Per diem for nursing home care of veterans in State homes. Department of Veterans Affairs. Final rule

This document amends regulations regarding the payment of per diem to State homes that provide nursing home care to eligible veterans. The intended effect of the final rule is to ensure that veterans receive high quality care in State homes.     

Per diem payments for the care provided to eligible veterans evacuated from a state home as a result of an emergency. Final rule

The Department of Veterans Affairs (VA) amends its regulations concerning per diem payments to States to permit continuation of such payments in some situations for veterans who have been evacuated from a State home as a result of an emergency. Per diem is the daily rate paid by VA to a State for providing a specified level of care to eligible veterans in a facility that is officially recognized and certified by VA. This final rule authorizes VA to continue to pay per diem when veterans for whom VA is paying per diem are evacuated as a result of an emergency from a State home to a facility that is not recognized by VA as a State home. The rule requires, in order for per diem payments to continue while the veteran is relocated due to an emergency, that an appropriate VA official determine whether an emergency exists and whether the facility to which veterans may be evacuated (evacuation facility) complies with certain minimum standards. The rule establishes the minimum standards that facilities to which veterans are evacuated must meet in order for States to continue receiving per diem for relocated veterans. These standards also apply to evacuation facilities when veterans are evacuated from contract nursing homes.     

Technical revisions to update reference to the required assessment tool for state nursing homes receiving per diem payments from VA. Final rule

This rule updates the reference to the required resident assessment tool for State homes that receive per diem from VA for providing nursing home care to veterans. It requires State nursing homes receiving per diem from VA to use the most recent version of the Centers for Medicare and Medicaid Services (CMS) Resident Assessment Instrument/Minimum Data Set (MDS), which is version 3.0. This will ensure that the standard used to assess veterans is the same as the standard applicable to Medicare and Medicaid beneficiaries.     

Fiscal year 1993 state home per diem rates for domiciliary, nursing home, and hospital care--DVA. Notice of state home program per diem rates for FY 1993

Public Law 100-322, section 134(a)(2) provides for an increase in per diem rates for domiciliary, nursing home, and hospital care in State Veterans Homes. The VA is giving notice of increases for State home per diem for FY 1993 as follows: Domiciliary care--$11.79, nursing home care--$27.61, and hospital care--$27.61.     

VA homeless providers grant and per diem program--VA. Final rule

We are, with changes, adopting as a final rule the provisions of an interim final rule promulgated pursuant to The Homeless Veterans Comprehensive Service Programs Act of 1992. The Act authorizes the Department of Veterans Affairs to assist public or nonprofit private entities in establishing new programs to furnish supportive services and supportive housing for homeless veterans through grants. The Act also authorizes VA to provide per diem payments, or in-kind assistance in lieu of per diem payments, to eligible entities that established programs after November 10, 1992 that provide supportive services or supportive housing for homeless veterans, or service centers providing supportive services. This rule contains criteria and requirements relating to the awarding of grants and relating to per diem payments. Accordingly, this rule is necessary so that grants can be awarded and per diem payments can be made.     

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)--Department of Defense. Notice of revised rates

This notice provides the updated adjusted standardized amounts, DRG relative weights, outlier thresholds, and beneficiary cost-share per diem rates to be used for FY 1992 under the CHAMPUS DRG-based payment system. It also describes the non-regulatory changes made to the CHAMPUS DRG-based payment system in order to conform to changes made to the Medicare Prospective Payment System (PPS).     

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); FY97 DRG updates--DoD. Notice of DRG revised rates

This notice provides the updated adjusted standardized amounts, DRG relative weights, outlier thresholds, and beneficiary cost-share per diem rates to be used for FY 1997 under the CHAMPUS DRG-based payment system. It also describes the changes made to the CHAMPUS DRG-based payment system in order to conform to changes made to the Medicare Prospective Payment System (PPS).     

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); FY96 DRG updates--DoD. Notice of DRG revised rates

This notice provides the updated adjusted standardized amounts, DRG relative weights, outlier thresholds, and beneficiary cost-share per diem rates to be used for FY 1996 under the CHAMPUS DRG-based payment system. It also describes the changes made to the CHAMPUS DRG-based payment system in order to conform to changes made to the Medicare Prospective Payment System (PPS).     

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); FY95 DRG updates--DoD. Notice of DRG revised rates

This notice provides the updated adjusted standardized amounts, DRG relative weights, outlier thresholds, and beneficiary cost-share per diem rates to be used for FY 1995 under the CHAMPUS DRG-based payment system. It also describes the non-regulatory changes made to the CHAMPUS DRG-based payment system in order to conform to changes made to the Medicare Prospective Payment System (PPS).     

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)--DoD. Notice of revised rates

This notice provides the updated adjusted standardized amounts, DRG relative weights, outlier thresholds, and beneficiary cost-share per diem rates to be used for FY 1993 under the CHAMPUS DRG-based payment system. It also describes the non-regulatory changes made to the CHAMPUS DRG-based payment system in order to conform to changes made to the Medicare Prospective Payment System (PPS).     

TRICARE/CHAMPUS; FY98 DRG updates--DoD. Notice of DRG revised rates

This notice provides the updated adjusted standardized amounts, DRG relative weights, outlier thresholds, and beneficiary cost-share per diem rates to be used for FY98 under the TRICARE/CHAMPUS DRG-based payment system. It also describes the changes made to the TRICARE/ CHAMPUS DRG-based payment system in order to conform to changes made to the Medicare Prospective Payment System (PPS).     

A Need for Training: Preparing Juvenile and Family Court Judges on Military‐Related Issues

This brief report presents a study undertaken to better understand the training needs of judicial officers related to military issues. A snowball sample of judicial officers and court‐affiliated stakeholders were asked to identify the most critical training topics regarding military issues in juvenile and family court, as well as rate the importance of 13 potential training topics. The highest rated training topics for judicial officers (N = 129) were the (1) Welfare of spouses and children, (2) Protocols to consider when selecting kinship care for children of deployed parents, (3) Mental and physical health consequences of military service and deployment, (4) Reporting standards regarding Intimate Partner Violence or Family Violence, as well as implications for civil case investigation, and (5) Education support for children of deployed parents. Findings suggest a desire in the field for specific training on a multitude of issues related to serving/veteran men and women, spouses, and dependents. Recommendations for such trainings are discussed.     

Developmental and Validation of The Illustrated Version of The Home Inventory for Dangers and Safety Precautions: Continuing to Address Learning Needs of Parents in Injury Prevention

This paper describes the development and validation of the Home Inventory for Dangers and Safety Precautions – Illustrated Version to be used with parents whose children are at significant risk for home injury. Because illustrations are useful in facilitating learning by parents who have difficulty ensuring child and self home safety, colored illustrations representing 6 home rooms or areas were empirically developed for assessment purposes. The dangers depicted were selected from previous work and represented those associated with the majority of family home injuries. Score-sheets contained dangers and associated precautions administered to 62 referred young parents. Administration and psychometric characteristics were examined; specific hypotheses were tested. Obtained measures of internal consistency for dangers and precautions for all illustrations (except for Stairway) and for totals were satisfactory. Administration was suitable for use with this population. Parents were able to identify approximately half of the depicted dangers while being able to provide a suitable precaution for 40%. Reading comprehension was predictive of danger identification whereas reading recognition was predictive of precautions given. The HIDSP-IV is useful in assessing a parent's knowledge of dangers and precautions from which more individualized home safety instruction can occur.     

TRICARE/CHAMPUS: FY99 DRG updates--DoD. Notice of DRG revised rates

This notice describes the changes made to the TRICARE/CHAMPUS DRG-based payment system in order to conform to changes made to the Medicare Prospective Payment System (PPS). It also provides the updated fixed loss cost outlier threshold, cost-to-charge ratios and the Internet address for accessing the updated adjusted standardized amounts, DRG relative weights, and beneficiary cost-share per diem rates to be used for FY 1999 under the TRICARE/CHAMPUS DRG-based payment system.     

A shot in the arm for the military: consent to immunisation against biological warfare agents

The risk to Britain's Armed Forces from Biological Warfare (BW) is low but without protection their use would be devastating. Available protective measures include immunisation. The Government owes a legal duty of care to Servicemen to provide protection against a range of hazards, including those of BW. The State also owes Servicemen a duty of care to allow free and informed consent or free and informed refusal to medical procedures, including immunisation. However, refusal by key personnel to accept BW immunisation could degrade operational capability. Resolution between these two, potentially conflicting, duties of care may be controversial. To override a soldier's expressed interests would rank society's needs higher than those of the individual. Yet there are circumstances, such as exposure of Servicemen to BW used by an aggressor, where this would be ethically acceptable. The State's interests, combined with the best interests of the Servicemen, provide adequate ethical argument for both occupational immunisation (where it is an entry criterion for the Armed Forces) and mandatory immunisation (where disciplinary action may be taken against the non-compliant). Historically, both approaches have been used for public health immunisations and the legal framework already exists for both.     

Medicare program; schedule of limits for skilled nursing facility inpatient routine service costs--HCFA. Final notice with comment period

This final notice with comment period sets forth an updated schedule of limits on skilled nursing facility routine service costs for which payment may be made under the Medicare program. Section 1888(a) of the Social Security Act requires that for cost reporting periods beginning on or after October 1, 1992, and every two years thereafter, the Secretary update the per diem cost limits for skilled nursing facility routine service costs.     

Medicare program; schedules of limits and prospectively determined payment rates for skilled nursing facility inpatient routine service costs--HCFA. Final notice with comment period

This final notice with comment period sets forth an updated schedule of limits on skilled nursing facility (SNF) routine service costs for which payment may be made under the Medicare program and sets forth an updated schedule of payment rates for low Medicare volume SNFs that elect to receive prospectively determined payment rates for routine service costs. Section 1888(a) of the Social Security Act (the Act) requires that the Secretary update the per diem cost limits for SNF routine service costs for cost reporting periods beginning on or after October 1, 1995, and every 2 years thereafter. In addition, section 1888(d)(4) of the Act requires the Secretary to establish and publish prospectively determined payment rates at least 90 days prior to the beginning of the Federal fiscal year (FY) to which such rates are to be applied.     

Deemed duration of marriage for widows/widowers and removal of restriction on benefits to children of military parents overseas. Final rules

We are issuing these final rules to reflect in our regulations changes to the Social Security Act (the Act) made by two provisions in the Social Security Protection Act of 2004 (SSPA), enacted on March 2, 2004. One provision added a new situation in which the 9-month duration-of-marriage requirement for surviving spouses under title II of the Act is deemed to have been met. The other provision removed a restriction against payment of Supplemental Security Income (SSI) benefits, under title XVI of the Act, to certain blind or disabled children who were not eligible for SSI benefits the month before their military parents reported for duty outside the United States.     

Omnibus Budget Reconciliation Act of 1993--VA. Final rule

This document amends the Department of Veterans Affairs (VA) adjudication regulations to extend the date concerning limitation of pension benefits for veterans and surviving spouses receiving Medicaid-covered nursing home care. This amendment is necessary to conform the regulations to statutory provisions.     

The impact of prospective payment: a multi-dimensional analysis of New Jersey's SHARE program

The SHARE program, which set per diem prospective rates for New Jersey hospitals during the period 1975-1982, is evaluated. Analysis suggests that this program did contain hospital cost increase. However, the program threatened the viability of most inner-city hospitals. Indirect evidence suggests that there was cost-shifting in response to this program, which regulated payment for only Blue Cross and Medicaid patients. Structural features of this program and its successor, the New Jersey DRG program, are analyzed; and implications for the Medicare prospective payment system are examined.