[Congressional Record Volume 164, Number 44 (Tuesday, March 13, 2018)]
[House]
[Pages H1513-H1515]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




   STATE VETERANS HOME ADULT DAY HEALTH CARE IMPROVEMENT ACT OF 2017

  Mr. ROE of Tennessee. Mr. Speaker, I move to suspend the rules and 
pass the bill (S. 324) to amend title 38, United States Code, to 
improve the provision of adult day health care services for veterans.
  The Clerk read the title of the bill.
  The text of the bill is as follows

                                 S. 324

       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 ``State Veterans Home Adult 
     Day Health Care Improvement Act of 2017''.

     SEC. 2. PROVISION OF CERTAIN ADULT DAY HEALTH CARE SERVICES 
                   FOR VETERANS.

       (a) In General.--Section 1745 of title 38, United States 
     Code, is amended--
       (1) by adding at the end the following new subsection:
       ``(d)(1) The Secretary shall enter into an agreement with 
     each State home for payment by the Secretary for medical 
     supervision model adult day health care provided to a veteran 
     described in subsection (a)(1) on whose behalf the State home 
     is not in receipt of payment for nursing home care from the 
     Secretary.
       ``(2)(A) Payment under each agreement between the Secretary 
     and a State home under paragraph (1) for each veteran who 
     receives medical supervision model adult day health care 
     under such agreement shall be made at a rate established 
     through regulations prescribed by the Secretary to adequately 
     reimburse the State home for the care provided by the State 
     home, including necessary transportation expenses.
       ``(B) The Secretary shall consult with the State homes in 
     prescribing regulations under subparagraph (A).
       ``(C) The rate established through regulations under 
     subparagraph (A) shall not take effect until the date that is 
     30 days after the date on which those regulations are 
     published in the Federal Register.
       ``(3) Payment by the Secretary under paragraph (1) to a 
     State home for medical supervision model adult day health 
     care provided to a veteran described in that paragraph 
     constitutes payment in full to the State home for such care 
     furnished to that veteran.
       ``(4) In this subsection, the term `medical supervision 
     model adult day health care' means adult day health care that 
     includes the coordination of physician services, dental 
     services, nursing services, the administration of drugs, and 
     such other requirements as determined appropriate by the 
     Secretary.''; and
       (2) in the section heading, by inserting ``, adult day 
     health care,'' after ``home care''.
       (b) Initial Rate.--Before the Secretary of Veterans Affairs 
     establishes a payment rate under subsection (d)(2)(A) of 
     section 1745 of such title, as added by subsection (a), the 
     Secretary shall pay to a State home that has entered into an 
     agreement with the Secretary for medical supervision model 
     adult day health care (as defined in subsection (d)(4) of 
     such section) an amount equal to 65 percent of the rate the 
     Secretary would pay under subsection (a)(2) of such section 
     to the State home for nursing home care provided to the 
     veteran.
       (c) Clerical Amendment.--The table of sections at the 
     beginning of chapter 17 of such title is amended by striking 
     the item relating to section 1745 and inserting the following 
     new item:

``1745. Nursing home care, adult day health care, and medications for 
              veterans with service-connected disabilities.''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Tennessee (Mr. Roe) and the gentleman from Minnesota (Mr. Walz) each 
will control 20 minutes.
  The Chair recognizes the gentleman from Tennessee.


                             General Leave

  Mr. ROE of Tennessee. Mr. Speaker, I ask unanimous consent that all 
Members have 5 legislative days to revise and extend their remarks and 
include extraneous material.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Tennessee?
  There was no objection.
  Mr. ROE of Tennessee. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, before I begin today, I would like to take a moment to 
express my deepest sympathies to those affected by last week's tragedy 
in Yountville, California. I closely followed the situation. I am truly 
saddened by what has occurred.
  All three employees who lost their lives--Christine Loeber and 
Jennifer Golick from the Pathway Home and Jennifer Gonzales from the 
Department of Veterans Affairs--were committed to helping veterans 
struggling with difficulties like post-traumatic stress disorder and 
other mental problems.
  As Secretary Shulkin said: ``Caring for veterans and our employees 
serving them is always important. It is even more critical that we 
reach out to one another and provide support during painful times like 
these.''
  I think I can speak for myself and the rest of the members on the 
House Committee on Veterans' Affairs when I offer prayers and support 
during this incredibly difficult and challenging time for these 
families.
  Mr. Speaker, I rise today in support of S. 324, the State Veterans 
Home Adult Day Health Care Improvement Act of 2017. It is imperative 
that we ensure that VA is equipped with a variety of geriatric and 
long-term care programs to best meet the individual needs and goals of 
the increasing number of veterans who are reaching retirement age.
  Current law requires VA to cover the cost of nursing home care in a 
State Veterans Home for any veteran in need of such care due to a 
service-connected disability or with a service-connected disability 
rating of 70 percent or more. However, veterans are increasingly 
seeking opportunities to get additional care they need as they age 
while remaining at home rather than in a nursing care facility or other 
institutional setting. S. 324 would help those veterans by requiring VA 
to enter into an agreement or a contract with the State Veterans Home 
to pay for adult day healthcare for veterans who are eligible but not 
receiving nursing home care.
  Adult day healthcare programs provide companionship, peer support, 
recreation, certain healthcare services, case management assistance 
with activities of daily living, and more to veterans, and needed 
respite and relief to caregivers. What is more, adult day healthcare 
programs are a much less costly alternative to nursing home care, 
meaning that, with the enactment of this bill, we could grant veterans 
who desire to age at home the opportunity to do so without sacrificing 
the care and support services they may need and save taxpayer dollars.
  S. 324, which is sponsored by Senator Orrin Hatch of Utah, is 
companion legislation to H.R. 1005, which is sponsored by the gentleman 
from New York (Mr. Zeldin) and passed the House with unanimous support 
earlier this year. I am grateful to both of them for their leadership 
on this issue, and I urge all of my colleagues to join me in supporting 
S. 324.
  Mr. Speaker, I reserve the balance of my time.
  Mr. WALZ. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I would like to thank the gentleman from Tennessee for 
his compassionate words on the tragic loss of three dedicated, selfless 
servants in care of our veterans. I very much appreciate that, and it 
is a challenging time.
  Mr. Speaker, I rise today in support of S. 324, the State Veterans 
Home Adult Day Health Care Improvement Act. I want to thank Senator 
Hatch for introducing this innovative and bipartisan bill.
  S. 324 directs the VA to enter into an agreement with each State home 
to pay for medical supervision model adult healthcare for a veteran for 
whom the home is not receiving VA nursing home payments.
  Ensuring that veterans have access to appropriate affordable 
geriatric and long-term care is becoming increasingly important. In 
2017, approximately 9.8 million veterans, or 46 percent, were 65 years 
or older.
  In addition, VA's own Enrollee Health Care Projection Model indicates 
a further demand on long-term care and support services is coming as 
the Vietnam-era cohort ages, with most having gone beyond age 75 by 
2026.
  At present, VA is required to cover the cost of nursing home care in 
the

[[Page H1514]]

State Veterans Home for any veteran in need of such care due to a 
service-connected disability or with a service-connected disability 
rated 70 percent or more. However, there is increasing demand for VA to 
offer geriatric and long-term programs for veterans in noninstitutional 
settings that would allow them to receive the services and support they 
need to remain in their homes--their preferred venue.
  Adult day healthcare programs provide veterans in need of supportive 
services with companionship, peer support, recreation, and certain 
healthcare services, while allowing them to stay and maintain their 
independence.
  In testimony before the Subcommittee on Health last year, the 
National Association of State Veterans Homes claimed that there are a 
number of State homes across the country interested in providing 
medical model ADHC services; however, the current basic ADHC per diem 
paid to the State Veterans Home by the VA is not sufficient for most 
homes to cover the cost of this program. As a result, only 3 State 
Veterans Homes out of 153, nationwide, provide this program.
  This legislation would correct that imbalance, allowing veterans who 
would otherwise qualify for more costly VA nursing home care the 
ability to stay in their home longer, at a reduced cost.

  Mr. Speaker, I reserve the balance of my time.
  Mr. ROE of Tennessee. Mr. Speaker, I yield 3 minutes to the gentleman 
from Michigan (Mr. Bergman), from the Upper Peninsula, chairman of the 
Subcommittee on Oversight and Investigations.
  Mr. BERGMAN. Mr. Speaker, I rise today in support of S. 324, the 
State Veterans Home Adult Day Health Care Improvement Act of 2017.
  This is very personal to me. My cousin, a fellow Vietnam vet who 
served on the DMZ with the Army, is currently in need of and receiving 
some of that care for some serious health issues he has right now as a 
result of exposure to Agent Orange.
  The bill we are talking about here strikes a responsible balance by 
promoting access to necessary medical services for veterans, while also 
improving quality of life by allowing them to return home to their 
families each night. Adult day healthcare does more than just provide 
veterans with the medical care that they need; it also offers much-
needed relief to their caregivers. Oftentimes, friends and family come 
together to help with the daily care that these veterans and their 
families require.
  By giving veterans the opportunity to access medical care for up to 8 
hours a day through a State veterans home, caregivers will have the 
opportunity to fulfill their personal responsibilities for themselves 
and their families. They can get on and get their life in order while 
still serving their veteran family member.
  These folks work day in and day out to provide unparalleled care, 
loving care to our most vulnerable veterans. S. 324 recognizes their 
selfless commitment and works to enhance their work-life balance so 
they can continue to serve veterans.
  In my district, folks deal with the circumstances of rural living 
every day. This often means limited access to resources and fewer 
options for receiving the services they need.
  The D.J. Jacobetti Home for Veterans in Marquette is a perfect 
example of what can be achieved when Federal resources are narrowly 
focused and responsibly applied. Jacobetti Home's ability to create a 
family environment where veterans can receive the care they need while 
maintaining quality in their daily lives is a testament to what is 
possible when the Federal Government helps local institutions provide 
services for the people they know best.
  Mr. Speaker, I urge support of S. 324.
  Mr. WALZ. Mr. Speaker, I continue to reserve the balance of my time.
  Mr. ROE of Tennessee. Mr. Speaker, I yield 3 minutes to the gentleman 
from New York (Mr. Zeldin), the author of the bill on the House side 
and also an Iraq war veteran.
  Mr. ZELDIN. Mr. Speaker, I am very excited to be here because I know 
just how many disabled veterans in our country are on wait lists for 
adult day healthcare and now will be getting a service that is just so 
important and overdue.
  I certainly want to thank Chairman Roe and his great staff, the House 
Veterans' Affairs Committee, the ranking member and his team as well, 
everybody coming together working hard on behalf of our disabled 
veterans who need it most.
  I rise in support of S. 324. It is the Senate companion to my bill, 
H.R. 1005, which is a bill to provide adult day healthcare and save 
State Veterans Homes for veterans who are 70 percent or more service-
connected disabled. This bill is an extension to the Veterans Benefits, 
Health Care, and Information Technology Act of 2006, which currently 
provides no-cost nursing home care at any State Veterans Home to 
veterans who are 70 percent or more service-connected disabled.
  Medical model adult day healthcare provides comprehensive medical 
nursing and personal care services combined with engaging social 
activities for physically or cognitively impaired adults. Medical model 
adult day healthcare offers a complete array of rehabilitative 
therapies, including physical, occupational, and speech therapies, 
hospice and palliative care, social work, spiritual, nutritional 
counseling, and therapeutic recreation.
  The program is designed to promote socialization and stimulation and 
maximize the participant's independence, while enhancing their quality 
of life. The program is staffed by a great team of multidisciplinary 
healthcare professionals who evaluate each participant and customize an 
individualized plan of care specific to their health and social needs.
  Adult day healthcare is an alternative care setting that can allow 
some veterans who require long-term care services to remain in their 
homes as opposed to being institutionalized in a nursing home. Such 
veterans typically require support from some, but not all, activities 
of assisted daily living--ADLs--such as bathing, dressing, or feeding.
  In many cases, the spouse or their family member may provide the 
veteran with much of their care, but they require additional support 
for some of the veteran's ADLs. By filling these gaps, adult day 
healthcare can allow these veterans to remain in their homes and 
communities for additional months, or even years, and thereby lower the 
financial cost of caring for these heroes.
  Adult day healthcare also provides family caregivers support and 
relief to meet their other professional and family obligations and 
provides a well-deserved respite while their loved ones are 
participating in the program.
  In addition to thanking Chairman Roe for his leadership and support 
on this important issue, I also want to thank Senator Hatch for 
carrying this effort in the Senate, as well as Fred Sganga and the Long 
Island State Veterans Home in Stony Brook for their great efforts. That 
is a State Veterans Home located in the First Congressional District of 
New York, one of three places currently offering adult day healthcare.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. ROE of Tennessee. Mr. Speaker, I yield an additional 1 minute to 
the gentleman from New York.

  Mr. ZELDIN. Mr. Speaker, this is a piece of legislation that will 
provide a valuable and necessary service to our Nation's veterans, and 
I am urging my colleagues to support this commonsense, bipartisan 
legislation.
  What goes on too often unnoticed in this House is the great staff 
that we have to help make these efforts possible. So, from the 
leadership team, I want to thank staff John Leganski and Kelly Dixon, 
and in my office, as legislative director, Kevin Dowling, and Matthew 
Scott.
  Thank you again to the great House Veterans' Affairs Committee, and 
we will all greatly miss Chairman Roe as he departs. Hopefully, maybe 
we will get him to change his mind, but in the meantime, I will just 
say we enjoyed serving with him, and I hope that he won't go anywhere 
for a very long time. He is a great leader for our veterans as well as 
being our ranking member.
  Mr. WALZ. Mr. Speaker, if the gentleman has no further speakers, I am 
prepared to close.
  Mr. Speaker, I would like to thank the gentleman from Long Island--he 
clearly understands this issue--for his

[[Page H1515]]

passionate work on this, and we are grateful for it.
  I, too, would like to add my voice to this, to the chairman for once 
again proving to America that this Congress can work, that there are 
bipartisan solutions to issues that we care about in serving our 
constituents and our veterans and others. It is something that we are 
very proud of here. It doesn't always come easy, but his leadership 
somehow finds a way to bring us to the table. We get it done, and I am 
grateful for that.
  I urge my colleagues to join us in passing S. 324, and I yield back 
the balance of my time.
  Mr. ROE of Tennessee. Mr. Speaker, unless Mr. Zeldin has talked to my 
doctor and knows something I don't know, I hope to be here next year. 
That is my plan.
  I appreciate the opportunity to work on this bill with him. He has 
been a great advocate, as the ranking member has been. This is a bill 
that is long overdue, much needed, and I give my strong support along 
with--I think I can speak for them--the entire Veterans' Affairs 
Committee. We voiced this. I encourage Members to support this 
legislation.
  Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Tennessee (Mr. Roe) that the House suspend the rules and 
pass the bill, S. 324.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill was passed.
  A motion to reconsider was laid on the table.

                          ____________________