[Congressional Record Volume 169, Number 199 (Monday, December 4, 2023)]
[House]
[Pages H6097-H6103]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
ELIZABETH DOLE HOME- AND COMMUNITY-BASED SERVICES FOR VETERANS AND
CAREGIVERS ACT OF 2023
Mr. BERGMAN. Mr. Speaker, I move to suspend the rules and pass the
bill (H.R. 542) to amend title 38, United States Code, to improve
certain programs of the Department of Veterans Affairs for home- and
community-based services for veterans, and for other purposes, as
amended.
The Clerk read the title of the bill.
The text of the bill is as follows:
H.R. 542
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Elizabeth
Dole Home- and Community-Based Services for Veterans and
Caregivers Act of 2023'' or the ``Elizabeth Dole Home Care
Act of 2023''.
(b) Table of Contents.--The table of contents for this Act
is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Increase of expenditure cap for noninstitutional care
alternatives to nursing home care.
Sec. 3. Coordination with Program of All-Inclusive Care for the
Elderly.
Sec. 4. Home- and community-based services: programs.
Sec. 5. Coordination with assistance and support services for
caregivers.
Sec. 6. Development of centralized website for program information.
Sec. 7. Improvements relating to Homemaker and Home Health Aide
program.
Sec. 8. Reviews and other improvements relating to home- and community-
based services.
Sec. 9. Modification of certain housing loan fees.
Sec. 10. Definitions.
SEC. 2. INCREASE OF EXPENDITURE CAP FOR NONINSTITUTIONAL CARE
ALTERNATIVES TO NURSING HOME CARE.
(a) Increase of Expenditure Cap.--Section 1720C(d) of title
38, United States Code, is amended--
(1) by striking ``The total cost'' and inserting ``(1)
Except as provided in paragraph (2), the total cost'';
(2) by striking ``65 percent'' and inserting ``100
percent''; and
(3) by adding at the end the following new paragraph:
``(2)(A) The total cost of providing services or in-kind
assistance in the case of any veteran described in
subparagraph (B) for any fiscal year under the program may
exceed 100 percent of the cost that would otherwise have been
incurred as specified in paragraph (1) if the Secretary
determines, based on a consideration of clinical need,
geographic market factors, and such other matters as the
Secretary may prescribe through regulation, that such higher
total cost is in the best interest of the veteran.
``(B) A veteran described in this subparagraph is a veteran
with amyotrophic lateral sclerosis, a spinal cord injury, or
a condition the Secretary determines to be similar to such
conditions.''.
(b) Applicability.--The amendments made by subsection (a)
shall apply with respect to fiscal years beginning on or
after the date of the enactment of this Act.
SEC. 3. COORDINATION WITH PROGRAM OF ALL-INCLUSIVE CARE FOR
THE ELDERLY.
Section 1720C of title 38, United States Code, as amended
by section 2, is further amended by adding at the end the
following new subsection:
``(f) In furnishing services to a veteran under the program
conducted pursuant to subsection (a), if a medical center of
the Department through which such program is administered is
located in a geographic area in which services are available
to the veteran under a PACE program (as such term is defined
in sections 1894(a)(2) and 1934(a)(2) of the Social Security
Act (42 U.S.C. 1395eee(a)(2); 1396u-4(a)(2))), the Secretary
shall seek to enter into an agreement with the PACE program
operating in that area for the furnishing of such
services.''.
SEC. 4. HOME- AND COMMUNITY-BASED SERVICES: PROGRAMS.
(a) Programs.--Chapter 17 of title 38, United States Code,
is amended by inserting after section 1720J the following new
section (and conforming the table of sections at the
beginning of such chapter accordingly):
``Sec. 1720K. Home- and community-based services: programs
``(a) In General.--In furnishing noninstitutional
alternatives to nursing home care pursuant to the authority
of section 1720C of this title (or any other authority under
this chapter or other provision of law administered by the
Secretary of Veterans Affairs), the Secretary shall carry out
each of the programs specified in this section in accordance
with such relevant authorities except as otherwise provided
in this section.
``(b) Veteran-Directed Care Program.--(1) The Secretary of
Veterans Affairs, in collaboration with the Secretary of
Health and Human Services, shall carry out a program to be
known as the `Veteran-Directed Care program'. Under such
program, the Secretary of Veterans Affairs may enter into
agreements with the providers described in paragraph (2) to
provide to eligible veterans funds, to the extent
practicable, to obtain such in-home care services and related
items as may be determined appropriate by the Secretary of
Veterans Affairs and selected by the veteran, including
through the veteran hiring individuals to provide such
services and items or directly purchasing such services and
items.
``(2) The providers described in this paragraph are the
following:
``(A) An Aging and Disability Resource Center, an area
agency on aging, or a State agency.
``(B) A center for independent living.
``(C) An Indian tribe or tribal organization receiving
assistance under title VI of the Older Americans Act of 1965
(42 U.S.C. 3057 et seq.).
[[Page H6098]]
``(3) In carrying out the Veteran-Directed Care program,
the Secretary of Veterans Affairs shall--
``(A) administer such program through each medical center
of the Department of Veterans Affairs;
``(B) seek to ensure the availability of such program in
American Samoa, Guam, the Commonwealth of the Northern
Mariana Islands, the Commonwealth of Puerto Rico, the Virgin
Islands of the United States, and any other territory or
possession of the United States, to the extent practicable;
and
``(C) seek to ensure the availability of such program for
eligible veterans who are Native American veterans receiving
care and services furnished by the Indian Health Service, a
tribal health program, an Urban Indian organization, or (in
the case of a Native Hawaiian veteran) a Native Hawaiian
health care system, to the extent practicable.
``(4) If a veteran participating in the Veteran-Directed
Care program is catastrophically disabled, the veteran may
continue to use funds under the program during a period of
hospitalization in the same manner that the veteran would be
authorized to use such funds under the program if the veteran
were not hospitalized.
``(c) Homemaker and Home Health Aide Program.--(1) The
Secretary shall carry out a program to be known as the
`Homemaker and Home Health Aide program' under which the
Secretary may enter into agreements with home health agencies
to provide to eligible veterans such home health aide
services as may be determined appropriate by the Secretary.
``(2) In carrying out the Homemaker and Home Health Aide
program, the Secretary shall, to the extent practicable,
ensure the availability of such program--
``(A) in the locations specified in subparagraph (B) of
subsection (b)(3); and
``(B) for the veteran populations specified in subparagraph
(C) of such subsection.
``(d) Home-Based Primary Care Program.--The Secretary shall
carry out a program to be known as the `Home-Based Primary
Care program' under which the Secretary may furnish to
eligible veterans in-home health care, the provision of which
is overseen by a provider of the Department.
``(e) Purchased Skilled Home Care Program.--The Secretary
shall carry out a program to be known as the `Purchased
Skilled Home Care program' under which the Secretary may
furnish to eligible veterans such in-home care services as
may be determined appropriate and selected by the Secretary
for the veteran.
``(f) Caregiver Support.--(1) With respect to a resident
eligible caregiver of a veteran participating in a program
under this section, the Secretary shall--
``(A) if the veteran meets the requirements of a covered
veteran under section 1720G(b) of this title, provide to such
caregiver the option of enrolling in the program of general
caregiver support services under such section;
``(B) provide to such caregiver covered respite care of not
less than 30 days annually; and
``(C) conduct on an annual basis (and, to the extent
practicable, in connection with in-person services provided
under the program in which the veteran is participating), a
wellness contact of such caregiver.
``(2) Covered respite care provided to a resident eligible
caregiver of a veteran under paragraph (1) may exceed 30 days
annually if such extension is requested by the resident
eligible caregiver or veteran and determined medically
appropriate by the Secretary.
``(g) Rule of Construction.--Nothing in this section shall
be construed to limit the authority of the Secretary to carry
out programs providing home- and community-based services
under any other provision of law.
``(h) Definitions.--In this section:
``(1) The terms `Aging and Disability Resource Center',
`area agency on aging', and `State agency' have the meanings
given those terms in section 102 of the Older Americans Act
of 1965 (42 U.S.C. 3002).
``(2) The terms `caregiver' and `family caregiver', with
respect to a veteran, have the meanings given those terms,
respectively, under subsection (e) of section 1720G of this
title with respect to an eligible veteran under subsection
(a) of such section or a covered veteran under subsection (b)
of such section, as the case may be.
``(3) The term `center for independent living' has the
meaning given that term in section 702 of the Rehabilitation
Act of 1973 (29 U.S.C. 796a).
``(4) The term `covered respite care' has the meaning given
such term in section 1720G(d) of this title.
``(5) The term `eligible veteran' means any veteran--
``(A) for whom the Secretary determines participation in a
specific program under this section is medically necessary to
promote, preserve, or restore the health of the veteran; and
``(B) who absent such participation would be at increased
risk for hospitalization, placement in a nursing home, or
emergency room care.
``(6) The term `home health aide' means an individual
employed by a home health agency to provide in-home care
services.
``(7) The term `in-home care service' means any service,
including a personal care service, provided to enable the
recipient of such service to live at home.
``(8) The terms `Indian tribe' and `tribal organization'
have the meanings given those terms in section 4 of the
Indian Self-Determination and Education Assistance Act (25
U.S.C. 5304).
``(9) The terms `Native American' and `Native American
veteran' have the meanings given those terms in section 3765
of this title.
``(10) The terms `Native Hawaiian' and `Native Hawaiian
health care system' have the meanings given those terms in
section 12 of the Native Hawaiian Health Care Improvement Act
(42 U.S.C. 11711).
``(11) The terms `tribal health programs' and `Urban Indian
organizations' have the meanings given those terms in section
4 of the Indian Health Care Improvement Act (25 U.S.C. 1603).
``(12) The term `resident eligible caregiver' means an
individual who--
``(A) is a caregiver, or a family caregiver, of a veteran
and resides with that veteran; and
``(B) has not entered into a contract, agreement, or other
arrangement for such individual to act as a caregiver for
that veteran unless such individual is a family member of the
veteran or is furnishing caregiver services through a medical
foster home.''.
(b) Deadline for Improved Administration.--The Secretary of
Veterans Affairs shall ensure that the Veteran-Directed Care
program and the Homemaker and Home Health Aide program are
administered through each medical center of the Department of
Veterans Affairs in accordance with section 1720K of title
38, United States Code (as added by subsection (a)), by not
later than two years after the date of the enactment of this
Act.
SEC. 5. COORDINATION WITH ASSISTANCE AND SUPPORT SERVICES FOR
CAREGIVERS.
(a) Coordination With Program of Comprehensive Assistance
for Family Caregivers.--
(1) Coordination.--Section 1720G(a) of title 38, United
States Code, is amended by adding at the end the following
new paragraph:
``(14)(A) In the case of a veteran or caregiver who seeks
services under this subsection and is denied such services,
or a veteran or the family caregiver of a veteran who is
discharged from the program under this subsection, the
Secretary shall--
``(i) if the veteran meets the requirements of a covered
veteran under subsection (b), provide to such caregiver the
option of enrolling in the program of general caregiver
support services under such subsection;
``(ii) assess the veteran or caregiver for participation in
any other available program of the Department for home- and
community-based services (including the programs specified in
section 1720K of this title) for which the veteran or
caregiver may be eligible and, with respect to the veteran,
store (and make accessible to the veteran) the results of
such assessment in the electronic medical record of the
veteran; and
``(iii) provide to the veteran or caregiver written
information on any such program identified pursuant to the
assessment under clause (ii), including information about
facilities, eligibility requirements, and relevant contact
information for each such program.
``(B) For each veteran or family caregiver who is
discharged from the program under this subsection, a
caregiver support coordinator shall provide for a smooth and
personalized transition from such program to an appropriate
program of the Department for home- and community-based
services (including the programs specified in section 1720K
of this title), including by integrating caregiver support
across programs.''.
(2) Applicability.--The amendments made by paragraph (1)
shall apply with respect to denials and discharges occurring
on or after the date that is 180 days after the date of the
enactment of this Act.
(3) Technical and conforming amendments.--Section 1720G(d)
of such title is amended--
(A) by striking ``or a covered veteran'' each place it
appears and inserting ``, a veteran denied or discharged as
specified in paragraph (14) of such subsection, or a covered
veteran''; and
(B) by striking ``under subsection (a), means'' each place
it appears and inserting ``under subsection (a) or a veteran
denied or discharged as specified in paragraph (14) of such
subsection, means''.
(b) Conformity of Respite Care Across Programs.--Section
1720G of title 38, United States Code, as amended by
subsection (a)(3), is further amended--
(1) in subsection (a)(3)--
(A) by amending subparagraph (A)(ii)(III) to read as
follows:
``(III) covered respite care of not less than 30 days
annually;''; and
(B) by striking subparagraph (B) and redesignating
subparagraphs (C) and (D) as subparagraphs (B) through (C),
respectively; and
(2) by amending subsection (b)(3)(A)(iii) to read as
follows:
``(iii) Covered respite care of not less than 30 days
annually.''; and
(3) in subsection (d)--
(A) by redesignating paragraphs (2) through (4) as
paragraphs (3) through (5), respectively; and
(B) by inserting after paragraph (1) the following new
paragraph:
[[Page H6099]]
``(2) The term `covered respite care' means, with respect
to a caregiver of a veteran, respite care under section 1720B
of this title that--
``(A) is medically and age appropriate for the veteran
(including 24-hour per day care of the veteran commensurate
with the care provided by the caregiver); and
``(B) includes in-home care.''.
(c) Review Relating to Caregiver Contact.--The Secretary
shall conduct a review of the capacity of the Department to
establish a streamlined system for contacting all caregivers
enrolled in the program of general caregiver support services
under section 1720G(b) of title 38, United States Code, to
provide to such caregivers program updates and alerts
relating to emerging services for which such caregivers may
be eligible.
SEC. 6. DEVELOPMENT OF CENTRALIZED WEBSITE FOR PROGRAM
INFORMATION.
(a) Centralized Website.--The Secretary shall develop and
maintain a centralized and publically accessible internet
website of the Department as a clearinghouse for information
and resources relating to covered programs.
(b) Contents.--The website under subsection (a) shall
contain the following:
(1) A description of each covered program.
(2) An informational assessment tool that--
(A) explains the administrative eligibility, if applicable,
of a veteran, or a caregiver of a veteran, for any covered
program; and
(B) provides information, as a result of such explanation,
on any covered program for which the veteran or caregiver (as
the case may be) may be eligible.
(3) A list of required procedures for the directors of the
medical facilities of the Department to follow in determining
the eligibility and suitability of veterans for participation
in a covered program, including procedures applicable to
instances in which the resource constraints of a facility (or
of a community in which a facility is located) may result in
the inability to address the health needs of a veteran under
a covered program in a timely manner.
(c) Updates.--The Secretary shall ensure the website under
subsection (a) is updated on a periodic basis.
SEC. 7. IMPROVEMENTS RELATING TO HOMEMAKER AND HOME HEALTH
AIDE PROGRAM.
(a) Pilot Program for Communities With Shortage of Home
Health Aides.--
(1) Program.--Beginning not later than 18 months after the
date of the enactment of this Act, the Secretary shall carry
out a three-year pilot program under which the Secretary
shall provide homemaker and home health aide services to
veterans who reside in communities with a shortage of home
health aides.
(2) Locations.--The Secretary shall select not fewer than
five geographic locations in which the Secretary determines
there is a shortage of home health aides at which to carry
out the pilot program under paragraph (1).
(3) Nursing assistants.--
(A) In general.--In carrying out the pilot program under
paragraph (1), the Secretary may hire nursing assistants as
new employees of the Department of Veterans Affairs, or
reassign nursing assistants who are existing employees of the
Department, to provide to veterans in-home care services
(including basic tasks authorized by the State certification
of the nursing assistant) under the pilot program, in lieu of
or in addition to the provision of such services through non-
Department home health aides.
(B) Relationship to home-based primary care program.--
Nursing assistants hired or reassigned under subparagraph (A)
may provide services to a veteran under the pilot program
under paragraph (1) while serving as part of a health care
team for the veteran under the Home-Based Primary Care
program.
(4) Report to congress.--Not later than one year after the
date on which the Secretary determines the pilot program
under paragraph (1) has terminated, the Secretary shall
submit to the Committees on Veterans' Affairs of the House of
Representatives and the Senate a report on the result of the
pilot program.
(b) Report on Use of Funds.--Not later than one year after
the date of the enactment of this Act, the Secretary of
Veterans Affairs shall submit to the Committees on Veterans'
Affairs of the House of Representatives and the Senate a
report containing, with respect to the period beginning in
fiscal year 2012 and ending in fiscal year 2023, the
following:
(1) An identification of the amount of funds that were
included in a budget of the Department of Veterans Affairs
during such period for the provision of in-home care to
veterans under the Homemaker and Home Health Aide program but
were not expended for such provision, disaggregated by
medical center of the Department for which such unexpended
funds were budgeted (if such disaggregation is possible).
(2) To the extent practicable, an identification of the
number of veterans for whom, during such period, the hours
during which a home health aide was authorized to provide
services to the veteran under the Homemaker and Home Health
Aide program were reduced for a reason other than a change in
the health care needs of the veteran, and a detailed
description of the reasons why any such reductions may have
occurred.
(c) Updated Guidance on Program.--Not later than one year
after the date of the enactment of this Act, the Secretary
shall issue updated guidance for the Homemaker and Home
Health Aide program. Such updated guidance shall include the
following:
(1) A process for the transition of veterans from the
Homemaker and Home Health Aide program to other covered
programs.
(2) A requirement for the directors of the medical
facilities of the Department to complete such process
whenever a veteran with care needs has been denied services
from home health agencies under the Homemaker and Home Health
Aide program as a result of the clinical needs or behavioral
issues of the veteran.
SEC. 8. REVIEWS AND OTHER IMPROVEMENTS RELATING TO HOME- AND
COMMUNITY-BASED SERVICES.
(a) Office of Geriatric and Extended Care.--
(1) Review of programs.--The Under Secretary for Health of
the Department of Veterans Affairs shall conduct a review of
each program administered through the Office of Geriatric and
Extended Care of the Department, or successor office, to--
(A) ensure consistency in program management;
(B) eliminate service gaps at the medical center level; and
(C) ensure the availability of, and the access by veterans
to, home- and community-based services.
(2) Assessment of staffing needs.--The Secretary of
Veterans Affairs shall conduct an assessment of the staffing
needs of the Office of Geriatric and Extended Care of the
Department of Veterans Affairs, or successor office.
(3) Goals for geographic alignment of care.--
(A) Establishment of goals.--The Director of the Office of
Geriatric and Extended Care, or successor office, shall
establish quantitative goals to enable aging or disabled
veterans who are not located near medical centers of the
Department to access extended care services (including by
improving access to home- and community-based services for
such veterans).
(B) Implementation timeline.--Each goal established under
subparagraph (A) shall include a timeline for the
implementation of the goal at each medical center of the
Department.
(4) Goals for in-home specialty care.--The Director of the
Office of Geriatric and Extended Care, or successor office,
shall establish quantitative goals to address the specialty
care needs of veterans through in-home care, including by
ensuring the education of home health aides and caregivers of
veterans in the following areas:
(A) Dementia care.
(B) Care for spinal cord injuries and diseases.
(C) Ventilator care.
(D) Other speciality care areas as determined by the
Secretary.
(5) Report to congress.--Not later than one year after the
date of the enactment of this Act, the Secretary shall submit
to the Committees on Veterans' Affairs of the House of
Representatives and the Senate a report containing the
findings of the review under paragraph (1), the results of
the assessment under paragraph (2), and the goals established
under paragraphs (3) and (4).
(b) Review of Incentives and Efforts Relating to Home- and
Community-Based Services.--
(1) Review.--The Secretary of Veterans Affairs shall
conduct a review of the following:
(A) The financial and organizational incentives for the
directors of medical centers of the Department to establish
or expand covered programs at such medical centers.
(B) Any incentives for such directors to provide to
veterans home- and community-based services in lieu of
institutional care.
(C) The efforts taken by the Secretary to enhance spending
of the Department for extended care by shifting the balance
of such spending from institutional care to home- and
community-based services.
(D) The plan of the Under Secretary for Health of the
Department to accelerate efforts to enhance spending as
specified in subparagraph (C), to match the progress of
similar efforts taken by the Administrator of the Centers for
Medicare & Medicaid Services with respect to spending of the
Centers for Medicare & Medicaid Services for extended care.
(2) Report to congress.--Not later than one year after the
date of the enactment of this Act, the Secretary shall submit
to the Committees on Veterans' Affairs of the House of
Representatives and the Senate a report on the findings of
the review under paragraph (1).
(c) Review of Respite Care Services.--Not later than two
years after the date of the enactment of this Act, the
Secretary of Veterans Affairs shall conduct a review of the
use, availability, and effectiveness, of the respite care
services furnished by the Secretary under chapter 17 of title
38, United States Code.
(d) Collaboration To Improve Home- and Community-Based
Services.--
(1) Report on expansion of certain mental health
services.--
(A) Report.--Not later than two years after the date of the
enactment of this Act, the Secretary of Veterans Affairs, in
collaboration with the Secretary of Health and Human
Services, shall submit to the Committees on Veterans' Affairs
of the House of Representatives and the Senate a report
containing recommendations for the expansion
[[Page H6100]]
of mental health services and related support to the
caregivers of veterans.
(B) Matters included.--The report under subparagraph (A)
shall include an assessment of the feasibility and
advisability of authorizing access to Vet Centers by--
(i) family caregivers enrolled in a program under section
1720G of title 38, United States Code; and
(ii) family caregivers of veterans participating in a
program specified in section 1720K of such title, as added by
section 4.
(2) Recommendations.--
(A) Development.--The Secretary of Veterans Affairs shall
develop recommendations as follows:
(i) With respect to home- and community-based services for
veterans, the Secretary of Veterans Affairs shall develop
recommendations regarding new services (in addition to those
furnished as of the date of the enactment of this Act) in
collaboration with the Secretary of Health and Human
Services.
(ii) With respect to the national shortage of home health
aides, the Secretary of Veterans Affairs shall develop
recommendations regarding methods to address such shortage in
collaboration with the Secretary of Health and Human Services
and the Secretary of Labor.
(B) Submission to congress.--The Secretary of Veterans
Affairs shall submit to the Committees on Veterans' Affairs
of the House of Representatives and the Senate a report
containing the recommendations developed under subparagraph
(A) and an identification of any changes in existing law or
new statutory authority necessary to implement the
recommendations, as determined by the Secretary.
(C) Consultation with secretary of labor.--In carrying out
this paragraph, the Secretary of Veterans Affairs shall
consult with the Secretary of Labor.
(3) Feedback and recommendations on caregiver support.--
(A) Feedback and recommendations.--The Secretary of
Veterans Affairs shall solicit from the entities described in
subparagraph (B) feedback and recommendations regarding
opportunities for the Secretary to enhance home- and
community-based services for veterans and the caregivers of
veterans, including through the potential provision by the
entity of care and respite services to veterans and
caregivers who may not be eligible for any program under
section 1720G of title 38, United States Code, or section
1720K of such title (as added by section 4), but have a need
for assistance.
(B) Covered entities.--The entities described in this
subparagraph are veterans service organizations and nonprofit
organizations with a focus on caregiver support (as
determined by the Secretary).
(4) Collaboration for native american veterans.--The
Secretary of Veterans Affairs shall collaborate with the
Director of the Indian Health Service and representatives
from tribal health programs and Urban Indian organizations to
ensure the availability of home- and community-based services
for Native American veterans, including Native American
veterans receiving health care and medical services under
multiple health care systems.
SEC. 9. MODIFICATION OF CERTAIN HOUSING LOAN FEES.
The loan fee table in section 3729(b)(2) of title 38,
United States Code, is amended by striking ``November 15,
2031'' each place it appears and inserting ``February 4,
2032''.
SEC. 10. DEFINITIONS.
In this Act:
(1) The terms ``caregiver'' and ``family caregiver'' have
the meanings given those terms under section 1720K(h) of
title 38, United States Code (as added by section 4).
(2) The term ``covered program''--
(A) means any program of the Department of Veterans Affairs
for home- and community-based services; and
(B) includes the programs specified in section 1720K of
title 38, United States Code (as added by section 4).
(3) The term ``home- and community-based services''--
(A) means the services referred to in section 1701(6)(E) of
title 38, United States Code; and
(B) includes services furnished under a program specified
in section 1720K of such title (as added by section 4).
(4) The terms ``Home-Based Primary Care program'',
``Homemaker and Home Health Aide program'', and ``Veteran-
Directed Care program'' mean the programs of the Department
of Veterans Affairs specified in subsection (d), (c), and (b)
of such section 1720K, respectively.
(5) The terms ``home health aide'', ``Native American'',
``Native American veteran'', ``tribal health programs'', and
``Urban Indian organizations'' have the meanings given those
terms in subsection (h) of such section 1720K.
(6) The term ``Vet Center'' has the meaning given that term
in section 1712A(h) of title 38, United States Code.
(7) The term ``veterans service organization'' means any
organization recognized by the Secretary under section 5902
of such title.
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
Michigan (Mr. Bergman) and the gentleman from California (Mr. Takano)
each will control 20 minutes.
The Chair recognizes the gentleman from Michigan.
General Leave
Mr. BERGMAN. Mr. Speaker, I ask unanimous consent that all Members
may have 5 legislative days in which to revise and extend their
remarks.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Michigan?
There was no objection.
Mr. BERGMAN. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I rise today in support of H.R. 542, the Elizabeth Dole
Home- and Community-Based Services for Veterans and Caregivers Act of
2023, or the Elizabeth Dole Home Care Act of 2023, as amended.
The bill is a pivotal piece of legislation aimed at transforming the
landscape of long-term care for our Nation's veterans. I commend
Representative Brownley for her bipartisan work with me on it.
Veterans, like all Americans, are living longer. This requires the
Veterans Administration to adapt to this evolving veteran population to
ensure that eligible veterans entering their later years have access to
long-term care that meets their needs.
As of fiscal year 2022, approximately 3.1 million veterans, roughly
half of VA's active patient population, were 65 years or older. These
veterans, often older, sicker, and poorer than the general population,
and often residing in rural areas, demand a tailored approach to
healthcare.
Veterans want to remain at home for care, avoiding admission to long-
term care facilities. This preference is not only understandable but
becomes imperative given the current challenges with long-term care
facilities and limited admissions nationwide.
By expanding VA's noninstitutional long-term care services through
Representative Brownley's and my bill, we would allow aging and
disabled veterans the option of staying in their homes. Institutional
care can be reserved for veterans who truly need intensive round-the-
clock care and services.
While many States have shifted investments from institutional to
home- and community-based care, VA has not kept pace. The lack of a
statutory mandate has led to inconsistent availability of home- and
community-based services, leaving many veterans underserved simply
based on where they live. That is unacceptable.
Veterans and veteran service organizations have consistently urged VA
to focus on expanding access to home- and community-based services to
allow veterans to age comfortably and safely in place.
The Veterans' Affairs Committee answered these demands head-on, and
we held numerous hearings on the issue and focused on equitable long-
term care access. Our bill would also rightfully eliminate the annual
cap on noninstitutional care to include greater flexibility in meeting
the needs of veterans living with ALS or spinal cord injuries, for
example.
Under current law, these veterans are often forced into institutional
care simply because funding cannot be provided for home care. This bill
would ensure availability of all programs, such as veteran-directed
care, homemaker home health aide, home-based primary care, and
purchased skilled home care at all VA medical centers.
In addition to expanding access, the Dole Act urges the VA to take a
more active role in helping veterans and their caregivers navigate the
multiple options that may be available to them as they consider long-
term care.
It is no secret that the Nation is facing a shortage of qualified
professionals capable of taking on the tasks required by home- or
community-based care.
Representative Brownley's and my bill would create a pilot program to
bring in more professionals to serve veterans through homemaker and
home health services.
Finally, I want to emphasize that we are committed to fiscal
responsibility and have identified an offset to fully fund these
programs that will ultimately address the pressing needs of America's
aging veteran population.
The Elizabeth Dole Home Care Act of 2023 is a pledge to ensure
veterans receive the care they deserve, preserving their dignity and
independence, whether they are catastrophically disabled or in the
twilight of their lives.
Mr. Speaker, I sincerely thank Representative Brownley for her
dedication to this issue and her bipartisan work with me on this
legislation.
[[Page H6101]]
Mr. Speaker, I ask unanimous consent to include in the Record a
letter from 46 organizations, including all of the major veterans
service organizations, the Elizabeth Dole Foundation, and many other
groups, and I thank them for their dedication to caring for and serving
veterans.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Michigan?
There was no objection.
November 30, 2023.
Hon. Jon Tester,
Chairman, Senate Committee on Veterans' Affairs, Washington,
DC.
Hon. Jerry Moran,
Ranking Member, Senate Committee on Veterans' Affairs,
Washington, DC.
Hon. Mike Bost
Chairman, House Committee on Veterans' Affairs, Washington,
DC.
Hon. Mark Takano,
Ranking Member, House Committee on Veterans' Affairs,
Washington, DC.
Dear Chairmen and Ranking Members: As national
organizations representing service-disabled veterans and
their caregivers, we are writing to thank you for your
ongoing commitment to the well-being of our nation's most
vulnerable heroes. Together, we hope you quickly Consider and
pass the Elizabeth Dole Home Care Act either as part of a
veteran supported omnibus package or a standalone bill.
The enactment of this bipartisan legislation will help to
ensure that severely injured, ill, and aging veterans and
their caregivers have access to a comprehensive suite of VA
services necessary to age in place with well-deserved dignity
and much-needed support.
Most importantly, it would help veterans and their
caregivers get the care and support they need now while
ensuring that the required program infrastructure is
available to serve veterans into the future. Disabled
veterans and their families cannot wait any longer.
Sincerely,
The Elizabeth Dole Foundation; Paralyzed Veterans of
America; AARP; ALS Association; Wounded Warrior Project; IAM
ALS; Disabled American Veterans; Air Force Sergeants
Association; The Retired Enlisted Association; Veterans of
Foreign Wars; American Legion; Military Officers Association
of America; Blinded Veterans of America; National Military
Family Association; Reserve Officers' Association; Blue Star
Families.
America's Warrior Partnership; Tragedy Assistance Program
for Survivors; The American Red Cross; TEAM Public Choices;
Psycharmor; Psych Hub; Vets' Community Connections;
Association of Military Banks; K9s For Warriors; Travis
Manion Foundation; Operation Homefront; Project Sanctuary;
Modern Military Association of America; US Military Spouse
Chamber of Commerce; Military Family Advisory Network.
Student Veterans of America; Military Child Education
Coalition; RallyPoint; Code of Support; Women in Military
Service for America Memorial Foundation, Inc.; Easter Seals
DC MD VA; Partners in Promise; Maxim Healthcare Services;
Hope for the Warriors; Cohen Veterans Network; Armed Services
YMCA; SolaMed Solutions; Exceptional Families of the
Military; Easterseals, Inc.; Nation's Finest.
Mr. BERGMAN. Mr. Speaker, while we are considering this bill today, I
would remind my colleagues that this legislation is also a part of a
comprehensive veterans package being negotiated between the House and
Senate Veterans' Affairs Committees.
Mr. Speaker, I look forward to working with my colleagues in the days
ahead to collectively advance not only this legislation, but many other
proposals that support the interests and the well-being of all
veterans.
Finally, I thank the numerous veteran service organization partners
who have worked with us.
Mr. Speaker, I urge all my colleagues to support H.R. 542, as
amended, and I reserve the balance of my time.
Mr. TAKANO. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I rise to express my support for H.R. 542, as amended,
the Elizabeth Dole Home Care Act of 2023.
This bill, introduced by Representative Brownley and Representative
Bergman and reported out of committee with unanimous support in July,
is truly landmark legislation.
It would require VA to provide access to all home-and community-based
services, such as home health aides, home-based primary care, and
respite care to all veterans and caregivers who need them.
Currently, elderly and disabled veterans only have access to
important home- and community-based services if their VA medical
centers have chosen to offer these services.
This bill is named for a person, who in her personal life and in
public service, has dedicated herself to caring for others: Senator
Elizabeth Dole. Tomorrow will mark the second anniversary of the
passing of Senator Bob Dole, an Army veteran who had a dedicated
caregiver in the other Senator Dole.
This legislation will enable veterans to remain at home, safely age
in place, and avoid or delay admission to nursing homes and other
costly institutional settings of care. It will also help connect
veterans' caregivers to respite care and other supportive services that
help them care for veterans at home and improve VA's coordination with
other Federal long-term care programs that promote aging at home.
Finally, the Elizabeth Dole Home Care Act of 2023 will require VA to
create a website where veterans and their families can more easily
obtain information about VA's home- and community-based services
programs and assess whether any of these programs may be right for
them. The research is clear: veterans prefer to remain at home and
their health outcomes are better when they do. Home care is by far the
cheaper alternative to institutional settings.
Nearly every veteran will at some point face the need for additional
care at home, or if they can't get it, spend their last years in a
nursing home setting. This legislation is an investment in care for
millions of veterans and current servicemembers who need this help now
or in the future.
The Elizabeth Dole Home Care Act of 2023 has the support of every
major veteran service organization, including Paralyzed Veterans of
America, Disabled American Veterans, Veterans of Foreign Wars, the
American Legion, the Wounded Warrior Project, and the Military Officers
Association of America.
It is also supported by AARP, the National Association of Counties,
the National PACE Association, and the Elizabeth Dole Foundation.
It has been these groups' number one policy priority. Shouldn't it be
ours?
These groups, and dozens of others, have advocated tirelessly for
passage since its introduction 2 years ago.
Despite the great need for this bill, it has been an uphill battle to
get it to the floor. We have worked to get support and get the cost
down. That showed when it was voted unanimously out of committee in
July.
It seems the battle is not over yet because this bill cannot be taken
up by the Senate as is. Since the bill was reported, we have worked
with our counterparts in the Senate to ensure the bill was as near to
perfect as possible. There were a few changes that were agreed upon by
all four corners of the Committee on Veterans' Affairs.
{time} 1645
Unfortunately, instead of advancing text with full sign-off, the
majority has gone back to text they know has problems in the Senate, so
we will have to either await amendment by the Senate or some other
legislative action before this legislation can move to President
Biden's desk for signature.
The programs and services in this bill are life-changing. In the next
16 years, VA will have doubled its spending on long-term care services,
nearing $15 billion, to meet these needs. While enrolled veterans have
a right to institutional care, there are not enough beds or staff in
institutional settings in the country to meet the projected need.
Good sense tells us that VA must move quickly to expand home- and
community-based services to keep veterans safely in their homes.
Providing home- and community-based services would also ensure that VA
has the space and staff to care for those who truly do need
institutional care.
It is disappointing that we have not gotten this bill on the fast
track to signing and that disabled and elderly veterans and their
caregivers will have to wait even longer for the care they deserve.
This holiday season, we could have given these veterans a gift with
lasting impact. The House majority instead tells us we must content
ourselves to wait for the Elizabeth Dole Home Care Act to be included
in a larger package.
The majority has committed to moving this legislative package out of
the House and the Senate with delivery to the President by the end of
January. I remind everyone that there are some other big items that we
have to get done in January, and I am worried about whether or not that
other big item might impede our ability to get this item done.
[[Page H6102]]
The intention is that the Elizabeth Dole Home Care Act and the HOME
Act be included as key pillars of the package.
The majority has also committed in the last week to not abuse these
bipartisan bills as leverage to include partisan poison pills in that
package. I intend to hold my Republican colleagues to that agreement,
and the stakeholders and the VSOs will, as well.
This agreement includes the fallback that if this package cannot be
completed in time, then these bills should be advanced as standalone.
We received a letter on Friday from a broad coalition of national
organizations representing service-disabled veterans and their
caregivers memorializing this agreement that said it best: ``Disabled
veterans and their families cannot wait any longer.''
It was the same exact letter that was already included in the Record
by my colleague from Michigan, so I don't have to include it again now.
Mr. Speaker, I support H.R. 542, as amended, and I ask my colleagues
to do the same.
Mr. Speaker, I yield such time as she may consume to the gentlewoman
from the great State of California (Ms. Brownley), who is the ranking
member of the Subcommittee on Health and the author of this amazing
piece of legislation.
Ms. BROWNLEY. Mr. Speaker, I thank Ranking Member Takano for his
partnership and his efforts to bring this important bill for our
Nation's disabled and aging veterans and their caregivers to the floor.
Mr. Speaker, I rise in support of this bill, Representative Bergman's
and my bill, H.R. 542, the Elizabeth Dole Home Care Act.
I am so proud to have authored this legislation, which delivers the
largest set of reforms to the VA's long-term care programs in decades.
The bill will significantly expand access to the programs disabled and
aging veterans need to live their lives at home and with their
families.
Specifically, the bill requires the Department of Veterans Affairs to
provide access to all home- and community-based services, such as home
health aides, home-based primary care, home skilled nursing, and
respite care for caregivers to all veterans who need them. Currently,
elderly and disabled veterans only have access to these programs if
their VA medical centers choose to offer them.
My bill would also require VA to improve care coordination between
the Program of Comprehensive Assistance for Family Caregivers and VA's
other home-based programs. If a veteran does not meet the enrollment
criteria for the comprehensive caregiver program, VA would be required
to proactively assist the veteran and their caregiver in enrolling in
other home-based programs and ensure there is a warm handoff for those
who do not qualify for the comprehensive caregiver program.
Finally, my legislation would require VA to establish a public-facing
website that will enable veterans and their loved ones to assess their
eligibility for each of the home- and community-based services VA
offers and provide information about how to access these services.
I have served on the Veterans' Affairs Committee since my first term
in Congress, and over the last 10 years, I have participated in at
least five oversight hearings related to improving long-term care for
our veterans. I have also spoken with countless veterans and their
loved ones, and based on my experience, one thing is very clear: Almost
every veteran would prefer to age at home rather than in a facility.
However, for many veterans, doing so requires certain clinical support
that can be prohibitively expensive if not covered by the VA. This bill
would help address just that.
Furthermore, it is important to really underscore this point: Home-
and community-based care is far and away higher quality and cheaper to
provide than institutional care. VA's veteran-directed care program can
serve three veterans for every one who would be in institutionalized
care at VA's expense. It is important to note that veterans who
participate in this program are less likely to develop complications or
to be hospitalized than those who do not.
Yet, this program is currently not made available to all veterans.
The Elizabeth Dole Home Care Act changes that.
Passage of this legislation cannot wait any longer. Like so many
families across the country, thousands of elderly and catastrophically
disabled veterans and their families are having critical and often
difficult conversations about their long-term care. They question
whether they spend their lifesavings to keep their veterans at home or
whether it is safer to go to a VA-funded nursing facility.
H.R. 542 would help relieve this heartache and give families access
to programs that will help veterans stay in their homes and receive the
care they need, the care that they have earned, and the care that they
deserve.
I will repeat one more time that, most importantly, health outcomes
prove to be far better at home compared to institutionalized care.
Last week, 45 veterans service organizations, military service
organizations, and community-based organizations sent a letter to House
and Senate leadership, urging the swift passage of this bill and saying
that, as the ranking member said, disabled veterans and their families
cannot wait any longer. I could not agree more.
Mr. Speaker, I would like to try to put a face to the experiences
that so many disabled or aging veterans often go through and why this
bill is so necessary.
This bill is for the 40-year-old veteran who is quadriplegic and who
may have to move into institutionalized care because VA won't provide
the skilled nursing services that would help him remain at home.
This bill is for the 50-year-old veteran with ALS who has three small
children and wants to spend the remaining time he has with them at
home. He shouldn't be forced to move into a long-term care facility
because the cost of his care has gone over an arbitrary spending cap.
This bill is for the Vietnam-era amputee who needs help getting
dressed and preparing food but can otherwise live safely at home. He
should not have to wait for Congress to act to get the care and
assistance he needs.
Moreover, this bill is for the Korean war veteran whose aging spouse
can no longer provide the level of care she once did. They want to stay
at home together. It is unconscionable this Congress would make them
wait a moment longer. They need these services and support, and they
need it now.
I am, therefore, perplexed that when the majority brought H.R. 542 to
the House floor, they chose to bring a version of the legislation that
did not include the minor revisions that had been negotiated with our
Senate counterparts. This means future House action will be warranted,
which is truly inexcusable to me and the veterans, their families, and
their caregivers who are waiting on passage of this bill. We had the
opportunity to get this done before the end of the year, send it to the
Senate, and then to the President's desk for enactment.
When Representative Bergman and I first introduced this legislation,
we named it after Senator Elizabeth Dole. She has done more for aging
and disabled veterans and their caregivers in one lifetime than most of
us could hope to do in several.
It was introduced in February 2022, just a few months after the
veteran she cared for, Senator Bob Dole, passed away. Tomorrow, we will
mark the second anniversary of Senator Bob Dole's passing. It is a
shame that we could not honor Senator Elizabeth Dole's example and
life's work on this anniversary by sending a hotline-ready bill to the
Senate that the President could sign before Christmas. It is shameful,
and it is disrespectful, really, to play politics with a bill the
veteran community wants so badly and a bill that is more cost-
effective, provides better outcomes, and is what our Nation's veterans
need and want.
I hope we will soon be voting on the final passage of the bill
language that the House and Senate have already agreed to and that
veterans and their families so desperately need. All of us will, one
day, have conversations about what we want our last years to look like.
Our aging and disabled veterans have more than earned the right to have
the option of living out these final years at home.
Of all the things we owe these men and women, a peaceful and
dignified
[[Page H6103]]
life after their service to our country is the least we can do. I call
on my colleagues to do right by these veterans. Put politics aside,
keep families together, and keep veterans healthy and at home.
Mr. Speaker, I urge my colleagues to join me in voting for the
Elizabeth Dole Home Care Act, and I thank Ranking Member Takano and
Representative Bergman for their work on this bill.
Mr. TAKANO. Mr. Speaker, I have no further speakers. I am prepared to
close, and I reserve the balance of my time.
Mr. BERGMAN. Mr. Speaker, once again, I strongly encourage all
Members to support this legislation, and I yield back the balance of my
time.
Mr. TAKANO. Mr. Speaker, I ask all of my colleagues to join me in
support of this very important, transformational piece of legislation,
H.R. 542, 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 Michigan (Mr. Bergman) that the House suspend the rules
and pass the bill, H.R. 542, 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. TAKANO. 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.
____________________