[Congressional Record Volume 145, Number 115 (Wednesday, September 8, 1999)]
[Senate]
[Pages S10621-S10623]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




      VETERANS COMPENSATION COST-OF-LIVING ADJUSTMENT ACT OF 1999

                                 ______
                                 

              ROCKEFELLER (AND SPECTER) AMENDMENT NO. 1622

  Mr. BROWNBACK (for Mr. Rockefeller (for himself and Mr. Specter)) 
proposed an amendment to the bill (S. 1076) to amend title 38, United 
States Code, to provide a cost-of-living adjustment in rates of 
compensation paid to veterans with service-connected disabilities, to 
enhance programs providing health care, education, and other benefits 
for veterans, to authorize major medical facility projects, to reform 
eligibility for burial in Arlington National Cemetery, and for other 
purposes; as follows:

       On page 66, strike lines 9 through 19 and insert the 
     following:

     SEC. 101. CONTINUUM OF CARE FOR VETERANS.

       (a) Inclusion of Noninstitutional Extended Care Services in 
     Definition of Medical Services.--Section 1701 is amended--

[[Page S10622]]

       (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) home health aide visits.
       ``(11) The term `respite care' means hospital care, nursing 
     home care, or residence-based care which--
       ``(A) is of limited duration;
       ``(B) is furnished in a Department facility or in the 
     residence of an individual on an intermittent basis to an 
     individual who is suffering from a chronic illness and who 
     resides primarily at that residence; and
       ``(C) is furnished for the purpose of helping the 
     individual to continue residing primarily at that 
     residence.''.
       (b) Conforming Amendments to Title 38.--(1)(A) Section 1720 
     is amended by striking subsection (f).
       (B) The section heading of such section is amended by 
     striking ``; adult day health care''.
       (2) Section 1720B is repealed.
       (3) Chapter 17 is further amended by redesignating sections 
     1720C, 1720D, and 1720E as sections 1720B, 1720C, and 1720D, 
     respectively.
       (c) Clerical Amendments.--The table of sections for chapter 
     17 is amended--
       (1) in the item relating to section 1720, by striking ``; 
     adult day health care''; and
       (2) by striking the items relating to sections 1720B, 
     1720C, 1720D, and 1720E and inserting the following:

``1720B. Noninstitutional alternatives to nursing home care.
``1720C. Counseling and treatment for sexual trauma.
``1720D. Nasopharyngeal radium irradiation.''.
       (d) Additional Conforming Amendment.--Section 101(g)(2) of 
     the Veterans Health Programs Extension Act of 1994 (Public 
     Law 103-452; 108 Stat. 4785; 38 U.S.C. 1720D note) is amended 
     by striking ``section 1720D'' both places it appears and 
     inserting ``section 1720C''.

     SEC. 102. 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 in two designated 
     health care regions of the Department of Veterans Affairs 
     selected by the Secretary for purposes of this section.
       (2) In selecting designated health care regions of the 
     Department for purposes of a particular pilot program, the 
     Secretary shall, to the maximum extent practicable, select 
     designated health care regions containing a medical center or 
     medical centers whose current circumstances and activities 
     most closely mirror the circumstances and activities proposed 
     to be achieved under such pilot program.
       (3) The Secretary may not carry out more than one pilot 
     program in any given designated health care region of the 
     Department.
       (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; and
       (B) non-institutional long-term care, including hospital-
     based primary care, adult day health care, respite care, and 
     other community-based interventions and care.
       (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.
       (4) The Secretary may provide health care services or other 
     services under the pilot programs only if the Secretary is 
     otherwise authorized to provide such services by law.
       (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 made by the 
     Department to the extent that payment for such services is 
     not otherwise provided by another government or non-
     government entity.
       (g) Data Collection.--As part of the pilot programs under 
     this section, the Secretary shall collect data regarding--
       (1) the cost-effectiveness of such programs and of other 
     activities of the Department for purposes of meeting the 
     long-term care needs of eligible veterans, including any cost 
     advantages under such programs and activities when compared 
     with the Medicare program, Medicaid program, or other Federal 
     program serving similar populations;
       (2) the quality of the services provided under such 
     programs and activities;
       (3) the satisfaction of participating veterans, non-
     Department, and non-Government entities with such programs 
     and activities; and
       (4) the effect of such programs and activities on the 
     ability of veterans to carry out basic activities of daily 
     living over the course of such veterans' participation in 
     such programs and activities.
       (h) Report.--(1) Not later than six months after the 
     completion of the pilot programs under subsection (i), the 
     Secretary shall submit to Congress a report on the health 
     services and other services furnished by the Department to 
     meet the long-term care needs of eligible veterans.
       (2) The report under paragraph (1) shall--
       (A) describe the comprehensive array of health services and 
     other services furnished by the Department under law to meet 
     the long-term care needs of eligible veterans, including--
       (i) inpatient long-term care in intermediate care beds, in 
     nursing homes, and in domiciliary care facilities; and
       (ii) non-institutional long-term care, including hospital-
     based primary care, adult day health care, respite care, and 
     other community-based interventions and care;
       (B) describe the case management services furnished as part 
     of the services described in subparagraph (A) and assess the 
     role of such case management services in ensuring that 
     eligible veterans receive services to meet their long-term 
     care needs; and
       (C) in describing services under subparagraphs (A) and (B), 
     emphasize the role of preventive services in the furnishing 
     of such services.
       (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) Eligible veteran.--The term ``eligible veteran'' means 
     the following:
       (A) Any veteran eligible to receive 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) Long-term care needs.--The term ``long-term care 
     needs'' means the need by an individual for any of the 
     following services:
       (A) Hospital care.
       (B) Medical services.
       (C) Nursing home care.
       (D) Case management and other social services.
       (E) Home and community based services.

     SEC. 103. PILOT PROGRAM RELATING TO ASSISTED LIVING SERVICES.

       (a) In General.--The Secretary of Veterans Affairs shall 
     carry out a pilot program for the purpose of determining the 
     feasibility and practicability of providing assisted living 
     services to eligible veterans. The pilot program shall be 
     carried out in accordance with this section.
       (b) Location.--The pilot program under this section shall 
     be carried out at a designated health care region of the 
     Department of Veterans Affairs selected by the Secretary for 
     purposes of this section.
       (c) Scope of Services.--(1) Subject to paragraph (2), the 
     Secretary shall provide assisted living services under the 
     pilot program to eligible veterans.
       (2) Assisted living services may not be provided under the 
     pilot program to a veteran eligible for care under section 
     1710(a)(3) of title 38, United States Code, unless such 
     veteran agrees to pay the United States an amount equal to 
     the amount determined in accordance with the provisions of 
     section 1710(f) of such title.
       (3) Assisted living services may also be provided under the 
     pilot program to the spouse of an eligible veteran if--
       (A) such services are provided coincidentally with the 
     provision of identical services to the veteran under the 
     pilot program; and

[[Page S10623]]

       (B) such spouse agrees to pay the United States an amount 
     equal to the cost, as determined by the Secretary, of the 
     provision of such services.
       (d) Reports.--(1) The Secretary shall annually submit to 
     Committees on Veterans' Affairs of the Senate and the House 
     of Representatives a report on the pilot program under this 
     section. The report shall include a detailed description of 
     the activities under the pilot program during the one-year 
     period ending on the date of the report and such other 
     matters as the Secretary considers appropriate.
       (2)(A) In addition to the reports required by paragraph 
     (1), not later than 90 days before concluding the pilot 
     program under this section, the Secretary shall submit to the 
     committees referred to in that paragraph a final report on 
     the pilot program.
       (B) The report on the pilot program under this paragraph 
     shall include the following:
       (i) An assessment of the feasibility and practicability of 
     providing assisted living services for veterans and their 
     spouses.
       (ii) A financial assessment of the pilot program, including 
     a management analysis, cost-benefit analysis, Department 
     cash-flow analysis, and strategic outlook assessment.
       (iii) Recommendations, if any, regarding an extension of 
     the pilot program, including recommendations regarding the 
     desirability of authorizing or requiring the Secretary to 
     seek reimbursement for the costs of the Secretary in 
     providing assisted living services in order to reduce demand 
     for higher-cost nursing home care under the pilot program.
       (iv) Any other information or recommendations that the 
     Secretary considers appropriate regarding the pilot program.
       (e) Duration.--(1) The Secretary shall commence carrying 
     out the pilot program 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 program shall cease on the date that is three 
     years after the date of the commencement of the pilot program 
     under paragraph (1).
       (f) Definitions.--In this section:
       (1) Eligible veteran.--The term ``eligible veteran'' means 
     the following:
       (A) Any veteran eligible to receive 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) Assisted living services.--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--
       (A) maximizes flexibility in the provision of such care, 
     activities, supervision, and assistance;
       (B) maximizes the autonomy, privacy, and independence of an 
     individual; and
       (C) encourages family and community involvement with the 
     individual.
       On page 85, between lines 4 and 5, insert the following:
       (4) Renovations and environmental improvements at the 
     Department of Veterans Affairs Medical Center, Atlanta, 
     Georgia, in an amount not to exceed $12,400,000.
       On page 85, line 9, strike ``$213,100,000'' and insert 
     ``$225,500,000''.

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