[Congressional Record Volume 168, Number 183 (Tuesday, November 29, 2022)]
[House]
[Pages H8607-H8609]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                   LONG-TERM CARE VETERANS CHOICE ACT

  Mr. TAKANO. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 7158) to amend title 38, United States Code, to authorize 
the Secretary of Veterans Affairs to enter into contracts and 
agreements for the payment of care in non-Department of Veterans 
Affairs medical foster homes for certain veterans who are unable to 
live independently, and for other purposes, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 7158

       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 
                   PAYMENT OF CARE FOR VETERANS IN NON-DEPARTMENT 
                   OF VETERANS AFFAIRS MEDICAL FOSTER HOMES.

       (a) Authority.--
       (1) In general.--Section 1720 of title 38, United States 
     Code, is amended by adding at the end the following new 
     subsection:
       ``(h)(1) During the five-year period beginning on the date 
     of the enactment of the Long-Term Care Veterans Choice Act, 
     and subject to paragraph (3)--
       ``(A) 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; and
       ``(B) the Secretary may pay for care of a veteran placed in 
     a medical foster home before such date of enactment, if the 
     home meets Department standards, pursuant to a contract, 
     agreement, or other arrangement entered into between the 
     Secretary and the medical foster home for such purpose.
       ``(2) A veteran on whose behalf the Secretary pays for care 
     in a medical foster home under paragraph (1) shall agree, as 
     a condition of such payment, to accept home health services 
     furnished by the Secretary under section 1717 of this title.
       ``(3) In any year, not more than a daily average of 900 
     veterans receiving care in a medical foster home, whether 
     placed before, on, or after the date of the enactment of the 
     Long-Term Care Veterans Choice Act, may have their care 
     covered at the expense of the United States under paragraph 
     (1).
       ``(4) The prohibition under section 1730(b)(3) of this 
     title shall not apply to a veteran whose care is covered at 
     the expense of the United States under paragraph (1).
       ``(5) 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.''.
       (2) Effective date.--Subsection (h) of section 1720 of 
     title 38, United States Code, as added by paragraph (1), 
     shall take effect 90 days after the date of the enactment of 
     this Act.
       (b) Ongoing Monitoring of Medical Foster Home Program.--
       (1) In general.--The Secretary of Veterans Affairs shall 
     create a system to monitor and assess the workload for the 
     Department of Veterans Affairs in carrying out the authority 
     under section 1720(h) of title 38, United States Code, as 
     added by subsection (a)(1), including by tracking--
       (A) requests by veterans to be placed in a medical foster 
     home under such section;
       (B) denials of such requests, including the reasons for 
     such denials;
       (C) the total number of medical foster homes applying to 
     participate under such section, disaggregated by those 
     approved and those denied approval by the Department to 
     participate;
       (D) veterans receiving care at a medical foster home at the 
     expense of the United States; and
       (E) veterans receiving care at a medical foster home at 
     their own expense.
       (2) Report.--Based on the monitoring and assessments 
     conducted under paragraph (1), the Secretary shall identify 
     and submit to Congress a report on such modifications to 
     implementing section 1720(h) of title 38, United States Code, 
     as added by subsection (a)(1), as the Secretary considers 
     necessary to ensure the authority under such section is 
     functioning as intended and care is provided to veterans 
     under such section as intended.
       (3) Medical foster home defined.--In this subsection, the 
     term ``medical foster home'' has the meaning given that term 
     in section 1720(h) of title 38, United States Code, as added 
     by subsection (a)(1).
       (c) Comptroller General Report.--Not later than each of 
     three years and six years after the date of the enactment of 
     this Act, the Comptroller General of the United States shall 
     submit to Congress a report--
       (1) assessing the implementation of this section and the 
     amendments made by this section;
       (2) assessing the impact of the monitoring and 
     modifications under subsection (b) on care provided under 
     section 1720(h) of title 38, United States Code, as added by 
     subsection (a)(1); and
       (3) setting forth recommendations for improvements to the 
     implementation of such section, as the Comptroller General 
     considers appropriate.
       (d) Modification of Certain Housing Loan Fee.--The loan fee 
     table in section 3729(b)(2) of title 38, United States Code, 
     is amended by striking ``January 14, 2031'' each place it 
     appears and inserting ``February 15, 2031''.

     SEC. 3. DETERMINATION OF BUDGETARY EFFECTS.

       The budgetary effects of this Act, for the purpose of 
     complying with the Statutory Pay-As-You-Go Act of 2010, shall 
     be determined by reference to the latest statement titled 
     ``Budgetary Effects of PAYGO Legislation'' for this Act, 
     submitted for printing in the Congressional Record by the 
     Chairman of

[[Page H8608]]

     the House Budget Committee, provided that such statement has 
     been submitted prior to the vote on passage.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
California (Mr. Takano) and the gentleman from Illinois (Mr. Bost) each 
will control 20 minutes.
  The Chair recognizes the gentleman from California.


                             General Leave

  Mr. TAKANO. Mr. Speaker, I ask unanimous consent that all Members may 
have 5 legislative days in which to revise and extend their remarks and 
include extraneous material on H.R. 7158, as amended.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from California?
  There was no objection.
  Mr. TAKANO. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise in support of H.R. 7158, as amended, the Long-
Term Care Veterans Choice Act.
  This bill, authored and long championed by Congressman Higgins and 
Chairwoman Brownley, would enable VA to better provide long-term 
services and support for our aging and disabled veterans.

                              {time}  1445

  The VA's medical foster homes are one of its most creative and 
effective initiatives. Veterans who have access to these care settings 
thrive and are able to remain a part of their community, even if their 
conditions do not allow them to remain independently in their homes.
  Veterans who are not yet ready for institutional care but need the 
help and assistance of professional caregivers are able to live in a 
home setting among other veterans in their communities. Satisfaction 
with the program is very high, but veterans have to pay for the care 
themselves, which is a barrier for many veterans. Yet, VA is currently 
prohibited from paying a veteran's room and board. This legislation 
would change that.
  Community-based programs like these are what veterans want and 
deserve. They also prevent veterans from being forced into much more 
expensive institutional care settings.
  Mr. Speaker, I wholeheartedly support this bill, and I encourage all 
of my colleagues to join me in supporting this legislation.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BOST. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise today in support of H.R. 7158, the Long-Term Care 
Veterans Choice Act.
  H.R. 7158 would give VA the authority to grant payments to non-VA 
entities for veterans who require long-term care in medical foster 
homes. A medical foster home is a private home, not an institutional 
facility, where trained caregivers provide wraparound care and service 
to patients.
  VA inspects and approves medical foster homes and enrolls veterans in 
the VA Home Healthcare Program. But under current law, VA is not 
authorized to pay for veterans' medical foster home care. Veterans must 
cover the bill themselves, even if they would otherwise be eligible for 
a VA-run nursing home facility.
  Now, medical foster homes are a more cost-effective alternative to 
nursing home care. They typically cost between $1,500 and $3,000 a 
month, compared to a typical $7,000-a-month cost in a nursing home.
  Allowing veterans to age with dignity and being comfortable is 
something that I care deeply about, and this bill is a critical step 
towards helping us to do just that.
  However, this is another bill that CBO gave a large mandatory score 
to because of the toxic exposure fund. We were able to fully offset 
this score, but we won't be able to do that for every piece of 
legislation. Our offsets are quickly running out, and we have to solve 
the scoring problem before the work of our committee grinds to a 
complete halt.
  This bill is supported by the VA and numerous VSOs, and I thank 
Congressman Higgins for his tireless work on it.
  Mr. Speaker, I ask all of my colleagues to support H.R. 7158, and I 
reserve the balance of my time.
  Mr. TAKANO. Mr. Speaker, I appreciate the ranking member's desire to 
engage in talks regarding the toxic exposure fund. It is an important 
issue, which is the long-term implications of the Cost of War Toxic 
Exposures Fund, otherwise known as TEV, and it was created by the 
Honoring our PACT Act.
  This fund is absolutely crucial to ensuring VA has the resources 
necessary to fully support our veterans and to deliver the new benefits 
available to them without having to sacrifice existing programs.
  As I have said repeatedly, any potential change to this fund and how 
it operates must be considered very carefully and requires the input of 
other committees that have a stake in this issue, to include 
appropriations and budget in the House and Senate.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BOST. Mr. Speaker, I look forward to working with the chairman as 
we move forward to try to cure that problem that we were just talking 
about.
  Mr. Speaker, I yield 3 minutes to the gentleman from Louisiana (Mr. 
Higgins), a great Member, who has worked hard on this bill.
  Mr. HIGGINS of Louisiana. Mr. Speaker, I rise in support of the Long-
Term Care Veterans Choice Act. The Department of Veterans Affairs has 
been running its medical foster homes initiative since the year 2000, 
and as of 2021, the Veterans Health Administration oversees about 600 
medical foster home caregivers taking care of veterans in about 40 
States.
  Medical foster homes are private homes where a caregiver provides 
services to a small group of individuals who are unable to live without 
day-to-day assistance.
  Currently, veterans enrolled in home-based primary care through the 
VA may elect to receive their care at medical foster homes. However, 
the VA does not cover the cost of medical foster homes for veterans 
that would otherwise be eligible for nursing home care through the VA. 
As has been noted by my colleagues, full nursing home traditional care 
is far more expensive than medical foster homes.
  Veterans must pay for medical foster homes out of their pocket or 
through private insurance. This bill would fix that.
  My bill would authorize the Secretary of the VA to enter into 
contracts and agreements for placement of up to 900 veterans a day in 
medical foster homes. These are veterans who are unable to live 
independently.
  In addition, medical foster home caregivers would be required to pass 
a Federal background check and undergo VA screening. They would be 
required to participate in annual training, and they would have to 
permit the VA to make announced and unannounced home visits.
  Finally, the VA would provide these veterans with full 
interdisciplinary home care that includes, physicians, nurses, 
rehabilitation therapists, medical healthcare providers, dietitians, 
and pharmacists.
  My bill is supported by the American Legion, the VFW, Disabled 
American Veterans, and the Wounded Warrior Project.

  In closing, I sincerely thank Chairman Takano and Ranking Member Bost 
for bringing this bill to the floor, and I urge my colleagues to 
support this bill.
  Mr. TAKANO. Mr. Speaker, I thank the gentleman from Louisiana for his 
hard work. I feel his sincere words. I take them to heart, and I 
sincerely hope that we get this through the Senate so that we can see 
this signed into law before the end of this year.
  Mr. Speaker, I have no further speakers, and I am prepared to close.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BOST. Mr. Speaker, I encourage all of my colleagues to support 
this bill, and I yield back the balance of my time.
  Mr. TAKANO. Mr. Speaker, as I have said before on the floor of this 
House, serving our veterans is not about red or blue. It is about red, 
white, and blue. I know that the ranking member stands with me in 
service of our veterans, and he stands with me right now in the 
optimism that Team USA is going to prevail today at the World Cup. They 
are ahead 1-0. I know the ranking member and I, and the gentleman from 
Louisiana, are all standing united with the hope of an American victory 
there.
  Mr. Speaker, again, I ask all my colleagues to join me in passing 
H.R. 7158,

[[Page H8609]]

as amended, and I yield back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from California (Mr. Takano) that the House suspend the rules 
and pass the bill, H.R. 7158, as amended.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds 
being in the affirmative, the ayes have it.
  Mr. GOOD of Virginia. Mr. Speaker, on that I demand the yeas and 
nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further 
proceedings on this motion will be postponed.

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