Comptroller General Brown to the Administrator of Veterans' Affairs, November 29, 1939: Consideration has been given your letter of October 30, 1939, as follows: "In connection with the payment of Federal aid to States for the care of veterans in State homes, the question has arisen as to whether a State is entitled to Federal aid under Public No. 250, 76th Congress, for hospitalization furnished a veteran suffering from a non-service connected disability, who is not eligible under existing Veterans' Administration regulations for domiciliary care but is eligible under such regulations for hospitalization in Veterans' Administration facilities if beds are available. "Under existing law (Public, No. 312, 74th Congress) and regulations (Regulations and Procedure, Veterans' Administration. Paragraphs R-6047 and R-6048), the Veterans' Administration is authorized to furnish, within the limits of existing Veterans' Administration facilities, hosptalization to veterans suffering from a disability, disease or defect which, being susceptible to cure or decided improvement, indicates need for hospital care (as for example, veterans suffering from reparable hernia, chronic appendicitis, acute tonsilitis, etc.), and domiciliary care to veterans suffering from disability, disease or defect which, being essentially chronic in type and not susceptible of cure or decided improvement by hosiptal care, is producing disablement of such degree and of such probable persistency as will incapacitate from earning a living for a prospective period and thereby indicates need for domiciliary care. "Public No. 250, 76th Congress, approved August 1, 1939, which is an act "To increase the amount of Federal aid to State or Territorial homes for the support of disabled soldiers and sailors of the United States,' provide: "That the act entitled 'An Act to provide aid to States or Territorial homes for the support of disabled soldiers and sailors of the United States,' approved August 27, 1888, as amended (U.S.C., 1934 edition, title 24, sec. 134), is amended by striking out in the first paragraph thereof '$120 per annum' and inserting in lieu thereof $240 per annum.' 66 SEC. 2. The amendment made by this act shall apply to payments with respect to the care given to disabled soldiers and sailors on and after the first day of the month next following the month during which this act is enacted: Provided, That said payments shall be made regardless of whether said veteran may be receiving domiciliary care or hospitalization in said home and the appropriations of the Veterans' Administration for medical, hospital, and domiciliary care shall be available for this purpose: Provided further, That no payment to a State or Territory under this act shall be made for any period prior to the date upon which the Administrator of Veterans' Affairs determines that the veteran on whose account such payment is requested is eligible for such care in a Veterans' Administration facility.' "The Regulations and Procedure of the Veterans' Administration in effect prior to the enactment of this law contained the following provision : 66 6 "'(C) Federal aid payments will be made to States in behalf of veterans cared for in State Homes who are eligible for domiciliary care in Veterans Administration facilities. Federal aid payments will not be made to States in behalf of veterans who are receiving hospitalization as distinct from domiciliary care in a State Home.' (Regulations and Procedure, Veterans' Administration, Paragraph 7883.) "The above quoted provision of Regulations and Procedure is based on the provsion contained in the annual appropriation acts applicable to the Veterans' Administration since the 1935 Appropriation Act, which read in part as follows: "Provided further, That this appropriation shall be available for continuing aid to State or Territorial homes for the support of disabled volunteer soldiers and sailors, in conformity with the act approved August 27, 1888 (U. S. C., title 24, sec. 134), as amended, for those veterans eligible for admission to Veterans' Administration faciilties for domiciliary care ***' "Prior to the enactment of the 1935 Appropriation Act the annual appropriations provided that they should be available for continuing aid to State or Territorial homes for the support of disabled volunteer soldiers and sailors in conformity with the act of August 27, 1888, as amended, 'including all classes of veterans admissible to the Veterans' Administration Homes. "In explaining the change in the 1935 Appropriation Act to the subcommittee of the House Committee on Appropriations in charge of the Independent Offices Appropriation Bill for 1935, it was stated: 666* ** The second change is the deletion of the words, "including all classes of veterans admissible to the Veterans' Administration homes": and substituting the language, "for those veterans eligible for admission to Veterans' Administration facilities for domiciliary care": so as to distinguish definitely that only domiciliary cases may be cared for in State homes at the expense of the Government. ** *' (P. 249, Report of Hearings before subcommittee of House Committee on Appropriations in charge of Independent Offices Appropriation Bill for 1935, 73d Cong., 2d Sess.) "It is being contended that the language of section 2, Public No. 250, supra, authorizes the payment of Federal aid to State homes for the hospitalization of veterans, even though such veterans are not eligible for domiciliary care. It is my understanding that the reference to hospitalization in Public No. 250, 76th Congress, refers only to those cases having entitlement to domiciliary care but who because of their physical condition must be cared for in the hospital part of a home; this because the purpose of the Bill, as stated in the title, was 'To increase the amount of Federal aid to State or Territorial homes for the support of disabled soldiers and sailors of the United States," and secondly, because it would be a major reversal of policy and contrary to that announced in the basic law for Federal aid to be extended to State homes in cases in which there existed no eligibility to domiciliary care from the Federal Government. I do not believe it was intended to change the general policy by the above referred to act, which, if construed in a manner as has been suggested, would create the anomalous situation of allowing veterans not eligible for domiciliary care to be hospitalized in State homes on the one hand when, on the other hand, the Veterans' Administration is precluded, except under circumstances not here material, from contracting with State hospitals for the care of the very class of veterans whom it is sought to read into the Act of August 1, 1939. To interpret this act as broadening hospital rights would completely nullify the limitations in Public No. 312, 74th Congress, and would allow the accomplishment of something indirectly which could not be done directly. "Inasmuch as the question deals with the expenditure of appropriated funds, I respectfully request your decision as to whether the appropriation to the Veterans' Administration as afore referred to is available to pay Federal aid to State homes under Public No. 250, 76th Congress, for hospital care and treatment furnished veterans suffering from non-service connected disabilities who are not eligible for domiciliary care under existing law and regulations, since, as indicated above, the Veterans' Administration is limited in furnishing hospitalization in this type of cases to available Veterans' Administration facilities." The act of August 27, 1888, 25 Stat. 450, which was amended by the recent act quoted in your letter, appears with its previous amendments in 24 U. S. C. 134, 1934 edition, as follows: "Aid to State or Territorial homes. All States or Territories which have established, or which shall establish, State homes for disabled soldiers and sailors of the United States who served in the Civil War or in any previous or subsequent war who are disabled by age, disease, or otherwise, and by reason of such disability are incapable of earning a living, provided such disability was not incurred in service against the United States, shall be paid for every such disabled soldier or sailor who may be admitted and cared for in such home at the rate of $120 per annum. "The number of such persons for whose care any State or Territory shall receive the said payment under this section shall be ascertained by the Administrator of Veterans' Affairs under such regulations as it many prescribe, but the said State or Territorial homes shall be exclusively under the control of the respective State or Territorial authorities, and the Administrator shall not have nor assume any management or control of said State or Territorial homes. "The Administrator of Veterans' Affairs shall, however, have power to have the said State or Territorial homes inspected at such times as it may consider necessary, and shall report the result of such inspections to Congress in its annual report: Provided, That no State shall be paid a sum exceeding one-half the cost of maintenance of each soldier or sailor by such State: Provided further, That one-half of any sum or sums retained by State homes on account of pensions received from inmates shall be deducted from the aid provided for in this section. No money shall be apportioned to any State or Territorial home that maintains a bar or canteen where intoxicating liquors are sold: Provided further, That for any sum or sums collected in any manner from inmates of such State or Territorial homes to be used for the support of said homes a like amount shall be deducted from the aid provided for in this section, but this proviso shall not apply to any State or Territorial home into which the wives or widows of soldiers are admitted and maintained." The amending act of August 1, 1939, 53 Stat. 1145, increases prospectively the amount payable to the States for the care of each disabled soldier or sailor, and incorporates two new provisions, reading as follows: "*** Provided, That said payments shall be made regardless of whether said veteran may be receiving domiciliary care or hospitalization in said home and the appropriations of the Veterans' Administration for medical, hospital, and domiciliary care shall be available for this purpose: Provided further, That no payment to a State or Territory under this Act shall be made for any period prior to the date upon which the Administrator of Veterans' Affairs determines that the veteran on whose account such payment is requested is eligible for such care in a Veterans' Administration facility." The question is whether either or both of the quoted provisos were intended to modify or qualify the proviso appearing in the annual appropriation acts which hitherto has limited these payments to States to cases of veterans who would be eligible for domiciliary care in Veterans' Adminstration facilities. It will be observed that under the provisions last above quoted, the payments are to be required for either "domiciliary care or hospitalization," the appropriations for "medical, hospital, and domiciliary care" are specifically made available, and the payments are conditioned upon your finding that the veterans are "eligible for such care in a Veterans' Administration facility." The language of the two provisos is too plain to admit of construction and clearly provides that eligibility of a veteran for either domiciliary or hospital care entitles a State to the payments provided for his care. Any doubt there might be in the matter would appear to be resolved by reference to the legislative history of the bill. H.R. 4647. The two provisos in question were added to the House bill by Senate amendment—a fact which may account for the failure of the title to reflect their purpose and it must be assumed the Congress was fully aware of the former limitations restricting aid to cases eligible for domiciliary care. See Senate Report No. 705, 76th Congress, 1st Session-particularly pages 7 and 8. It was understood and explained that the Senate Amendments would effect a change in the existing Veterans' Administration regulations. See Congressional Record (Semi-mo. Ed.), 76th Congress, 1st Session, at page 13500. While, as you state, it is evident that payments to States will be required for a type of care which may not be obtained by contract, it will be noted that an alternate proposal to obtain this service solely by contract was made, but not approved. Senate Report, supra, at page 6 There has been carefully considered the suggestion that the reference to hospitalization was for the purpose of including persons entitled to domiciliary care but actually receiving hospitalization. But since the appropriation acts theretofore required only that the veterans be "eligible for admission to Veterans' Administration facilities for domiciliary care," it would appear that such persons as referred to by you who were receiving State care were already entitled to Government aid. Furthermore, it is quite evident that the language of the first proviso in question was derived from the nearly identical wording of an amendment proposed to the companion bill, S. 1325. In commenting upon the latter proposed amendment, the Veterans' Administration expressed the view that the enactment of such amendment would materially modify the existing procedure under which no payments are made for State hospitalization as distinguished from domiciliary care (Sen. Rep. supra, p. 7). It appears the procedure was so modified by the adoption of the substance of that amendment as a part of the act of August 1, 1939. For the reasons herein stated, the question presented in the concluding paragraph of your letter is answered in the affirmative, subject, of course, to the limitations contained in the second proviso of the act of August 1, 1939. |