[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 4556 Introduced in Senate (IS)]

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118th CONGRESS
  2d Session
                                S. 4556

To amend title 38, United States Code, to establish the Office of Falls 
    Prevention of the Department of Veterans Affairs, and for other 
                               purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             June 17, 2024

 Mr. King (for himself and Mr. Rounds) 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 establish the Office of Falls 
    Prevention of the Department of Veterans Affairs, 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 ``Supporting Access to Falls Education 
and Prevention and Strengthening Training Efforts and Promoting Safety 
Initiatives for Veterans Act of 2024'' or the ``SAFE STEPS for Veterans 
Act of 2024''.

SEC. 2. ESTABLISHMENT OF OFFICE OF FALLS PREVENTION OF DEPARTMENT OF 
              VETERANS AFFAIRS.

    (a) Establishment of Office.--
            (1) In general.--Subchapter I of chapter 73 of title 38, 
        United States Code, is amended by inserting after section 7310A 
        the following new section:
``Sec. 7310B. Office of Falls Prevention
    ``(a) Office.--
            ``(1) Establishment and operation.--The Under Secretary for 
        Health shall establish and operate in the Veterans Health 
        Administration the Office of Falls Prevention (in this section 
        referred to as the `Office').
            ``(2) Location of office.--The Office shall be located at 
        the Central Office of the Department.
            ``(3) Leadership.--
                    ``(A) Head.--The head of the Office is the Chief 
                Officer of Falls Prevention (in this section referred 
                to as the `Chief Officer').
                    ``(B) Reporting.--The Chief Officer shall report to 
                the Under Secretary for Health.
            ``(4) Staffing and support.--The Under Secretary for Health 
        shall provide the Office with such staff and other support as 
        may be necessary for the Office to carry out effectively the 
        functions of the Office under this section.
            ``(5) Reorganization.--The Under Secretary for Health may 
        reorganize existing offices within the Veterans Health 
        Administration as of the date of the enactment of this section 
        in order to avoid duplication with the functions of the Office.
    ``(b) Functions.--The functions of the Office include the 
following:
            ``(1) To provide a central office for monitoring and 
        encouraging the activities of the Veterans Health 
        Administration with respect to the provision, evaluation, and 
        improvement of health care services relating to falls 
        prevention provided to veterans by the Department, with the 
        goal of averting costly health care utilization while 
        decreasing the incidence of falls.
            ``(2) To develop and implement standards of care for the 
        provision by the Department of health care services relating to 
        falls prevention.
            ``(3) To monitor and identify deficiencies in standards of 
        care for the provision of health care services relating to 
        falls prevention, to provide technical assistance to medical 
        facilities of the Department, to provide technical assistance 
        to programs of the Department that support veterans in their 
        own homes, to address and remedy deficiencies of such 
        facilities and programs, and to perform oversight of 
        implementation of such standards of care.
            ``(4) To monitor and identify deficiencies in standards of 
        care for the provision of health care services relating to 
        falls prevention through the community pursuant to this title 
        and to provide recommendations to the appropriate office to 
        address and remedy any deficiencies.
            ``(5) To oversee distribution of resources and information 
        related to falls prevention for veterans under this title.
            ``(6) To promote the expansion and improvement of clinical, 
        research, and educational activities of the Veterans Health 
        Administration with respect to health care services relating to 
        falls prevention, including research activities on falls 
        prevention conducted between the Office of Research and 
        Development of the Department and the National Institute on 
        Aging.
            ``(7) To promote the development or expansion of rigorous 
        quality assessment or improvement processes designed to prevent 
        falls, including through coordination and collaboration with 
        offices within the Department determined appropriate by the 
        Secretary.
            ``(8) To coordinate home modification and adaptation 
        programs administered by the Under Secretary for Benefits under 
        chapter 21 of this title and the Under Secretary for Health 
        under section 1717(a)(2) of this title.
            ``(9) To carry out such other duties as the Under Secretary 
        for Health may require.
    ``(c) Public Education Campaign.--The Chief Officer shall--
            ``(1) oversee and support a national education campaign 
        that--
                    ``(A) is directed principally to veterans 
                determined to be at risk for falls, their families, and 
                their health care providers; and
                    ``(B) focuses on--
                            ``(i) reducing falls, falls with major 
                        injury, and repeat falls for veterans receiving 
                        care under the laws administered by the 
                        Secretary; and
                            ``(ii) increasing awareness of available 
                        benefits, grants, devices, or services provided 
                        by the Department that would aid veterans in 
                        reducing falls and preventing repeat falls; and
            ``(2) award grants or contracts to qualified organizations 
        for the purpose of supporting local education campaigns 
        focusing on reducing falls, falls with major injury, and repeat 
        falls for veterans receiving care under the laws administered 
        by the Secretary.
    ``(d) Research on Falls Prevention Programs for Veteran 
Populations.--
            ``(1) In general.--The Chief Officer shall work with the 
        Office of Research and Development of the Department and the 
        National Institute on Aging to develop research for evidence-
        based falls prevention programs that will benefit veterans, 
        including--
                    ``(A) programs that overlap with the priorities of 
                the Department;
                    ``(B) programs that may focus on or be of 
                particular benefit to veterans; and
                    ``(C) programs that may include participants with 
                multiple comorbidities.
            ``(2) Matters to be included.--The research required under 
        paragraph (1) shall include the following:
                    ``(A) Research in supporting veterans with and 
                without service-connected disabilities receiving home 
                modification grants under section 1717 or 2101 of this 
                title.
                    ``(B) Development of recommendations for falls 
                prevention interventions for veterans with service-
                connected disabilities, including home modification 
                interventions.
                    ``(C) Research addressing medication management and 
                polypharmacy as risk factors for falls prevention and 
                developing recommendations for providers and electronic 
                health records systems of the Department to monitor for 
                veterans at risk of falls based on use of certain 
                medications.
                    ``(D) Research on improvements for safe patient 
                handling and mobility among veterans, particularly in 
                facilities (both medical and non-medical) that are not 
                spinal cord injury centers.
            ``(3) Subject matter expert panel.--
                    ``(A) In general.--The Secretary and the Director 
                of the National Institute on Aging shall establish a 
                joint subject matter expert panel to develop 
                recommendations as required under paragraph (2)(B).
                    ``(B) Membership.--The subject matter expert panel 
                required under subparagraph (A) shall be comprised of 
                eight members, of which--
                            ``(i) four shall be appointed by the 
                        Secretary; and
                            ``(ii) four shall be appointed by the 
                        Director of the National Institute on Aging.''.
            (2) Establishment of joint subject matter expert panel.--
        Not later than 180 days after the date of the enactment of this 
        Act, the Secretary of Veterans Affairs and the Director of the 
        National Institute on Aging shall establish the joint subject 
        matter expert panel required under section 7310B(d)(3) of title 
        38, United States Code, as added by paragraph (1).
            (3) Clerical amendment.--The table of sections at the 
        beginning of such chapter is amended by inserting after the 
        item relating to section 7310A the following new item:

``7310B. Office of Falls Prevention.''.
    (b) Expansion of Interagency Coordinating Committee on Healthy 
Aging and Age-Friendly Communities.--Section 203(c) of the Older 
Americans Act of 1965 (42 U.S.C. 3013(c)) is amended--
            (1) in paragraph (2), by inserting ``the Secretary of 
        Veterans Affairs,'' after ``the Commissioner of Social 
        Security,''; and
            (2) in paragraph (7), in the matter preceding subparagraph 
        (A)--
                    (A) by inserting ``the Committee on Veterans' 
                Affairs of the House of Representatives,'' after ``the 
                Committee on Ways and Means of the House of 
                Representatives,''; and
                    (B) by inserting ``the Committee on Veterans' 
                Affairs of the Senate,'' after ``the Committee on 
                Health, Education, Labor, and Pensions of the 
                Senate,''.
    (c) Safe Handling Transfer Techniques.--Not later than 180 days 
after the date of the enactment of this Act, the Secretary of Veterans 
Affairs shall issue or update directives of the Veterans Health 
Administration for facilities and providers relating to safe patient 
handling and mobility policies at the national, Veterans Integrated 
Service Network, and health-care system levels, which shall include the 
following:
            (1) Requiring biennial training for providers, including 
        that all providers be trained in safe patient handling and use 
        of mobility aids and mobility techniques.
            (2) Requiring that any medical facility where patients may 
        need assistance with transfer or mobility have access to safe 
        patient handling and mobility technology appropriate for the 
        setting to enable safe transfer and mobilization for access to 
        care and activities of daily living for veterans who are 
        paralyzed or who need assistance with mobility.
            (3) Requiring that all emergency settings have immediate 
        access to safe patient handling and mobility technology to 
        enable safe transfer, fall recovery, and repositioning.
    (d) Pilot Program on Falls Prevention Interventions Tied to 
Residential Adaptations and Alterations.--
            (1) Determination.--The Secretary of Veterans Affairs shall 
        determine the feasibility and advisability of carrying out a 
        pilot program to provide home improvements and structural 
        alterations to prevent falls for all veterans eligible for 
        those services under the laws administered by the Secretary.
            (2) Plan.--Not later than one year after the date of the 
        enactment of this Act, the Secretary shall submit to Congress a 
        report--
                    (A) indicating the plans of the Secretary to carry 
                out a pilot program to provide home improvements and 
                structural alterations to prevent falls for all 
                veterans eligible for those services under the laws 
                administered by the Secretary; or
                    (B) specifying why the Secretary determined under 
                paragraph (1) that it is not feasible or advisable to 
                carry out such a pilot program.
            (3) Report on lessons learned.--If the Secretary carries 
        out the pilot program described in paragraph (1), not later 
        than 180 days after the termination of the pilot program, the 
        Chief Officer of Falls Prevention of the Department of Veterans 
        Affairs established under section 7310B(a)(3)(A) of title 38, 
        United States Code, as added by subsection (a)(1), shall submit 
        to Congress a report on lessons learned from the pilot program 
        and any recommendations on extending or expanding the pilot 
        program.
    (e) Report on Falls Prevention Initiatives.--
            (1) In general.--Not later than two years after the date of 
        the enactment of this Act, or one year after the appointment of 
        the Chief Officer of Falls Prevention of the Department of 
        Veterans Affairs established under section 7310B(a)(3)(A) of 
        title 38, United States Code, as added by subsection (a)(1), 
        whichever occurs first, the Chief Officer, or the Under 
        Secretary for Health of the Department of Veterans Affairs if a 
        Chief Officer has not yet been appointed, shall submit to 
        Congress a report on falls prevention initiatives within the 
        Department.
            (2) Elements.--The report required by paragraph (1) shall 
        evaluate, for the three-year period preceding the date of the 
        enactment of this Act--
                    (A) screening procedures at facilities of the 
                Veterans Health Administration for risk of falls and 
                the prevalence of resulting falls prevention 
                interventions;
                    (B) the use by the Department of electronic health 
                record documentation for risk of falls among veterans;
                    (C) the number of home modification grants provided 
                under either the Home Improvements and Structural 
                Alterations Program of the Department under section 
                1717 of title 38, United States Code, or the Specially 
                Adapted Housing Program of the Department under section 
                2101 of such title;
                    (D) the extent to which grants provided under the 
                programs specified under subparagraph (C) prevent falls 
                among veterans and any recommendations with respect to 
                such programs in the case of falls among veterans that 
                were not prevented;
                    (E) for veterans eligible for the Home Improvements 
                and Structural Alterations Program of the Department 
                under section 1717 of title 38, United States Code, 
                pursuant to subsection (a)(2)(B) of such section, the 
                number of home modification grants provided to each 
                veteran in receipt of such a grant;
                    (F) the types of providers that have conducted 
                medical assessments leading to a recommendation for a 
                home modification tied to medical necessity, and any 
                recommendations for legislative or administrative 
                action to expand the list of providers eligible to 
                conduct medical assessments leading to a recommendation 
                for a home modification;
                    (G) home evaluation processes that are conducted in 
                connection with awards made under the programs 
                specified under subparagraph (C) and any 
                recommendations for improving the evaluation and review 
                process;
                    (H) reporting programs and software of the 
                Department used to capture incidences of falls in care 
                sites of the Veterans Health Administration and other 
                veterans' settings;
                    (I) limitations on uptake and use of current 
                prevention, screening, and intervention programs 
                designed to address falls prevention; and
                    (J) recommendations for the Secretary of Veterans 
                Affairs to work with the Centers for Disease Control 
                and Prevention, or other entities determined 
                appropriate by the Secretary, to better capture data on 
                falls by a veteran occurring in the home or in the 
                community.

SEC. 3. ESTABLISHMENT OF FALLS ASSESSMENT AND FALL PREVENTION SERVICE 
              REQUIREMENTS FOR VETERANS.

    (a) Required Nursing Home Care.--Section 1710A of title 38, United 
States Code, is amended by striking subsection (d) and inserting the 
following:
    ``(d) In the case of an individual determined by a physician to 
have fallen or to have been at risk of falling during the previous one-
year period, the Secretary shall ensure that a licensed physical 
therapist or a licensed occupational therapist conducts a falls risk 
assessment for the individual and provides fall prevention services 
during the stay of the individual in the nursing home.
    ``(e) The provisions of subsection (a) shall terminate on September 
30, 2028.''.
    (b) Extended Care Services.--Section 1710B(a) of such title is 
amended by adding at the end the following new paragraph:
            ``(7) The conduct of an annual falls risk assessment and 
        the provision of fall prevention services by a licensed 
        physical therapist or licensed occupational therapist.''.
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