II 

117TH CONGRESS 

2D SESSION S. 4169 

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 

MAY 10, 2022 

Mr. TESTER (for himself, Mr. MORAN, and Mrs. MURRAY) 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.— 


pbinns on DSKJLVW7X2PROD with $$_JOB
2 

•S 4169 IS

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 subsections (e) and (f), determines that it is 

15 appropriate 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 


pbinns on DSKJLVW7X2PROD with $$_JOB
3 

•S 4169 IS

1 fewer than three Veterans Integrated Service 

2 Networks selected under subparagraph (A) 

3 serve areas with the highest percentage of vet4 erans who are currently receiving nursing home 

5 care through the Department and would be eli6 gible to receive assisted living services under the 

7 pilot program. 

8 (2) FACILITIES.— 

9 (A) IN GENERAL.—Within each Veterans 

10 Integrated Service Network 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); 


pbinns on DSKJLVW7X2PROD with $$_JOB
4 

•S 4169 IS

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 05:21 May 11, 2022 Jkt 000000 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S4169.IS S4169

pbinns on DSKJLVW7X2PROD with $$_JOB
5 

•S 4169 IS

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 the standards for 

5 care established under subpart E of part 51 of 

6 title 38, Code of Federal Regulations, or suc7 cessor regulations, and any additional standards 

8 of care as the Secretary may specify. 

9 (3) INSPECTION.—The Secretary shall inspect 

10 facilities at which veterans are placed under the pilot 

11 program under subsection (a)(1)— 

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

13 State home, not less frequently than annually 

14 and in the same manner as the Secretary con15 ducts inspection of State homes under section 

16 1742 of title 38, United States Code; and 

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

18 less frequently than annually and in the same 

19 manner as the Secretary conducts inspection of 

20 facilities under section 1730 of such title. 

21 (4) PAYMENT TO CERTAIN FACILITIES.— 

22 (A) STATE HOMES.—In the case of a facil23 ity participating in the pilot program under 

24 subsection (a)(1) that is a State home, the Sec25 retary shall pay to the State home a per diem 


pbinns on DSKJLVW7X2PROD with $$_JOB
6 

•S 4169 IS

1 for each veteran participating in the pilot pro2 gram at the State home that is— 

3 (i) greater than the per diem for 

4 domiciliary care at the State home, if ap5 plicable; and 

6 (ii) less than the per diem for nursing 

7 home care at the State home. 

8 (B) COMMUNITY ASSISTED LIVING FACILI9 TIES.—In the case of a facility participating in 

10 the pilot program that is a community assisted 

11 living facility, the Secretary shall pay to the fa12 cility an amount that is less than the average 

13 rate paid by the Department for placement in 

14 a community nursing home in the same Vet15 erans Integrated Service Network. 

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

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

18 shall— 

19 (1) provide to all veterans participating in the 

20 pilot program at the time of such termination the 

21 option to continue to receive assisted living services 

22 at the site they were assigned to under the pilot pro23 gram, at the expense of the Department; and 

24 (2) for such veterans who do not opt to con25 tinue to receive such services— 


pbinns on DSKJLVW7X2PROD with $$_JOB
7 

•S 4169 IS

1 (A) ensure such veterans do not experience 

2 lapses in care; and 

3 (B) provide such veterans with information 

4 on, and enroll participants in, other long-term 

5 care options based on their preferences and best 

6 medical interest. 

7 (e) ANNUAL REPORT.— 

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

9 after the initiation of the pilot program under sub10 section (a)(1), and annually thereafter for each year 

11 in which the pilot program is carried out, the Sec12 retary shall submit to the Committee on Veterans’ 

13 Affairs of the Senate and the Committee on Vet14 erans’ Affairs of the House of Representatives a re15 port on the pilot program, including— 

16 (A) an identification of Veterans Inte17 grated Services Networks and facilities of the 

18 Department participating in the pilot program 

19 and assisted living facilities and State homes at 

20 which veterans are placed under the pilot pro21 gram; 

22 (B) the number of participants in the pilot 

23 program, disaggregated by facility; 


pbinns on DSKJLVW7X2PROD with $$_JOB
8 

•S 4169 IS

1 (C) general demographic information of 

2 participants in the pilot program, including av3 erage age, gender, and race or ethnicity; 

4 (D) disability status of participants in the 

5 pilot program; 

6 (E) an identification of any barriers or 

7 challenges to enrolling veterans in the pilot pro8 gram, conducting oversight of the pilot pro9 gram, or any other barriers or challenges; 

10 (F) the cost of care at each assisted living 

11 facility and State home participating in the 

12 pilot program, including an analysis of any cost 

13 savings by the Department when comparing 

14 that cost to the cost of nursing home care; 

15 (G) aggregated feedback from participants 

16 in the pilot program; and 

17 (H) such other matters the Secretary con18 siders appropriate. 

19 (2) FINAL REPORT.—As part of the final report 

20 submitted under paragraph (1), the Secretary shall 

21 include recommendations on whether the model 

22 studied in the pilot program should be continued or 

23 adopted throughout the Department. 

24 (f) REPORT BY INSPECTOR GENERAL.— 


pbinns on DSKJLVW7X2PROD with $$_JOB
9 

•S 4169 IS

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

2 after the initiation of the pilot program under sub3 section (a)(1), the Inspector General of the Depart4 ment of Veterans Affairs shall submit to the Sec5 retary, the Committee on Veterans’ Affairs of the 

6 Senate, and the Committee on Veterans’ Affairs of 

7 the House of Representatives a report on the pilot 

8 program. 

9 (2) ELEMENTS.—The report required by para10 graph (1) shall include an assessment of— 

11 (A) the quality of care provided to veterans 

12 at facilities participating in the pilot program; 

13 (B) the oversight of such facilities, as con14 ducted by the Department, the Centers for 

15 Medicare & Medicaid Services, State agencies, 

16 and other relevant entities; and 

17 (C) such other matters as the Inspector 

18 General considers appropriate. 

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

20 the submittal of the report required by paragraph 

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

22 Veterans’ Affairs of the Senate and the Committee 

23 on Veterans’ Affairs of the House of Representatives 

24 a plan to address the deficiencies identified in the 

25 report, if any. 


pbinns on DSKJLVW7X2PROD with $$_JOB
10 

•S 4169 IS

1 (g) DEFINITIONS.—In this section: 

2 (1) ASSISTED LIVING SERVICES.—The term 

3 ‘‘assisted living services’’ means— 

4 (A) services of a facility in providing room, 

5 board, and personal care for and supervision of 

6 residents for their health, safety, and welfare; 

7 and 

8 (B) a level of care more intensive than 

9 domiciliary care and less intensive than nursing 

10 home care. 

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

12 veteran’’ means a veteran who— 

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

14 level care paid for by the Department; 

15 (ii) is eligible to receive nursing home level 

16 care paid for by the Department; or 

17 (iii) exceeds the requirements for domi18 ciliary care paid for by the Department but 

19 does not meet the requirements for nursing 

20 home level care paid for by the Department; 

21 and 

22 (B) is eligible for assisted living services, 

23 as determined by the Secretary. 


pbinns on DSKJLVW7X2PROD with $$_JOB
11 

•S 4169 IS

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

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

3 title 38, United States Code. 

Æ 


pbinns on DSKJLVW7X2PROD with $$_JOB