II 

118TH CONGRESS 

1ST SESSION S. 495 

To require the Secretary of Veterans Affairs to carry out a pilot program 

to provide assisted living services to eligible veterans, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 16, 2023 

Mr. TESTER (for himself, Mr. MORAN, Mrs. MURRAY, and Mr. ROUNDS) introduced the following bill; which was read twice and referred to the Committee on Veterans’ Affairs 

A BILL 

To require the Secretary of Veterans Affairs to carry out 

a pilot program to provide assisted living services to 

eligible 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 ‘‘Expanding Veterans’ 

5 Options for Long Term Care Act’’. 

6 SEC. 2. PILOT PROGRAM ON ASSISTED LIVING SERVICES 

7 FOR VETERANS. 

8 (a) PROGRAM.— 


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1 (1) IN GENERAL.—Beginning not later than 

2 one year after the date of the enactment of this Act, 

3 the Secretary of Veterans Affairs shall carry out a 

4 three-year pilot program to assess— 

5 (A) the effectiveness of providing assisted 

6 living services to eligible veterans, at the elec7 tion of such veterans; and 

8 (B) the satisfaction with the pilot program 

9 of veterans participating in the pilot program. 

10 (2) EXTENSION.—The Secretary may extend 

11 the duration of the pilot program under paragraph 

12 (1) for an additional three-year period if the Sec13 retary, based on the results of the reports submitted 

14 under subsection (f), determines that it is appro15 priate to do so. 

16 (b) PROGRAM LOCATIONS.— 

17 (1) VETERANS INTEGRATED SERVICE NET18 WORKS.— 

19 (A) IN GENERAL.—The Secretary shall se20 lect not fewer than six Veterans Integrated 

21 Service Networks of the Department of Vet22 erans Affairs at which to carry out the pilot 

23 program under subsection (a)(1). 

24 (B) VETERANS RECEIVING NURSING HOME

25 CARE.—The Secretary shall ensure that not 


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1 fewer than three Veterans Integrated Service 

2 Networks selected under subparagraph (A) 

3 serve regions with the top three highest per4 centage of veterans who are currently receiving 

5 nursing home care through the Department and 

6 would be eligible to receive assisted living serv7 ices under the pilot program. 

8 (2) FACILITIES.— 

9 (A) IN GENERAL.—Within the Veterans 

10 Integrated Service Networks selected under 

11 paragraph (1), the Secretary shall select facili12 ties at which to carry out the pilot program 

13 under subsection (a)(1). 

14 (B) SELECTION CRITERIA.—In selecting 

15 facilities under subparagraph (A), the Secretary 

16 shall ensure that— 

17 (i) the locations of such facilities are 

18 in geographically diverse areas; 

19 (ii) not fewer than two such facilities 

20 serve veterans in rural or highly rural 

21 areas (as determined through the use of 

22 the Rural-Urban Commuting Areas coding 

23 system of the Department of Agriculture); 


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1 (iii) not fewer than one such facility is 

2 located in each Veterans Integrated Service 

3 Network selected under paragraph (1); and 

4 (iv) not fewer than two such facilities 

5 are State homes. 

6 (c) PROVISION OF ASSISTED LIVING SERVICES.— 

7 (1) AGREEMENTS.—In carrying out the pilot 

8 program under subsection (a)(1), the Secretary may 

9 enter into agreements for the provision of assisted 

10 living services on behalf of eligible veterans with— 

11 (A) a provider participating under a State 

12 plan or waiver under title XIX of the Social Se13 curity Act (42 U.S.C. 1396 et seq.); or 

14 (B) a State home recognized and certified 

15 under subpart B of part 51 of title 38, Code of 

16 Federal Regulations, or successor regulations. 

17 (2) STANDARDS.—The Secretary may not place, 

18 transfer, or admit a veteran to any facility for as19 sisted living services under the pilot program under 

20 subsection (a)(1) unless the Secretary determines 

21 that— 

22 (A) the facility meets the standards for 

23 community residential care established under 

24 sections 17.61 through 17.72 of title 38, Code 

25 of Federal Regulations, or successor regulaVerDate Sep 11 2014 00:22 Mar 07, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S495.IS S495

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1 tions, and any additional standards of care as 

2 the Secretary may specify; or 

3 (B) in the case of a facility that is a State 

4 home, the State home meets such standards of 

5 care as the Secretary may specify. 

6 (3) INSPECTION.—The Secretary shall inspect 

7 facilities at which veterans are placed under the pilot 

8 program under subsection (a)(1)— 

9 (A) with respect to a facility that is a 

10 State home, not less frequently than annually 

11 and in the same manner as the Secretary con12 ducts inspection of State homes under section 

13 1742 of title 38, United States Code; and 

14 (B) with respect to any other facility, not 

15 less frequently than annually and in the same 

16 manner as the Secretary conducts inspection of 

17 facilities under section 1730 of such title. 

18 (4) PAYMENT TO CERTAIN FACILITIES.— 

19 (A) STATE HOMES.—In the case of a facil20 ity participating in the pilot program under 

21 subsection (a)(1) that is a State home, the Sec22 retary shall pay to the State home a per diem 

23 for each veteran participating in the pilot pro24 gram at a rate agreed to by the Secretary and 

25 the State home. 


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1 (B) COMMUNITY ASSISTED LIVING FACILI2 TIES.—In the case of a facility participating in 

3 the pilot program under subsection (a)(1) that 

4 is a community assisted living facility, the Sec5 retary shall— 

6 (i) pay to the facility an amount that 

7 is less than the average rate paid by the 

8 Department for placement in a community 

9 nursing home in the same Veterans Inte10 grated Service Network; and 

11 (ii) re-evaluate payment rates annu12 ally to account for current economic condi13 tions and current costs of assisted living 

14 services. 

15 (d) CONTINUITY OF CARE.—Upon the termination of 

16 the pilot program under subsection (a)(1), the Secretary 

17 shall— 

18 (1) provide to all veterans participating in the 

19 pilot program at the time of such termination the 

20 option to continue to receive assisted living services 

21 at the site they were assigned to under the pilot pro22 gram, at the expense of the Department; and 

23 (2) for such veterans who do not opt to con24 tinue to receive such services— 


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1 (A) ensure such veterans do not experience 

2 lapses in care; and 

3 (B) provide such veterans with information 

4 on, and enroll such veterans in, other extended 

5 care services based on their preferences and 

6 best medical interest. 

7 (e) DETERMINATION OF QUALITY.—The Secretary 

8 shall determine a method for assessment of quality of care 

9 provided to veterans participating in the pilot program 

10 under subsection (a)(1) and shall communicate that meth11 od to providers of services under the pilot program. 

12 (f) ANNUAL REPORT.—Not later than one year after 

13 the initiation of the pilot program under subsection (a)(1), 

14 and annually thereafter for each year in which the pilot 

15 program is carried out, the Secretary shall submit to the 

16 Committee on Veterans’ Affairs of the Senate and the 

17 Committee on Veterans’ Affairs of the House of Rep18 resentatives a report on the pilot program, including— 

19 (1) an identification of Veterans Integrated 

20 Services Networks and facilities of the Department 

21 participating in the pilot program and assisted living 

22 facilities and State homes at which veterans are 

23 placed under the pilot program; 

24 (2) the number of participants in the pilot pro25 gram, disaggregated by facility; 


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1 (3) general demographic information of partici2 pants in the pilot program, including average age, 

3 gender, and race or ethnicity; 

4 (4) disability status of participants in the pilot 

5 program; 

6 (5) an identification of any barriers or chal7 lenges to enrolling veterans in the pilot program, 

8 conducting oversight of the pilot program, or any 

9 other barriers or challenges; 

10 (6) the cost of care at each assisted living facil11 ity and State home participating in the pilot pro12 gram, including an analysis of any cost savings by 

13 the Department when comparing that cost to the 

14 cost of nursing home care; 

15 (7) aggregated feedback from participants in 

16 the pilot program, including from veteran resident 

17 surveys and interviews; and 

18 (8) such other matters the Secretary considers 

19 appropriate. 

20 (g) FINAL REPORT.—Not later than four years after 

21 the initiation of the pilot program under subsection (a)(1), 

22 or not later than seven years after the initiation of the 

23 pilot program if the pilot program is extended under sub24 section (a)(2), the Secretary shall submit to the Com25 mittee on Veterans’ Affairs of the Senate and the ComVerDate Sep 11 2014 00:22 Mar 07, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S495.IS S495

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1 mittee on Veterans’ Affairs of the House of Representa2 tives a report on the pilot program that— 

3 (1) includes the matters required under para4 graphs (1) through (8) of subsection (f); 

5 (2) includes recommendations on whether the 

6 model studied in the pilot program should be contin7 ued or adopted throughout the Department; and 

8 (3) indicates whether the Secretary requests ac9 tion by Congress to make the pilot program perma10 nent. 

11 (h) REPORT BY INSPECTOR GENERAL.— 

12 (1) IN GENERAL.—Not later than three years 

13 after the initiation of the pilot program under sub14 section (a)(1), the Inspector General of the Depart15 ment of Veterans Affairs shall submit to the Sec16 retary, the Committee on Veterans’ Affairs of the 

17 Senate, and the Committee on Veterans’ Affairs of 

18 the House of Representatives a report on the pilot 

19 program. 

20 (2) ELEMENTS.—The report required by para21 graph (1) shall include an assessment of— 

22 (A) the quality of care provided to veterans 

23 at facilities participating in the pilot program, 

24 measured pursuant to the method determined 

25 under subsection (e); 


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1 (B) the oversight of such facilities, as con2 ducted by the Department, the Centers for 

3 Medicare & Medicaid Services, State agencies, 

4 and other relevant entities; and 

5 (C) such other matters as the Inspector 

6 General considers appropriate. 

7 (3) FOLLOW-UP.—Not later than 90 days after 

8 the submittal of the report required by paragraph 

9 (1), the Secretary shall submit to the Committee on 

10 Veterans’ Affairs of the Senate and the Committee 

11 on Veterans’ Affairs of the House of Representatives 

12 a plan to address the deficiencies identified in the 

13 report, if any. 

14 (i) DEFINITIONS.—In this section: 

15 (1) ASSISTED LIVING SERVICES.—The term 

16 ‘‘assisted living services’’ means services of a facility 

17 in providing room, board, and personal care for and 

18 supervision of residents for their health, safety, and 

19 welfare. 

20 (2) ELIGIBLE VETERAN.—The term ‘‘eligible 

21 veteran’’ means a veteran who— 

22 (A)(i) is already receiving nursing home 

23 level care paid for by the Department; 

24 (ii) is eligible to receive nursing home level 

25 care paid for by the Department pursuant to 


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1 section 1710A of title 38, United States Code; 

2 or 

3 (iii) requires a higher level of care than the 

4 domiciliary care provided by the Department 

5 but does not meet the requirements for nursing 

6 home level care provided by the Department 

7 pursuant to such section; and 

8 (B)(i) is eligible for assisted living services, 

9 as determined by the Secretary; or 

10 (ii) meets such additional criteria for eligi11 bility for the pilot program under subsection 

12 (a)(1) as the Secretary may establish. 

13 (3) STATE HOME.—The term ‘‘State home’’ has 

14 the meaning given that term in section 101(19) of 

15 title 38, United States Code. 

Æ 


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