II 

118TH CONGRESS 

2D SESSION S. 4556 

To amend title 38, United States Code, to establish the Office of Falls 

Prevention of the Department of Veterans Affairs, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JUNE 17, 2024 

Mr. KING (for himself and Mr. ROUNDS) 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 establish the 

Office of Falls Prevention of the Department of Veterans 

Affairs, 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 ‘‘Supporting Access to 

5 Falls Education and Prevention and Strengthening Train6 ing Efforts and Promoting Safety Initiatives for Veterans 

7 Act of 2024’’ or the ‘‘SAFE STEPS for Veterans Act of 

8 2024’’. 


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1 SEC. 2. ESTABLISHMENT OF OFFICE OF FALLS PREVEN2 TION OF DEPARTMENT OF VETERANS AF3 FAIRS. 

4 (a) ESTABLISHMENT OF OFFICE.— 

5 (1) IN GENERAL.—Subchapter I of chapter 73 

6 of title 38, United States Code, is amended by in7 serting after section 7310A the following new sec8 tion: 

9 ‘‘§ 7310B. Office of Falls Prevention 

10 ‘‘(a) OFFICE.— 

11 ‘‘(1) ESTABLISHMENT AND OPERATION.—The 

12 Under Secretary for Health shall establish and oper13 ate in the Veterans Health Administration the Office 

14 of Falls Prevention (in this section referred to as the 

15 ‘Office’). 

16 ‘‘(2) LOCATION OF OFFICE.—The Office shall 

17 be located at the Central Office of the Department. 

18 ‘‘(3) LEADERSHIP.— 

19 ‘‘(A) HEAD.—The head of the Office is the 

20 Chief Officer of Falls Prevention (in this sec21 tion referred to as the ‘Chief Officer’). 

22 ‘‘(B) REPORTING.—The Chief Officer shall 

23 report to the Under Secretary for Health. 

24 ‘‘(4) STAFFING AND SUPPORT.—The Under 

25 Secretary for Health shall provide the Office with 

26 such staff and other support as may be necessary 


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1 for the Office to carry out effectively the functions 

2 of the Office under this section. 

3 ‘‘(5) REORGANIZATION.—The Under Secretary 

4 for Health may reorganize existing offices within the 

5 Veterans Health Administration as of the date of 

6 the enactment of this section in order to avoid dupli7 cation with the functions of the Office. 

8 ‘‘(b) FUNCTIONS.—The functions of the Office in9 clude the following: 

10 ‘‘(1) To provide a central office for monitoring 

11 and encouraging the activities of the Veterans 

12 Health Administration with respect to the provision, 

13 evaluation, and improvement of health care services 

14 relating to falls prevention provided to veterans by 

15 the Department, with the goal of averting costly 

16 health care utilization while decreasing the incidence 

17 of falls. 

18 ‘‘(2) To develop and implement standards of 

19 care for the provision by the Department of health 

20 care services relating to falls prevention. 

21 ‘‘(3) To monitor and identify deficiencies in 

22 standards of care for the provision of health care 

23 services relating to falls prevention, to provide tech24 nical assistance to medical facilities of the Depart25 ment, to provide technical assistance to programs of 


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1 the Department that support veterans in their own 

2 homes, to address and remedy deficiencies of such 

3 facilities and programs, and to perform oversight of 

4 implementation of such standards of care. 

5 ‘‘(4) To monitor and identify deficiencies in 

6 standards of care for the provision of health care 

7 services relating to falls prevention through the com8 munity pursuant to this title and to provide rec9 ommendations to the appropriate office to address 

10 and remedy any deficiencies. 

11 ‘‘(5) To oversee distribution of resources and 

12 information related to falls prevention for veterans 

13 under this title. 

14 ‘‘(6) To promote the expansion and improve15 ment of clinical, research, and educational activities 

16 of the Veterans Health Administration with respect 

17 to health care services relating to falls prevention, 

18 including research activities on falls prevention con19 ducted between the Office of Research and Develop20 ment of the Department and the National Institute 

21 on Aging. 

22 ‘‘(7) To promote the development or expansion 

23 of rigorous quality assessment or improvement proc24 esses designed to prevent falls, including through co25 ordination and collaboration with offices within the 


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1 Department determined appropriate by the Sec2 retary. 

3 ‘‘(8) To coordinate home modification and ad4 aptation programs administered by the Under Sec5 retary for Benefits under chapter 21 of this title and 

6 the Under Secretary for Health under section 

7 1717(a)(2) of this title. 

8 ‘‘(9) To carry out such other duties as the 

9 Under Secretary for Health may require. 

10 ‘‘(c) PUBLIC EDUCATION CAMPAIGN.—The Chief Of11 ficer shall— 

12 ‘‘(1) oversee and support a national education 

13 campaign that— 

14 ‘‘(A) is directed principally to veterans de15 termined to be at risk for falls, their families, 

16 and their health care providers; and 

17 ‘‘(B) focuses on— 

18 ‘‘(i) reducing falls, falls with major in19 jury, and repeat falls for veterans receiving 

20 care under the laws administered by the 

21 Secretary; and 

22 ‘‘(ii) increasing awareness of available 

23 benefits, grants, devices, or services pro24 vided by the Department that would aid 


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1 veterans in reducing falls and preventing 

2 repeat falls; and 

3 ‘‘(2) award grants or contracts to qualified or4 ganizations for the purpose of supporting local edu5 cation campaigns focusing on reducing falls, falls 

6 with major injury, and repeat falls for veterans re7 ceiving care under the laws administered by the Sec8 retary. 

9 ‘‘(d) RESEARCH ON FALLS PREVENTION PROGRAMS

10 FOR VETERAN POPULATIONS.— 

11 ‘‘(1) IN GENERAL.—The Chief Officer shall 

12 work with the Office of Research and Development 

13 of the Department and the National Institute on 

14 Aging to develop research for evidence-based falls 

15 prevention programs that will benefit veterans, in16 cluding— 

17 ‘‘(A) programs that overlap with the prior18 ities of the Department; 

19 ‘‘(B) programs that may focus on or be of 

20 particular benefit to veterans; and 

21 ‘‘(C) programs that may include partici22 pants with multiple comorbidities. 

23 ‘‘(2) MATTERS TO BE INCLUDED.—The re24 search required under paragraph (1) shall include 

25 the following: 


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1 ‘‘(A) Research in supporting veterans with 

2 and without service-connected disabilities receiv3 ing home modification grants under section 

4 1717 or 2101 of this title. 

5 ‘‘(B) Development of recommendations for 

6 falls prevention interventions for veterans with 

7 service-connected disabilities, including home 

8 modification interventions. 

9 ‘‘(C) Research addressing medication man10 agement and polypharmacy as risk factors for 

11 falls prevention and developing recommenda12 tions for providers and electronic health records 

13 systems of the Department to monitor for vet14 erans at risk of falls based on use of certain 

15 medications. 

16 ‘‘(D) Research on improvements for safe 

17 patient handling and mobility among veterans, 

18 particularly in facilities (both medical and non19 medical) that are not spinal cord injury centers. 

20 ‘‘(3) SUBJECT MATTER EXPERT PANEL.— 

21 ‘‘(A) IN GENERAL.—The Secretary and the 

22 Director of the National Institute on Aging 

23 shall establish a joint subject matter expert 

24 panel to develop recommendations as required 

25 under paragraph (2)(B). 


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1 ‘‘(B) MEMBERSHIP.—The subject matter 

2 expert panel required under subparagraph (A) 

3 shall be comprised of eight members, of 

4 which— 

5 ‘‘(i) four shall be appointed by the 

6 Secretary; and 

7 ‘‘(ii) four shall be appointed by the 

8 Director of the National Institute on 

9 Aging.’’. 

10 (2) ESTABLISHMENT OF JOINT SUBJECT MAT11 TER EXPERT PANEL.—Not later than 180 days after 

12 the date of the enactment of this Act, the Secretary 

13 of Veterans Affairs and the Director of the National 

14 Institute on Aging shall establish the joint subject 

15 matter expert panel required under section 

16 7310B(d)(3) of title 38, United States Code, as 

17 added by paragraph (1). 

18 (3) CLERICAL AMENDMENT.—The table of sec19 tions at the beginning of such chapter is amended 

20 by inserting after the item relating to section 7310A 

21 the following new item: 

‘‘7310B. Office of Falls Prevention.’’. 

22 (b) EXPANSION OF INTERAGENCY COORDINATING

23 COMMITTEE ON HEALTHY AGING AND AGE-FRIENDLY

24 COMMUNITIES.—Section 203(c) of the Older Americans 

25 Act of 1965 (42 U.S.C. 3013(c)) is amended— 


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1 (1) in paragraph (2), by inserting ‘‘the Sec2 retary of Veterans Affairs,’’ after ‘‘the Commissioner 

3 of Social Security,’’; and 

4 (2) in paragraph (7), in the matter preceding 

5 subparagraph (A)— 

6 (A) by inserting ‘‘the Committee on Vet7 erans’ Affairs of the House of Representatives,’’ 

8 after ‘‘the Committee on Ways and Means of 

9 the House of Representatives,’’; and 

10 (B) by inserting ‘‘the Committee on Vet11 erans’ Affairs of the Senate,’’ after ‘‘the Com12 mittee on Health, Education, Labor, and Pen13 sions of the Senate,’’. 

14 (c) SAFE HANDLING TRANSFER TECHNIQUES.—Not 

15 later than 180 days after the date of the enactment of 

16 this Act, the Secretary of Veterans Affairs shall issue or 

17 update directives of the Veterans Health Administration 

18 for facilities and providers relating to safe patient han19 dling and mobility policies at the national, Veterans Inte20 grated Service Network, and health-care system levels, 

21 which shall include the following: 

22 (1) Requiring biennial training for providers, 

23 including that all providers be trained in safe patient 

24 handling and use of mobility aids and mobility tech25 niques. 


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1 (2) Requiring that any medical facility where 

2 patients may need assistance with transfer or mobil3 ity have access to safe patient handling and mobility 

4 technology appropriate for the setting to enable safe 

5 transfer and mobilization for access to care and ac6 tivities of daily living for veterans who are paralyzed 

7 or who need assistance with mobility. 

8 (3) Requiring that all emergency settings have 

9 immediate access to safe patient handling and mobil10 ity technology to enable safe transfer, fall recovery, 

11 and repositioning. 

12 (d) PILOT PROGRAM ON FALLS PREVENTION INTER13 VENTIONS TIED TO RESIDENTIAL ADAPTATIONS AND AL14 TERATIONS.— 

15 (1) DETERMINATION.—The Secretary of Vet16 erans Affairs shall determine the feasibility and ad17 visability of carrying out a pilot program to provide 

18 home improvements and structural alterations to 

19 prevent falls for all veterans eligible for those serv20 ices under the laws administered by the Secretary. 

21 (2) PLAN.—Not later than one year after the 

22 date of the enactment of this Act, the Secretary 

23 shall submit to Congress a report— 

24 (A) indicating the plans of the Secretary to 

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1 provements and structural alterations to pre2 vent falls for all veterans eligible for those serv3 ices under the laws administered by the Sec4 retary; or 

5 (B) specifying why the Secretary deter6 mined under paragraph (1) that it is not fea7 sible or advisable to carry out such a pilot pro8 gram. 

9 (3) REPORT ON LESSONS LEARNED.—If the 

10 Secretary carries out the pilot program described in 

11 paragraph (1), not later than 180 days after the ter12 mination of the pilot program, the Chief Officer of 

13 Falls Prevention of the Department of Veterans Af14 fairs established under section 7310B(a)(3)(A) of 

15 title 38, United States Code, as added by subsection 

16 (a)(1), shall submit to Congress a report on lessons 

17 learned from the pilot program and any rec18 ommendations on extending or expanding the pilot 

19 program. 

20 (e) REPORT ON FALLS PREVENTION INITIATIVES.— 

21 (1) IN GENERAL.—Not later than two years 

22 after the date of the enactment of this Act, or one 

23 year after the appointment of the Chief Officer of 

24 Falls Prevention of the Department of Veterans Af25 fairs established under section 7310B(a)(3)(A) of 


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1 title 38, United States Code, as added by subsection 

2 (a)(1), whichever occurs first, the Chief Officer, or 

3 the Under Secretary for Health of the Department 

4 of Veterans Affairs if a Chief Officer has not yet 

5 been appointed, shall submit to Congress a report on 

6 falls prevention initiatives within the Department. 

7 (2) ELEMENTS.—The report required by para8 graph (1) shall evaluate, for the three-year period 

9 preceding the date of the enactment of this Act— 

10 (A) screening procedures at facilities of the 

11 Veterans Health Administration for risk of falls 

12 and the prevalence of resulting falls prevention 

13 interventions; 

14 (B) the use by the Department of elec15 tronic health record documentation for risk of 

16 falls among veterans; 

17 (C) the number of home modification 

18 grants provided under either the Home Im19 provements and Structural Alterations Program 

20 of the Department under section 1717 of title 

21 38, United States Code, or the Specially Adapt22 ed Housing Program of the Department under 

23 section 2101 of such title; 

24 (D) the extent to which grants provided 

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1 graph (C) prevent falls among veterans and any 

2 recommendations with respect to such programs 

3 in the case of falls among veterans that were 

4 not prevented; 

5 (E) for veterans eligible for the Home Im6 provements and Structural Alterations Program 

7 of the Department under section 1717 of title 

8 38, United States Code, pursuant to subsection 

9 (a)(2)(B) of such section, the number of home 

10 modification grants provided to each veteran in 

11 receipt of such a grant; 

12 (F) the types of providers that have con13 ducted medical assessments leading to a rec14 ommendation for a home modification tied to 

15 medical necessity, and any recommendations for 

16 legislative or administrative action to expand 

17 the list of providers eligible to conduct medical 

18 assessments leading to a recommendation for a 

19 home modification; 

20 (G) home evaluation processes that are 

21 conducted in connection with awards made 

22 under the programs specified under subpara23 graph (C) and any recommendations for im24 proving the evaluation and review process; 


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1 (H) reporting programs and software of 

2 the Department used to capture incidences of 

3 falls in care sites of the Veterans Health Ad4 ministration and other veterans’ settings; 

5 (I) limitations on uptake and use of cur6 rent prevention, screening, and intervention 

7 programs designed to address falls prevention; 

8 and 

9 (J) recommendations for the Secretary of 

10 Veterans Affairs to work with the Centers for 

11 Disease Control and Prevention, or other enti12 ties determined appropriate by the Secretary, to 

13 better capture data on falls by a veteran occur14 ring in the home or in the community. 

15 SEC. 3. ESTABLISHMENT OF FALLS ASSESSMENT AND FALL 

16 PREVENTION SERVICE REQUIREMENTS FOR 

17 VETERANS. 

18 (a) REQUIRED NURSING HOME CARE.—Section 

19 1710A of title 38, United States Code, is amended by 

20 striking subsection (d) and inserting the following: 

21 ‘‘(d) In the case of an individual determined by a phy22 sician to have fallen or to have been at risk of falling dur23 ing the previous one-year period, the Secretary shall en24 sure that a licensed physical therapist or a licensed occu25 pational therapist conducts a falls risk assessment for the 


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1 individual and provides fall prevention services during the 

2 stay of the individual in the nursing home. 

3 ‘‘(e) The provisions of subsection (a) shall terminate 

4 on September 30, 2028.’’. 

5 (b) EXTENDED CARE SERVICES.—Section 1710B(a) 

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

7 new paragraph: 

8 ‘‘(7) The conduct of an annual falls risk assess9 ment and the provision of fall prevention services by 

10 a licensed physical therapist or licensed occupational 

11 therapist.’’. 

Æ 


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