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[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 542 Received in Senate (RDS)]

<DOC>
118th CONGRESS
  1st Session
                                H. R. 542

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                            December 6, 2023

                                Received

_______________________________________________________________________

                                 AN ACT

 
 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.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Elizabeth Dole 
Home- and Community-Based Services for Veterans and Caregivers Act of 
2023'' or the ``Elizabeth Dole Home Care Act of 2023''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Increase of expenditure cap for noninstitutional care 
                            alternatives to nursing home care.
Sec. 3. Coordination with Program of All-Inclusive Care for the 
                            Elderly.
Sec. 4. Home- and community-based services: programs.
Sec. 5. Coordination with assistance and support services for 
                            caregivers.
Sec. 6. Development of centralized website for program information.
Sec. 7. Improvements relating to Homemaker and Home Health Aide 
                            program.
Sec. 8. Reviews and other improvements relating to home- and community-
                            based services.
Sec. 9. Modification of certain housing loan fees.
Sec. 10. Definitions.

SEC. 2. INCREASE OF EXPENDITURE CAP FOR NONINSTITUTIONAL CARE 
              ALTERNATIVES TO NURSING HOME CARE.

    (a) Increase of Expenditure Cap.--Section 1720C(d) of title 38, 
United States Code, is amended--
            (1) by striking ``The total cost'' and inserting ``(1) 
        Except as provided in paragraph (2), the total cost'';
            (2) by striking ``65 percent'' and inserting ``100 
        percent''; and
            (3) by adding at the end the following new paragraph:
    ``(2)(A) The total cost of providing services or in-kind assistance 
in the case of any veteran described in subparagraph (B) for any fiscal 
year under the program may exceed 100 percent of the cost that would 
otherwise have been incurred as specified in paragraph (1) if the 
Secretary determines, based on a consideration of clinical need, 
geographic market factors, and such other matters as the Secretary may 
prescribe through regulation, that such higher total cost is in the 
best interest of the veteran.
    ``(B) A veteran described in this subparagraph is a veteran with 
amyotrophic lateral sclerosis, a spinal cord injury, or a condition the 
Secretary determines to be similar to such conditions.''.
    (b) Applicability.--The amendments made by subsection (a) shall 
apply with respect to fiscal years beginning on or after the date of 
the enactment of this Act.

SEC. 3. COORDINATION WITH PROGRAM OF ALL-INCLUSIVE CARE FOR THE 
              ELDERLY.

    Section 1720C of title 38, United States Code, as amended by 
section 2, is further amended by adding at the end the following new 
subsection:
    ``(f) In furnishing services to a veteran under the program 
conducted pursuant to subsection (a), if a medical center of the 
Department through which such program is administered is located in a 
geographic area in which services are available to the veteran under a 
PACE program (as such term is defined in sections 1894(a)(2) and 
1934(a)(2) of the Social Security Act (42 U.S.C. 1395eee(a)(2); 1396u-
4(a)(2))), the Secretary shall seek to enter into an agreement with the 
PACE program operating in that area for the furnishing of such 
services.''.

SEC. 4. HOME- AND COMMUNITY-BASED SERVICES: PROGRAMS.

    (a) Programs.--Chapter 17 of title 38, United States Code, is 
amended by inserting after section 1720J the following new section (and 
conforming the table of sections at the beginning of such chapter 
accordingly):
``Sec. 1720K. Home- and community-based services: programs
    ``(a) In General.--In furnishing noninstitutional alternatives to 
nursing home care pursuant to the authority of section 1720C of this 
title (or any other authority under this chapter or other provision of 
law administered by the Secretary of Veterans Affairs), the Secretary 
shall carry out each of the programs specified in this section in 
accordance with such relevant authorities except as otherwise provided 
in this section.
    ``(b) Veteran-Directed Care Program.--(1) The Secretary of Veterans 
Affairs, in collaboration with the Secretary of Health and Human 
Services, shall carry out a program to be known as the `Veteran-
Directed Care program'. Under such program, the Secretary of Veterans 
Affairs may enter into agreements with the providers described in 
paragraph (2) to provide to eligible veterans funds, to the extent 
practicable, to obtain such in-home care services and related items as 
may be determined appropriate by the Secretary of Veterans Affairs and 
selected by the veteran, including through the veteran hiring 
individuals to provide such services and items or directly purchasing 
such services and items.
    ``(2) The providers described in this paragraph are the following:
            ``(A) An Aging and Disability Resource Center, an area 
        agency on aging, or a State agency.
            ``(B) A center for independent living.
            ``(C) An Indian tribe or tribal organization receiving 
        assistance under title VI of the Older Americans Act of 1965 
        (42 U.S.C. 3057 et seq.).
    ``(3) In carrying out the Veteran-Directed Care program, the 
Secretary of Veterans Affairs shall--
            ``(A) administer such program through each medical center 
        of the Department of Veterans Affairs;
            ``(B) seek to ensure the availability of such program in 
        American Samoa, Guam, the Commonwealth of the Northern Mariana 
        Islands, the Commonwealth of Puerto Rico, the Virgin Islands of 
        the United States, and any other territory or possession of the 
        United States, to the extent practicable; and
            ``(C) seek to ensure the availability of such program for 
        eligible veterans who are Native American veterans receiving 
        care and services furnished by the Indian Health Service, a 
        tribal health program, an Urban Indian organization, or (in the 
        case of a Native Hawaiian veteran) a Native Hawaiian health 
        care system, to the extent practicable.
    ``(4) If a veteran participating in the Veteran-Directed Care 
program is catastrophically disabled, the veteran may continue to use 
funds under the program during a period of hospitalization in the same 
manner that the veteran would be authorized to use such funds under the 
program if the veteran were not hospitalized.
    ``(c) Homemaker and Home Health Aide Program.--(1) The Secretary 
shall carry out a program to be known as the `Homemaker and Home Health 
Aide program' under which the Secretary may enter into agreements with 
home health agencies to provide to eligible veterans such home health 
aide services as may be determined appropriate by the Secretary.
    ``(2) In carrying out the Homemaker and Home Health Aide program, 
the Secretary shall, to the extent practicable, ensure the availability 
of such program--
            ``(A) in the locations specified in subparagraph (B) of 
        subsection (b)(3); and
            ``(B) for the veteran populations specified in subparagraph 
        (C) of such subsection.
    ``(d) Home-Based Primary Care Program.--The Secretary shall carry 
out a program to be known as the `Home-Based Primary Care program' 
under which the Secretary may furnish to eligible veterans in-home 
health care, the provision of which is overseen by a provider of the 
Department.
    ``(e) Purchased Skilled Home Care Program.--The Secretary shall 
carry out a program to be known as the `Purchased Skilled Home Care 
program' under which the Secretary may furnish to eligible veterans 
such in-home care services as may be determined appropriate and 
selected by the Secretary for the veteran.
    ``(f) Caregiver Support.--(1) With respect to a resident eligible 
caregiver of a veteran participating in a program under this section, 
the Secretary shall--
            ``(A) if the veteran meets the requirements of a covered 
        veteran under section 1720G(b) of this title, provide to such 
        caregiver the option of enrolling in the program of general 
        caregiver support services under such section;
            ``(B) provide to such caregiver covered respite care of not 
        less than 30 days annually; and
            ``(C) conduct on an annual basis (and, to the extent 
        practicable, in connection with in-person services provided 
        under the program in which the veteran is participating), a 
        wellness contact of such caregiver.
    ``(2) Covered respite care provided to a resident eligible 
caregiver of a veteran under paragraph (1) may exceed 30 days annually 
if such extension is requested by the resident eligible caregiver or 
veteran and determined medically appropriate by the Secretary.
    ``(g) Rule of Construction.--Nothing in this section shall be 
construed to limit the authority of the Secretary to carry out programs 
providing home- and community-based services under any other provision 
of law.
    ``(h) Definitions.--In this section:
            ``(1) The terms `Aging and Disability Resource Center', 
        `area agency on aging', and `State agency' have the meanings 
        given those terms in section 102 of the Older Americans Act of 
        1965 (42 U.S.C. 3002).
            ``(2) The terms `caregiver' and `family caregiver', with 
        respect to a veteran, have the meanings given those terms, 
        respectively, under subsection (e) of section 1720G of this 
        title with respect to an eligible veteran under subsection (a) 
        of such section or a covered veteran under subsection (b) of 
        such section, as the case may be.
            ``(3) The term `center for independent living' has the 
        meaning given that term in section 702 of the Rehabilitation 
        Act of 1973 (29 U.S.C. 796a).
            ``(4) The term `covered respite care' has the meaning given 
        such term in section 1720G(d) of this title.
            ``(5) The term `eligible veteran' means any veteran--
                    ``(A) for whom the Secretary determines 
                participation in a specific program under this section 
                is medically necessary to promote, preserve, or restore 
                the health of the veteran; and
                    ``(B) who absent such participation would be at 
                increased risk for hospitalization, placement in a 
                nursing home, or emergency room care.
            ``(6) The term `home health aide' means an individual 
        employed by a home health agency to provide in-home care 
        services.
            ``(7) The term `in-home care service' means any service, 
        including a personal care service, provided to enable the 
        recipient of such service to live at home.
            ``(8) The terms `Indian tribe' and `tribal organization' 
        have the meanings given those terms in section 4 of the Indian 
        Self-Determination and Education Assistance Act (25 U.S.C. 
        5304).
            ``(9) The terms `Native American' and `Native American 
        veteran' have the meanings given those terms in section 3765 of 
        this title.
            ``(10) The terms `Native Hawaiian' and `Native Hawaiian 
        health care system' have the meanings given those terms in 
        section 12 of the Native Hawaiian Health Care Improvement Act 
        (42 U.S.C. 11711).
            ``(11) The terms `tribal health programs' and `Urban Indian 
        organizations' have the meanings given those terms in section 4 
        of the Indian Health Care Improvement Act (25 U.S.C. 1603).
            ``(12) The term `resident eligible caregiver' means an 
        individual who--
                    ``(A) is a caregiver, or a family caregiver, of a 
                veteran and resides with that veteran; and
                    ``(B) has not entered into a contract, agreement, 
                or other arrangement for such individual to act as a 
                caregiver for that veteran unless such individual is a 
                family member of the veteran or is furnishing caregiver 
                services through a medical foster home.''.
    (b) Deadline for Improved Administration.--The Secretary of 
Veterans Affairs shall ensure that the Veteran-Directed Care program 
and the Homemaker and Home Health Aide program are administered through 
each medical center of the Department of Veterans Affairs in accordance 
with section 1720K of title 38, United States Code (as added by 
subsection (a)), by not later than two years after the date of the 
enactment of this Act.

SEC. 5. COORDINATION WITH ASSISTANCE AND SUPPORT SERVICES FOR 
              CAREGIVERS.

    (a) Coordination With Program of Comprehensive Assistance for 
Family Caregivers.--
            (1) Coordination.--Section 1720G(a) of title 38, United 
        States Code, is amended by adding at the end the following new 
        paragraph:
    ``(14)(A) In the case of a veteran or caregiver who seeks services 
under this subsection and is denied such services, or a veteran or the 
family caregiver of a veteran who is discharged from the program under 
this subsection, the Secretary shall--
            ``(i) if the veteran meets the requirements of a covered 
        veteran under subsection (b), provide to such caregiver the 
        option of enrolling in the program of general caregiver support 
        services under such subsection;
            ``(ii) assess the veteran or caregiver for participation in 
        any other available program of the Department for home- and 
        community-based services (including the programs specified in 
        section 1720K of this title) for which the veteran or caregiver 
        may be eligible and, with respect to the veteran, store (and 
        make accessible to the veteran) the results of such assessment 
        in the electronic medical record of the veteran; and
            ``(iii) provide to the veteran or caregiver written 
        information on any such program identified pursuant to the 
        assessment under clause (ii), including information about 
        facilities, eligibility requirements, and relevant contact 
        information for each such program.
    ``(B) For each veteran or family caregiver who is discharged from 
the program under this subsection, a caregiver support coordinator 
shall provide for a smooth and personalized transition from such 
program to an appropriate program of the Department for home- and 
community-based services (including the programs specified in section 
1720K of this title), including by integrating caregiver support across 
programs.''.
            (2) Applicability.--The amendments made by paragraph (1) 
        shall apply with respect to denials and discharges occurring on 
        or after the date that is 180 days after the date of the 
        enactment of this Act.
            (3) Technical and conforming amendments.--Section 1720G(d) 
        of such title is amended--
                    (A) by striking ``or a covered veteran'' each place 
                it appears and inserting ``, a veteran denied or 
                discharged as specified in paragraph (14) of such 
                subsection, or a covered veteran''; and
                    (B) by striking ``under subsection (a), means'' 
                each place it appears and inserting ``under subsection 
                (a) or a veteran denied or discharged as specified in 
                paragraph (14) of such subsection, means''.
    (b) Conformity of Respite Care Across Programs.--Section 1720G of 
title 38, United States Code, as amended by subsection (a)(3), is 
further amended--
            (1) in subsection (a)(3)--
                    (A) by amending subparagraph (A)(ii)(III) to read 
                as follows:
                    ``(III) covered respite care of not less than 30 
                days annually;''; and
                    (B) by striking subparagraph (B) and redesignating 
                subparagraphs (C) and (D) as subparagraphs (B) through 
                (C), respectively; and
            (2) by amending subsection (b)(3)(A)(iii) to read as 
        follows:
            ``(iii) Covered respite care of not less than 30 days 
        annually.''; and
            (3) in subsection (d)--
                    (A) by redesignating paragraphs (2) through (4) as 
                paragraphs (3) through (5), respectively; and
                    (B) by inserting after paragraph (1) the following 
                new paragraph:
            ``(2) The term `covered respite care' means, with respect 
        to a caregiver of a veteran, respite care under section 1720B 
        of this title that--
                    ``(A) is medically and age appropriate for the 
                veteran (including 24-hour per day care of the veteran 
                commensurate with the care provided by the caregiver); 
                and
                    ``(B) includes in-home care.''.
    (c) Review Relating to Caregiver Contact.--The Secretary shall 
conduct a review of the capacity of the Department to establish a 
streamlined system for contacting all caregivers enrolled in the 
program of general caregiver support services under section 1720G(b) of 
title 38, United States Code, to provide to such caregivers program 
updates and alerts relating to emerging services for which such 
caregivers may be eligible.

SEC. 6. DEVELOPMENT OF CENTRALIZED WEBSITE FOR PROGRAM INFORMATION.

    (a) Centralized Website.--The Secretary shall develop and maintain 
a centralized and publically accessible internet website of the 
Department as a clearinghouse for information and resources relating to 
covered programs.
    (b) Contents.--The website under subsection (a) shall contain the 
following:
            (1) A description of each covered program.
            (2) An informational assessment tool that--
                    (A) explains the administrative eligibility, if 
                applicable, of a veteran, or a caregiver of a veteran, 
                for any covered program; and
                    (B) provides information, as a result of such 
                explanation, on any covered program for which the 
                veteran or caregiver (as the case may be) may be 
                eligible.
            (3) A list of required procedures for the directors of the 
        medical facilities of the Department to follow in determining 
        the eligibility and suitability of veterans for participation 
        in a covered program, including procedures applicable to 
        instances in which the resource constraints of a facility (or 
        of a community in which a facility is located) may result in 
        the inability to address the health needs of a veteran under a 
        covered program in a timely manner.
    (c) Updates.--The Secretary shall ensure the website under 
subsection (a) is updated on a periodic basis.

SEC. 7. IMPROVEMENTS RELATING TO HOMEMAKER AND HOME HEALTH AIDE 
              PROGRAM.

    (a) Pilot Program for Communities With Shortage of Home Health 
Aides.--
            (1) Program.--Beginning not later than 18 months after the 
        date of the enactment of this Act, the Secretary shall carry 
        out a three-year pilot program under which the Secretary shall 
        provide homemaker and home health aide services to veterans who 
        reside in communities with a shortage of home health aides.
            (2) Locations.--The Secretary shall select not fewer than 
        five geographic locations in which the Secretary determines 
        there is a shortage of home health aides at which to carry out 
        the pilot program under paragraph (1).
            (3) Nursing assistants.--
                    (A) In general.--In carrying out the pilot program 
                under paragraph (1), the Secretary may hire nursing 
                assistants as new employees of the Department of 
                Veterans Affairs, or reassign nursing assistants who 
                are existing employees of the Department, to provide to 
                veterans in-home care services (including basic tasks 
                authorized by the State certification of the nursing 
                assistant) under the pilot program, in lieu of or in 
                addition to the provision of such services through non-
                Department home health aides.
                    (B) Relationship to home-based primary care 
                program.--Nursing assistants hired or reassigned under 
                subparagraph (A) may provide services to a veteran 
                under the pilot program under paragraph (1) while 
                serving as part of a health care team for the veteran 
                under the Home-Based Primary Care program.
            (4) Report to congress.--Not later than one year after the 
        date on which the Secretary determines the pilot program under 
        paragraph (1) has terminated, the Secretary shall submit to the 
        Committees on Veterans' Affairs of the House of Representatives 
        and the Senate a report on the result of the pilot program.
    (b) Report on Use of Funds.--Not later than one year after the date 
of the enactment of this Act, the Secretary of Veterans Affairs shall 
submit to the Committees on Veterans' Affairs of the House of 
Representatives and the Senate a report containing, with respect to the 
period beginning in fiscal year 2012 and ending in fiscal year 2023, 
the following:
            (1) An identification of the amount of funds that were 
        included in a budget of the Department of Veterans Affairs 
        during such period for the provision of in-home care to 
        veterans under the Homemaker and Home Health Aide program but 
        were not expended for such provision, disaggregated by medical 
        center of the Department for which such unexpended funds were 
        budgeted (if such disaggregation is possible).
            (2) To the extent practicable, an identification of the 
        number of veterans for whom, during such period, the hours 
        during which a home health aide was authorized to provide 
        services to the veteran under the Homemaker and Home Health 
        Aide program were reduced for a reason other than a change in 
        the health care needs of the veteran, and a detailed 
        description of the reasons why any such reductions may have 
        occurred.
    (c) Updated Guidance on Program.--Not later than one year after the 
date of the enactment of this Act, the Secretary shall issue updated 
guidance for the Homemaker and Home Health Aide program. Such updated 
guidance shall include the following:
            (1) A process for the transition of veterans from the 
        Homemaker and Home Health Aide program to other covered 
        programs.
            (2) A requirement for the directors of the medical 
        facilities of the Department to complete such process whenever 
        a veteran with care needs has been denied services from home 
        health agencies under the Homemaker and Home Health Aide 
        program as a result of the clinical needs or behavioral issues 
        of the veteran.

SEC. 8. REVIEWS AND OTHER IMPROVEMENTS RELATING TO HOME- AND COMMUNITY-
              BASED SERVICES.

    (a) Office of Geriatric and Extended Care.--
            (1) Review of programs.--The Under Secretary for Health of 
        the Department of Veterans Affairs shall conduct a review of 
        each program administered through the Office of Geriatric and 
        Extended Care of the Department, or successor office, to--
                    (A) ensure consistency in program management;
                    (B) eliminate service gaps at the medical center 
                level; and
                    (C) ensure the availability of, and the access by 
                veterans to, home- and community-based services.
            (2) Assessment of staffing needs.--The Secretary of 
        Veterans Affairs shall conduct an assessment of the staffing 
        needs of the Office of Geriatric and Extended Care of the 
        Department of Veterans Affairs, or successor office.
            (3) Goals for geographic alignment of care.--
                    (A) Establishment of goals.--The Director of the 
                Office of Geriatric and Extended Care, or successor 
                office, shall establish quantitative goals to enable 
                aging or disabled veterans who are not located near 
                medical centers of the Department to access extended 
                care services (including by improving access to home- 
                and community-based services for such veterans).
                    (B) Implementation timeline.--Each goal established 
                under subparagraph (A) shall include a timeline for the 
                implementation of the goal at each medical center of 
                the Department.
            (4) Goals for in-home specialty care.--The Director of the 
        Office of Geriatric and Extended Care, or successor office, 
        shall establish quantitative goals to address the specialty 
        care needs of veterans through in-home care, including by 
        ensuring the education of home health aides and caregivers of 
        veterans in the following areas:
                    (A) Dementia care.
                    (B) Care for spinal cord injuries and diseases.
                    (C) Ventilator care.
                    (D) Other speciality care areas as determined by 
                the Secretary.
            (5) Report to congress.--Not later than one year after the 
        date of the enactment of this Act, the Secretary shall submit 
        to the Committees on Veterans' Affairs of the House of 
        Representatives and the Senate a report containing the findings 
        of the review under paragraph (1), the results of the 
        assessment under paragraph (2), and the goals established under 
        paragraphs (3) and (4).
    (b) Review of Incentives and Efforts Relating to Home- and 
Community-Based Services.--
            (1) Review.--The Secretary of Veterans Affairs shall 
        conduct a review of the following:
                    (A) The financial and organizational incentives for 
                the directors of medical centers of the Department to 
                establish or expand covered programs at such medical 
                centers.
                    (B) Any incentives for such directors to provide to 
                veterans home- and community-based services in lieu of 
                institutional care.
                    (C) The efforts taken by the Secretary to enhance 
                spending of the Department for extended care by 
                shifting the balance of such spending from 
                institutional care to home- and community-based 
                services.
                    (D) The plan of the Under Secretary for Health of 
                the Department to accelerate efforts to enhance 
                spending as specified in subparagraph (C), to match the 
                progress of similar efforts taken by the Administrator 
                of the Centers for Medicare & Medicaid Services with 
                respect to spending of the Centers for Medicare & 
                Medicaid Services for extended care.
            (2) Report to congress.--Not later than one year after the 
        date of the enactment of this Act, the Secretary shall submit 
        to the Committees on Veterans' Affairs of the House of 
        Representatives and the Senate a report on the findings of the 
        review under paragraph (1).
    (c) Review of Respite Care Services.--Not later than two years 
after the date of the enactment of this Act, the Secretary of Veterans 
Affairs shall conduct a review of the use, availability, and 
effectiveness, of the respite care services furnished by the Secretary 
under chapter 17 of title 38, United States Code.
    (d) Collaboration To Improve Home- and Community-Based Services.--
            (1) Report on expansion of certain mental health 
        services.--
                    (A) Report.--Not later than two years after the 
                date of the enactment of this Act, the Secretary of 
                Veterans Affairs, in collaboration with the Secretary 
                of Health and Human Services, shall submit to the 
                Committees on Veterans' Affairs of the House of 
                Representatives and the Senate a report containing 
                recommendations for the expansion of mental health 
                services and related support to the caregivers of 
                veterans.
                    (B) Matters included.--The report under 
                subparagraph (A) shall include an assessment of the 
                feasibility and advisability of authorizing access to 
                Vet Centers by--
                            (i) family caregivers enrolled in a program 
                        under section 1720G of title 38, United States 
                        Code; and
                            (ii) family caregivers of veterans 
                        participating in a program specified in section 
                        1720K of such title, as added by section 4.
            (2) Recommendations.--
                    (A) Development.--The Secretary of Veterans Affairs 
                shall develop recommendations as follows:
                            (i) With respect to home- and community-
                        based services for veterans, the Secretary of 
                        Veterans Affairs shall develop recommendations 
                        regarding new services (in addition to those 
                        furnished as of the date of the enactment of 
                        this Act) in collaboration with the Secretary 
                        of Health and Human Services.
                            (ii) With respect to the national shortage 
                        of home health aides, the Secretary of Veterans 
                        Affairs shall develop recommendations regarding 
                        methods to address such shortage in 
                        collaboration with the Secretary of Health and 
                        Human Services and the Secretary of Labor.
                    (B) Submission to congress.--The Secretary of 
                Veterans Affairs shall submit to the Committees on 
                Veterans' Affairs of the House of Representatives and 
                the Senate a report containing the recommendations 
                developed under subparagraph (A) and an identification 
                of any changes in existing law or new statutory 
                authority necessary to implement the recommendations, 
                as determined by the Secretary.
                    (C) Consultation with secretary of labor.--In 
                carrying out this paragraph, the Secretary of Veterans 
                Affairs shall consult with the Secretary of Labor.
            (3) Feedback and recommendations on caregiver support.--
                    (A) Feedback and recommendations.--The Secretary of 
                Veterans Affairs shall solicit from the entities 
                described in subparagraph (B) feedback and 
                recommendations regarding opportunities for the 
                Secretary to enhance home- and community-based services 
                for veterans and the caregivers of veterans, including 
                through the potential provision by the entity of care 
                and respite services to veterans and caregivers who may 
                not be eligible for any program under section 1720G of 
                title 38, United States Code, or section 1720K of such 
                title (as added by section 4), but have a need for 
                assistance.
                    (B) Covered entities.--The entities described in 
                this subparagraph are veterans service organizations 
                and nonprofit organizations with a focus on caregiver 
                support (as determined by the Secretary).
            (4) Collaboration for native american veterans.--The 
        Secretary of Veterans Affairs shall collaborate with the 
        Director of the Indian Health Service and representatives from 
        tribal health programs and Urban Indian organizations to ensure 
        the availability of home- and community-based services for 
        Native American veterans, including Native American veterans 
        receiving health care and medical services under multiple 
        health care systems.

SEC. 9. MODIFICATION OF CERTAIN HOUSING LOAN FEES.

    The loan fee table in section 3729(b)(2) of title 38, United States 
Code, is amended by striking ``November 15, 2031'' each place it 
appears and inserting ``February 4, 2032''.

SEC. 10. DEFINITIONS.

    In this Act:
            (1) The terms ``caregiver'' and ``family caregiver'' have 
        the meanings given those terms under section 1720K(h) of title 
        38, United States Code (as added by section 4).
            (2) The term ``covered program''--
                    (A) means any program of the Department of Veterans 
                Affairs for home- and community-based services; and
                    (B) includes the programs specified in section 
                1720K of title 38, United States Code (as added by 
                section 4).
            (3) The term ``home- and community-based services''--
                    (A) means the services referred to in section 
                1701(6)(E) of title 38, United States Code; and
                    (B) includes services furnished under a program 
                specified in section 1720K of such title (as added by 
                section 4).
            (4) The terms ``Home-Based Primary Care program'', 
        ``Homemaker and Home Health Aide program'', and ``Veteran-
        Directed Care program'' mean the programs of the Department of 
        Veterans Affairs specified in subsection (d), (c), and (b) of 
        such section 1720K, respectively.
            (5) The terms ``home health aide'', ``Native American'', 
        ``Native American veteran'', ``tribal health programs'', and 
        ``Urban Indian organizations'' have the meanings given those 
        terms in subsection (h) of such section 1720K.
            (6) The term ``Vet Center'' has the meaning given that term 
        in section 1712A(h) of title 38, United States Code.
            (7) The term ``veterans service organization'' means any 
        organization recognized by the Secretary under section 5902 of 
        such title.

            Passed the House of Representatives December 5, 2023.

            Attest:

                                             KEVIN F. MCCUMBER,

                                                                 Clerk.
```