[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 1250 Introduced in Senate (IS)]







106th CONGRESS
  1st Session
                                S. 1250

To amend title 38, United States Code, to ensure a continuum of health 
  care for veterans, to require pilot programs relating to long-term 
           health care for veterans, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             June 21, 1999

Mr. Rockefeller introduced the following bill; which was read twice and 
             referred to the Committee on Veterans' Affairs

_______________________________________________________________________

                                 A BILL


 
To amend title 38, United States Code, to ensure a continuum of health 
  care for veterans, to require pilot programs relating to long-term 
           health care for veterans, and for other purposes.

    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 Enhancement 
Act of 1999''.

SEC. 2. CONTINUUM OF CARE FOR VETERANS.

    (a) Inclusion of Noninstitutional Extended Care Services in 
Definition of Medical Services.--Section 1701 of title 38, United 
States Code, is amended--
            (1) in paragraph (6)(A)(i), by inserting ``noninstitutional 
        extended care services,'' after ``preventive health 
        services,''; and
            (2) by adding at the end the following new paragraphs:
            ``(10) The term `noninstitutional extended care services' 
        includes--
                    ``(A) home-based primary care;
                    ``(B) adult day health care;
                    ``(C) respite care;
                    ``(D) palliative and end-of-life care; and
                    ``(E) homemaker or home health aide visits.
            ``(11) The term `respite care' means hospital or nursing 
        home care which--
                    ``(A) is of limited duration;
                    ``(B) is furnished on an intermittent basis to an 
                individual who is suffering from a chronic illness and 
                who resides primarily at home; and
                    ``(C) is furnished for the purpose of helping the 
                individual to continue residing primarily at home.''.
    (b) Assisted Living.--Subchapter II of chapter 17 of such title is 
amended by adding at the end the following new section:
``Sec. 1720F. Assisted living
    ``(a) The Secretary may, subject to subsection (b), provide 
assisted living services to a veteran who is eligible to receive care 
under section 1710 of this title and to the spouse of such veteran in 
connection with the provision of such services to such veteran.
    ``(b) The Secretary may not provide assisted living services under 
this section to a veteran eligible to receive care under section 
1710(a)(3) of this title, or to a spouse of any veteran, unless such 
veteran or spouse agrees to pay the United States an amount equal to 
the cost, as determined in regulations prescribed by the Secretary, of 
the provision of such services.
    ``(c) For purposes of this section, the term `assisted living 
services' means services which provide personal care, activities, 
health-related care, supervision, and other assistance on a 24-hour 
basis within a residential or similar setting which--
            ``(1) maximizes flexibility in the provision of such care, 
        activities, supervision, and assistance;
            ``(2) maximizes the autonomy, privacy, and independence of 
        an individual; and
            ``(3) encourages family and community involvement with the 
        individual.''.
    (c) Conforming Amendments.--(1)(A) Section 1720 of such title is 
amended by striking subsection (f).
    (B) The section heading of such section is amended by striking ``; 
adult day health care''.
    (2) Section 1720B of such title is repealed.
    (d) Clerical Amendments.--The table of sections for chapter 17 of 
such title is amended--
            (1) in the item relating to section 1720, by striking ``; 
        adult day health care'';
            (2) by striking the item relating to section 1720B; and
            (3) by inserting after the item relating to section 1720E 
        the following new item:

``1720F. Assisted living.''.

SEC. 3. PILOT PROGRAMS RELATING TO LONG-TERM CARE OF VETERANS.

    (a) In General.--The Secretary of Veterans Affairs shall carry out 
three pilot programs for the purpose of determining the feasibility and 
practicability of a variety of methods of meeting the long-term care 
needs of eligible veterans. The pilot programs shall be carried out in 
accordance with the provisions of this section.
    (b) Locations of Pilot Programs.--(1) Each pilot program under this 
section shall be carried out at two Veterans Integrated Service 
Networks (VISNs) selected by the Secretary for purposes of this 
section.
    (2) The Secretary may not carry out more than one pilot program in 
any given Veterans Integrated Service Network.
    (c) Scope of Services Under Pilot Programs.--(1) The services 
provided under the pilot programs under this section shall include a 
comprehensive array of health care services and other services that 
meet the long-term care needs of veterans, including--
            (A) inpatient long-term care in intermediate care beds, in 
        nursing homes, and in domiciliary care facilities;
            (B) noninstitutional long-term care, including hospital-
        based primary care, adult day care, personal assistance 
        services, respite care, and other community-based interventions 
        and care; and
            (C) assisted living services for veterans and their 
        families.
    (2) As part of the provision of services under the pilot programs, 
the Secretary shall also provide appropriate case management services.
    (3) In providing services under the pilot programs, the Secretary 
shall emphasize the provision of preventive care services, including 
screening and education.
    (d) Direct Provision of Services.--Under one of the pilot programs 
under this section, the Secretary shall provide long-term care services 
to eligible veterans directly through facilities and personnel of the 
Department of Veterans Affairs.
    (e) Provision of Services Through Cooperative Arrangements.--(1) 
Under one of the pilot programs under this section, the Secretary shall 
provide long-term care services to eligible veterans through a 
combination (as determined by the Secretary) of--
            (A) services provided under cooperative arrangements with 
        appropriate public and private non-Governmental entities, 
        including community service organizations; and
            (B) services provided through facilities and personnel of 
        the Department.
    (2) The consideration provided by the Secretary for services 
provided by entities under cooperative arrangements under paragraph 
(1)(A) shall be limited to the provision by the Secretary of 
appropriate in-kind services to such entities.
    (f) Provision of Services by Non-Department Entities.--(1) Under 
one of the pilot programs under this section, the Secretary shall 
provide long-term care services to eligible veterans through 
arrangements with appropriate non-Department entities under which 
arrangements the Secretary acts solely as the case manager for the 
provision of such services.
    (2) Payment for services provided to veterans under the pilot 
programs under this subsection shall be as follows:
            (A) By the medicare program or the medicaid program, but 
        only--
                    (i) if the veterans concerned are entitled to 
                benefits under such programs; and
                    (ii) to the extent that payment for such services 
                is provided for under such programs.
            (B) By the Department, to the extent that payment for such 
        services is not otherwise provided for under subparagraph (A).
    (g) Data Collection.--As part of each pilot program under this 
section, the Secretary shall collect data regarding--
            (1) the cost-effectiveness of such program, including any 
        savings achieved under such program when compared with the 
        medicare program, medicaid program, or other Federal program 
        serving similar populations;
            (2) the quality of the services provided under such 
        program;
            (3) the satisfaction of participating veterans, non-
        Department, and non-Government entities with such program; and
            (4) the effect of such program on the ability of veterans 
        to carry out basic activities of daily living over the course 
        of such veterans' participation in such program.
    (h) Reports.--(1) The Secretary shall annually submit to Congress a 
report on the pilot programs under this section.
    (2) Each report under paragraph (1) shall include the following:
            (A) A detailed description of activities under the pilot 
        programs during the one-year period ending on the date of the 
        report.
            (B) An evaluation of the data collected under subsection 
        (g) during that period.
            (C) Any other matters regarding the programs that the 
        Secretary considers appropriate.
    (i) Duration of Programs.--(1) The Secretary shall commence 
carrying out the pilot programs required by this section not later than 
90 days after the date of the enactment of this Act.
    (2) The authority of the Secretary to provide services under the 
pilot programs shall cease on the date that is three years after the 
date of the commencement of the pilot programs under paragraph (1).
    (j) Definitions.--In this section:
            (1) The term ``eligible veteran'' means the following:
                    (A) Any veteran entitled to hospital care and 
                medical services under section 1710(a)(1) of title 38, 
                United States Code.
                    (B) Any veteran (other than a veteran described in 
                subparagraph (A)) if the veteran is enrolled in the 
                system of annual patient enrollment under section 1705 
                of title 38, United States Code.
            (2) The term ``long-term care needs'' means the need by an 
        individual for any of the following services:
                    (A) Personal care.
                    (B) Nursing home and home health care services.
                    (C) Habilitation and rehabilitation services.
                    (D) Adult day care services.
                    (E) Case management services.
                    (F) Social services.
                    (G) Assistive technology services.
                    (H) Home and community based services, including 
                assistive living.
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