II

106TH CONGRESS

1ST SESSION S. 1250

To amend title 38, United States Code, to ensure a continuum of health

care for veterans, to require pilot programs relating to long-term health

care for veterans, and for other purposes.

IN THE SENATE OF THE UNITED STATES

JUNE 21, 1999

Mr. ROCKEFELLER introduced the following bill; which was read twice and

referred to the Committee on Veterans’ Affairs

A BILL

To amend title 38, United States Code, to ensure a continuum of health care for veterans, to require pilot programs relating to long-term health care for veterans,

and for other purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Veterans’ Long-Term

5 Care Enhancement Act of 1999’’.

6 SEC. 2. CONTINUUM OF CARE FOR VETERANS.

7 (a) INCLUSION OF NONINSTITUTIONAL EXTENDED

8 CARE SERVICES IN DEFINITION OF MEDICAL SERV-
2

•S 1250 IS

1 ICES.—Section 1701 of title 38, United States Code, is

2 amended—

3 (1) in paragraph (6)(A)(i), by inserting ‘‘non4 institutional extended care services,’’ after ‘‘preven5 tive health services,’’; and

6 (2) by adding at the end the following new

7 paragraphs:

8 ‘‘(10) The term ‘noninstitutional extended care

9 services’ includes—

10 ‘‘(A) home-based primary care;

11 ‘‘(B) adult day health care;

12 ‘‘(C) respite care;

13 ‘‘(D) palliative and end-of-life care; and

14 ‘‘(E) homemaker or home health aide vis15 its.

16 ‘‘(11) The term ‘respite care’ means hospital or

17 nursing home care which—

18 ‘‘(A) is of limited duration;

19 ‘‘(B) is furnished on an intermittent basis

20 to an individual who is suffering from a chronic

21 illness and who resides primarily at home; and

22 ‘‘(C) is furnished for the purpose of help23 ing the individual to continue residing primarily

24 at home.’’.
3

•S 1250 IS

1 (b) ASSISTED LIVING.—Subchapter II of chapter 17

2 of such title is amended by adding at the end the following

3 new section:

4 ‘‘§ 1720F. Assisted living

5 ‘‘(a) The Secretary may, subject to subsection (b),

6 provide assisted living services to a veteran who is eligible

7 to receive care under section 1710 of this title and to the

8 spouse of such veteran in connection with the provision

9 of such services to such veteran.

10 ‘‘(b) The Secretary may not provide assisted living

11 services under this section to a veteran eligible to receive

12 care under section 1710(a)(3) of this title, or to a spouse

13 of any veteran, unless such veteran or spouse agrees to

14 pay the United States an amount equal to the cost, as

15 determined in regulations prescribed by the Secretary, of

16 the provision of such services.

17 ‘‘(c) For purposes of this section, the term ‘assisted

18 living services’ means services which provide personal care,

19 activities, health-related care, supervision, and other as20 sistance on a 24-hour basis within a residential or similar

21 setting which—

22 ‘‘(1) maximizes flexibility in the provision of

23 such care, activities, supervision, and assistance;

24 ‘‘(2) maximizes the autonomy, privacy, and

25 independence of an individual; and
4

•S 1250 IS

1 ‘‘(3) encourages family and community involve2 ment with the individual.’’.

3 (c) CONFORMING AMENDMENTS.—(1)(A) Section

4 1720 of such title is amended by striking subsection (f).

5 (B) The section heading of such section is amended

6 by striking ‘‘; adult day health care’’.

7 (2) Section 1720B of such title is repealed.

8 (d) CLERICAL AMENDMENTS.—The table of sections

9 for chapter 17 of such title is amended—

10 (1) in the item relating to section 1720, by

11 striking ‘‘; adult day health care’’;

12 (2) by striking the item relating to section

13 1720B; and

14 (3) by inserting after the item relating to sec15 tion 1720E the following new item:

‘‘1720F. Assisted living.’’.

16 SEC. 3. PILOT PROGRAMS RELATING TO LONG-TERM CARE

17 OF VETERANS.

18 (a) IN GENERAL.—The Secretary of Veterans Affairs

19 shall carry out three pilot programs for the purpose of

20 determining the feasibility and practicability of a variety

21 of methods of meeting the long-term care needs of eligible

22 veterans. The pilot programs shall be carried out in ac23 cordance with the provisions of this section.

24 (b) LOCATIONS OF PILOT PROGRAMS.—(1) Each

25 pilot program under this section shall be carried out at
5

•S 1250 IS

1 two Veterans Integrated Service Networks (VISNs) se2 lected by the Secretary for purposes of this section.

3 (2) The Secretary may not carry out more than one

4 pilot program in any given Veterans Integrated Service

5 Network.

6 (c) SCOPE OF SERVICES UNDER PILOT PRO7 GRAMS.—(1) The services provided under the pilot pro8 grams under this section shall include a comprehensive

9 array of health care services and other services that meet

10 the long-term care needs of veterans, including—

11 (A) inpatient long-term care in intermediate

12 care beds, in nursing homes, and in domiciliary care

13 facilities;

14 (B) noninstitutional long-term care, including

15 hospital-based primary care, adult day care, personal

16 assistance services, respite care, and other commu17 nity-based interventions and care; and

18 (C) assisted living services for veterans and

19 their families.

20 (2) As part of the provision of services under the pilot

21 programs, the Secretary shall also provide appropriate

22 case management services.

23 (3) In providing services under the pilot programs,

24 the Secretary shall emphasize the provision of preventive

25 care services, including screening and education.
6

•S 1250 IS

1 (d) DIRECT PROVISION OF SERVICES.—Under one of

2 the pilot programs under this section, the Secretary shall

3 provide long-term care services to eligible veterans directly

4 through facilities and personnel of the Department of Vet5 erans Affairs.

6 (e) PROVISION OF SERVICES THROUGH COOPERA7 TIVE ARRANGEMENTS.—(1) Under one of the pilot pro8 grams under this section, the Secretary shall provide long9 term care services to eligible veterans through a combina10 tion (as determined by the Secretary) of—

11 (A) services provided under cooperative ar12 rangements with appropriate public and private non13 Governmental entities, including community service

14 organizations; and

15 (B) services provided through facilities and per16 sonnel of the Department.

17 (2) The consideration provided by the Secretary for

18 services provided by entities under cooperative arrange19 ments under paragraph (1)(A) shall be limited to the pro20 vision by the Secretary of appropriate in-kind services to

21 such entities.

22 (f) PROVISION OF SERVICES BY NON-DEPARTMENT

23 ENTITIES.—(1) Under one of the pilot programs under

24 this section, the Secretary shall provide long-term care

25 services to eligible veterans through arrangements with
7

•S 1250 IS

1 appropriate non-Department entities under which ar2 rangements the Secretary acts solely as the case manager

3 for the provision of such services.

4 (2) Payment for services provided to veterans under

5 the pilot programs under this subsection shall be as fol6 lows:

7 (A) By the medicare program or the medicaid

8 program, but only—

9 (i) if the veterans concerned are entitled to

10 benefits under such programs; and

11 (ii) to the extent that payment for such

12 services is provided for under such programs.

13 (B) By the Department, to the extent that pay14 ment for such services is not otherwise provided for

15 under subparagraph (A).

16 (g) DATA COLLECTION.—As part of each pilot pro17 gram under this section, the Secretary shall collect data

18 regarding—

19 (1) the cost-effectiveness of such program, in20 cluding any savings achieved under such program

21 when compared with the medicare program, med22 icaid program, or other Federal program serving

23 similar populations;

24 (2) the quality of the services provided under

25 such program;
8

•S 1250 IS

1 (3) the satisfaction of participating veterans,

2 non-Department, and non-Government entities with

3 such program; and

4 (4) the effect of such program on the ability of

5 veterans to carry out basic activities of daily living

6 over the course of such veterans’ participation in

7 such program.

8 (h) REPORTS.—(1) The Secretary shall annually sub9 mit to Congress a report on the pilot programs under this

10 section.

11 (2) Each report under paragraph (1) shall include the

12 following:

13 (A) A detailed description of activities under

14 the pilot programs during the one-year period ending

15 on the date of the report.

16 (B) An evaluation of the data collected under

17 subsection (g) during that period.

18 (C) Any other matters regarding the programs

19 that the Secretary considers appropriate.

20 (i) DURATION OF PROGRAMS.—(1) The Secretary

21 shall commence carrying out the pilot programs required

22 by this section not later than 90 days after the date of

23 the enactment of this Act.

24 (2) The authority of the Secretary to provide services

25 under the pilot programs shall cease on the date that is
9

•S 1250 IS

1 three years after the date of the commencement of the

2 pilot programs under paragraph (1).

3 (j) DEFINITIONS.—In this section:

4 (1) The term ‘‘eligible veteran’’ means the fol5 lowing:

6 (A) Any veteran entitled to hospital care

7 and medical services under section 1710(a)(1)

8 of title 38, United States Code.

9 (B) Any veteran (other than a veteran de10 scribed in subparagraph (A)) if the veteran is

11 enrolled in the system of annual patient enroll12 ment under section 1705 of title 38, United

13 States Code.

14 (2) The term ‘‘long-term care needs’’ means the

15 need by an individual for any of the following serv16 ices:

17 (A) Personal care.

18 (B) Nursing home and home health care

19 services.

20 (C) Habilitation and rehabilitation serv21 ices.

22 (D) Adult day care services.

23 (E) Case management services.

24 (F) Social services.

25 (G) Assistive technology services.
10

•S 1250 IS

1 (H) Home and community based services,

2 including assistive living.

Æ