State Home Programs for Veterans (VA Forms 10-5588, 10-5588A, 10-10SH) -- AR61

The information collection under OMB Control Number 2900-0160 includes VA Forms 10-5588, 10-5588A, and 10-10SH and has a current Paperwork Reduction Act (PRA) clearance with an expiration date of 10/31/2026. VHA is implementing a new regulation that will add another element to this information collection. Specifically, the new regulation will allow State homes to submit a list of veteran names to VA for reconsideration of previously denied claims. This will be a time limited opportunity that must occur within 30 days of the effective date of the rule. Authority for this information collection can be found in two public laws affecting State homes: Public Law 115-159, the State Veterans Home Adult Day Health Care Improvement Act of 2017, which requires VA to pay State Veteran Homes (SVHs) for medical model adult day health care provided to certain eligible Veterans; and Public Law 116-315, Section 3007, Waiver of Requirements of Department of Veterans Affairs for Receipt of Per Diem Payments for Domiciliary Care at State Homes and Modification of Eligibility for such Payments. This information collection also enables the payment of per diem to State homes that provide care to eligible Veterans in accordance with Title 38, CFR Part 51. The intended effect of these provisions is to create a safeguard that Veterans are receiving a high quality of care in SVHs. To ensure that high quality care is furnished to Veterans, VA requires those facilities providing nursing home care, domiciliary care, and adult day health care programs to Veterans to supply various kinds of information. The information required includes an application and justification for payment; records and reports that facility management must maintain regarding payment activities of residents or participants; and records and reports that facilities management and health care professionals must maintain regarding eligibility and level of care for residents or participants. The following three forms are included in this information collection: 10-5588, 10-5588A, and 10-10SH. The State Home Per Diem (SHPD) Program made updates to the automated the 10-10SH form to increase functionality and usage. This form was converted into a web-based, fillable form that can be electronically submitted from the SVH to the appropriate VAMC. It includes data field validation, assuring that all required fields have been filled before the user can electronically submit the 10-10SH form. The VA portion of the application also includes business rules to assist the VA representatives in making uniform determinations, allow the VA representative to return incomplete applications to the SVH along with a notification to them, and record the receipt of the completed application.

The latest form for State Home Programs for Veterans (VA Forms 10-5588, 10-5588A, 10-10SH) -- AR61 expires 2027-11-30 and can be found here.

State Home Report and Statement of Federal Aid Claimed

Federal Enterprise Architecture: Health - Health Care Services

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