II 

118TH CONGRESS 

1ST SESSION S. 141 

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. 

IN THE SENATE OF THE UNITED STATES 

JANUARY 30, 2023 

Mr. MORAN (for himself, Mr. TESTER, and Ms. HASSAN) 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 improve certain 

programs of the Department of Veterans Affairs for 

home and community based services 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; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Elizabeth Dole Home and Community Based Services for 

6 Veterans and Caregivers Act of 2023’’ or the ‘‘Elizabeth 

7 Dole Home Care Act’’. 


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1 (b) TABLE OF CONTENTS.—The table of contents for 

2 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Definitions. 

Sec. 3. Increase of expenditure cap for noninstitutional care alternatives to 

nursing home care. 

Sec. 4. Coordination with Program of All-Inclusive Care for the Elderly. 

Sec. 5. Home and community based services: programs. 

Sec. 6. Coordination with assistance and support services for caregivers. 

Sec. 7. Development of centralized website for program information. 

Sec. 8. Improvements relating to Home Maker and Home Health Aide program. 

Sec. 9. Reviews and other improvements relating to home and community based 

services. 

3 SEC. 2. DEFINITIONS. 

4 In this Act: 

5 (1) CAREGIVER; FAMILY CAREGIVER.—The 

6 terms ‘‘caregiver’’ and ‘‘family caregiver’’ have the 

7 meanings given those terms under section 1720K(g) 

8 of title 38, United States Code (as added by section 

9 5(a)(1)). 

10 (2) COVERED PROGRAM.—The term ‘‘covered 

11 program’’— 

12 (A) means any program of the Department 

13 for home and community based services; and 

14 (B) includes the programs specified in sec15 tion 1720K of title 38, United States Code (as 

16 added by section 5(a)(1)). 

17 (3) DEPARTMENT.—The term ‘‘Department’’ 

18 means the Department of Veterans Affairs. 


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1 (4) HOME AND COMMUNITY BASED SERV2 ICES.—The term ‘‘home and community based serv3 ices’’— 

4 (A) means the services referred to in sec5 tion 1701(6)(E) of title 38, United States Code; 

6 and 

7 (B) includes services furnished under a 

8 program specified in section 1720K of such title 

9 (as added by section 5(a)(1)). 

10 (5) HOME BASED PRIMARY CARE PROGRAM; 

11 HOME MAKER AND HOME HEALTH AIDE PROGRAM; 

12 VETERAN DIRECTED CARE PROGRAM.—The terms 

13 ‘‘Home Based Primary Care program’’, ‘‘Home 

14 Maker and Home Health Aide program’’, and ‘‘Vet15 eran Directed Care program’’ mean the programs of 

16 the Department specified in subsections (d), (c), and 

17 (b) of such section 1720K, respectively. 

18 (6) HOME HEALTH AGENCY; HOME HEALTH

19 AIDE; NATIVE AMERICAN VETERAN, TRIBAL HEALTH

20 PROGRAM; URBAN INDIAN ORGANIZATION.—The 

21 terms ‘‘home health agency’’, ‘‘home health aide’’, 

22 ‘‘Native American veteran’’, ‘‘tribal health pro23 gram’’, and ‘‘Urban Indian organization’’ have the 

24 meanings given those terms in subsection (g) of such 

25 section 1720K. 


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1 (7) SECRETARY.—The term ‘‘Secretary’’ means 

2 the Secretary of Veterans Affairs. 

3 (8) VETERANS SERVICE ORGANIZATION.—The 

4 term ‘‘veterans service organization’’ means any or5 ganization recognized by the Secretary under section 

6 5902 of title 38, United States Code. 

7 SEC. 3. INCREASE OF EXPENDITURE CAP FOR NONINSTITU8 TIONAL CARE ALTERNATIVES TO NURSING 

9 HOME CARE. 

10 (a) INCREASE OF EXPENDITURE CAP.—Section 

11 1720C(d) of title 38, United States Code, is amended— 

12 (1) by striking ‘‘The total cost’’ and inserting 

13 ‘‘(1) Except as provided in paragraph (2), the total 

14 cost’’; 

15 (2) in paragraph (1), as designated by para16 graph (1), by striking ‘‘65 percent of’’; and 

17 (3) by adding at the end the following new 

18 paragraph: 

19 ‘‘(2) The total cost of providing services or in-kind 

20 assistance in the case of any veteran for any fiscal year 

21 under the program may exceed the cost that would other22 wise have been incurred as specified in paragraph (1) if 

23 the Secretary determines such higher total cost is in the 

24 best interest of the veteran.’’. 


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1 (b) APPLICABILITY.—The amendments made by sub2 section (a) shall apply with respect to any fiscal year be3 ginning on or after the date of the enactment of this Act. 

4 SEC. 4. COORDINATION WITH PROGRAM OF ALL-INCLUSIVE 

5 CARE FOR THE ELDERLY. 

6 Section 1720C of title 38, United States Code, as 

7 amended by section 3, is further amended by adding at 

8 the end the following new subsection: 

9 ‘‘(f) In furnishing services to a veteran under the pro10 gram conducted pursuant to subsection (a), if a medical 

11 center of the Department through which such program is 

12 administered is located in a geographic area in which serv13 ices are available to the veteran under a PACE program 

14 (as such term is defined in sections 1894(a)(2) and 

15 1934(a)(2) of the Social Security Act (42 U.S.C. 

16 1395eee(a)(2); 1396u–4(a)(2))), the Secretary shall estab17 lish a partnership with the PACE program operating in 

18 that area for the furnishing of such services.’’. 

19 SEC. 5. HOME AND COMMUNITY BASED SERVICES: PRO20 GRAMS. 

21 (a) PROGRAMS.— 

22 (1) IN GENERAL.—Subchapter II of chapter 17 

23 of title 38, United States Code, is amended by in24 serting after section 1720J the following new sec25 tion: 


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1 ‘‘§ 1720K. Home and community based services: pro2 grams 

3 ‘‘(a) IN GENERAL.—In furnishing noninstitutional al4 ternatives to nursing home care under the authority of 

5 section 1720C of this title (or any other authority under 

6 this chapter or other provision of law administered by the 

7 Secretary of Veterans Affairs), the Secretary shall carry 

8 out each of the programs specified in this section in ac9 cordance with such relevant authorities except as other10 wise provided in this section. 

11 ‘‘(b) VETERAN DIRECTED CARE PROGRAM.—(1) The 

12 Secretary of Veterans Affairs, in collaboration with the 

13 Secretary of Health and Human Services, shall carry out 

14 a program to be known as the ‘Veteran Directed Care pro15 gram’ under which the Secretary of Veterans Affairs may 

16 enter into agreements with the providers described in 

17 paragraph (2) to provide to eligible veterans funds to ob18 tain such in-home care services and related items as may 

19 be determined appropriate by the Secretary of Veterans 

20 Affairs and selected by the veteran, including through the 

21 veteran hiring individuals to provide such services and 

22 items or directly purchasing such services and items. 

23 ‘‘(2) The providers described in this paragraph are 

24 the following: 

25 ‘‘(A) An Aging and Disability Resource Center, 

26 an area agency on aging, or a State agency. 


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1 ‘‘(B) A center for independent living. 

2 ‘‘(3) In carrying out the Veteran Directed Care pro3 gram, the Secretary of Veterans Affairs shall— 

4 ‘‘(A) administer such program through each 

5 medical center of the Department of Veterans Af6 fairs; 

7 ‘‘(B) ensure the availability of such program in 

8 American Samoa, Guam, the Commonwealth of the 

9 Northern Mariana Islands, the Commonwealth of 

10 Puerto Rico, the Virgin Islands of the United States, 

11 and any other territory or possession of the United 

12 States; and 

13 ‘‘(C) ensure the availability of such program for 

14 eligible veterans who are Native American veterans 

15 receiving care and services furnished by the Indian 

16 Health Service, a tribal health program, an Urban 

17 Indian organization, or (in the case of a Native Ha18 waiian veteran) a Native Hawaiian health care sys19 tem. 

20 ‘‘(4) If a veteran participating in the Veteran Di21 rected Care program is catastrophically disabled, the vet22 eran may continue to use funds under the program during 

23 a period of hospitalization in the same manner that the 

24 veteran would be authorized to use such funds under the 

25 program if the veteran were not hospitalized. 


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1 ‘‘(c) HOME MAKER AND HOME HEALTH AIDE PRO2 GRAM.—(1) The Secretary shall carry out a program to 

3 be known as the ‘Home Maker and Home Health Aide 

4 program’ under which the Secretary may enter into agree5 ments with home health agencies to provide to eligible vet6 erans such home health aide services as may be deter7 mined appropriate by the Secretary. 

8 ‘‘(2) In carrying out the Home Maker and Home 

9 Health Aide program, the Secretary shall ensure the avail10 ability of such program— 

11 ‘‘(A) in the locations specified in subparagraph 

12 (B) of subsection (b)(3); and 

13 ‘‘(B) for the veteran populations specified in 

14 subparagraph (C) of such subsection. 

15 ‘‘(d) HOME BASED PRIMARY CARE PROGRAM.—The 

16 Secretary shall carry out a program to be known as the 

17 ‘Home Based Primary Care program’ under which the 

18 Secretary may furnish to eligible veterans in-home health 

19 care, the provision of which is overseen by a physician of 

20 the Department. 

21 ‘‘(e) PURCHASED SKILLED HOME CARE PROGRAM.— 

22 The Secretary shall carry out a program to be known as 

23 the ‘Purchased Skilled Home Care program’ under which 

24 the Secretary may furnish to eligible veterans such inVerDate Sep 11 2014 00:06 Feb 07, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S141.IS S141

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1 home care services as may be determined appropriate and 

2 selected by the Secretary for the veteran. 

3 ‘‘(f) CAREGIVER SUPPORT.—(1) With respect to a 

4 resident caregiver of a veteran participating in a program 

5 under this section who is a family caregiver, the Secretary 

6 shall— 

7 ‘‘(A) if the veteran meets the requirements of 

8 a covered veteran under section 1720G(b) of this 

9 title, provide to such caregiver the option of enroll10 ing in the program of general caregiver support serv11 ices under such section; 

12 ‘‘(B) subject to paragraph (2), provide to such 

13 caregiver not fewer than 14 days of covered respite 

14 care each year; and 

15 ‘‘(C) conduct on an annual basis (and, to the 

16 extent practicable, in connection with in-person serv17 ices provided under the program in which the vet18 eran is participating), a wellness check of such care19 giver. 

20 ‘‘(2) The Secretary shall provide not fewer than 30 

21 days of covered respite care each year to any resident care22 giver who provides services funded under the Veteran Di23 rected Care program under subsection (b). 

24 ‘‘(3) Covered respite care provided to a resident care25 giver of a veteran under paragraph (1) or (2), as the case 


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1 may be, may exceed 14 days annually or 30 days annually, 

2 respectively, if an extension is requested by the resident 

3 caregiver or veteran and determined medically appropriate 

4 by the Secretary. 

5 ‘‘(g) DEFINITIONS.—In this section: 

6 ‘‘(1) The terms ‘Aging and Disability Resource 

7 Center’, ‘area agency on aging’, and ‘State agency’ 

8 have the meanings given those terms in section 102 

9 of the Older Americans Act of 1965 (42 U.S.C. 

10 3002). 

11 ‘‘(2) The terms ‘caregiver’ and ‘family care12 giver’, with respect to a veteran, have the meanings 

13 given those terms, respectively, under subsection (d) 

14 of section 1720G of this title with respect to an eli15 gible veteran under subsection (a) of such section or 

16 a covered veteran under subsection (b) of such sec17 tion, as the case may be. 

18 ‘‘(3) The term ‘center for independent living’ 

19 has the meaning given that term in section 702 of 

20 the Rehabilitation Act of 1973 (29 U.S.C. 796a). 

21 ‘‘(4) The term ‘covered respite care’ means, 

22 with respect to a caregiver of a veteran, respite care 

23 that— 


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1 ‘‘(A) includes 24-hour per day care of the 

2 veteran commensurate with the care provided 

3 by the caregiver; 

4 ‘‘(B) is medically and age-appropriate; and 

5 ‘‘(C) includes in-home care services. 

6 ‘‘(5) The term ‘eligible veteran’ means any vet7 eran— 

8 ‘‘(A) for whom the Secretary determines 

9 participation in a specific program under this 

10 section is medically necessary to promote, pre11 serve, or restore the health of the veteran; and 

12 ‘‘(B) who absent such participation would 

13 be at increased risk for hospitalization, place14 ment in a nursing home, or emergency room 

15 care. 

16 ‘‘(6) The term ‘home health agency’ has the 

17 meaning given that term in section 1861(o) of the 

18 Social Security Act (42 U.S.C. 1395x(o)). 

19 ‘‘(7) The term ‘home health aide’ means an in20 dividual employed by a home health agency to pro21 vide in-home care services. 

22 ‘‘(8) The term ‘in-home care service’ means any 

23 service, including a personal care service, provided to 

24 enable the recipient of such service to live at home. 


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1 ‘‘(9) The term ‘Native American veteran’ has 

2 the meaning given that term in section 3765 of this 

3 title. 

4 ‘‘(10) The terms ‘Native Hawaiian’ and ‘Native 

5 Hawaiian health care system’ have the meanings 

6 given those terms in section 12 of the Native Hawai7 ian Health Care Improvement Act (42 U.S.C. 

8 11711). 

9 ‘‘(11) The term ‘resident caregiver’ means a 

10 caregiver or a family caregiver of a veteran who re11 sides with the veteran. 

12 ‘‘(12) The terms ‘tribal health program’ and 

13 ‘Urban Indian organization’ have the meanings 

14 given those terms in section 4 of the Indian Health 

15 Care Improvement Act (25 U.S.C. 1603).’’. 

16 (2) CLERICAL AMENDMENT.—The table of sec17 tions at the beginning of such subchapter is amend18 ed by inserting after the item relating to section 

19 1720J the following new item: 

‘‘1720K. Home and community based services: programs.’’. 

20 (b) DEADLINE FOR IMPROVED ADMINISTRATION.— 

21 The Secretary shall ensure that the Veteran Directed Care 

22 program and the Home Maker and Home Health Aide 

23 program are administered through each medical center of 

24 the Department in accordance with section 1720K of title 

25 38, United States Code (as added by subsection (a)(1)), 


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1 by not later than two years after the date of the enactment 

2 of this Act. 

3 (c) ADMINISTRATION OF VETERAN DIRECTED CARE

4 PROGRAM.— 

5 (1) PROCEDURES.—The Secretary shall estab6 lish procedures to identify staffing needs for the 

7 Program and define the roles and responsibilities of 

8 personnel of the Program at the national, Veterans 

9 Integrated Service Network, and facility levels, in10 cluding responsibilities for engagement with veterans 

11 participating in the Program, veterans interested in 

12 the Program, and providers described in section 

13 1720K(b)(2), as added by subsection (a)(1). 

14 (2) STAFFING MODEL.— 

15 (A) IN GENERAL.—The Secretary shall es16 tablish a staffing model for the administration 

17 of the Program at each medical center of the 

18 Department. 

19 (B) STAFFING RATIO.—The Secretary 

20 shall establish a staffing ratio for administra21 tion of the Program at each facility of the De22 partment at which the Program is carried out, 

23 which shall include a specified number of full24 time equivalent employees, with no collateral 


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1 duties, per number of veterans served by the 

2 Program. 

3 (3) FUNDING FOR PROGRAM.— 

4 (A) IN GENERAL.—The Secretary shall de5 velop methods for tracking and reporting de6 mand by veterans for and use by veterans of 

7 services under the Program to inform yearly 

8 cost estimates for the Program. 

9 (B) DEDICATED FUNDING.—The Secretary 

10 shall ensure each medical center of the Depart11 ment receives dedicated funding for administra12 tion and staffing of the Program, tailored to de13 mand for and use of the Program at such med14 ical center. 

15 (C) SEPARATE FUNDING.—Funding pro16 vided to carry out the Program shall be sepa17 rate from any other funding for the purchased 

18 long term services and supports programs of 

19 the Department. 

20 (4) PROGRAM DEFINED.—In this subsection, 

21 the term ‘‘Program’’ means the Veteran Directed 

22 Care program. 


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1 SEC. 6. COORDINATION WITH ASSISTANCE AND SUPPORT 

2 SERVICES FOR CAREGIVERS. 

3 (a) COORDINATION WITH PROGRAM OF COMPREHEN4 SIVE ASSISTANCE FOR FAMILY CAREGIVERS.— 

5 (1) COORDINATION.—Section 1720G(a) of title 

6 38, United States Code, is amended by adding at 

7 the end the following new paragraph: 

8 ‘‘(14)(A) In the case of a veteran or caregiver who 

9 seeks services under this subsection and is denied such 

10 services, or a veteran or the family caregiver of a veteran 

11 who is discharged from the program under this subsection, 

12 the Secretary shall— 

13 ‘‘(i) if the veteran meets the requirements of a 

14 covered veteran under subsection (b), provide to 

15 such caregiver the option of enrolling in the program 

16 of general caregiver support services under such sub17 section; 

18 ‘‘(ii) assess the veteran or caregiver for partici19 pation in any other available program of the Depart20 ment for home and community based services (in21 cluding the programs specified in section 1720K of 

22 this title) for which the veteran or caregiver may be 

23 eligible and, with respect to the veteran, store (and 

24 make accessible to the veteran) the results of such 

25 assessment in the electronic medical record of the 

26 veteran; and 


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1 ‘‘(iii) provide to the veteran or caregiver written 

2 information on any such program identified pursu3 ant to the assessment under clause (ii), including in4 formation about facilities, eligibility requirements, 

5 and relevant contact information for each such pro6 gram. 

7 ‘‘(B) For each veteran or family caregiver who is dis8 charged from the program under this subsection, a care9 giver support coordinator shall provide for a smooth and 

10 personalized transition from such program to an appro11 priate program of the Department for home and commu12 nity based services (including the programs specified in 

13 section 1720K of this title), including by integrating care14 giver support across programs.’’. 

15 (2) APPLICABILITY.—The amendment made by 

16 paragraph (1) shall apply with respect to denials 

17 and discharges described in paragraph (14) of such 

18 section, as added by paragraph (1), occurring on or 

19 after the date of the enactment of this Act. 

20 (b) TECHNICAL AND CONFORMING AMENDMENTS.— 

21 Section 1720G(d) of such title is amended— 

22 (1) by striking ‘‘or a covered veteran’’ each 

23 place it appears and inserting ‘‘, a veteran denied or 

24 discharged as specified in paragraph (14) of such 

25 subsection, or a covered veteran’’; and 


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1 (2) by striking ‘‘under subsection (a), means’’ 

2 each place it appears and inserting ‘‘under sub3 section (a) or a veteran denied or discharged as 

4 specified in paragraph (14) of such subsection, 

5 means’’. 

6 (c) REVIEW RELATING TO CAREGIVER CONTACT.— 

7 The Secretary shall conduct a review of the capacity of 

8 the Department to establish a streamlined system for con9 tacting all caregivers enrolled in the program of general 

10 caregiver support services under section 1720G(b) of title 

11 38, United States Code, to provide to such caregivers pro12 gram updates and alerts relating to emerging services for 

13 which such caregivers may be eligible. 

14 SEC. 7. DEVELOPMENT OF CENTRALIZED WEBSITE FOR 

15 PROGRAM INFORMATION. 

16 (a) CENTRALIZED WEBSITE.—The Secretary shall 

17 develop and maintain a centralized and publicly accessible 

18 internet website of the Department as a clearinghouse for 

19 information and resources relating to covered programs. 

20 (b) CONTENTS.—The website under subsection (a) 

21 shall contain the following: 

22 (1) A description of each covered program. 

23 (2) An informational assessment tool that en24 ables users to— 


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1 (A) assess the eligibility of a veteran, or a 

2 caregiver of a veteran, for any covered program; 

3 and 

4 (B) receive information, as a result of such 

5 assessment, on any covered program for which 

6 the veteran or caregiver (as the case may be) 

7 may be eligible. 

8 (3) A list of required procedures for the direc9 tors of medical facilities of the Department to follow 

10 in determining the eligibility and suitability of vet11 erans for participation in a covered program, includ12 ing procedures applicable to instances in which the 

13 resource constraints of a facility (or of a community 

14 in which a facility is located) may result in the in15 ability to address the health needs of a veteran 

16 under a covered program in a timely manner. 

17 (c) UPDATES.—The Secretary shall ensure the 

18 website under subsection (a) is updated on a periodic 

19 basis. 

20 SEC. 8. IMPROVEMENTS RELATING TO HOME MAKER AND 

21 HOME HEALTH AIDE PROGRAM. 

22 (a) PILOT PROGRAM FOR COMMUNITIES WITH

23 SHORTAGE OF HOME HEALTH AIDES.— 

24 (1) PROGRAM.—The Secretary shall carry out a 

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1 vide home maker and home health aide services to 

2 veterans who reside in communities with a shortage 

3 of home health aides. 

4 (2) LOCATIONS.—The Secretary shall select 10 

5 geographic locations in which the Secretary deter6 mines there is a shortage of home health aides at 

7 which to carry out the pilot program under para8 graph (1). 

9 (3) NURSING ASSISTANTS.— 

10 (A) IN GENERAL.—In carrying out the 

11 pilot program under paragraph (1), the Sec12 retary may hire nursing assistants as new em13 ployees of the Department, or reassign nursing 

14 assistants who are existing employees of the 

15 Department, to provide to veterans in-home 

16 care services (including basic tasks authorized 

17 by the State certification of the nursing assist18 ant) under the pilot program, in lieu of or in 

19 addition to the provision of such services 

20 through non-Department home health aides. 

21 (B) RELATIONSHIP TO HOME BASED PRI22 MARY CARE PROGRAM.—Nursing assistants 

23 hired or reassigned under subparagraph (A) 

24 may provide services to a veteran under the 

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1 ing as part of a health care team for the vet2 eran under the Home Based Primary Care pro3 gram. 

4 (4) DURATION.—The pilot program under para5 graph (1) shall be for a duration of three years. 

6 (5) REPORT TO CONGRESS.—Not later than one 

7 year after the date on which the Secretary deter8 mines the pilot program under paragraph (1) has 

9 terminated, the Secretary shall submit to the Com10 mittee on Veterans’ Affairs of the Senate and the 

11 Committee on Veterans’ Affairs of the House of 

12 Representatives a report on the result of the pilot 

13 program. 

14 (b) REPORT ON USE OF FUNDS.—Not later than one 

15 year after the date of the enactment of this Act, the Sec16 retary shall submit to the Committee on Veterans’ Affairs 

17 of the Senate and the Committee on Veterans’ Affairs of 

18 the House of Representatives a report containing, with re19 spect to the period beginning in fiscal year 2011 and end20 ing in fiscal year 2022, the following: 

21 (1) An identification of the amount of funds 

22 that were included in a budget of the Department 

23 during such period for the provision of in-home care 

24 to veterans under the Home Maker and Home 

25 Health Aide program in effect during such period 


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1 but were not expended for the provision of such 

2 care, disaggregated by medical center of the Depart3 ment for which such unexpended funds were budg4 eted. 

5 (2) An identification of the number of veterans 

6 for whom, during such period, the hours during 

7 which a home health aide was authorized to provide 

8 services to the veteran under such program were re9 duced for a reason other than a change in the health 

10 care needs of the veteran, and a detailed description 

11 of the reasons why any such reductions may have oc12 curred. 

13 (c) UPDATED GUIDANCE ON PROGRAM.— 

14 (1) IN GENERAL.—Not later than one year 

15 after the date of the enactment of this Act, the Sec16 retary shall issue updated guidance for the Home 

17 Maker and Home Health Aide program. 

18 (2) MATTERS TO INCLUDE.—Guidance updated 

19 under paragraph (1) shall include the following: 

20 (A) A process for the transition of veterans 

21 from the Home Maker and Home Health Aide 

22 program to other covered programs. 

23 (B) A requirement for the directors of the 

24 medical facilities of the Department to complete 

25 such process whenever a veteran with care 


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1 needs has been denied services from home 

2 health agencies under the Home Maker and 

3 Home Health Aide program as a result of the 

4 clinical needs or behavioral issues of the vet5 eran. 

6 SEC. 9. REVIEWS AND OTHER IMPROVEMENTS RELATING 

7 TO HOME AND COMMUNITY BASED SERVICES. 

8 (a) OFFICE OF GERIATRIC AND EXTENDED CARE.— 

9 (1) REVIEW OF PROGRAMS.—The Under Sec10 retary for Health of the Department shall conduct 

11 a review of each program administered through the 

12 Office of Geriatric and Extended Care of the De13 partment, or successor office, to— 

14 (A) ensure consistency in program man15 agement; 

16 (B) eliminate service gaps at the medical 

17 center level; and 

18 (C) ensure the availability of, and the ac19 cess by veterans to, home and community based 

20 services. 

21 (2) ASSESSMENT OF STAFFING NEEDS.—The 

22 Secretary shall conduct an assessment of the staff23 ing needs of the Office of Geriatric and Extended 

24 Care of the Department, or successor office. 


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1 (3) GOALS FOR GEOGRAPHIC ALIGNMENT OF

2 CARE.— 

3 (A) ESTABLISHMENT OF GOALS.—The Di4 rector of the Office of Geriatric and Extended 

5 Care, or successor office, shall establish quan6 titative goals to enable aging or disabled vet7 erans who are not located near medical centers 

8 of the Department to access extended care serv9 ices (including by improving access to home and 

10 community based services for such veterans). 

11 (B) IMPLEMENTATION TIMELINE.—Each 

12 goal established under subparagraph (A) shall 

13 include a timeline for the implementation of the 

14 goal at each medical center of the Department. 

15 (4) GOALS FOR IN-HOME SPECIALTY CARE.— 

16 The Director of the Office of Geriatric and Extended 

17 Care, or successor office, shall establish quantitative 

18 goals to address the specialty care needs of veterans 

19 through in-home care, including by ensuring the 

20 education of home health aides and caregivers of vet21 erans in the following areas: 

22 (A) Dementia care. 

23 (B) Care for spinal cord injuries and dis24 eases. 

25 (C) Ventilator care. 


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1 (D) Other speciality care areas as deter2 mined by the Secretary. 

3 (5) REPORT TO CONGRESS.—Not later than one 

4 year after the date of the enactment of this Act, the 

5 Secretary shall submit to the Committee on Vet6 erans’ Affairs of the Senate and the Committee on 

7 Veterans’ Affairs of the House of Representatives a 

8 report containing the findings of the review under 

9 paragraph (1), the results of the assessment under 

10 paragraph (2), and the goals established under para11 graphs (3) and (4). 

12 (b) REVIEW OF INCENTIVES AND EFFORTS RELAT13 ING TO HOME AND COMMUNITY BASED SERVICES.— 

14 (1) REVIEW.—The Secretary shall conduct a re15 view of the following: 

16 (A) The financial and organizational incen17 tives for the directors of medical centers of the 

18 Department to establish or expand covered pro19 grams at such medical centers. 

20 (B) Any incentives for such directors to 

21 provide to veterans home and community based 

22 services in lieu of institutional care. 

23 (C) The efforts taken by the Secretary to 

24 enhance spending of the Department for ex25 tended care by shifting the balance of such 


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1 spending from institutional care to home and 

2 community based services. 

3 (D) The plan of the Under Secretary for 

4 Health of the Department to accelerate efforts 

5 to enhance spending as specified in subpara6 graph (C), to match the progress of similar ef7 forts taken by the Administrator of the Centers 

8 for Medicare & Medicaid Services with respect 

9 to spending of the Centers for Medicare & Med10 icaid Services for extended care. 

11 (2) REPORT TO CONGRESS.—Not later than one 

12 year after the date of the enactment of this Act, the 

13 Secretary shall submit to the Committee on Vet14 erans’ Affairs of the Senate and the Committee on 

15 Veterans’ Affairs of the House of Representatives a 

16 report on the findings of the review under paragraph 

17 (1). 

18 (c) REVIEW OF RESPITE CARE SERVICES.—Not later 

19 than two years after the date of the enactment of this Act, 

20 the Secretary shall conduct a review of the use, avail21 ability, and effectiveness of the respite care services fur22 nished by the Secretary under chapter 17 of title 38, 

23 United States Code. 

24 (d) COLLABORATION TO IMPROVE HOME AND COM25 MUNITY BASED SERVICES.— 


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1 (1) FEEDBACK AND RECOMMENDATIONS ON

2 CAREGIVER SUPPORT.— 

3 (A) FEEDBACK AND RECOMMENDA4 TIONS.—The Secretary shall solicit from the en5 tities described in subparagraph (B) feedback 

6 and recommendations regarding opportunities 

7 for the Secretary to enhance home and commu8 nity based services for veterans and caregivers 

9 of veterans, including through the potential pro10 vision by the entity of care and respite services 

11 to veterans and caregivers who may not be eli12 gible for any program under section 1720G of 

13 title 38, United States Code, or section 1720K 

14 of such title (as added by section 5(a)(1)), but 

15 have a need for assistance. 

16 (B) COVERED ENTITIES.—The entities de17 scribed in this subparagraph are veterans serv18 ice organizations and nonprofit organizations 

19 with a focus on caregiver support (as deter20 mined by the Secretary). 

21 (2) COLLABORATION FOR NATIVE AMERICAN

22 VETERANS.—The Secretary shall collaborate with 

23 the Director of the Indian Health Service and rep24 resentatives from tribal health programs and Urban 

25 Indian organizations to ensure the availability of 


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1 home and community based services for Native 

2 American veterans, including Native American vet3 erans receiving health care and medical services 

4 under multiple health care systems. 

Æ 


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