Notice2026-00380
Implementation of Section 120 of the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
January 12, 2026
Effective
September 11, 2025
Issuing agencies
Veterans Affairs Department
Abstract
This notice informs the public of the Department of Veterans Affairs (VA) implementation of section 120 of the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act, which allows VA to increase the expenditure cap for non-institutional care alternatives for eligible veterans.
Full Text
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<title>Federal Register, Volume 91 Issue 7 (Monday, January 12, 2026)</title>
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[Federal Register Volume 91, Number 7 (Monday, January 12, 2026)]
[Notices]
[Pages 1238-1239]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2026-00380]
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DEPARTMENT OF VETERANS AFFAIRS
[Docket No. VA-2026-VACO-0002]
Implementation of Section 120 of the Senator Elizabeth Dole 21st
Century Veterans Healthcare and Benefits Improvement Act
AGENCY: Department of Veterans Affairs.
ACTION: Notification of sub-regulatory guidance.
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SUMMARY: This notice informs the public of the Department of Veterans
Affairs (VA) implementation of section 120 of the Senator Elizabeth
Dole 21st Century Veterans Healthcare and Benefits Improvement Act,
which allows VA to increase the expenditure cap for non-institutional
care alternatives for eligible veterans.
DATES: This guidance is effective on September 11, 2025.
FOR FURTHER INFORMATION CONTACT: Daniel Schoeps, Director, Purchased
Long Term Services and Supports, Office of Geriatrics and Extended
Care, Veterans Health Administration, (202) 461-6750.
SUPPLEMENTARY INFORMATION: On January 2, 2025, the President signed
into law the Senator Elizabeth Dole 21st Century Veterans Healthcare
and Benefits Improvement Act (the Act). Public Law 118-210. Section
120(a) of the Act amended 38 U.S.C. 1720C(d), which generally governs
the provision of non-institutional care alternatives for eligible
veterans. Under this amendment, VA may pay up to 100% of the cost that
would otherwise have been incurred by VA during that fiscal year if the
veteran had been furnished, instead, nursing home care under 38 U.S.C.
1710 during that fiscal year. The cost of nursing home care is
established for each Veterans Integrated Service Network based on the
cost of care in a community living center and published each year by
the Office of Geriatrics and Extended Care. Section 120(a) further
amended section 1720C(d) to permit VA to exceed this payment cap for
certain veterans if VA determines, based on a consideration of clinical
need, geographic market factors, and such other matters as VA may
prescribe through regulation, that such higher total cost is in the
best interest of the veteran. Veterans eligible for non-institutional
care costs in excess of the nursing home care rate are those with
amyotrophic lateral sclerosis (ALS), a spinal cord injury, or a
condition VA determines to be similar to such conditions.
Before the amendments made by section 120 of the Act, VA was
limited to paying no more than 65% of the nursing home rate.
Historically, VA has found that a small number of veterans each year
encountered this 65% cap. When veterans reached this cap, they were
required either to assume liability for the cost of their care for the
remainder of the fiscal year or to be admitted for nursing home care.
This sometimes resulted in care disruption, greater stress on veterans
and their families, or both. In VA's experience, the clinical need for
non-institutional care is the sole factor that has resulted in veterans
reaching the prior 65% cap, and the vast majority of those who would
reach this 65% cap would have all of their non-institutional care needs
met for costs less than 100% of the nursing home rate.
VA is informing the public of its approach to implementing four
aspects of these new authorities.
<bullet> Beginning September 11, 2025, VA will pay up to 100% of
the nursing home rate in a fiscal year for all eligible veterans who
need non-institutional care to improve continuity of care and patient
outcomes. VA may pay for non-institutional care constituting Homemaker/
Home Health Aide, Home Respite, Community Adult Day Health Care,
Veteran Directed Care, Skilled Home Health Care, and Program of All-
Inclusive Care for the Elderly.
<bullet> For veterans whose non-institutional care needs exceed
100% of the nursing home rate, VA will approve such additional
expenditures on a case-by-case basis informed by a clinical review of
the veteran's needs. VA anticipates that the only veterans who may
require non-institutional care that would cost more than 100% of the
nursing home rate would be veterans with ALS or spinal cord injuries or
disorders; however, VA will still consider, and may pay costs for non-
institutional care in excess of 100% of the nursing home rate for
veterans who do not have ALS or a spinal cord injury or disorder
because the statute permits VA to do so if the veteran has ``a
condition the Secretary determines to be similar to such conditions.''
See 38 U.S.C. 1720C(d)(2)(B). Veterans whose care needs would exceed
100% of the nursing home rate have a high need for skilled home nursing
care and are often dependent on ventilators to breathe, which is why
their costs for care may be higher. These veterans can still live
safely in their homes, but they do require additional care and services
that can result in higher costs. Remaining in their homes, though, can
improve their quality of life and overall health outcomes as well, so
there is value in keeping these veterans in non-institutional settings.
Such options for care also promote veterans' choice in where to live
and how to receive their care. VA anticipates fewer than 30 veterans in
a fiscal year will require non-institutional care that would result in
costs in excess of 100% of the nursing home rate, and VA will review
these on a case-by-case basis to determine the clinical need for and
appropriateness of additional non-institutional care.
At this time, VA is not exercising its authority to establish
through regulation other matters that VA may consider in exceeding 100%
of the nursing home rate. Should VA do so in the future, it will do so
through rulemaking consistent with the Administrative Procedure Act (5
U.S.C. 553).
<bullet> VA is also not specifically incorporating any additional
geographic market factors in its analysis because the nursing home care
rate already is determined on a regional level and includes
consideration of geographic market factors. Consideration of geographic
market factors through another basis than the calculation of the
nursing home rate or using another metric would be redundant.
This notice provides information on how VA is implementing section
120 of the Act and is not a solicitation for public comment or request
for information regarding VA's implementation of section 120 of the
Act, as outlined above. Therefore, responses to this notice may not be
used to inform VA's implementation of section 120 of the Act, and VA
will not address such responses.
Signing Authority
Douglas A. Collins, Secretary of Veterans Affairs, approved this
document on December 18, 2025 and authorized to sign and submit the
document to the Office of the Federal Register for publication
electronically as
[[Page 1239]]
an official document of the Department of Veterans Affairs.
Nicole R. Cherry,
Alternate Federal Register Liaison Officer, Department of Veterans
Affairs.
[FR Doc. 2026-00380 Filed 1-9-26; 8:45 am]
BILLING CODE 8320-01-P
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</html>Indexed from Federal Register on January 12, 2026.
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