[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3122 Introduced in House (IH)]

103d CONGRESS
  1st Session
                                H. R. 3122

 To amend title 38, United States Code, to revise and improve the long-
       term care programs of the Department of Veterans Affairs.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 22, 1993

  Mr. Stump (for himself, Mr. Smith of New Jersey, Mr. Bilirakis, Mr. 
 Hutchinson, and Mr. Linder) introduced the following bill; which was 
             referred to the Committee on Veterans' Affairs

_______________________________________________________________________

                                 A BILL


 
 To amend title 38, United States Code, to revise and improve the long-
       term care programs of the Department of Veterans Affairs.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Veterans' Long-Term Care Act of 
1993''.

SEC. 2. DEFINITION OF LONG-TERM CARE.

    Section 1701 of title 38, United States Code, is amended by adding 
at the end the following:
    ``(10) The term `long-term care' means a continuum of institutional 
and noninstitutional programs and services that provide comprehensive 
restorative care and support services through a time period generally 
exceeding 90 days. Such term includes the following care and services 
authorized to be provided by the Secretary:
            ``(A) Nursing home care.
            ``(B) Domiciliary care.
            ``(C) State home care.
            ``(D) Hospital-based home care.
            ``(E) Adult day health care.
            ``(F) Hospice care.
            ``(G) Respite care.
            ``(H) Social support services.
            ``(I) Non-institutional alternatives pilot program.
            ``(J) Community residential care.
            ``(K) Rehabilitative services.
            ``(L) Care provided through Geriatric Research, Education, 
        and Clinical Centers.
            ``(M) Care provided through Geriatric Evaluation and 
        Management Programs.
            ``(N) Provision of intermediate medicine.
            ``(O) Any other services that the Secretary determines to 
        be needed on a long-term basis.''.

SEC. 3. ELIGIBILITY CRITERIA FOR LONG-TERM CARE.

    (a) In General.--(1) Chapter 17 of title 38, United States Code, is 
amended--
            (A) by redesignating section 1711 as section 1710A; and
            (B) by inserting after such section the following new 
        section 1711:
``Sec. 1711. Eligibility for long-term care
    ``(a) The Secretary shall furnish long-term care which the 
Secretary determines is medically needed--
            ``(1) to any veteran for a service-connected disability;
            ``(2) to any veteran who has a service-connected disability 
        rated at 50 percent or more, for any disability;
            ``(3) to any veteran who is eligible for pension from the 
        Department, for any disability; and
            ``(4) to any veteran for any disability resulting from 
        treatment by the Department.
    ``(b) The Secretary shall furnish long-term care which the 
Secretary determines is medically needed to any veteran enrolled in a 
long-term care coinsurance plan under subsection (f).
    ``(c) Subject to subsection (e), the Secretary shall furnish long-
term care which the Secretary determines is medically needed--
            ``(1) to any veteran who has a service-connected disability 
        rated at less than 50 percent, for any disability;
            ``(2) to any veteran whose annual income (as determined 
        under section 1503 of this title) is less than three times the 
        maximum income amount for eligibility of that veteran for 
        pension, for any disability;
            ``(3) to any veteran who has a catastrophic illness (as 
        determined by the Secretary) resulting from a nonservice-
        connected disability;
            ``(4) to any veteran who is a veterans' continuing care 
        center resident under section 8119 of this title, for treatment 
        provided by the medical center associated with that veterans' 
        continuing care center to obviate the need for institutional 
        care; and
            ``(5) to any veteran who needs such care as a follow-on to 
        hospitalization in a Department medical center, for a period 
        not exceeding six months from the termination of 
        hospitalization.
    ``(d) Subject to subsection (d), the Secretary may furnish long-
term care which the Secretary determines is medically needed to any 
veteran not described in subsection (a), (b), or (c), subject to the 
availability of staff and facilities.
    ``(e)(1) The Secretary may not furnish long-term care under this 
section to a veteran who is eligible for such care under subsection (c) 
or (d) unless the veteran agrees to pay to the United States the 
applicable long-term care copayment prescribed under paragraph (2).
    ``(2) The Secretary shall establish by regulation a schedule of 
long-term care copayments for the purposes of this section. A veteran 
who is furnished long-term care under this section and who is required 
under paragraph (1) to agree to pay a long-term care copayment to the 
United States in order to be furnished such care shall be liable to the 
United States for the amount applicable to that veteran under the 
schedule prescribed under this subsection. In the case of a veteran 
enrolled in the long-term care coinsurance plan under subsection (f), 
copayments may be waived or may be lower than copayments for veterans 
not so enrolled.
    ``(3) A copayment required to be paid under this section may be 
paid by the veteran from any insurance coverage that would be available 
to the veteran if the care for which the payment is required was 
provided in a non-Government facility.
    ``(f)(1) The Secretary shall establish by regulation a long-term 
care coinsurance plan for the purposes of this section. The plan shall 
provide for enrollment of veterans and the assessment and collection of 
premiums from veterans who are enrolled. The Secretary shall determine 
enrollment periods and the requirements for enrollment.
    ``(2) The amount of the premiums under the coinsurance plan shall 
be established by the Secretary taking into consideration the needs of 
veterans and the needs of the Department. The Secretary may establish 
different premiums for veterans based upon such factors as the 
Secretary determines appropriate, including cost-of-living differences 
in different geographic regions and income level of veterans. For 
veterans whose annual income is greater than the maximum income amount 
for eligibility of that veteran for pension, but less than three times 
that amount, the Secretary shall establish a premium scale based upon a 
veteran's ability to pay.
    ``(g)(1)(A) Notwithstanding any condition, limitation, or other 
provision of title XVIII of the Social Security Act, a facility of the 
Department through which long-term care is provided shall be deemed for 
the purposes of this section to be a Medicare participating provider 
with respect to long-term care (as defined in section 1701(9) of this 
title), and when such a facility provides long-term care covered under 
title XVIII of the Social Security Act to a veteran who is entitled to 
benefits under that title, amounts for such care shall be paid to the 
Secretary as a Medicare participating provider, but in accordance with 
rates determined under subparagraph (B).
    ``(B) Reimbursement for long-term care provided under this section 
shall be based upon a methodology which is agreed upon by the Secretary 
and the Secretary of Health and Human Services and which provides (i) 
appropriate flexibility to the directors of the medical facilities to 
take into account local conditions and needs and the actual costs to 
the facility, and (ii) an overall reimbursement applicable to each such 
facility for any fiscal year that is less than the otherwise applicable 
amount that would be allowed under title XVIII of the Social Security 
Act for the care provided.
    ``(2)(A) Notwithstanding any condition, limitation, or other 
provision of title XIX of the Social Security Act, if a facility of the 
Department is providing long-term care to an individual who would be 
entitled to medical assistance under a State plan under such title with 
respect to such care if the care were provided by a qualified medicaid 
participating provider, such facility shall be deemed for the purposes 
of this section to be a qualified medicaid participating provider with 
respect to such care. Amounts for such care shall be paid in accordance 
with rates determined under subparagraph (B).
    ``(B) Reimbursement for long-term care provided under this section 
shall be based upon a methodology which is agreed upon by the Secretary 
and the Secretary of Health and Human Services and which provides (i) 
appropriate flexibility to the directors of the medical facilities to 
take into account local conditions and needs and the actual costs to 
the facility, and (ii) an overall reimbursement applicable to each such 
facility for any fiscal year that is less than the otherwise applicable 
amount that would be allowed under title XIX of the Social Security Act 
for the care provided.
    ``(h) Amounts received by the Secretary under this section as 
premiums or copayments shall be deposited into the Long-Term Care 
Revolving Fund.''.
    (2) The table of sections at the beginning of such chapter is 
amended by striking out the item relating to section 1711 and inserting 
in lieu thereof the following:

``1710A. Care during examinations and in emergencies.
``1711. Eligibility for long-term care.''.
    (3) The Secretary of Veterans Affairs and the Secretary of Health 
and Human Services shall enter into an agreement to establish 
methodologies for medicare and medicaid reimbursement rates under 
subsection (g) of section 1711 of title 38, United States Code, as 
added by paragraph (1), not later than six months after the date of the 
enactment of this Act.
    (b) Conforming Amendments to Section 1710.--Section 1710 of such 
title is amended as follows:
            (1) Subsection (a) is amended--
                    (A) in paragraph (1)(A), by striking out ``, and 
                may furnish nursing home care,'';
                    (B) in paragraph (2), by striking out ``and nursing 
                home care''; and
                    (C) in paragraph (3), by striking out ``and nursing 
                home care'' and ``and may furnish such nursing home 
                care as authorized under section 1720 of this title''.
            (2) Subsection (b) is repealed.
            (3) Subsection (c) is amended by striking out ``or nursing 
        home care'' in the first sentence.
            (4) Subsection (d) is repealed.

SEC. 4. CONTRACTS FOR LONG-TERM CARE.

    (a) In General.--Chapter 17 of title 38, United States Code, is 
amended--
            (1) by redesignating section 1704 as 1705; and
             (2) by inserting after section 1703 the following new 
        section:
``Sec. 1704. Contracts for long-term care in non-Department facilities
    ``(a) In carrying out section 1711 of this title, the Secretary may 
contract for needed long-term care for veterans eligible for long-term 
care under section 1711 of this title when Department facilities are 
geographically inaccessible, lack sufficient capacity, or are otherwise 
not capable of furnishing needed care or when the Secretary determines 
that it would be more economical to contract for such care than to 
provide it through Department facilities. The authority to enter into a 
contract under this section shall be subject to the availability of 
appropriations.
    ``(b) No veteran may be transferred or admitted to any institution 
for long-term care under this chapter unless the institution has been 
determined by the Secretary to meet such standards as the Secretary may 
prescribe. The standards prescribed and any report of inspection of 
institutions furnishing care to veterans under this section made by or 
for the Secretary shall, to the extent possible, be made available to 
all Federal, State, and local agencies charged with the responsibility 
of licensing or otherwise regulating or inspecting such institutions.
    ``(c) In applying the provisions of section 2(b)(1) of the Service 
Contract Act of 1965 (41 U.S.C. 351(b)(1)) with respect to any contract 
entered into under this section to provide long-term care of veterans, 
the payment of wages not less than those specified in section 6(b) of 
the Fair Labor Standards Act of 1938 (29 U.S.C. 206(b)) shall be deemed 
to constitute compliance with such provisions.
    ``(d) In arranging to provide adult day health care and other 
health-related services in noninstitutional settings under section 1711 
of this title, the Secretary may provide in-kind assistance (through 
the services of Department employees and the sharing of other 
Department resources) to a facility furnishing such services to 
veterans under this chapter. Any such in-kind assistance shall be 
provided under a contract between the Secretary and the facility 
concerned. The Secretary may provide such assistance only for use 
solely in the furnishing of adult day health care or other health-
related services and only if, under such contract, the Department 
receives reimbursement for the full cost of such assistance, including 
the cost of services and supplies and normal depreciation and 
amortization of equipment. Such reimbursement may be made by reduction 
in the charges to the United States or by payment to the United States. 
Any funds received through such reimbursement shall be credited to 
funds allotted to the Department facility that provided the 
assistance.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by striking out the item relating to section 
1704 and inserting in lieu thereof the following:

``1704. Contracts for long-term care in non-Department facilities.
``1705. Preventive health services: annual report.''.

SEC. 5. SOCIAL SUPPORT SERVICES.

    (a) In General.--Chapter 17 of title 38, United States Code, is 
amended by inserting after section 1720D the following new section:
``Sec. 1720E. Social support services
    ``As part of a program of long-term care for a veteran, the 
Secretary may provide social support services, including personal care 
and homemaker services, if needed to enable the veteran to reside in 
the home, or another noninstitutional setting, while receiving care 
under section 1710, 1711, or 1712 of this title.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item relating to section 
1720D the following new item:

``1720E. Social support services.''.

SEC. 6. LONG-TERM CARE FACILITIES.

    (a) Veterans' Service Areas.--Chapter 81 of title 38, United States 
Code, is amended by inserting after section 8116 the following new 
sections:
``Sec. 8117. Veterans' service areas for provision of long-term care
    ``(a) The Secretary shall designate geographic areas (to be known 
as `veterans' service areas') throughout the United States as areas in 
which the complete range of long-term care services will be available 
to veterans. Such areas shall be established based on the number of 
veterans in an area and their health needs and on traveltime to various 
facilities.
    ``(b)(1) Not later than six months after the date of the enactment 
of this section, the Secretary shall submit to Congress a report on the 
Secretary's plan for the implementation of this section and the 
provisions of chapter 17 of this title relating to long-term care. The 
Secretary shall set forth in the report the plans of the Secretary for 
ensuring by October 1, 1999, that there is available within each 
service area designated under subsection (a) all of the services 
considered to be long-term care for the purposes of chapter 17 of this 
title and that such services are available in each such area in an 
appropriate balance of services for the needs of veterans in that area.
    ``(2) The Secretary shall use the authority provided in section 
1704 of this title as appropriate to ensure that the plan is fully 
complied with.
    ``(c)(1) The Secretary shall on a regular basis assess the need for 
new long-term care facilities for the Department in each veterans' 
service area. In assessing the need for construction or acquisition of 
new facilities for the Department in any veterans' service area, the 
Secretary shall assess and take into consideration other Government 
facilities in the area and facilities available in the community so as 
to avoid duplication of existing long-term care capacity.
    ``(2) The Secretary shall include the Secretary's findings and 
recommendations under paragraph (1) in each report of the Secretary 
under section 8107 of this title.
    ``(d) The Secretary shall ensure that not less than one-third of 
the amount programmed for major construction projects in the budget of 
the Department for any fiscal year, and not less than one-third of the 
amount obligated for minor construction projects in any fiscal year, 
are for projects and activities relating to long-term care until such 
time as the Secretary determines that the appropriate mix of long-term 
care facilities and services are available in each veterans' service 
area.
``Sec. 8118. Long-term care fund
    ``(a) There is hereby established on the books of the Treasury the 
Veterans' Long-Term Care Fund. The fund shall be administered by the 
Secretary of Veterans Affairs.
    ``(b) Assets of the fund shall consist of amounts deposited in the 
fund pursuant to section 1711 of this title and any amounts that may be 
appropriated to the fund.
    ``(c) The Secretary may use the assets of the fund for the 
provision of long-term care services to veterans and for construction, 
acquisition, and alteration of long-term care facilities (including 
site preparation).
    ``(d) Obligations from the fund may only be made to the extent 
provided in appropriation Acts.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item relating to section 
8116 the following new item:

``8117. Veterans' service areas for provision of long-term care.
``8118. Long-term care fund.''.

SEC. 7. VETERANS' CONTINUING CARE CENTERS.

    (a) Authority To Allow Use of Department Property.--Chapter 81 of 
title 38, United States Code, is amended by inserting after section 
8118 (as added by section 6) the following new section:
``Sec. 8119. Veterans' continuing care centers
    ``(a)(1) The Secretary, using the authority to enter into enhanced-
use leases under section 8162 of this title, may enter into agreements 
to permit the establishment, on property of the Department, of 
residential facilities for veterans. Such agreements may be entered 
into with private sector entities, with entities of State or local 
government, or with other Federal departments or agencies.
    ``(2) Such a facility shall be available as a residence--
            ``(A) for veterans whose requirements for long-term care 
        are such that they would otherwise require nursing home care 
        (or another form of institutional care), with consequent loss 
        of functional independence; and
            ``(B) for veterans with respect to whom the Secretary 
        determines, in any case, that the condition of the veteran is 
        such that the veteran would be most appropriately served in the 
        setting provided by such a facility.
    ``(3) In this section--
            ``(A) a facility established on property of the Department 
        pursuant to this section is referred to as a `veterans' 
        continuing care center';
            ``(B) an agreement under this section for the establishment 
        of such a facility is referred to as a `veterans' continuing 
        care center agreement'; and
            ``(C) an entity with which the Secretary enters into such 
        an agreement is referred to as a `participating entity'.
    ``(4) A veterans' continuing care center agreement shall provide 
for the colocation of the veterans' continuing care center covered by 
the agreement with a Department medical center, outpatient clinic, or 
nursing home.
    ``(b)(1) Each veterans' continuing care center agreement shall 
provide that residence in the veterans' continuing care center covered 
by the agreement shall, subject to space limitations, be available to 
any veteran covered by subsection (a)(2) who meets the financial 
qualification requirements of the participating entity.
    ``(2) Acceptance of a veteran for residence in a veterans' 
continuing care center shall include acceptance for residence with the 
veteran of the veteran's spouse (if any) or other person designated by 
the veteran as the veteran's primary caretaker.
    ``(c) Under a veterans' continuing care center agreement, the 
participating entity shall agree to--
            ``(1) construct or otherwise establish on the property 
        covered by the agreement a residential facility that includes 
        individual, handicap-accessible apartment units;
            ``(2) provide by contract with each resident for specified 
        nonmedical services (which may include meals, housekeeping, 
        recreation, security, 24-hour monitoring, and transportation); 
        and
            ``(3) provide case management services to the veteran's 
        spouse (or other primary caretaker designated under subsection 
        (b)(2)) for the management of necessary health care services 
        required by the spouse (or other designated primary caretaker) 
        from sources outside the Department.
    ``(d) A veteran who is accepted for residence in a veterans' 
continuing care center shall enter into a lease agreement with the 
participating entity for at least one year.
    ``(e) In entering into agreements under this section, the Secretary 
shall, in order to make veterans' continuing care centers affordable to 
low-income veterans, give priority, in selecting participating 
entities, to agreements with entities that would establish facilities 
through which public housing subsidies would be available to residents.
    ``(f) The Secretary shall establish, at each Department facility 
that has colocated with it a veterans' continuing care center, a team 
of primary care providers to be known as the Veterans' Continuing Care 
Center Health team. Each such team shall, at a minimum, consist of a 
physician and a home-health nurse and shall be responsible for 
maintaining access of the veterans' continuing care center residents to 
appropriate health care services and for home health visits at the 
center.
    ``(g)(1) Before entering into any veterans' continuing care center 
agreement, the Secretary shall submit to the congressional veterans' 
affairs committees notice in writing of the Secretary's intention to 
enter into the agreement. Each such notice shall include the following:
            (A) Identification of the property involved.
            (B) A description of the proposed veterans' continuing care 
        center.
            (C) A statement of the number of veterans who would be 
        residents at the proposed center.
            (D) A statement of the projected costs of the proposed 
        center.
    ``(2) If a proposed veterans' continuing care center agreement for 
which a notice is submitted under paragraph (1) is not executed within 
one year from the date on which such notice is submitted, the Secretary 
shall submit to the congressional veterans' affairs committees notice 
in writing that the proposed agreement has not been executed. Any such 
notice shall include an identification of the specific reasons why the 
agreement was not executed.
    ``(h) The Secretary shall submit to the congressional veterans' 
affairs committees a report on the first year's operation of each 
veterans' continuing care center. Each such report shall be submitted 
not later than 30 days after the one-year anniversary of the date on 
which the veterans' continuing care center began operation. Each such 
report shall set forth--
            ``(1) the cost to the Department of the veterans' 
        continuing care center;
            ``(2) any cost savings to the Department that are derived 
        from the avoidance of institutionalization of veterans residing 
        at the center;
            ``(3) degree of use by veterans of the center;
            ``(4) the types of health-care services used by residents 
        of the center; and
            ``(5) any plans of the Secretary for expansion of the 
        center or for creation of additional centers.
    ``(i) The provisions of section 8163, 8168, and 8169 of this title 
shall not apply with respect to a veterans' continuing care center 
agreement under this section. ''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item relating to section 
8118 (as added by section 6) the following new item:

``8119. Veterans' continuing care centers.''.

                                 <all>

HR 3122 IH----2