[House Report 114-35]
[From the U.S. Government Publishing Office]
114th Congress } { Report
HOUSE OF REPRESENTATIVES
1st Session } { 114-35
======================================================================
LONG-TERM CARE VETERANS CHOICE ACT
_______
March 2, 2015.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Miller of Florida, from the Committee on Veterans' Affairs,
submitted the following
R E P O R T
[To accompany H.R. 294]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred
the bill (H.R. 294) to amend title 38, United States Code, to
authorize the Secretary of Veterans Affairs to enter into
contracts and agreements for the transfer of veterans to non-
Department medical foster homes for certain veterans who are
unable to live independently, having considered the same,
report favorably thereon with amendments and recommend that the
bill as amended do pass.
CONTENTS
Page
Amendment........................................................ 2
Purpose and Summary.............................................. 2
Background and Need for Legislation.............................. 3
Hearings......................................................... 4
Subcommittee Consideration....................................... 5
Committee Consideration.......................................... 5
Committee Votes.................................................. 5
Committee Oversight Findings..................................... 5
Statement of General Performance Goals and Objectives............ 6
New Budget Authority, Entitlement Authority, and Tax Expenditures 6
Earmarks and Tax and Tariff Benefits............................. 6
Committee Cost Estimate.......................................... 6
Congressional Budget Office Estimate............................. 6
Federal Mandates Statement....................................... 8
Advisory Committee Statement..................................... 8
Statement of Constitutional Authority............................ 8
Applicability to Legislative Branch.............................. 9
Statement on Duplication of Federal Programs..................... 9
Disclosure of Directed Rulemaking................................ 9
Section-by-Section Analysis of the Legislation................... 9
Changes in Existing Law Made by the Bill as Reported............. 10
Amendment in the Nature of a Substitute
The amendments are as follows:
Strike all after the enacting clause and insert the
following:
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.--
(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 three-year period beginning on October 1, 2015,
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 or agreement 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) Not more than 900 veterans placed in a medical foster home,
whether placed before or after the enactment of the Long-Term Care
Veterans Choice Act, 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.''.
(2) Effective date.--Subsection (h) of title 38, United
States Code, as added by subsection (a), shall take effect on
October 1, 2015.
(b) Limitations on Awards and Bonuses.--Section 705 of the Veterans
Access, Choice, and Accountability Act of 2014 (Public Law 113-146; 38
U.S.C. 703 note) is amended to read as follows:
``SEC. 705. LIMITATION ON AWARDS AND BONUSES PAID TO EMPLOYEES OF
DEPARTMENT OF VETERANS AFFAIRS.
``The Secretary of Veterans Affairs shall ensure that the aggregate
amount of awards and bonuses paid by the Secretary in a fiscal year
under chapter 45 or 53 of title 5, United States Code, or any other
awards or bonuses authorized under such title or title 38, United
States Code, does not exceed the following amounts:
``(1) With respect to each of fiscal years 2015 through 2018,
$300,000,000.
``(2) With respect to each of fiscal years 2019 through 2024,
$360,000,000.''.
Amend the title so as to read:
A bill 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.
Purpose and Summary
H.R. 294, the Long-Term Care Veterans Choice Act, was
introduced by Representative Jeff Miller of Florida, the
Chairman of the Committee, on January 13, 2015.
H.R. 294, as amended would authorize the Department of
Veterans Affairs (VA), for three years beginning on October 1,
2015, to enter into a contract or agreement with a certified
medical foster home to pay for long-term care for not more than
900 eligible veterans. Eligible veterans are defined as those
who are eligible for VA-paid nursing home care and agree to
receive VA home health services. H.R. 294, as amended, would
also limit the amount of the awards and bonuses paid to VA
employees to $300 million over each of fiscal years (FYs) 2015-
2018.
Background
Section 2--Secretary of Veterans Affairs contract authority for
placement of veterans in non-department medical foster homes
Section 101 of the Veterans Millennium Health Care and
Benefits Act, Public Law 106-117 (113 Stat. 1545, 1547)
requires VA to provide nursing home services to all enrolled
veterans who are: 70 percent or more service-connected; 60
percent or more service-connected and unemployable and in need
of such care; or, who are service-connected for a condition
that makes such care necessary. VA meets the requirements of
the law by providing short- and long-term nursing home care,
respite care, and end-of-life care through Community Living
Centers located on VA medical center (VAMC) campuses; purchased
care in Community Nursing Homes; and, through the State
Veterans Nursing Home program.
Additionally, VA provides a variety of non-institutional
long-term care services to allow many veterans to remain within
their homes and delay or avoid nursing home placement. One of
the many non-institutional long-term care programs VA provides
is the Community Residential Care (CRC) program.
The CRC program is authorized under section 1730 of title
38, United States Code (U.S.C.) and is a form of enriched
housing which provides health care supervision to eligible
veterans who do not require hospital or nursing home care but
are not able to live independently because of medical or
psychosocial limitations or care needs that exceed the
capabilities of their families. VA health care personnel may
assist veterans by referring them for placement in a privately
or publicly owned community residential care facility if
certain criteria--codified at 38 C.F.R. Sec. 17.61 through
Sec. 17.72--are met.
A relatively new variant of CRC is known as Medical Foster
Home (MFH) care. VA's MFH program began in 1999 as a pilot
project for veterans who prefer to live in a family setting but
have complex medical conditions and/or disabilities due to
chronic disease, frailty, or traumatic injury and,
consequently, are unable to live independently. In general, a
MFH is an adult foster home that, combined with a VA
interdisciplinary home care team, provides non-institutional
long-term care for veterans.
A MFH is distinguished from other CRC homes because, in
general: the home is owned or rented by the MFH caregiver; the
MFH caregiver lives in the MFH and provides personal care and
supervision; there are not more than three residents receiving
care in the MFH, including both veterans and non-veterans; and,
veteran MFH residents are enrolled in a VA Home Based Primary
Care or Spinal Cord Injury Home Care Program.
However, because a MFH is not considered institutional care
that is eligible for VA nursing home payments, VA does not have
the authority under the CRC program to pay for the cost of the
MFH. A veteran who chooses to live in a MFH must pay out of
pocket with personal funds, regardless of whether or not such
veteran is eligible for VA-paid nursing home care.
The inability of VA to pay for this type of long term care
has forced service-connected veterans eligible for VA paid
nursing home care who choose to reside in MFHs to pay for the
service themselves, or to defer the MFH option in order to
reside in an institutional setting that may not be the best
option for the veteran's needs. VA believes many more veterans
would elect to receive care in a MFH should VA be granted the
authority to pay for care in such facilities.
According to VA testimony from January 2015, VA considers
MFHs to offer safe, highly veteran-centric care that many
veterans prefer at a lower cost than traditional nursing home
care while increasing access and promoting veteran choice. More
than 900 veterans receive care in MFHs--at their own cost--and
more than two-thirds of VAMCs currently manage a MFH program.
These programs are managed by local MFH Coordinators who
oversee the approval, inspection and placement process for MFHs
in the community.
VA also provides safeguards to ensure veterans receive
safe, high-quality care by requiring MFH caregivers to: pass a
federal background check and VA screening, agree to undergo
annual training, and allow VA to make both announced and
unannounced home visits.
The Committee commends VA for these efforts and for
focusing on education and training of MFH caregivers to ensure
they provide safe, quality, and effective specialized care for
veterans. The Committee recommends VA enter into partnerships
with ongoing caregiver training initiatives to develop and host
additional training to ensure incoming MFH caregivers are
adequately trained and experienced and to help support and
retain existing MFH caregivers.
As the veteran population continues to age, the need for
long-term care services will continue to grow. The Committee
believes it is important to expand the long term care choices
offered to veterans beyond traditional services and provide VA
authority to pay for long term care in qualifying MFHs for
eligible veterans. Granting VA the authority to pay for
veterans who are eligible for VA-paid nursing home care to
receive care in a MFH would allow veterans a choice of a more
tailored long term care option that may better fit the quality
of life they seek. Of additional benefit, VA has found that
this action would ultimately provide a cost saving for the
Department.
Section 2 would authorize VA for three years beginning on
October 1, 2015, to enter into a contract or agreement with a
certified medical foster home to pay for long-term care for not
more than 900 eligible veterans. It would also require an
eligible veteran to receive VA home health services as a
component of such payment and to be eligible for VA-paid
nursing home care. To pay for this authority, Section 2 would
also limit the amount the awards and bonuses paid to VA
employees at $300 million over fiscal years (FYs) 2015-2018.
Hearings
On May 21, 2013, the Full Committee conducted a legislative
hearing on various bills introduced during the 114th Congress,
including H.R. 189, H.R. 216, H.R. 245, H.R. 294, and H.R. 294.
The following witnesses testified:
The Honorable Alan Grayson of Florida; David R. McLenachen,
Acting Deputy Under Secretary for Disability Assistance for the
Veterans Benefits Administration of the U.S. Department of
Veterans Affairs, accompanied by Dr. Rajiv Jain, the Assistant
Deputy Under Secretary for Health for Patient Services for the
Veterans Health Administration of the U.S. Department of
Veterans Affairs, Susan Sullivan, the Deputy Assistant
Secretary for Policy Office of Policy and Planning for the U.S.
Department of Veterans Affairs, and Kim McLeod, Counsel for the
Office of General Counsel of the U.S. Department of Veterans
Affairs; Joseph A. Violante, the National Legislative Director
for the Disabled American Veterans; Aleks Morosky, the Deputy
Director of the National Legislative Service of the Veterans of
Foreign Wars; Zachary Hearn, the Deputy Director of Claims for
the Veterans Affairs and Rehabilitation Commission of The
American Legion; and, Blake Ortner, the Deputy Government
Relations Director for the Paralyzed Veterans of America.
Statements for the record were submitted by the following:
Vietnam Veterans of America and the Housing Policy Council.
Subcommittee Consideration
There was no Subcommittee consideration of H.R. 294, as
amended.
Committee Consideration
On February 12, 2015, the full Committee met in an open
markup session, a quorum being present, and ordered H.R. 294,
as amended, reported favorably to the House of Representatives
by voice vote.
During consideration of H.R. 294, the following amendment
was considered and agreed to by voice vote:
An amendment in the nature of a substitute offered by
Chairman Miller of Florida which limited the number of veterans
eligible for VA-paid medical foster home care to 900 and also
limited the awards and bonuses paid to VA employees at $300
million for each of FYs 2015-2018.
Committee Votes
Clause 3(b) of rule XIII of the Rules of the House of
Representatives requires the Committee to list the record votes
on the motion to report the legislation and amendments thereto.
There were no recorded votes taken on amendments or in
connection with ordering H.R. 294, as amended, reported to the
House. A motion by Ranking Member Corrine Brown of Florida to
report H.R. 294, as amended, favorably to the House of
Representatives was agreed to by voice vote.
Committee Oversight Findings
In compliance with clause 3(c)(1) of rule XIII and clause
(2)(b)(1) of rule X of the Rules of the House of
Representatives, the Committee's oversight findings and
recommendations are reflected in the descriptive portions of
this report.
Statement of General Performance Goals and Objectives
In accordance with clause 3(c)(4) of rule XIII of the Rules
of the House of Representatives, the Committee's performance
goals and objectives are reflected in the descriptive portions
of this report.
New Budget Authority, Entitlement Authority, and Tax Expenditures
In compliance with clause 3(c)(2) of rule XIII of the Rules
of the House of Representatives, the Committee adopts as its
own the estimate of new budget authority, entitlement
authority, or tax expenditures or revenues contained in the
cost estimate prepared by the Director of the Congressional
Budget Office pursuant to section 402 of the Congressional
Budget Act of 1974.
Earmarks and Tax and Tariff Benefits
H.R. 294, as amended, does not contain any Congressional
earmarks, limited tax benefits, or limited tariff benefits as
defined in clause 9 of rule XXI of the Rules of the House of
Representatives.
Committee Cost Estimate
The Committee adopts as its own the cost estimate on H.R.
294, as amended, prepared by the Director of the Congressional
Budget Office pursuant to section 402 of the Congressional
Budget Act of 1974.
Congressional Budget Office Cost Estimate
Pursuant to clause 3(c)(3) of rule XIII of the Rules of the
House of Representatives, the following is the cost estimate
for H.R. 294, as amended, provided by the Congressional Budget
Office pursuant to section 402 of the Congressional Budget Act
of 1974:
U.S. Congress,
Congressional Budget Office,
Washington, DC, March 2, 2015.
Hon. Jeff Miller,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 294, the Long-Term
Care Veterans Choice Act.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Ann E.
Futrell.
Sincerely,
Douglas W. Elmendorf,
Director.
Enclosure.
H.R. 294--Long-Term Care Veterans Choice Act
H.R. 294 would authorize the Department of Veterans Affairs
(VA) to provide long-term care in medical foster homes (MFHs)
for certain veterans with severe service-connected
disabilities. The bill also would limit the awards and bonuses
paid to VA employees. On net, CBO estimates that implementing
the bill would reduce discretionary costs by $253 million over
the 2016-2020 period, subject to appropriation action
consistent with the bill.
Pay-as-you-go procedures do not apply to this legislation
because it would not affect direct spending or revenues.
H.R. 294 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA)
and would not affect the budgets of state, local, or tribal
governments.
Estimated cost to the Federal Government: The estimated
budgetary effect of H.R. 294 is shown in the following table.
The costs of this legislation fall within budget function 700
(veterans benefits and services).
Basis of estimate: For this estimate, CBO assumes that the
legislation will be enacted near the end of fiscal year 2015,
that the necessary amounts will be appropriated for each year,
and that outlays will follow historical spending patterns for
similar and existing programs.
----------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
----------------------------------------------------------------------
2015 2016 2017 2018 2019 2020 2015-2020
----------------------------------------------------------------------------------------------------------------
CHANGES IN SPENDING SUBJECT TO APPROPRIATION
Medical Foster Care:
Estimated Authorization Level........ 0 27 33 40 39 38 177
Estimated Outlays.................... 0 24 32 39 39 38 172
Limitation on Awards and Bonuses:
Estimated Authorization Level........ 0 -101 -105 -109 -53 -57 -425
Estimated Outlays.................... 0 -101 -105 -109 -53 -57 -425
Total Changes:
Estimated Authorization Level.... 0 -74 -72 -69 -14 -19 -248
Estimated Outlays................ 0 -77 -73 -70 -14 -19 -253
----------------------------------------------------------------------------------------------------------------
Medical foster care
For the three-year period beginning on October 1, 2015, the
bill would authorize VA to place up to 900 veterans with severe
service-connected disabilities in MFHs and to pay the full cost
of their stay in those establishments. A MPH is a private home
in which a trained caregiver provides services to a few
individuals. VA has an existing program under which it inspects
and approves MFHs for veterans. Veterans currently living in
such homes are eligible to receive VA's Home Based Primary Care
services, which include case management and health care
provided in the home. VA is not currently authorized to pay for
the cost of living in MFHs, but under this bill, VA could pay
that cost. CBO expects that once veterans are placed in medical
foster care under this new program, VA will pay for their stays
in those facilities indefinitely.
CBO estimates that half of the veterans eligible for this
program (or 450 individuals) would become residents of MFHs as
a result of the bill's enactment. For those veterans, VA would
pay for their living expenses, as well as the costs for Home
Based Primary Care services. We estimate that those veterans
would receive health care that would cost $9,000 per year more
than they would receive under current law because providing
care in the individual homes is costlier than providing health
care at VA medical facilities Including the costs for living
expenses at the MFHs of $39,000 per year, we estimate total
costs per new resident of $48,000 per year. As a result, total
costs for new MPH residents would be about $22 million a year,
CBO estimates.
CBO estimates that the remaining half of the eligible
population (450 veterans) would be individuals already living
in MFHs. Because VA already provides those veterans with in-
home health care services, the incremental cost would be
$39,000 a year per veteran to cover the expense of living in
the MFHs. Those costs would total about $18 million a year for
those 450 veterans, CBO estimates.
After factoring in inflation, appropriate mortality rates,
and a gradual implementation period to reflect the time for VA
to transition additional veterans into the MFH program, CBO
estimates that implementing this bill would cost an additional
$172 million over the 2016-2020 period, assuming appropriation
of the necessary amounts.
Limitation on awards and bonuses
This bill also would limit to $300 million the amount that
VA could pay in awards and bonuses to VA employees through 2018
and $360 million from 2019 to 2024. Over the 2010-2013 period,
VA paid an average of $395 million each year in awards and
bonus payments to employees. Assuming such payments will grow
with inflation under current law, CBO estimates that
implementing this provision would reduce discretionary spending
for pay and performance by $425 million over the 2016-2020
period, assuming appropriation actions consistent with the
bill.
Pay-As-You-Go considerations: None.
Intergovernmental and private-sector impact: H.R. 294
contains no intergovernmental or private-sector mandates as
defined in UMRA and would not affect the budgets of state,
local, or tribal governments.
Estimate prepared by: Federal Costs: Ann E. Futrell and
Dwayne M. Wright; Impact on State, Local, and Tribal
Governments: Jon Sperl; Impact on the Private Sector: Paige
Piper-Bach.
Estimate approved by: Theresa Gullo, Deputy Assistant
Director for Budget Analysis.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates regarding H.R. 294, as amended, prepared by the
Director of the Congressional Budget Office pursuant to section
423 of the Unfunded Mandates Reform Act.
Advisory Committee Statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act would be created by H.R.
294, as amended.
Statement of Constitutional Authority
Pursuant to Article I, section 8 of the United States
Constitution, the reported bill is authorized by Congress'
power to ``provide for the common Defense and general Welfare
of the United States.''
Applicability to Legislative Branch
The Committee finds that the legislation does not relate to
the terms and conditions of employment or access to public
services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act.
Statement on Duplication of Federal Programs
Pursuant to section 3(g) of H. Res. 5, 114th Cong. (2015),
the Committee finds that no provision of H.R. 294, as amended,
establishes or reauthorizes a program of the Federal Government
known to be duplicative of another Federal program, a program
that was included in any report from the Government
Accountability Office to Congress pursuant to section 21 of
Public Law 111-139, or a program related to a program
identified in the most recent Catalog of Federal Domestic
Assistance.
Disclosure of Directed Rulemaking
Pursuant to section 3(i) of H. Res. 5, 114th Cong. (2015),
the Committee estimates that H.R. 294, as amended, does not
require directed rule making.
Section-by-Section Analysis of the Legislation
Section 1. Short title
Section 1 of the bill would provide that the short title of
H.R. 294, as amended, would be the ``Long-Term Care Veterans
Choice Act.''
Section 2--Secretary of Veterans Affairs contract authority for
placement of veterans in non-department medical foster homes
Section 2(a)(1) of the bill would amend section 1720 of
title 38, United States Code, by adding a new subsection (h)
that would authorize VA, during the three year period beginning
on October 1, 2015, to facilitate the placement of veterans to
medical foster homes at the request of the veteran for whom VA
is required to provide nursing home care under 38 U.S.C. Sec.
1710(A). Under this subsection, the medical foster home would
be required to meet department standards, and not more than 900
veterans, whether placed in a MFH before or after enactment,
would be eligible to have the cost of their MFH care paid for
by VA. Such care would be pursuant to a contract or agreement
entered into between the Secretary and the medical foster home.
A veteran who is placed in a medical foster home under this
subsection would be required to agree, as a condition of such
transfer, to accept home health services furnished by the
Secretary under 38 U.S.C. Sec. 1717.
Section 2(a)(2) of the bill would set an effective date of
October 1, 2015, for the (h).
Section 2(b) of the bill would amend Section 705 of Public
Law 113-146 to limit the aggregate amount of awards and bonuses
that can be paid to VA employees to $300 million for each of
FYs 2015-2018.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italic, existing law in which no change is
proposed is shown in roman):
TITLE 38, UNITED STATES CODE
* * * * * * *
PART II--GENERAL BENEFITS
* * * * * * *
CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE
* * * * * * *
SUBCHAPTER II--HOSPITAL, NURSING HOME, OR DOMICILIARY CARE AND MEDICAL
TREATMENT
* * * * * * *
Sec. 1720. Transfers for nursing home care; adult day health care
(a)(1) Subject to subsection (b) of this section, the
Secretary may transfer to a non-Department nursing home, for
care at the expense of the United States--
(A) a veteran--
(i) who has been furnished care by the
Secretary in a facility under the direct
jurisdiction of the Secretary; and
(ii) who the Secretary determines--
(I) requires a protracted period of
nursing home care which can be
furnished in the non-Department nursing
home; and
(II) in the case of a veteran who has
been furnished hospital care in a
facility under the direct jurisdiction
of the Secretary, has received maximum
benefits from such care; and
(B) a member of the Armed Forces--
(i) who has been furnished care in a hospital
of the Armed Forces;
(ii) who the Secretary concerned determines
has received maximum benefits from such care
but requires a protracted period of nursing
home care; and
(iii) who upon discharge from the Armed
Forces will become a veteran.
(2) The Secretary may transfer a person to a nursing home
under this subsection only if the Secretary determines that the
cost to the United States of the care of such person in the
nursing home will not exceed--
(A) the amount equal to 45 percent of the cost of
care furnished by the Department in a general hospital
under the direct jurisdiction of the Secretary (as such
cost may be determined annually by the Secretary); or
(B) the amount equal to 50 percent of such cost, if
such higher amount is determined to be necessary by the
Secretary (upon the recommendation of the Under
Secretary for Health) to provide adequate care.
(3) Nursing home care may not be furnished under this
subsection at the expense of the United States for more than
six months in the aggregate in connection with any one transfer
except--
(A) in the case of a veteran--
(i) who is transferred to a non-Department
nursing home from a hospital under the direct
jurisdiction of the Secretary; and
(ii) whose hospitalization was primarily for
a service-connected disability;
(B) in a case in which the nursing home care is
required for a service-connected disability; or
(C) in a case in which, in the judgment of the
Secretary, a longer period of nursing home care is
warranted.
(4) A veteran who is furnished care by the Secretary in a
hospital or domiciliary facility in Alaska or Hawaii may be
furnished nursing home care at the expense of the United States
under this subsection even if such hospital or domiciliary
facility is not under the direct jurisdiction of the Secretary.
(b) No veteran may be transferred or admitted to any
institution for nursing home care under this section, unless
such institution is determined by the Secretary to meet such
standards as the Secretary may prescribe. The standards
prescribed and any report of inspection of institutions
furnishing care to veterans under this section made by or for
the Secretary shall, to the extent possible, be made available
to all Federal, State, and local agencies charged with the
responsibility of licensing or otherwise regulating or
inspecting such institutions.
(c)(1)(A) In furnishing nursing home care, adult day health
care, or other extended care services under this section, the
Secretary may enter into agreements for furnishing such care or
services with--
(i) in the case of the medicare program, a provider
of services that has entered into a provider agreement
under section 1866(a) of the Social Security Act (42
U.S.C. 1395cc(a));
(ii) in the case of the medicaid program, a provider
participating under a State plan under title XIX of
such Act (42 U.S.C. 1396 et seq.); and
(iii) a provider of services eligible to enter into a
contract pursuant to section 1745(a) of this title that
is not otherwise described in clause (i) or (ii).
(B) In entering into an agreement under subparagraph (A) with
a provider of services described in clause (i) of that
subparagraph or a provider described in clause (ii) of that
subparagraph, the Secretary may use the procedures available
for entering into provider agreements under section 1866(a) of
the Social Security Act.
(2) In applying the provisions of section 6704(a) of title 41
with respect to any contract entered into under this section to
provide nursing home care of veterans, the payment of wages not
less than those specified in section 6(b) of the Fair Labor
Standards Act of 1938 (29 U.S.C. 206(b)) shall be deemed to
constitute compliance with such provisions.
(d)(1) Subject to subsection (b) of this section, the
Secretary may authorize for any veteran requiring nursing home
care for a service-connected disability direct admission for
such care at the expense of the United States to any non-
Department nursing home. The Secretary may also authorize a
direct admission to such a nursing home for nursing home care
for any veteran who has been discharged from a hospital under
the direct jurisdiction of the Secretary and who is currently
receiving medical services as part of home health services from
the Department.
(2) Direct admission authorized by paragraph (1) of this
subsection may be authorized upon determination of need
therefor--
(A) by a physician employed by the Department; or
(B) in areas where no such physician is available, by
a physician carrying out such function under contract
or fee arrangement,
based on an examination by such physician.
(3) The amount which may be paid for such care and the length
of care available under this subsection shall be the same as
authorized under subsection (a) of this section.
(e)(1) The cost of intermediate care for purposes of payment
by the United States pursuant to subsection (a)(2)(B) of this
section shall be determined by the Secretary except that the
rate of reimbursement shall be commensurately less than that
provided for nursing home care.
(2) For the purposes of this section, the term ``non-
Department nursing home'' means a public or private institution
not under the direct jurisdiction of the Secretary which
furnishes nursing home care.
(f)(1)(A) The Secretary may furnish adult day health care
services to a veteran enrolled under section 1705(a) of this
title who would otherwise require nursing home care.
(B) The Secretary may provide in-kind assistance (through the
services of Department employees and the sharing of other
Department resources) to a facility furnishing care to veterans
under subparagraph (A) of this paragraph. Any such in-kind
assistance shall be provided under a contract or agreement
between the Secretary and the facility concerned. The Secretary
may provide such assistance only for use solely in the
furnishing of adult day health care and only if, under such
contract or agreement, the Department receives reimbursement
for the full cost of such assistance, including the cost of
services and supplies and normal depreciation and amortization
of equipment. Such reimbursement may be made by reduction in
the charges to the United States or by payment to the United
States. Any funds received through such reimbursement shall be
credited to funds allotted to the Department facility that
provided the assistance.
(2) The Secretary may conduct, at facilities over which the
Secretary has direct jurisdiction, programs for the furnishing
of adult day health care to veterans who are eligible for such
care under paragraph (1) of this subsection, except that
necessary travel and incidental expenses (or transportation in
lieu thereof) may be furnished under such a program only under
the terms and conditions set forth in section 111 of this
title. The furnishing of care under any such program shall be
subject to the limitations that are applicable to the duration
of adult day health care furnished under paragraph (1) of this
subsection.
(g) The Secretary may contract with appropriate entities to
provide specialized residential care and rehabilitation
services to a veteran of Operation Enduring Freedom or
Operation Iraqi Freedom who the Secretary determines suffers
from a traumatic brain injury, has an accumulation of deficits
in activities of daily living and instrumental activities of
daily living, and because of these deficits, would otherwise
require admission to a nursing home even though such care would
generally exceed the veteran's nursing needs.
(h)(1) During the three-year period beginning on October 1,
2015, 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 or agreement 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) Not more than 900 veterans placed in a medical foster
home, whether placed before or after the enactment of the Long-
Term Care Veterans Choice Act, 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.
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VETERANS ACCESS, CHOICE, AND ACCOUNTABILITY ACT OF 2014
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TITLE VII--OTHER VETERANS MATTERS
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[SEC. 705. LIMITATION ON AWARDS AND BONUSES PAID TO EMPLOYEES OF
DEPARTMENT OF VETERANS AFFAIRS.
[In each of fiscal years 2015 through 2024, the Secretary of
Veterans Affairs shall ensure that the aggregate amount of
awards and bonuses paid by the Secretary in a fiscal year under
chapter 45 or 53 of title 5, United States Code, or any other
awards or bonuses authorized under such title does not exceed
$360,000,000.]
SEC. 705. LIMITATION ON AWARDS AND BONUSES PAID TO EMPLOYEES OF
DEPARTMENT OF VETERANS AFFAIRS.
The Secretary of Veterans Affairs shall ensure that the
aggregate amount of awards and bonuses paid by the Secretary in
a fiscal year under chapter 45 or 53 of title 5, United States
Code, or any other awards or bonuses authorized under such
title or title 38, United States Code, does not exceed the
following amounts:
(1) With respect to each of fiscal years 2015 through
2018, $300,000,000.
(2) With respect to each of fiscal years 2019 through
2024, $360,000,000.
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