[Congressional Record Volume 164, Number 125 (Wednesday, July 25, 2018)]
[House]
[Pages H7172-H7175]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                   LONG-TERM CARE VETERANS CHOICE ACT

  Mr. ROE of Tennessee. Mr. Speaker, I move to suspend the rules and 
pass the bill (H.R. 5693) to amend title 38, United States Code, to 
authorize the Secretary of Veterans Affairs to enter into contracts and 
agreements for the placement of veterans in non-Department medical 
foster homes for certain veterans who are unable to live independently, 
to establish the Veterans Economic Opportunity and Transition 
Administration and the Under Secretary for Veterans Economic 
Opportunity and Transition of the Department of Veterans Affairs, to 
amend the interest rate for certain loans guaranteed under the home 
loan program of the Department of Veterans Affairs, and for other 
purposes, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 5693

       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 ``Long-Term Care Veterans 
     Choice Act''.

     SEC. 2. SECRETARY OF VETERANS AFFAIRS CONTRACT AUTHORITY FOR 
                   PLACEMENT OF VETERANS IN NON-DEPARTMENT MEDICAL 
                   FOSTER HOMES.

       (a) Authority.--Section 1720 of title 38, United States 
     Code, is amended by adding at the end the following new 
     subsection:
       ``(h)(1) During the three-year period beginning on October 
     1, 2019, and subject to paragraph (2), at the request of a 
     veteran for whom the Secretary is required to provide nursing 
     home care under section 1710A of this title, the Secretary 
     may place the veteran in a medical foster home that meets 
     Department standards, at the expense of the United States, 
     pursuant to a contract, agreement, or other arrangement 
     entered into between the Secretary and the medical foster 
     home for such purpose. A veteran who is placed in a medical 
     foster home under this subsection shall agree, as a condition 
     of such placement, to accept home health services furnished 
     by the Secretary under section 1717 of this title.
       ``(2) In any year, not more than a daily average of 900 
     veterans placed in a medical foster home, whether placed 
     before or after the date of the enactment of this subsection, 
     may have their care covered at the expense of the United 
     States under subsection (a).
       ``(3) In this subsection, the term `medical foster home' 
     means a home designed to provide non-institutional, long-
     term, supportive care for veterans who are unable to live 
     independently and prefer a family setting.''.
       (b) Effective Date.--Subsection (h) of title 38, United 
     States Code, as added by subsection (a), shall take effect on 
     October 1, 2019.

     SEC. 3. ESTABLISHMENT OF VETERANS ECONOMIC OPPORTUNITY AND 
                   TRANSITION ADMINISTRATION.

       (a) Veterans Economic Opportunity and Transition 
     Administration.--
       (1) In general.--Part V of title 38, United States Code, is 
     amended by adding at the end the following new chapter:

      ``CHAPTER 80--VETERANS ECONOMIC OPPORTUNITY AND TRANSITION 
                             ADMINISTRATION

``8001. Organization of Administration.
``8002. Functions of Administration.
``8003. Annual report to Congress.

     ``Sec. 8001. Organization of Administration

       ``(a) Veterans Economic Opportunity and Transition 
     Administration.--There is in the Department of Veterans 
     Affairs a Veterans Economic Opportunity and Transition 
     Administration. The primary function of the Veterans Economic 
     Opportunity and Transition Administration is the 
     administration of the programs of the Department that provide 
     assistance related to economic opportunity to veterans and 
     their dependents and survivors.
       ``(b) Under Secretary for Economic Opportunity and 
     Transition.--The Veterans Economic Opportunity and Transition 
     Administration is under the Under Secretary for Veterans 
     Economic Opportunity and Transition, who is directly 
     responsible to the Secretary for the operations of the 
     Administration.

     ``Sec. 8002. Functions of Administration

       ``The Veterans Economic Opportunity and Transition 
     Administration is responsible for the administration of the 
     following programs of the Department:
       ``(1) Vocational rehabilitation and employment programs.
       ``(2) Educational assistance programs.
       ``(3) Veterans' housing loan and related programs.
       ``(4) The verification of small businesses owned and 
     controlled by veterans pursuant to subsection (f) of section 
     8127 of this title, including the administration of the 
     database of veteran-owned businesses described in such 
     subsection.
       ``(5) The Transition Assistance Program under section 1144 
     of title 10.
       ``(6) Any other program of the Department that the 
     Secretary determines appropriate.

     ``Sec. 8003. Annual report to Congress

       ``The Secretary shall include in the annual report to the 
     Congress required by section 529 of this title a report on 
     the programs administered by the Under Secretary for Veterans 
     Economic Opportunity and Transition. Each such report shall 
     include the following with respect to each such program 
     during the fiscal year covered by that report:
       ``(1) The number of claims received.
       ``(2) The number of claims decided.
       ``(3) The average processing time for a claim.
       ``(4) The number of successful outcomes (as determined by 
     the Secretary).
       ``(5) The number of full-time equivalent employees.
       ``(6) The amounts expended for information technology.''.
       (2) Clerical amendments.--The tables of chapters at the 
     beginning of title 38, United States Code, and of part V of 
     title 38, United States Code, are each amended by inserting 
     after the item relating to chapter 79 the following new item:

``80.  Veterans Economic Opportunity and Transition Administ8001''.....

       (b) Effective Date.--Chapter 80 of title 38, United States 
     Code, as added by subsection (a), shall take effect on 
     October 1, 2019.
       (c) Full-Time Employees.--For fiscal years 2019 and 2020, 
     the total number of full-time equivalent employees authorized 
     for the Veterans Benefits Administration and the Veterans 
     Economic Opportunity and Transition Administration, as 
     established under chapter 80 of title 38, United States Code, 
     as added by subsection (a), may not exceed 23,692.

     SEC. 4. UNDER SECRETARY FOR VETERANS ECONOMIC OPPORTUNITY AND 
                   TRANSITION.

       (a) Under Secretary.--
       (1) In general.--Chapter 3 of title 38, United States Code, 
     is amended by inserting after section 306 the following new 
     section:

     ``Sec. 306A. Under Secretary for Veterans Economic 
       Opportunity and Transition

       ``(a) Under Secretary.--There is in the Department an Under 
     Secretary for Veterans Economic Opportunity and Transition, 
     who is appointed by the President, by and with the advice and 
     consent of the Senate. The Under Secretary for Veterans 
     Economic Opportunity and Transition shall be appointed 
     without regard to political affiliation or activity and 
     solely on the basis of demonstrated ability in--

[[Page H7173]]

       ``(1) information technology; and
       ``(2) the administration of programs within the Veterans 
     Economic Opportunity and Transition Administration or 
     programs of similar content and scope.
       ``(b) Responsibilities.--The Under Secretary for Veterans 
     Economic Opportunity and Transition is the head of, and is 
     directly responsible to the Secretary for the operations of, 
     the Veterans Economic Opportunity and Transition 
     Administration.
       ``(c) Vacancies.--(1) Whenever a vacancy in the position of 
     Under Secretary for Veterans Economic Opportunity and 
     Transition occurs or is anticipated, the Secretary shall 
     establish a commission to recommend individuals to the 
     President for appointment to the position.
       ``(2) A commission established under this subsection shall 
     be composed of the following members appointed by the 
     Secretary:
       ``(A) Three persons representing education and training, 
     vocational rehabilitation, employment, real estate, mortgage 
     finance and related industries, and survivor benefits 
     activities affected by the Veterans Economic Opportunity and 
     Transition Administration.
       ``(B) Two persons representing veterans served by the 
     Veterans Economic Opportunity and Transition Administration.
       ``(C) Two persons who have experience in the management of 
     private sector benefits programs of similar content and scope 
     to the economic opportunity and transition programs of the 
     Department.
       ``(D) The Deputy Secretary of Veterans Affairs.
       ``(E) The chairman of the Veterans' Advisory Committee on 
     Education formed under section 3692 of this title.
       ``(F) One person who has held the position of Under 
     Secretary for Veterans Economic Opportunity and Transition, 
     if the Secretary determines that it is desirable for such 
     person to be a member of the commission.
       ``(3) A commission established under this subsection shall 
     recommend at least three individuals for appointment to the 
     position of Under Secretary for Veterans Economic Opportunity 
     and Transition. The commission shall submit all 
     recommendations to the Secretary. The Secretary shall forward 
     the recommendations to the President and the Committees on 
     Veterans' Affairs of the Senate and House of Representatives 
     with any comments the Secretary considers appropriate. 
     Thereafter, the President may request the commission to 
     recommend additional individuals for appointment.
       ``(4) The Assistant Secretary or Deputy Assistant Secretary 
     of Veterans Affairs who performs personnel management and 
     labor relations functions shall serve as the executive 
     secretary of a commission established under this 
     subsection.''.
       (2) Clerical amendment.--The table of sections at the 
     beginning of such chapter is amended by inserting after the 
     item relating to section 306 the following new item:

``306A. Under Secretary for Veterans Economic Opportunity and 
              Transition.''.
       (b) Conforming Amendments.--Title 38, United States Code, 
     is further amended--
       (1) in section 306(c)(2), by striking subparagraphs (A) and 
     (E) and redesignating subparagraphs (B), (C), (D), and (F), 
     as subparagraphs (A) through (D), respectively;
       (2) in section 317(d)(2), by inserting after ``Under 
     Secretary for Benefits,'' the following: ``the Under 
     Secretary for Veterans Economic Opportunity and 
     Transition,'';
       (3) in section 318(d)(2), by inserting after ``Under 
     Secretary for Benefits,'' the following: ``the Under 
     Secretary for Veterans Economic Opportunity and 
     Transition,'';
       (4) in section 516(e)(2)(C), by striking ``Health and the 
     Under Secretary for Benefits'' and inserting ``Health, the 
     Under Secretary for Benefits, and the Under Secretary for 
     Veterans Economic Opportunity and Transition'';
       (5) in section 541(a)(2)(B), by striking ``Health and the 
     Under Secretary for Benefits'' and inserting ``Health, the 
     Under Secretary for Benefits, and the Under Secretary for 
     Veterans Economic Opportunity and Transition'';
       (6) in section 542(a)(2)(B)(iii), by striking ``Health and 
     the Under Secretary for Benefits'' and inserting ``Health, 
     the Under Secretary for Benefits, and the Under Secretary for 
     Veterans Economic Opportunity and Transition'';
       (7) in section 544(a)(2)(B)(vi), by striking ``Health and 
     the Under Secretary for Benefits'' and inserting ``Health, 
     the Under Secretary for Benefits, and the Under Secretary for 
     Veterans Economic Opportunity and Transition'';
       (8) in section 709(c)(2)(A), by inserting after ``Under 
     Secretary for Benefits,'' the following: ``the Under 
     Secretary for Veterans Economic Opportunity and 
     Transition,'';
       (9) in section 7701(a), by inserting after ``assistance'' 
     the following: ``, other than assistance related to Economic 
     Opportunity and Transition,''; and
       (10) in section 7703, by striking paragraphs (2) and (3) 
     and redesignating paragraphs (4) and (5) as paragraphs (2) 
     and (3), respectively.
       (c) Effective Date.--Section 306A of title 38, United 
     States Code, as added by subsection (a), and the amendments 
     made by this section, shall take effect on October 1, 2019.

     SEC. 5. LOANS GUARANTEED UNDER HOME LOAN PROGRAM OF 
                   DEPARTMENT OF VETERANS AFFAIRS.

       Section 3729(b)(2)(E) of such title is amended to read as 
     follows:

------------------------------------------------------------------------
                                 Active duty                    Other
        ``Type of loan             veteran      Reservist      obligor
------------------------------------------------------------------------
(E)(i) Interest rate reduction         0.50          0.50            NA
 refinancing loan (closed
 before January 1, 2019)......
(E)(ii) Interest rate                  0.75          0.75            NA
 reduction refinancing loan
 (closed on or after January
 1, 2019, but before March 1,
 2025)........................
(E)(iii) Interest rate                 0.50          0.50         NA''.
 reduction refinancing loan
 (closed on or after March 1,
 2025)........................
------------------------------------------------------------------------


  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Tennessee (Mr. Roe) and the gentleman from California (Mr. Takano) 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 
insert 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, I rise today in support of my bill, H.R. 5693, as 
amended, the Long-Term Care Veterans Choice Act. This bill would expand 
long-term care opportunities for veterans by allowing the Department of 
Veterans Affairs, VA, to cover the cost of a medical foster home for 
certain veterans.
  Medical foster homes are private homes in which a trained caregiver 
provides round-the-clock care to a small group of individuals. Medical 
foster homes have proven to be a popular, safe, and cost-effective 
alternative to traditional nursing homes, particularly for veterans who 
prefer a more familial, less institutional care setting.
  However, VA is unable to cover the cost of care for a veteran 
residing in a medical foster home. That is true even for veterans who 
VA would otherwise be required to pay for in a more expensive nursing 
home.
  As a result, VA estimates the department pays more than twice as much 
for nursing home care than it otherwise would. The Long-Term Care 
Veterans Choice Act would help address that issue, and, in doing so, 
ensure that veterans have the flexibility to choose the long-term care 
setting that feels most comfortable for them.
  The bill would also create a Veterans Economic Opportunity and 
Transition Administration to be led by an under secretary for Veterans 
Economic Opportunity and Transition. Investing in education and 
employment opportunities for our Nation's veterans is one of VA's most 
important but least recognized missions.
  Today, programs concerning education and employment are embedded 
within the Veterans Benefit Administration, which, understandably, 
devotes most of its time, attention, and resources on disability 
compensation-related issues and backlogs that rise and fall with time.
  Creating a new administration within VA to house education and 
employment programs will ensure that those programs receive the focused 
leadership, time and attention that they deserve.
  To offset the medical foster home and Veterans Economic Opportunity 
and Transition Administration provisions of the bill, it would also 
authorize a temporary increase in the VA home loan funding fee for 
interest reduction loans when refinancing homes. This bill is sponsored 
by Congressman Clay Higgins from Louisiana. As an engaged member of the 
Subcommittee on Health, Clay is a champion for his

[[Page H7174]]

fellow veterans, and I thank him for his leadership on this 
legislation.
  I am also grateful to my good friend and former senior committee 
member, Dr. Brad Wenstrup from Ohio, who has sponsored the Veterans 
Economic Opportunity and Transition Administration provisions of this 
bill. As a veteran and physician, Brad has championed veteran 
employment and education issues because he knows better than most how 
important it is that veterans transitioning from combat zones come home 
to meaningful education and employment opportunities.
  I thank him for his efforts and urge all of my colleagues to join me 
in supporting this bill today.
  Mr. Speaker, I reserve the balance of my time.
  Mr. TAKANO. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, to begin, I thank Representative Higgins for his hard 
work on this legislation, and I support H.R. 5693, as amended.
  This bipartisan legislation is a forward-thinking first step toward 
better aligning VA's long-term care options with veteran preferences.
  Medical foster homes are a solution for veterans that may not be 
comfortable in a traditional institutional setting, such as a nursing 
home, yet still need some form of daily assistance and care. These 
homes provide caregiving services in a group setting for veterans that 
lack access to caregiving services at home.
  By allowing VA to cover the cost of medical foster homes, VA will be 
able to ensure veterans are achieving the most appropriate level of 
care in the most appropriate setting.
  The care delivered at medical foster homes is less intensive; 
therefore, less expensive. Additionally, the sense of community and the 
familiar home-like setting can promote a veteran's physical and mental 
health.
  Again, I appreciate my colleague's hard work on this legislation and 
look forward to voting in favor of the bill. I congratulate the 
gentleman from Louisiana's hard work.
  Mr. Speaker, I reserve the balance of my time.
  Mr. ROE of Tennessee. Mr. Speaker, I yield 5 minutes to the gentleman 
from Louisiana (Mr. Higgins), an active member of the VA committee and 
one of the primary sponsors of this, an Army veteran, and reserve 
police officer.
  Mr. HIGGINS of Louisiana. Mr. Speaker, I rise today in support of 
H.R. 5693, the Long-Term Care Veterans Choice Act. My bill would 
authorize the Department of Veterans Affairs for 3 years to cover the 
cost of long-term care at medical foster homes for up to 900 veterans 
at a time who are otherwise eligible for nursing home care through the 
VA.
  Medical foster homes are private homes in which a caregiver provides 
services to a smaller group of individuals who are unable to live 
without day-to-day assistance. Medical foster homes are an alternative 
to nursing homes for those who require care but prefer a 
noninstitutional setting with fewer residents.
  For many younger veterans in need of round-the-clock care, medical 
foster homes can provide a more age-appropriate independent setting 
than traditional nursing homes. The VA has operated its medical foster 
home initiative for nearly 20 years, and currently oversees more than 
700 licensed caregivers assisting nearly 1,000 veterans across 42 
States.
  Unfortunately, Mr. Speaker, while the VA will cover the cost of home-
based primary care for eligible veterans living in medical foster 
homes, the VA does not cover the cost of medical foster home living 
arrangements for veterans eligible for nursing home care through the 
VA. The reforms in my bill increase access to medical foster homes and 
represent a significant cost savings for the Department of Veterans 
Affairs.
  There should be no one-size-fits-all standard of care for veterans. 
Veterans should be afforded flexibility to use the benefits they 
righteously earned in a manner that best suits their individual needs, 
which is why the VA, American Legion, and many other veteran service 
organizations have offered their support for this language.
  Further, the bill refocuses the administrative bodies of the VA to 
better prioritize programs like the GI bill, vocational rehabilitation, 
home loan benefits, and transition assistance programs that create 
economic opportunities for veterans.
  This allows existing veterans' health benefits and National Cemetery 
Administration to better focus on providing healthcare and cemetery 
services. This critical refocus will improve oversight and veterans 
access to important services like the medical foster home program that 
give much needed choice and personal dignity back to the brave men and 
women who have sacrificed so much for our Nation.
  Mr. Speaker, this bill reflects the compassion of the American 
citizenry in our dedication to serve the veterans who have served us. 
Please join me in supporting our servicemen and women by voting in 
support of H.R. 5693, the Long-Term Care Veterans Choice Act.
  Mr. TAKANO. Mr. Speaker, I yield 3 minutes to the gentleman from 
California (Mr. Correa), a member of the House Committee on Veterans' 
Affairs, and let it also be known that prior to his coming to Congress, 
he chaired a veterans committee in the California State Legislature.
  Mr. CORREA. Mr. Speaker, I rise in strong support of H.R. 5693, the 
Long-Term Care Veterans Choice Act. This bipartisan legislation will 
expand veterans' access to medical foster homes, an alternative to 
nursing home care, by allowing the Department of Veterans Affairs to 
cover such care for up to 900 veterans every year.

                              {time}  1230

  The Medical Foster Homes program allows eligible veterans who require 
day-to-day assistance to live in private homes with trained caregivers 
who provide around-the-clock care and the services needed to help these 
veterans with their daily tasks, such as getting dressed. The program 
requires that caregivers be licensed and involved in frequent 
inspections by the VA.
  Most importantly, the Medical Foster Homes program provides aging 
veterans the option to live in a private setting that may feel more 
like a home than a nursing institution.
  Additionally, the amended bill creates a fourth administration within 
the VA, headed by a new Under Secretary, to administer the educational 
and employment benefits currently managed by the Veterans Benefits 
Administration.
  Mr. Speaker, I urge passage of H.R. 5693.
  Mr. ROE of Tennessee. Mr. Speaker, I yield 2 minutes to the gentleman 
from Ohio (Mr. Wenstrup), my good friend, who has been an active member 
of the Veterans' Affairs Committee and chairs the Subcommittee on 
Health. I appreciate his leadership on this bill.
  Mr. WENSTRUP. Mr. Speaker, I rise to support the Long-Term Care 
Veterans Choice Act, legislation that contains the text of my bill, the 
VET OPP Act. The VET OPP Act continues our effort to invest in our 
troops from the day they take their oath of service to when they begin 
their civilian careers.
  Part of our commitment to our men and women in uniform is helping 
them reintegrate back into civilian life. We can ease this transition 
by prioritizing programs that help them find meaningful employment or 
educational opportunities when they return home.
  For too long, the outdated structure of the VA has allowed economic 
opportunity and transition programs for our veterans to fall by the 
wayside. H.R. 5693 will change that. With the inclusion of the VET OPP 
Act, it prioritizes veteran employment and education programs at the VA 
by utilizing existing resources to place educational, employment, and 
transition programs together in a fourth administration within the VA. 
This will promote transparency and oversight, while placing greater 
priority on opportunity-based programs within the VA.
  Mr. Speaker, I urge my colleagues to support H.R. 5693.
  Mr. TAKANO. Mr. Speaker, I ask my colleagues to join me in passing 
H.R. 5693, as amended, and I yield back the balance of my time.
  Mr. ROE of Tennessee. Mr. Speaker, this is commonsense legislation 
that will allow veterans in certain circumstances to stay in a less 
intense nursing home facility. We hear this all the time: ``I don't 
want to go to a nursing home.'' This will allow veterans who have 
earned these benefits to reside outside there. It is much less 
expensive for the VA, and it is also much

[[Page H7175]]

better for the veteran if they can do this.
  A second part of this bill, which is to create the fourth 
administration, is not more bureaucracy, but to focus on the education 
benefits and transition as Active-Duty military leave and enter 
civilian life again. I think it is one of the most critical things we 
do. A seamless transition from Active Duty to an active job, I think, 
will help reduce veteran depression, suicide, dependence, and other 
things. That is why we wanted to do this.
  Mr. Speaker, I urge my colleagues to support H.R. 5693, as amended, 
and I yield back the balance of my time.
  The SPEAKER pro tempore (Mr. Emmer). The question is on the motion 
offered by the gentleman from Tennessee (Mr. Roe) that the House 
suspend the rules and pass the bill, H.R. 5693, as amended.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.

                          ____________________