority: 38 U.S.C. 101, 501, 1744)
(The Office of Management and Budget has approved the
information collection provisions in this section under control
number 2900-0709.)
Sec. 53.41 Notification of funding decision.
If the Chief Consultant, Geriatrics and Extended Care, determines
that a submission from a State fails to meet the requirements of this
part for funding, the Chief Consultant shall provide written notice of
the decision and the reasons for the decision.
(Authority: 38 U.S.C. 101, 501, 1744)
[FR Doc. E8-28542 Filed 12-2-08; 8:45 am]
BILLING CODE 8320-01-P