[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 495 Introduced in Senate (IS)]

<DOC>






118th CONGRESS
  1st Session
                                 S. 495

   To require the Secretary of Veterans Affairs to carry out a pilot 
 program to provide assisted living services to eligible veterans, and 
                          for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           February 16, 2023

   Mr. Tester (for himself, Mr. Moran, Mrs. Murray, and Mr. Rounds) 
introduced the following bill; which was read twice and referred to the 
                     Committee on Veterans' Affairs

_______________________________________________________________________

                                 A BILL


 
   To require the Secretary of Veterans Affairs to carry out a pilot 
 program to provide assisted living services to eligible 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 ``Expanding Veterans' Options for Long 
Term Care Act''.

SEC. 2. PILOT PROGRAM ON ASSISTED LIVING SERVICES FOR VETERANS.

    (a) Program.--
            (1) In general.--Beginning not later than one year after 
        the date of the enactment of this Act, the Secretary of 
        Veterans Affairs shall carry out a three-year pilot program to 
        assess--
                    (A) the effectiveness of providing assisted living 
                services to eligible veterans, at the election of such 
                veterans; and
                    (B) the satisfaction with the pilot program of 
                veterans participating in the pilot program.
            (2) Extension.--The Secretary may extend the duration of 
        the pilot program under paragraph (1) for an additional three-
        year period if the Secretary, based on the results of the 
        reports submitted under subsection (f), determines that it is 
        appropriate to do so.
    (b) Program Locations.--
            (1) Veterans integrated service networks.--
                    (A) In general.--The Secretary shall select not 
                fewer than six Veterans Integrated Service Networks of 
                the Department of Veterans Affairs at which to carry 
                out the pilot program under subsection (a)(1).
                    (B) Veterans receiving nursing home care.--The 
                Secretary shall ensure that not fewer than three 
                Veterans Integrated Service Networks selected under 
                subparagraph (A) serve regions with the top three 
                highest percentage of veterans who are currently 
                receiving nursing home care through the Department and 
                would be eligible to receive assisted living services 
                under the pilot program.
            (2) Facilities.--
                    (A) In general.--Within the Veterans Integrated 
                Service Networks selected under paragraph (1), the 
                Secretary shall select facilities at which to carry out 
                the pilot program under subsection (a)(1).
                    (B) Selection criteria.--In selecting facilities 
                under subparagraph (A), the Secretary shall ensure 
                that--
                            (i) the locations of such facilities are in 
                        geographically diverse areas;
                            (ii) not fewer than two such facilities 
                        serve veterans in rural or highly rural areas 
                        (as determined through the use of the Rural-
                        Urban Commuting Areas coding system of the 
                        Department of Agriculture);
                            (iii) not fewer than one such facility is 
                        located in each Veterans Integrated Service 
                        Network selected under paragraph (1); and
                            (iv) not fewer than two such facilities are 
                        State homes.
    (c) Provision of Assisted Living Services.--
            (1) Agreements.--In carrying out the pilot program under 
        subsection (a)(1), the Secretary may enter into agreements for 
        the provision of assisted living services on behalf of eligible 
        veterans with--
                    (A) a provider participating under a State plan or 
                waiver under title XIX of the Social Security Act (42 
                U.S.C. 1396 et seq.); or
                    (B) a State home recognized and certified under 
                subpart B of part 51 of title 38, Code of Federal 
                Regulations, or successor regulations.
            (2) Standards.--The Secretary may not place, transfer, or 
        admit a veteran to any facility for assisted living services 
        under the pilot program under subsection (a)(1) unless the 
        Secretary determines that--
                    (A) the facility meets the standards for community 
                residential care established under sections 17.61 
                through 17.72 of title 38, Code of Federal Regulations, 
                or successor regulations, and any additional standards 
                of care as the Secretary may specify; or
                    (B) in the case of a facility that is a State home, 
                the State home meets such standards of care as the 
                Secretary may specify.
            (3) Inspection.--The Secretary shall inspect facilities at 
        which veterans are placed under the pilot program under 
        subsection (a)(1)--
                    (A) with respect to a facility that is a State 
                home, not less frequently than annually and in the same 
                manner as the Secretary conducts inspection of State 
                homes under section 1742 of title 38, United States 
                Code; and
                    (B) with respect to any other facility, not less 
                frequently than annually and in the same manner as the 
                Secretary conducts inspection of facilities under 
                section 1730 of such title.
            (4) Payment to certain facilities.--
                    (A) State homes.--In the case of a facility 
                participating in the pilot program under subsection 
                (a)(1) that is a State home, the Secretary shall pay to 
                the State home a per diem for each veteran 
                participating in the pilot program at a rate agreed to 
                by the Secretary and the State home.
                    (B) Community assisted living facilities.--In the 
                case of a facility participating in the pilot program 
                under subsection (a)(1) that is a community assisted 
                living facility, the Secretary shall--
                            (i) pay to the facility an amount that is 
                        less than the average rate paid by the 
                        Department for placement in a community nursing 
                        home in the same Veterans Integrated Service 
                        Network; and
                            (ii) re-evaluate payment rates annually to 
                        account for current economic conditions and 
                        current costs of assisted living services.
    (d) Continuity of Care.--Upon the termination of the pilot program 
under subsection (a)(1), the Secretary shall--
            (1) provide to all veterans participating in the pilot 
        program at the time of such termination the option to continue 
        to receive assisted living services at the site they were 
        assigned to under the pilot program, at the expense of the 
        Department; and
            (2) for such veterans who do not opt to continue to receive 
        such services--
                    (A) ensure such veterans do not experience lapses 
                in care; and
                    (B) provide such veterans with information on, and 
                enroll such veterans in, other extended care services 
                based on their preferences and best medical interest.
    (e) Determination of Quality.--The Secretary shall determine a 
method for assessment of quality of care provided to veterans 
participating in the pilot program under subsection (a)(1) and shall 
communicate that method to providers of services under the pilot 
program.
    (f) Annual Report.--Not later than one year after the initiation of 
the pilot program under subsection (a)(1), and annually thereafter for 
each year in which the pilot program is carried out, 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 pilot program, including--
            (1) an identification of Veterans Integrated Services 
        Networks and facilities of the Department participating in the 
        pilot program and assisted living facilities and State homes at 
        which veterans are placed under the pilot program;
            (2) the number of participants in the pilot program, 
        disaggregated by facility;
            (3) general demographic information of participants in the 
        pilot program, including average age, gender, and race or 
        ethnicity;
            (4) disability status of participants in the pilot program;
            (5) an identification of any barriers or challenges to 
        enrolling veterans in the pilot program, conducting oversight 
        of the pilot program, or any other barriers or challenges;
            (6) the cost of care at each assisted living facility and 
        State home participating in the pilot program, including an 
        analysis of any cost savings by the Department when comparing 
        that cost to the cost of nursing home care;
            (7) aggregated feedback from participants in the pilot 
        program, including from veteran resident surveys and 
        interviews; and
            (8) such other matters the Secretary considers appropriate.
    (g) Final Report.--Not later than four years after the initiation 
of the pilot program under subsection (a)(1), or not later than seven 
years after the initiation of the pilot program if the pilot program is 
extended under subsection (a)(2), 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 pilot 
program that--
            (1) includes the matters required under paragraphs (1) 
        through (8) of subsection (f);
            (2) includes recommendations on whether the model studied 
        in the pilot program should be continued or adopted throughout 
        the Department; and
            (3) indicates whether the Secretary requests action by 
        Congress to make the pilot program permanent.
    (h) Report by Inspector General.--
            (1) In general.--Not later than three years after the 
        initiation of the pilot program under subsection (a)(1), the 
        Inspector General of the Department of Veterans Affairs shall 
        submit to the Secretary, the Committee on Veterans' Affairs of 
        the Senate, and the Committee on Veterans' Affairs of the House 
        of Representatives a report on the pilot program.
            (2) Elements.--The report required by paragraph (1) shall 
        include an assessment of--
                    (A) the quality of care provided to veterans at 
                facilities participating in the pilot program, measured 
                pursuant to the method determined under subsection (e);
                    (B) the oversight of such facilities, as conducted 
                by the Department, the Centers for Medicare & Medicaid 
                Services, State agencies, and other relevant entities; 
                and
                    (C) such other matters as the Inspector General 
                considers appropriate.
            (3) Follow-up.--Not later than 90 days after the submittal 
        of the report required by paragraph (1), 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 plan to address the deficiencies identified 
        in the report, if any.
    (i) Definitions.--In this section:
            (1) Assisted living services.--The term ``assisted living 
        services'' means services of a facility in providing room, 
        board, and personal care for and supervision of residents for 
        their health, safety, and welfare.
            (2) Eligible veteran.--The term ``eligible veteran'' means 
        a veteran who--
                    (A)(i) is already receiving nursing home level care 
                paid for by the Department;
                    (ii) is eligible to receive nursing home level care 
                paid for by the Department pursuant to section 1710A of 
                title 38, United States Code; or
                    (iii) requires a higher level of care than the 
                domiciliary care provided by the Department but does 
                not meet the requirements for nursing home level care 
                provided by the Department pursuant to such section; 
                and
                    (B)(i) is eligible for assisted living services, as 
                determined by the Secretary; or
                    (ii) meets such additional criteria for eligibility 
                for the pilot program under subsection (a)(1) as the 
                Secretary may establish.
            (3) State home.--The term ``State home'' has the meaning 
        given that term in section 101(19) of title 38, United States 
        Code.
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