118TH CONGRESS 

1ST SESSION H. R. 542 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 
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1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

3 ‘‘Elizabeth Dole Home- and Community-Based Services 

4 for Veterans and Caregivers Act of 2023’’ or the ‘‘Eliza5 beth Dole Home Care Act of 2023’’. 

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

7 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 communitybased services. 

Sec. 9. Modification of certain housing loan fees. 

Sec. 10. Definitions. 

8 SEC. 2. INCREASE OF EXPENDITURE CAP FOR NONINSTITU9 TIONAL CARE ALTERNATIVES TO NURSING 

10 HOME CARE. 

11 (a) INCREASE OF EXPENDITURE CAP.—Section 

12 1720C(d) of title 38, United States Code, is amended— 

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

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

15 cost’’; 

16 (2) by striking ‘‘65 percent’’ and inserting ‘‘100 

17 percent’’; and 

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

19 paragraph: 
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1 ‘‘(2)(A) The total cost of providing services or in-kind 

2 assistance in the case of any veteran described in subpara3 graph (B) for any fiscal year under the program may ex4 ceed 100 percent of the cost that would otherwise have 

5 been incurred as specified in paragraph (1) if the Sec6 retary determines, based on a consideration of clinical 

7 need, geographic market factors, and such other matters 

8 as the Secretary may prescribe through regulation, that 

9 such higher total cost is in the best interest of the veteran. 

10 ‘‘(B) A veteran described in this subparagraph is a 

11 veteran with amyotrophic lateral sclerosis, a spinal cord 

12 injury, or a condition the Secretary determines to be simi13 lar to such conditions.’’. 

14 (b) APPLICABILITY.—The amendments made by sub15 section (a) shall apply with respect to fiscal years begin16 ning on or after the date of the enactment of this Act. 

17 SEC. 3. COORDINATION WITH PROGRAM OF ALL-INCLUSIVE 

18 CARE FOR THE ELDERLY. 

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

20 amended by section 2, is further amended by adding at 

21 the end the following new subsection: 

22 ‘‘(f) In furnishing services to a veteran under the pro23 gram conducted pursuant to subsection (a), if a medical 

24 center of the Department through which such program is 

25 administered is located in a geographic area in which serv-
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1 ices are available to the veteran under a PACE program 

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

3 1934(a)(2) of the Social Security Act (42 U.S.C. 

4 1395eee(a)(2); 1396u–4(a)(2))), the Secretary shall seek 

5 to enter into an agreement with the PACE program oper6 ating in that area for the furnishing of such services.’’. 

7 SEC. 4. HOME- AND COMMUNITY-BASED SERVICES: PRO8 GRAMS. 

9 (a) PROGRAMS.—Chapter 17 of title 38, United 

10 States Code, is amended by inserting after section 1720J 

11 the following new section (and conforming the table of sec12 tions at the beginning of such chapter accordingly): 

13 ‘‘§ 1720K. Home- and community-based services: pro14 grams 

15 ‘‘(a) IN GENERAL.—In furnishing noninstitutional al16 ternatives to nursing home care pursuant to the authority 

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

18 this chapter or other provision of law administered by the 

19 Secretary of Veterans Affairs), the Secretary shall carry 

20 out each of the programs specified in this section in ac21 cordance with such relevant authorities except as other22 wise provided in this section. 

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

24 Secretary of Veterans Affairs, in collaboration with the 

25 Secretary of Health and Human Services, shall carry out 
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1 a program to be known as the ‘Veteran-Directed Care pro2 gram’. Under such program, the Secretary of Veterans Af3 fairs may enter into agreements with the providers de4 scribed in paragraph (2) to provide to eligible veterans 

5 funds, to the extent practicable, to obtain such in-home 

6 care services and related items as may be determined ap7 propriate by the Secretary of Veterans Affairs and selected 

8 by the veteran, including through the veteran hiring indi9 viduals to provide such services and items or directly pur10 chasing such services and items. 

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

12 the following: 

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

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

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

16 ‘‘(C) An Indian tribe or tribal organization re17 ceiving assistance under title VI of the Older Ameri18 cans Act of 1965 (42 U.S.C. 3057 et seq.). 

19 ‘‘(3) In carrying out the Veteran-Directed Care pro20 gram, the Secretary of Veterans Affairs shall— 

21 ‘‘(A) administer such program through each 

22 medical center of the Department of Veterans Af23 fairs; 

24 ‘‘(B) seek to ensure the availability of such pro25 gram in American Samoa, Guam, the Common-
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1 wealth of the Northern Mariana Islands, the Com2 monwealth of Puerto Rico, the Virgin Islands of the 

3 United States, and any other territory or possession 

4 of the United States, to the extent practicable; and 

5 ‘‘(C) seek to ensure the availability of such pro6 gram for eligible veterans who are Native American 

7 veterans receiving care and services furnished by the 

8 Indian Health Service, a tribal health program, an 

9 Urban Indian organization, or (in the case of a Na10 tive Hawaiian veteran) a Native Hawaiian health 

11 care system, to the extent practicable. 

12 ‘‘(4) If a veteran participating in the Veteran-Di13 rected Care program is catastrophically disabled, the vet14 eran may continue to use funds under the program during 

15 a period of hospitalization in the same manner that the 

16 veteran would be authorized to use such funds under the 

17 program if the veteran were not hospitalized. 

18 ‘‘(c) HOMEMAKER AND HOME HEALTH AIDE PRO19 GRAM.—(1) The Secretary shall carry out a program to 

20 be known as the ‘Homemaker and Home Health Aide pro21 gram’ under which the Secretary may enter into agree22 ments with home health agencies to provide to eligible vet23 erans such home health aide services as may be deter24 mined appropriate by the Secretary. 
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1 ‘‘(2) In carrying out the Homemaker and Home 

2 Health Aide program, the Secretary shall, to the extent 

3 practicable, ensure the availability of such program— 

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

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

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

7 subparagraph (C) of such subsection. 

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

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

10 ‘Home-Based Primary Care program’ under which the 

11 Secretary may furnish to eligible veterans in-home health 

12 care, the provision of which is overseen by a provider of 

13 the Department. 

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

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

16 the ‘Purchased Skilled Home Care program’ under which 

17 the Secretary may furnish to eligible veterans such in18 home care services as may be determined appropriate and 

19 selected by the Secretary for the veteran. 

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

21 resident eligible caregiver of a veteran participating in a 

22 program under this section, the Secretary shall— 

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

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

25 title, provide to such caregiver the option of enroll-
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1 ing in the program of general caregiver support serv2 ices under such section; 

3 ‘‘(B) provide to such caregiver covered respite 

4 care of not less than 30 days annually; and 

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

6 extent practicable, in connection with in-person serv7 ices provided under the program in which the vet8 eran is participating), a wellness contact of such 

9 caregiver. 

10 ‘‘(2) Covered respite care provided to a resident eligi11 ble caregiver of a veteran under paragraph (1) may exceed 

12 30 days annually if such extension is requested by the resi13 dent eligible caregiver or veteran and determined medi14 cally appropriate by the Secretary. 

15 ‘‘(g) RULE OF CONSTRUCTION.—Nothing in this sec16 tion shall be construed to limit the authority of the Sec17 retary to carry out programs providing home- and commu18 nity-based services under any other provision of law. 

19 ‘‘(h) DEFINITIONS.—In this section: 

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

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

22 have the meanings given those terms in section 102 

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

24 3002). 
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1 ‘‘(2) The terms ‘caregiver’ and ‘family care2 giver’, with respect to a veteran, have the meanings 

3 given those terms, respectively, under subsection (e) 

4 of section 1720G of this title with respect to an eli5 gible veteran under subsection (a) of such section or 

6 a covered veteran under subsection (b) of such sec7 tion, as the case may be. 

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

9 has the meaning given that term in section 702 of 

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

11 ‘‘(4) The term ‘covered respite care’ has the 

12 meaning given such term in section 1720G(d) of this 

13 title. 

14 ‘‘(5) The term ‘eligible veteran’ means any vet15 eran— 

16 ‘‘(A) for whom the Secretary determines 

17 participation in a specific program under this 

18 section is medically necessary to promote, pre19 serve, or restore the health of the veteran; and 

20 ‘‘(B) who absent such participation would 

21 be at increased risk for hospitalization, place22 ment in a nursing home, or emergency room 

23 care. 
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1 ‘‘(6) The term ‘home health aide’ means an in2 dividual employed by a home health agency to pro3 vide in-home care services. 

4 ‘‘(7) The term ‘in-home care service’ means any 

5 service, including a personal care service, provided to 

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

7 ‘‘(8) The terms ‘Indian tribe’ and ‘tribal organi8 zation’ have the meanings given those terms in sec9 tion 4 of the Indian Self-Determination and Edu10 cation Assistance Act (25 U.S.C. 5304). 

11 ‘‘(9) The terms ‘Native American’ and ‘Native 

12 American veteran’ have the meanings given those 

13 terms in section 3765 of this title. 

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

15 Hawaiian health care system’ have the meanings 

16 given those terms in section 12 of the Native Hawai17 ian Health Care Improvement Act (42 U.S.C. 

18 11711). 

19 ‘‘(11) The terms ‘tribal health programs’ and 

20 ‘Urban Indian organizations’ have the meanings 

21 given those terms in section 4 of the Indian Health 

22 Care Improvement Act (25 U.S.C. 1603). 

23 ‘‘(12) The term ‘resident eligible caregiver’ 

24 means an individual who— 
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1 ‘‘(A) is a caregiver, or a family caregiver, 

2 of a veteran and resides with that veteran; and 

3 ‘‘(B) has not entered into a contract, 

4 agreement, or other arrangement for such indi5 vidual to act as a caregiver for that veteran un6 less such individual is a family member of the 

7 veteran or is furnishing caregiver services 

8 through a medical foster home.’’. 

9 (b) DEADLINE FOR IMPROVED ADMINISTRATION.— 

10 The Secretary of Veterans Affairs shall ensure that the 

11 Veteran-Directed Care program and the Homemaker and 

12 Home Health Aide program are administered through 

13 each medical center of the Department of Veterans Affairs 

14 in accordance with section 1720K of title 38, United 

15 States Code (as added by subsection (a)), by not later 

16 than two years after the date of the enactment of this Act. 

17 SEC. 5. COORDINATION WITH ASSISTANCE AND SUPPORT 

18 SERVICES FOR CAREGIVERS. 

19 (a) COORDINATION WITH PROGRAM OF COMPREHEN20 SIVE ASSISTANCE FOR FAMILY CAREGIVERS.— 

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

22 38, United States Code, is amended by adding at 

23 the end the following new paragraph: 

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

25 seeks services under this subsection and is denied such 
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1 services, or a veteran or the family caregiver of a veteran 

2 who is discharged from the program under this subsection, 

3 the Secretary shall— 

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

5 covered veteran under subsection (b), provide to 

6 such caregiver the option of enrolling in the program 

7 of general caregiver support services under such sub8 section; 

9 ‘‘(ii) assess the veteran or caregiver for partici10 pation in any other available program of the Depart11 ment for home- and community-based services (in12 cluding the programs specified in section 1720K of 

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

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

15 make accessible to the veteran) the results of such 

16 assessment in the electronic medical record of the 

17 veteran; and 

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

19 information on any such program identified pursu20 ant to the assessment under clause (ii), including in21 formation about facilities, eligibility requirements, 

22 and relevant contact information for each such pro23 gram. 

24 ‘‘(B) For each veteran or family caregiver who is dis25 charged from the program under this subsection, a care-
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1 giver support coordinator shall provide for a smooth and 

2 personalized transition from such program to an appro3 priate program of the Department for home- and commu4 nity-based services (including the programs specified in 

5 section 1720K of this title), including by integrating care6 giver support across programs.’’. 

7 (2) APPLICABILITY.—The amendments made 

8 by paragraph (1) shall apply with respect to denials 

9 and discharges occurring on or after the date that 

10 is 180 days after the date of the enactment of this 

11 Act. 

12 (3) TECHNICAL AND CONFORMING AMEND13 MENTS.—Section 1720G(d) of such title is amend14 ed— 

15 (A) by striking ‘‘or a covered veteran’’ 

16 each place it appears and inserting ‘‘, a veteran 

17 denied or discharged as specified in paragraph 

18 (14) of such subsection, or a covered veteran’’; 

19 and 

20 (B) by striking ‘‘under subsection (a), 

21 means’’ each place it appears and inserting 

22 ‘‘under subsection (a) or a veteran denied or 

23 discharged as specified in paragraph (14) of 

24 such subsection, means’’. 
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1 (b) CONFORMITY OF RESPITE CARE ACROSS PRO2 GRAMS.—Section 1720G of title 38, United States Code, 

3 as amended by subsection (a)(3), is further amended— 

4 (1) in subsection (a)(3)— 

5 (A) by amending subparagraph (A)(ii)(III) 

6 to read as follows: 

7 ‘‘(III) covered respite care of not less than 

8 30 days annually;’’; and 

9 (B) by striking subparagraph (B) and re10 designating subparagraphs (C) and (D) as sub11 paragraphs (B) through (C), respectively; and 

12 (2) by amending subsection (b)(3)(A)(iii) to 

13 read as follows: 

14 ‘‘(iii) Covered respite care of not less than 30 

15 days annually.’’; and 

16 (3) in subsection (d)— 

17 (A) by redesignating paragraphs (2) 

18 through (4) as paragraphs (3) through (5), re19 spectively; and 

20 (B) by inserting after paragraph (1) the 

21 following new paragraph: 

22 ‘‘(2) The term ‘covered respite care’ means, 

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

24 under section 1720B of this title that— 
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1 ‘‘(A) is medically and age appropriate for 

2 the veteran (including 24-hour per day care of 

3 the veteran commensurate with the care pro4 vided by the caregiver); and 

5 ‘‘(B) includes in-home care.’’. 

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. 6. DEVELOPMENT OF CENTRALIZED WEBSITE FOR 

15 PROGRAM INFORMATION. 

16 (a) CENTRALIZED WEBSITE.—The Secretary shall 

17 develop and maintain a centralized and publically acces18 sible internet website of the Department as a clearing19 house for information and resources relating to covered 

20 programs. 

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

22 shall contain the following: 

23 (1) A description of each covered program. 

24 (2) An informational assessment tool that— 
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1 (A) explains the administrative eligibility, 

2 if applicable, of a veteran, or a caregiver of a 

3 veteran, for any covered program; and 

4 (B) provides information, as a result of 

5 such explanation, on any covered program for 

6 which the veteran or caregiver (as the case may 

7 be) may be eligible. 

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

10 follow in determining the eligibility and suitability of 

11 veterans for participation in a covered program, in12 cluding procedures applicable to instances in which 

13 the resource constraints of a facility (or of a commu14 nity in which a facility is located) may result in the 

15 inability 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. 7. IMPROVEMENTS RELATING TO HOMEMAKER AND 

21 HOME HEALTH AIDE PROGRAM. 

22 (a) PILOT PROGRAM FOR COMMUNITIES WITH

23 SHORTAGE OF HOME HEALTH AIDES.— 

24 (1) PROGRAM.—Beginning not later than 18 

25 months after the date of the enactment of this Act, 
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1 the Secretary shall carry out a three-year pilot pro2 gram under which the Secretary shall provide home3 maker and home health aide services to veterans 

4 who reside in communities with a shortage of home 

5 health aides. 

6 (2) LOCATIONS.—The Secretary shall select not 

7 fewer than five geographic locations in which the 

8 Secretary determines there is a shortage of home 

9 health aides at which to carry out the pilot program 

10 under paragraph (1). 

11 (3) NURSING ASSISTANTS.— 

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

13 pilot program under paragraph (1), the Sec14 retary may hire nursing assistants as new em15 ployees of the Department of Veterans Affairs, 

16 or reassign nursing assistants who are existing 

17 employees of the Department, to provide to vet18 erans in-home care services (including basic 

19 tasks authorized by the State certification of 

20 the nursing assistant) under the pilot program, 

21 in lieu of or in addition to the provision of such 

22 services through non-Department home health 

23 aides. 

24 (B) RELATIONSHIP TO HOME-BASED PRI25 MARY CARE PROGRAM.—Nursing assistants 
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1 hired or reassigned under subparagraph (A) 

2 may provide services to a veteran under the 

3 pilot program under paragraph (1) while serv4 ing as part of a health care team for the vet5 eran under the Home-Based Primary Care pro6 gram. 

7 (4) REPORT TO CONGRESS.—Not later than one 

8 year after the date on which the Secretary deter9 mines the pilot program under paragraph (1) has 

10 terminated, the Secretary shall submit to the Com11 mittees on Veterans’ Affairs of the House of Rep12 resentatives and the Senate a report on the result of 

13 the pilot 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 of Veterans Affairs shall submit to the Committees 

17 on Veterans’ Affairs of the House of Representatives and 

18 the Senate a report containing, with respect to the period 

19 beginning in fiscal year 2012 and ending in fiscal year 

20 2023, the following: 

21 (1) An identification of the amount of funds 

22 that were included in a budget of the Department of 

23 Veterans Affairs during such period for the provision 

24 of in-home care to veterans under the Homemaker 

25 and Home Health Aide program but were not ex-
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1 pended for such provision, disaggregated by medical 

2 center of the Department for which such unex3 pended funds were budgeted (if such disaggregation 

4 is possible). 

5 (2) To the extent practicable, an identification 

6 of the number of veterans for whom, during such pe7 riod, the hours during which a home health aide was 

8 authorized to provide services to the veteran under 

9 the Homemaker and Home Health Aide program 

10 were reduced for a reason other than a change in 

11 the health care needs of the veteran, and a detailed 

12 description of the reasons why any such reductions 

13 may have occurred. 

14 (c) UPDATED GUIDANCE ON PROGRAM.—Not later 

15 than one year after the date of the enactment of this Act, 

16 the Secretary shall issue updated guidance for the Home17 maker and Home Health Aide program. Such updated 

18 guidance shall include the following: 

19 (1) A process for the transition of veterans 

20 from the Homemaker and Home Health Aide pro21 gram to other covered programs. 

22 (2) A requirement for the directors of the med23 ical facilities of the Department to complete such 

24 process whenever a veteran with care needs has been 

25 denied services from home health agencies under the 
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1 Homemaker and Home Health Aide program as a 

2 result of the clinical needs or behavioral issues of the 

3 veteran. 

4 SEC. 8. REVIEWS AND OTHER IMPROVEMENTS RELATING 

5 TO HOME- AND COMMUNITY-BASED SERV6 ICES. 

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

8 (1) REVIEW OF PROGRAMS.—The Under Sec9 retary for Health of the Department of Veterans Af10 fairs shall conduct a review of each program admin11 istered through the Office of Geriatric and Extended 

12 Care of the Department, or successor office, to— 

13 (A) ensure consistency in program man14 agement; 

15 (B) eliminate service gaps at the medical 

16 center level; and 

17 (C) ensure the availability of, and the ac18 cess by veterans to, home- and community19 based services. 

20 (2) ASSESSMENT OF STAFFING NEEDS.—The 

21 Secretary of Veterans Affairs shall conduct an as22 sessment of the staffing needs of the Office of Geri23 atric and Extended Care of the Department of Vet24 erans Affairs, 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 home10 and community-based services for such vet11 erans). 

12 (B) IMPLEMENTATION TIMELINE.—Each 

13 goal established under subparagraph (A) shall 

14 include a timeline for the implementation of the 

15 goal at each medical center of the Department. 

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

17 The Director of the Office of Geriatric and Extended 

18 Care, or successor office, shall establish quantitative 

19 goals to address the specialty care needs of veterans 

20 through in-home care, including by ensuring the 

21 education of home health aides and caregivers of vet22 erans in the following areas: 

23 (A) Dementia care. 

24 (B) Care for spinal cord injuries and dis25 eases. 
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1 (C) Ventilator care. 

2 (D) Other speciality care areas as deter3 mined by the Secretary. 

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

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

6 Secretary shall submit to the Committees on Vet7 erans’ Affairs of the House of Representatives and 

8 the Senate a report containing the findings of the 

9 review under paragraph (1), the results of the as10 sessment under paragraph (2), and the goals estab11 lished under paragraphs (3) and (4). 

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

14 (1) REVIEW.—The Secretary of Veterans Af15 fairs shall conduct a review 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 Committees on Vet14 erans’ Affairs of the House of Representatives and 

15 the Senate a report on the findings of the review 

16 under paragraph (1). 

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

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

19 the Secretary of Veterans Affairs shall conduct a review 

20 of the use, availability, and effectiveness, of the respite 

21 care services furnished by the Secretary under chapter 17 

22 of title 38, United States Code. 

23 (d) COLLABORATION TO IMPROVE HOME- AND COM24 MUNITY-BASED SERVICES.— 
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1 (1) REPORT ON EXPANSION OF CERTAIN MEN2 TAL HEALTH SERVICES.— 

3 (A) REPORT.—Not later than two years 

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

5 Secretary of Veterans Affairs, in collaboration 

6 with the Secretary of Health and Human Serv7 ices, shall submit to the Committees on Vet8 erans’ Affairs of the House of Representatives 

9 and the Senate a report containing rec10 ommendations for the expansion of mental 

11 health services and related support to the care12 givers of veterans. 

13 (B) MATTERS INCLUDED.—The report 

14 under subparagraph (A) shall include an assess15 ment of the feasibility and advisability of au16 thorizing access to Vet Centers by— 

17 (i) family caregivers enrolled in a pro18 gram under section 1720G of title 38, 

19 United States Code; and 

20 (ii) family caregivers of veterans par21 ticipating in a program specified in section 

22 1720K of such title, as added by section 4. 

23 (2) RECOMMENDATIONS.— 
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1 (A) DEVELOPMENT.—The Secretary of 

2 Veterans Affairs shall develop recommendations 

3 as follows: 

4 (i) With respect to home- and commu5 nity-based services for veterans, the Sec6 retary of Veterans Affairs shall develop 

7 recommendations regarding new services 

8 (in addition to those furnished as of the 

9 date of the enactment of this Act) in col10 laboration with the Secretary of Health 

11 and Human Services. 

12 (ii) With respect to the national short13 age of home health aides, the Secretary of 

14 Veterans Affairs shall develop rec15 ommendations regarding methods to ad16 dress such shortage in collaboration with 

17 the Secretary of Health and Human Serv18 ices and the Secretary of Labor. 

19 (B) SUBMISSION TO CONGRESS.—The Sec20 retary of Veterans Affairs shall submit to the 

21 Committees on Veterans’ Affairs of the House 

22 of Representatives and the Senate a report con23 taining the recommendations developed under 

24 subparagraph (A) and an identification of any 

25 changes in existing law or new statutory au-
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1 thority necessary to implement the rec2 ommendations, as determined by the Secretary. 

3 (C) CONSULTATION WITH SECRETARY OF

4 LABOR.—In carrying out this paragraph, the 

5 Secretary of Veterans Affairs shall consult with 

6 the Secretary of Labor. 

7 (3) FEEDBACK AND RECOMMENDATIONS ON

8 CAREGIVER SUPPORT.— 

9 (A) FEEDBACK AND RECOMMENDA10 TIONS.—The Secretary of Veterans Affairs shall 

11 solicit from the entities described in subpara12 graph (B) feedback and recommendations re13 garding opportunities for the Secretary to en14 hance home- and community-based services for 

15 veterans and the caregivers of veterans, includ16 ing through the potential provision by the entity 

17 of care and respite services to veterans and 

18 caregivers who may not be eligible for any pro19 gram under section 1720G of title 38, United 

20 States Code, or section 1720K of such title (as 

21 added by section 4), but have a need for assist22 ance. 

23 (B) COVERED ENTITIES.—The entities de24 scribed in this subparagraph are veterans serv25 ice organizations and nonprofit organizations 
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1 with a focus on caregiver support (as deter2 mined by the Secretary). 

3 (4) COLLABORATION FOR NATIVE AMERICAN

4 VETERANS.—The Secretary of Veterans Affairs shall 

5 collaborate with the Director of the Indian Health 

6 Service and representatives from tribal health pro7 grams and Urban Indian organizations to ensure the 

8 availability of home- and community-based services 

9 for Native American veterans, including Native 

10 American veterans receiving health care and medical 

11 services under multiple health care systems. 

12 SEC. 9. MODIFICATION OF CERTAIN HOUSING LOAN FEES. 

13 The loan fee table in section 3729(b)(2) of title 38, 

14 United States Code, is amended by striking ‘‘November 

15 15, 2031’’ each place it appears and inserting ‘‘February 

16 4, 2032’’. 

17 SEC. 10. DEFINITIONS. 

18 In this Act: 

19 (1) The terms ‘‘caregiver’’ and ‘‘family care20 giver’’ have the meanings given those terms under 

21 section 1720K(h) of title 38, United States Code (as 

22 added by section 4). 

23 (2) The term ‘‘covered program’’— 
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•HR 542 EH

1 (A) means any program of the Department 

2 of Veterans Affairs for home- and community3 based services; and 

4 (B) includes the programs specified in sec5 tion 1720K of title 38, United States Code (as 

6 added by section 4). 

7 (3) The term ‘‘home- and community-based 

8 services’’— 

9 (A) means the services referred to in sec10 tion 1701(6)(E) of title 38, United States Code; 

11 and 

12 (B) includes services furnished under a 

13 program specified in section 1720K of such title 

14 (as added by section 4). 

15 (4) The terms ‘‘Home-Based Primary Care pro16 gram’’, ‘‘Homemaker and Home Health Aide pro17 gram’’, and ‘‘Veteran-Directed Care program’’ mean 

18 the programs of the Department of Veterans Affairs 

19 specified in subsection (d), (c), and (b) of such sec20 tion 1720K, respectively. 

21 (5) The terms ‘‘home health aide’’, ‘‘Native 

22 American’’, ‘‘Native American veteran’’, ‘‘tribal 

23 health programs’’, and ‘‘Urban Indian organiza24 tions’’ have the meanings given those terms in sub25 section (h) of such section 1720K. 
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1 (6) The term ‘‘Vet Center’’ has the meaning 

2 given that term in section 1712A(h) of title 38, 

3 United States Code. 

4 (7) The term ‘‘veterans service organization’’ 

5 means any organization recognized by the Secretary 

6 under section 5902 of such title. 

Passed the House of Representatives December 5, 

2023. 

Attest: 

Clerk. 
118TH CONGRESS 

1ST SESSION H. R. 542 

AN ACT 

To amend title 38, United States Code, to improve 

for veterans, and for other purposes. Affairs for home- and community-based services certain programs of the Department of Veterans