I 

118TH CONGRESS 

1ST SESSION H. R. 5002 

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

for the cognitive care of veterans, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 27, 2023 

Mrs. HARSHBARGER introduced the following bill; which was referred to the 

Committee on Veterans’ Affairs 

A BILL 

To direct the Secretary of Veterans Affairs to carry out 

a pilot program for the cognitive care of 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 ‘‘Innovative Cognitive 

5 Care for Veterans Act of 2023’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 

8 (1) According to a 2020 study by the Office of 

9 the Assistant Deputy Under Secretary for Health 

10 for Policy and Planning of the Department of VetVerDate Sep 11 2014 04:14 Aug 15, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H5002.IH H5002

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1 erans Affairs, it is projected that the number of vet2 erans with Alzheimer’s dementia will increase by 

3 28.9 percent between fiscal year 2021 and fiscal 

4 year 2033, amounting to an estimated 48,000 new 

5 patients with cognitive impairments. 

6 (2) The cost of expenditures of the Department 

7 of Veterans Affairs for long-term care is growing 

8 rapidly, as demonstrated by a 2020 Government Ac9 countability Office report that estimates such ex10 penditures are projected to double to 

11 $14,300,000,000 by 2037. 

12 (3) As described in the report specified in para13 graph (2), the Department of Veterans Affairs also 

14 faces both a current and incoming workforce short15 age, in addition to other challenges relating to the 

16 provision of long-term care services to the more than 

17 2,800,000 estimated veterans who are enrolled in 

18 the patient enrollment system of the Department es19 tablished and operated under section 1705(a) of title 

20 38, United States Code, and live in rural areas. 

21 (4) As observed by the Secretary of Veterans 

22 Affairs, veterans can also be prone to unique factors 

23 that increase the risk for future cognitive impair24 ment. For example, it has been found that veterans 

25 who served during the Vietnam era and, while so 


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1 serving, were exposed to Agent Orange are nearly 

2 twice as likely as those without such exposure to re3 ceive a diagnosis of dementia. 

4 (5) According to the Department of Veterans 

5 Affairs, more than 185,000 veterans enrolled in the 

6 health care system of the Department of Veterans 

7 Affairs have been diagnosed with at least one trau8 matic brain injury. Traumatic brain injury often af9 fects the cognitive abilities of an individual and can 

10 disrupt normal brain function. Veterans with a trau11 matic brain injury are also 60 percent more likely to 

12 develop Alzheimer’s Disease or other forms of de13 mentia. 

14 (6) This data compels the United States Gov15 ernment to do more for veterans and their cognitive 

16 care. 

17 SEC. 3. PILOT PROGRAM OF DEPARTMENT OF VETERANS 

18 AFFAIRS FOR ADDRESSING COGNITIVE DIS19 ORDERS AMONG VETERANS. 

20 (a) PILOT PROGRAM.— 

21 (1) PILOT PROGRAM.—Not later than 180 days 

22 after the date of the enactment of this Act, the Sec23 retary of Veterans Affairs shall carry out, as a part 

24 of the Veterans Community Care Program under 

25 section 1703 of title 38, and in accordance with the 


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1 requirements of such program, a pilot program (in 

2 this section referred to as the ‘‘pilot program’’) 

3 under which the Secretary may enter into agree4 ments with eligible entities to furnish to partici5 pating veterans telehealth, virtual training tools for 

6 home health aides, and other innovative services, 

7 that slow the progression of cognitive disorders. 

8 (2) VETERANS CARE AGREEMENTS.—In enter9 ing into agreements under paragraph (1), the Sec10 retary may enter into a Veterans Care Agreement 

11 under section 1703A of title 38, United States Code, 

12 consistent with the requirements of such section. 

13 (b) SELECTION OF ENTITIES.— 

14 (1) ELIGIBLE ENTITIES.—An entity is eligible 

15 for entry into an agreement under the pilot program 

16 if the entity— 

17 (A) furnishes telehealth, virtual training 

18 tools for home health aides, or other innovative 

19 services, that slow the progression of cognitive 

20 disorders; and 

21 (B) meets such other requirements as the 

22 Secretary may prescribe. 

23 (2) PRIORITY.—In selecting eligible entities for 

24 entry into an agreement under the pilot program, 


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1 the Secretary shall give priority to eligible entities 

2 with— 

3 (A) demonstrated experience in— 

4 (i) providing assistance to individuals 

5 with cognitive disorders; 

6 (ii) addressing behavioral and tem7 perament issues, including through inter8 active engagement and stimulation solu9 tions; 

10 (iii) caregiver or home health aid 

11 training; and 

12 (iv) working in the field of cognitive 

13 disorders, including through the treatment 

14 of, or rehabilitation for, traumatic brain 

15 injury or neurodegenerative conditions; and 

16 (B) the ability to provide services under 

17 the pilot program to veterans at locations other 

18 than a hospital, nursing home, or other medical 

19 facility, in accordance with subsection (d)(2). 

20 (3) LIST OF SELECTED ENTITIES.—The Sec21 retary shall— 

22 (A) publish on an internet website of the 

23 Department a list identifying each eligible enti24 ty with which the Secretary has entered into an 

25 agreement under the pilot program; and 


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1 (B) ensure such list is accessible to vet2 erans selected for participation in the pilot pro3 gram. 

4 (c) SELECTION OF VETERANS.—In selecting veterans 

5 for participation in the pilot program, the Secretary— 

6 (1) shall ensure that not more than 500 vet7 erans participate in the pilot program at any given 

8 time; and 

9 (2) may not take into consideration age or risk 

10 factors for cognitive disorders. 

11 (d) SERVICES: SELF-DIRECTED AND IN-HOME NA12 TURE.—Each veteran selected by the Secretary for partici13 pation in the pilot program— 

14 (1) may select, from among the entities listed 

15 under subsection (b)(3) that are accessible to the 

16 veteran, the entity from which services shall be re17 ceived by the veteran under the pilot program; and 

18 (2) may elect to receive services under the pilot 

19 program at a location that is not a traditional med20 ical setting, such as at the residence of the veteran, 

21 in lieu of receiving such services at a hospital, nurs22 ing home, or other medical facility. 

23 (e) TERMINATION.—The pilot program shall termi24 nate on the date that is five years after the date on which 

25 the pilot program commences. 


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1 (f) REPORT.—Not later than 180 days after the date 

2 of termination under subsection (e), the Secretary shall 

3 submit to the Committees on Veterans’ Affairs of the 

4 House of Representatives and the Senate a report on the 

5 pilot program. Such report shall include the following: 

6 (1) A detailed overview of each entity with 

7 which the Secretary entered into an agreement 

8 under the pilot program, and the services that entity 

9 provided to participating veterans pursuant to such 

10 agreement. 

11 (2) An identification of the types of technology 

12 that eligible entities with which the Secretary en13 tered into an agreement under the pilot program 

14 used to provide services to participating veterans 

15 pursuant to such agreement. 

16 (3) An identification of the following: 

17 (A) The number of veterans that partici18 pated in the pilot program. 

19 (B) The number of veterans that applied 

20 to participate in the pilot program but were not 

21 selected for participation as a result of the limi22 tation under subsection (c)(2). 

23 (C) Of the veterans who participated in the 

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1 tion of such participation, received services 

2 under the pilot program. 

3 (D) Of the veterans who participated in 

4 the pilot program, the number who suffered 

5 traumatic brain injury while serving in the 

6 Armed Forces, including, for each such vet7 eran— 

8 (i) a classification of the traumatic 

9 brain injury so suffered as mild, moderate, 

10 or severe (as the case may be); and 

11 (ii) an identification of the mechanism 

12 of injury. 

13 (E) The percentage of veterans who par14 ticipated in the pilot program (disaggregated by 

15 type of outcome specified in clauses (i) through 

16 (iii)) who reported that such participation re17 sulted in the following outcomes, with respect to 

18 the individual veteran: 

19 (i) Quality of life improved. 

20 (ii) Quality of life was unaffected. 

21 (iii) Quality of life worsened. 

22 (F) A socioeconomic and demographic 

23 breakdown of veterans who participated in the 

24 pilot program. 


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1 (G) The type of housing in which the vet2 erans who participated in the pilot program re3 side. 

4 (H) Whether the veterans who participated 

5 in the pilot program have access to personal 

6 care services from a caregiver, and if so, wheth7 er such services were furnished by the Secretary 

8 (including through a non-Department of Vet9 erans Affairs health care provider providing 

10 such services under the laws administered by 

11 the Secretary). 

12 (I) Such other information as may be de13 termined relevant by the Secretary. 

14 (g) SOURCE OF FUNDS.—Amounts required to carry 

15 out this Act shall be derived from unobligated amounts 

16 appropriated to the Veterans Health Administration and 

17 determined appropriate by the Secretary. 

Æ 


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