[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 3854 Introduced in Senate (IS)]

<DOC>






117th CONGRESS
  2d Session
                                S. 3854

 To amend title 38, United States Code, to improve certain programs of 
    the Department of Veterans Affairs for home and community based 
             services for veterans, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 16, 2022

  Mr. Moran (for himself, Ms. Hassan, and Mr. Tester) 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 improve certain programs of 
    the Department of Veterans Affairs for home and community based 
             services 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; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Elizabeth Dole 
Home and Community Based Services for Veterans and Caregivers Act of 
2022'' or the ``Elizabeth Dole Home Care Act''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Definitions.
Sec. 3. Increase of expenditure cap for noninstitutional care 
                            alternatives to nursing home care.
Sec. 4. Coordination with Program of All-Inclusive Care for the 
                            Elderly.
Sec. 5. Home and community based services: programs.
Sec. 6. Coordination with assistance and support services for 
                            caregivers.
Sec. 7. Development of centralized website for program information.
Sec. 8. Improvements relating to Home Maker and Home Health Aide 
                            program.
Sec. 9. Reviews and other improvements relating to home and community 
                            based services.

SEC. 2. DEFINITIONS.

    In this Act:
            (1) Caregiver; family caregiver.--The terms ``caregiver'' 
        and ``family caregiver'' have the meanings given those terms 
        under section 1720K(g) of title 38, United States Code (as 
        added by section 5(a)(1)).
            (2) Covered program.--The term ``covered program''--
                    (A) means any program of the Department for home 
                and community based services; and
                    (B) includes the programs specified in section 
                1720K of title 38, United States Code (as added by 
                section 5(a)(1)).
            (3) Department.--The term ``Department'' means the 
        Department of Veterans Affairs.
            (4) Home and community based services.--The term ``home and 
        community based services''--
                    (A) means the services referred to in section 
                1701(6)(E) of title 38, United States Code; and
                    (B) includes services furnished under a program 
                specified in section 1720K of such title (as added by 
                section 5(a)(1)).
            (5) Home based primary care program; home maker and home 
        health aide program; veteran directed care program.--The terms 
        ``Home Based Primary Care program'', ``Home Maker and Home 
        Health Aide program'', and ``Veteran Directed Care program'' 
        mean the programs of the Department specified in subsections 
        (d), (c), and (b) of such section 1720K, respectively.
            (6) Home health agency; home health aide; native american 
        veteran, tribal health program; urban indian organization.--The 
        terms ``home health agency'', ``home health aide'', ``Native 
        American veteran'', ``tribal health program'', and ``Urban 
        Indian organization'' have the meanings given those terms in 
        subsection (g) of such section 1720K.
            (7) Secretary.--The term ``Secretary'' means the Secretary 
        of Veterans Affairs.
            (8) Veterans service organization.--The term ``veterans 
        service organization'' means any organization recognized by the 
        Secretary under section 5902 of title 38, United States Code.

SEC. 3. INCREASE OF EXPENDITURE CAP FOR NONINSTITUTIONAL CARE 
              ALTERNATIVES TO NURSING HOME CARE.

    (a) Increase of Expenditure Cap.--Section 1720C(d) of title 38, 
United States Code, is amended--
            (1) by striking ``The total cost'' and inserting ``(1) 
        Except as provided in paragraph (2), the total cost'';
            (2) in paragraph (1), as designated by paragraph (1), by 
        striking ``65 percent'' and inserting ``100 percent''; and
            (3) by adding at the end the following new paragraph:
    ``(2) The total cost of providing services or in-kind assistance in 
the case of any veteran for any fiscal year under the program may 
exceed 100 percent of the cost that would otherwise have been incurred 
as specified in paragraph (1) if the Secretary determines such higher 
total cost is in the best interest of the veteran.''.
    (b) Applicability.--The amendments made by subsection (a) shall 
apply with respect to any fiscal year beginning on or after the date of 
the enactment of this Act.

SEC. 4. COORDINATION WITH PROGRAM OF ALL-INCLUSIVE CARE FOR THE 
              ELDERLY.

    Section 1720C of title 38, United States Code, as amended by 
section 3, is further amended by adding at the end the following new 
subsection:
    ``(f) In furnishing services to a veteran under the program 
conducted pursuant to subsection (a), if a medical center of the 
Department through which such program is administered is located in a 
geographic area in which services are available to the veteran under a 
PACE program (as such term is defined in sections 1894(a)(2) and 
1934(a)(2) of the Social Security Act (42 U.S.C. 1395eee(a)(2); 1396u-
4(a)(2))), the Secretary shall establish a partnership with the PACE 
program operating in that area for the furnishing of such services.''.

SEC. 5. HOME AND COMMUNITY BASED SERVICES: PROGRAMS.

    (a) Programs.--
            (1) In general.--Subchapter II of chapter 17 of title 38, 
        United States Code, is amended by inserting after section 1720J 
        the following new section:
``Sec. 1720K. Home and community based services: programs
    ``(a) In General.--In furnishing noninstitutional alternatives to 
nursing home care under the authority of section 1720C of this title 
(or any other authority under this chapter or other provision of law 
administered by the Secretary of Veterans Affairs), the Secretary shall 
carry out each of the programs specified in this section in accordance 
with such relevant authorities except as otherwise provided in this 
section.
    ``(b) Veteran Directed Care Program.--(1) The Secretary of Veterans 
Affairs, in collaboration with the Secretary of Health and Human 
Services, shall carry out a program to be known as the `Veteran 
Directed Care program' under which the Secretary of Veterans Affairs 
may enter into agreements with the providers described in paragraph (2) 
to provide to eligible veterans funds to obtain such in-home care 
services and related items as may be determined appropriate by the 
Secretary of Veterans Affairs and selected by the veteran, including 
through the veteran hiring individuals to provide such services and 
items or directly purchasing such services and items.
    ``(2) The providers described in this paragraph are the following:
            ``(A) An Aging and Disability Resource Center, an area 
        agency on aging, or a State agency.
            ``(B) A center for independent living.
    ``(3) In carrying out the Veteran Directed Care program, the 
Secretary of Veterans Affairs shall--
            ``(A) administer such program through each medical center 
        of the Department of Veterans Affairs;
            ``(B) ensure the availability of such program in American 
        Samoa, Guam, the Commonwealth of the Northern Mariana Islands, 
        the Commonwealth of Puerto Rico, the Virgin Islands of the 
        United States, and any other territory or possession of the 
        United States; and
            ``(C) ensure the availability of such program for eligible 
        veterans who are Native American veterans receiving care and 
        services furnished by the Indian Health Service, a tribal 
        health program, an Urban Indian organization, or (in the case 
        of a Native Hawaiian veteran) a Native Hawaiian health care 
        system.
    ``(4) If a veteran participating in the Veteran Directed Care 
program is catastrophically disabled, the veteran may continue to use 
funds under the program during a period of hospitalization in the same 
manner that the veteran would be authorized to use such funds under the 
program if the veteran were not hospitalized.
    ``(c) Home Maker and Home Health Aide Program.--(1) The Secretary 
shall carry out a program to be known as the `Home Maker and Home 
Health Aide program' under which the Secretary may enter into 
agreements with home health agencies to provide to eligible veterans 
such home health aide services as may be determined appropriate by the 
Secretary.
    ``(2) In carrying out the Home Maker and Home Health Aide program, 
the Secretary shall ensure the availability of such program--
            ``(A) in the locations specified in subparagraph (B) of 
        subsection (b)(3); and
            ``(B) for the veteran populations specified in subparagraph 
        (C) of such subsection.
    ``(d) Home Based Primary Care Program.--The Secretary shall carry 
out a program to be known as the `Home Based Primary Care program' 
under which the Secretary may furnish to eligible veterans in-home 
health care, the provision of which is overseen by a physician of the 
Department.
    ``(e) Purchased Skilled Home Care Program.--The Secretary shall 
carry out a program to be known as the `Purchased Skilled Home Care 
program' under which the Secretary may furnish to eligible veterans 
such in-home care services as may be determined appropriate and 
selected by the Secretary for the veteran.
    ``(f) Caregiver Support.--(1) With respect to a resident caregiver 
of a veteran participating in a program under this section who is a 
family caregiver, the Secretary shall--
            ``(A) if the veteran meets the requirements of a covered 
        veteran under section 1720G(b) of this title, provide to such 
        caregiver the option of enrolling in the program of general 
        caregiver support services under such section;
            ``(B) subject to paragraph (2), provide to such caregiver 
        not fewer than 14 days of covered respite care each year; and
            ``(C) conduct on an annual basis (and, to the extent 
        practicable, in connection with in-person services provided 
        under the program in which the veteran is participating), a 
        wellness check of such caregiver.
    ``(2) The Secretary shall provide not fewer than 30 days of covered 
respite care each year to any resident caregiver who provides services 
funded under the Veteran Directed Care program under subsection (b).
    ``(3) Covered respite care provided to a resident caregiver of a 
veteran under paragraph (1) or (2), as the case may be, may exceed 14 
days annually or 30 days annually, respectively, if an extension is 
requested by the resident caregiver or veteran and determined medically 
appropriate by the Secretary.
    ``(g) Definitions.--In this section:
            ``(1) The terms `Aging and Disability Resource Center', 
        `area agency on aging', and `State agency' have the meanings 
        given those terms in section 102 of the Older Americans Act of 
        1965 (42 U.S.C. 3002).
            ``(2) The terms `caregiver' and `family caregiver', with 
        respect to a veteran, have the meanings given those terms, 
        respectively, under subsection (e) of section 1720G of this 
        title with respect to an eligible veteran under subsection (a) 
        of such section or a covered veteran under subsection (b) of 
        such section, as the case may be.
            ``(3) The term `center for independent living' has the 
        meaning given that term in section 702 of the Rehabilitation 
        Act of 1973 (29 U.S.C. 796a).
            ``(4) The term `covered respite care' means, with respect 
        to a caregiver of a veteran, respite care that--
                    ``(A) includes 24-hour per day care of the veteran 
                commensurate with the care provided by the caregiver;
                    ``(B) is medically and age-appropriate; and
                    ``(C) includes in-home care services.
            ``(5) The term `eligible veteran' means any veteran--
                    ``(A) for whom the Secretary determines 
                participation in a specific program under this section 
                is medically necessary to promote, preserve, or restore 
                the health of the veteran; and
                    ``(B) who absent such participation would be at 
                increased risk for hospitalization, placement in a 
                nursing home, or emergency room care.
            ``(6) The term `home health agency' has the meaning given 
        that term in section 1861(o) of the Social Security Act (42 
        U.S.C. 1395x(o)).
            ``(7) The term `home health aide' means an individual 
        employed by a home health agency to provide in-home care 
        services.
            ``(8) The term `in-home care service' means any service, 
        including a personal care service, provided to enable the 
        recipient of such service to live at home.
            ``(9) The term `Native American veteran' has the meaning 
        given that term in section 3765 of this title.
            ``(10) The terms `Native Hawaiian' and `Native Hawaiian 
        health care system' have the meanings given those terms in 
        section 12 of the Native Hawaiian Health Care Improvement Act 
        (42 U.S.C. 11711).
            ``(11) The term `resident caregiver' means a caregiver or a 
        family caregiver of a veteran who resides with the veteran.
            ``(12) The terms `tribal health program' and `Urban Indian 
        organization' have the meanings given those terms in section 4 
        of the Indian Health Care Improvement Act (25 U.S.C. 1603).''.
            (2) Clerical amendment.--The table of sections at the 
        beginning of such subchapter is amended by inserting after the 
        item relating to section 1720J the following new item:

``1720K. Home and community based services: programs.''.
    (b) Deadline for Improved Administration.--The Secretary shall 
ensure that the Veteran Directed Care program and the Home Maker and 
Home Health Aide program are administered through each medical center 
of the Department in accordance with section 1720K of title 38, United 
States Code (as added by subsection (a)(1)), by not later than two 
years after the date of the enactment of this Act.

SEC. 6. COORDINATION WITH ASSISTANCE AND SUPPORT SERVICES FOR 
              CAREGIVERS.

    (a) Coordination With Program of Comprehensive Assistance for 
Family Caregivers.--
            (1) Coordination.--Section 1720G(a) of title 38, United 
        States Code, is amended by adding at the end the following new 
        paragraph:
    ``(14)(A) In the case of a veteran or caregiver who seeks services 
under this subsection and is denied such services, or a veteran or the 
family caregiver of a veteran who is discharged from the program under 
this subsection, the Secretary shall--
            ``(i) if the veteran meets the requirements of a covered 
        veteran under subsection (b), provide to such caregiver the 
        option of enrolling in the program of general caregiver support 
        services under such subsection;
            ``(ii) assess the veteran or caregiver for participation in 
        any other available program of the Department for home and 
        community based services (including the programs specified in 
        section 1720K of this title) for which the veteran or caregiver 
        may be eligible and, with respect to the veteran, store (and 
        make accessible to the veteran) the results of such assessment 
        in the electronic medical record of the veteran; and
            ``(iii) provide to the veteran or caregiver written 
        information on any such program identified pursuant to the 
        assessment under clause (ii), including information about 
        facilities, eligibility requirements, and relevant contact 
        information for each such program.
    ``(B) For each veteran or family caregiver who is discharged from 
the program under this subsection, a caregiver support coordinator 
shall provide for a smooth and personalized transition from such 
program to an appropriate program of the Department for home and 
community based services (including the programs specified in section 
1720K of this title), including by integrating caregiver support across 
programs.''.
            (2) Applicability.--The amendments made by paragraph (1) 
        shall apply with respect to denials and discharges described in 
        paragraph (14) of such section, as added by paragraph (1), 
        occurring on or after the date of the enactment of this Act.
    (b) Technical and Conforming Amendments.--Section 1720G(d) of such 
title is amended--
            (1) by striking ``or a covered veteran'' each place it 
        appears and inserting ``, a veteran denied or discharged as 
        specified in paragraph (14) of such subsection, or a covered 
        veteran''; and
            (2) by striking ``under subsection (a), means'' each place 
        it appears and inserting ``under subsection (a) or a veteran 
        denied or discharged as specified in paragraph (14) of such 
        subsection, means''.
    (c) Review Relating to Caregiver Contact.--The Secretary shall 
conduct a review of the capacity of the Department to establish a 
streamlined system for contacting all caregivers enrolled in the 
program of general caregiver support services under section 1720G(b) of 
title 38, United States Code, to provide to such caregivers program 
updates and alerts relating to emerging services for which such 
caregivers may be eligible.

SEC. 7. DEVELOPMENT OF CENTRALIZED WEBSITE FOR PROGRAM INFORMATION.

    (a) Centralized Website.--The Secretary shall develop and maintain 
a centralized and publicly accessible internet website of the 
Department as a clearinghouse for information and resources relating to 
covered programs.
    (b) Contents.--The website under subsection (a) shall contain the 
following:
            (1) A description of each covered program.
            (2) An informational assessment tool that enables users 
        to--
                    (A) assess the eligibility of a veteran, or a 
                caregiver of a veteran, for any covered program; and
                    (B) receive information, as a result of such 
                assessment, on any covered program for which the 
                veteran or caregiver (as the case may be) may be 
                eligible.
            (3) A list of required procedures for the directors of 
        medical facilities of the Department to follow in determining 
        the eligibility and suitability of veterans for participation 
        in a covered program, including procedures applicable to 
        instances in which the resource constraints of a facility (or 
        of a community in which a facility is located) may result in 
        the inability to address the health needs of a veteran under a 
        covered program in a timely manner.
    (c) Updates.--The Secretary shall ensure the website under 
subsection (a) is updated on a periodic basis.

SEC. 8. IMPROVEMENTS RELATING TO HOME MAKER AND HOME HEALTH AIDE 
              PROGRAM.

    (a) Pilot Program for Communities With Shortage of Home Health 
Aides.--
            (1) Program.--The Secretary shall carry out a pilot program 
        under which the Secretary shall provide home maker and home 
        health aide services to veterans who reside in communities with 
        a shortage of home health aides.
            (2) Locations.--The Secretary shall select 10 geographic 
        locations in which the Secretary determines there is a shortage 
        of home health aides at which to carry out the pilot program 
        under paragraph (1).
            (3) Nursing assistants.--
                    (A) In general.--In carrying out the pilot program 
                under paragraph (1), the Secretary may hire nursing 
                assistants as new employees of the Department, or 
                reassign nursing assistants who are existing employees 
                of the Department, to provide to veterans in-home care 
                services (including basic tasks authorized by the State 
                certification of the nursing assistant) under the pilot 
                program, in lieu of or in addition to the provision of 
                such services through non-Department home health aides.
                    (B) Relationship to home based primary care 
                program.--Nursing assistants hired or reassigned under 
                subparagraph (A) may provide services to a veteran 
                under the pilot program under paragraph (1) while 
                serving as part of a health care team for the veteran 
                under the Home Based Primary Care program.
            (4) Duration.--The pilot program under paragraph (1) shall 
        be for a duration of three years.
            (5) Report to congress.--Not later than one year after the 
        date on which the Secretary determines the pilot program under 
        paragraph (1) has terminated, the Secretary shall submit to the 
        Committee on Veterans' Affairs of the Senate and the Committee 
        on Veterans' Affairs of the House of Representatives a report 
        on the result of the pilot program.
    (b) Report on Use of Funds.--Not later than one year after the date 
of the enactment of this Act, the Secretary shall submit to the 
Committee on Veterans' Affairs of the Senate and the Committee on 
Veterans' Affairs of the House of Representatives a report containing, 
with respect to the period beginning in fiscal year 2011 and ending in 
fiscal year 2022, the following:
            (1) An identification of the amount of funds that were 
        included in a budget of the Department during such period for 
        the provision of in-home care to veterans under the Home Maker 
        and Home Health Aide program but were not expended for the 
        provision of such care, disaggregated by medical center of the 
        Department for which such unexpended funds were budgeted.
            (2) An identification of the number of veterans for whom, 
        during such period, the hours during which a home health aide 
        was authorized to provide services to the veteran under the 
        Home Maker and Home Health Aide program were reduced for a 
        reason other than a change in the health care needs of the 
        veteran, and a detailed description of the reasons why any such 
        reductions may have occurred.
    (c) Updated Guidance on Program.--
            (1) In general.--Not later than one year after the date of 
        the enactment of this Act, the Secretary shall issue updated 
        guidance for the Home Maker and Home Health Aide program.
            (2) Matters to include.--Guidance updated under paragraph 
        (1) shall include the following:
                    (A) A process for the transition of veterans from 
                the Home Maker and Home Health Aide program to other 
                covered programs.
                    (B) A requirement for the directors of the medical 
                facilities of the Department to complete such process 
                whenever a veteran with care needs has been denied 
                services from home health agencies under the Home Maker 
                and Home Health Aide program as a result of the 
                clinical needs or behavioral issues of the veteran.

SEC. 9. REVIEWS AND OTHER IMPROVEMENTS RELATING TO HOME AND COMMUNITY 
              BASED SERVICES.

    (a) Office of Geriatric and Extended Care.--
            (1) Review of programs.--The Under Secretary for Health of 
        the Department shall conduct a review of each program 
        administered through the Office of Geriatric and Extended Care 
        of the Department, or successor office, to--
                    (A) ensure consistency in program management;
                    (B) eliminate service gaps at the medical center 
                level; and
                    (C) ensure the availability of, and the access by 
                veterans to, home and community based services.
            (2) Assessment of staffing needs.--The Secretary shall 
        conduct an assessment of the staffing needs of the Office of 
        Geriatric and Extended Care of the Department, or successor 
        office.
            (3) Goals for geographic alignment of care.--
                    (A) Establishment of goals.--The Director of the 
                Office of Geriatric and Extended Care, or successor 
                office, shall establish quantitative goals to enable 
                aging or disabled veterans who are not located near 
                medical centers of the Department to access extended 
                care services (including by improving access to home 
                and community based services for such veterans).
                    (B) Implementation timeline.--Each goal established 
                under subparagraph (A) shall include a timeline for the 
                implementation of the goal at each medical center of 
                the Department.
            (4) Goals for in-home specialty care.--The Director of the 
        Office of Geriatric and Extended Care, or successor office, 
        shall establish quantitative goals to address the specialty 
        care needs of veterans through in-home care, including by 
        ensuring the education of home health aides and caregivers of 
        veterans in the following areas:
                    (A) Dementia care.
                    (B) Care for spinal cord injuries and diseases.
                    (C) Ventilator care.
                    (D) Other speciality care areas as determined by 
                the Secretary.
            (5) Report to congress.--Not later than one year after the 
        date of the enactment of this Act, the Secretary shall submit 
        to the Committee on Veterans' Affairs of the Senate and the 
        Committee on Veterans' Affairs of the House of Representatives 
        a report containing the findings of the review under paragraph 
        (1), the results of the assessment under paragraph (2), and the 
        goals established under paragraphs (3) and (4).
    (b) Review of Incentives and Efforts Relating to Home and Community 
Based Services.--
            (1) Review.--The Secretary shall conduct a review of the 
        following:
                    (A) The financial and organizational incentives for 
                the directors of medical centers of the Department to 
                establish or expand covered programs at such medical 
                centers.
                    (B) Any incentives for such directors to provide to 
                veterans home and community based services in lieu of 
                institutional care.
                    (C) The efforts taken by the Secretary to enhance 
                spending of the Department for extended care by 
                shifting the balance of such spending from 
                institutional care to home and community based 
                services.
                    (D) The plan of the Under Secretary for Health of 
                the Department to accelerate efforts to enhance 
                spending as specified in subparagraph (C), to match the 
                progress of similar efforts taken by the Administrator 
                of the Centers for Medicare & Medicaid Services with 
                respect to spending of the Centers for Medicare & 
                Medicaid Services for extended care.
            (2) Report to congress.--Not later than one year after the 
        date of the enactment of this Act, the Secretary shall submit 
        to the Committee on Veterans' Affairs of the Senate and the 
        Committee on Veterans' Affairs of the House of Representatives 
        a report on the findings of the review under paragraph (1).
    (c) Review of Respite Care Services.--Not later than two years 
after the date of the enactment of this Act, the Secretary shall 
conduct a review of the use, availability, and effectiveness of the 
respite care services furnished by the Secretary under chapter 17 of 
title 38, United States Code.
    (d) Collaboration To Improve Home and Community Based Services.--
            (1) Feedback and recommendations on caregiver support.--
                    (A) Feedback and recommendations.--The Secretary 
                shall solicit from the entities described in 
                subparagraph (B) feedback and recommendations regarding 
                opportunities for the Secretary to enhance home and 
                community based services for veterans and caregivers of 
                veterans, including through the potential provision by 
                the entity of care and respite services to veterans and 
                caregivers who may not be eligible for any program 
                under section 1720G of title 38, United States Code, or 
                section 1720K of such title (as added by section 
                5(a)(1)), but have a need for assistance.
                    (B) Covered entities.--The entities described in 
                this subparagraph are veterans service organizations 
                and nonprofit organizations with a focus on caregiver 
                support (as determined by the Secretary).
            (2) Collaboration for native american veterans.--The 
        Secretary shall collaborate with the Director of the Indian 
        Health Service and representatives from tribal health programs 
        and Urban Indian organizations to ensure the availability of 
        home and community based services for Native American veterans, 
        including Native American veterans receiving health care and 
        medical services under multiple health care systems.
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