I 

118TH CONGRESS 

1ST SESSION H. R. 542 

To amend title 38, United States Code, to improve certain programs of 

the Department of Veterans Affairs for home- and community-based 

services for veterans, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JANUARY 26, 2023 

Ms. BROWNLEY (for herself and Mr. BERGMAN) introduced the following bill; 

which was referred to the Committee on Veterans’ Affairs 

A BILL 

To amend title 38, United States Code, to improve certain 

programs of the Department of Veterans Affairs for 

home- and community-based services for veterans, and 

for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

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

6 for Veterans and Caregivers Act of 2023’’ or the ‘‘Eliza7 beth Dole Home Care Act of 2023’’. 


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

2 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. 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. Definitions. 

3 SEC. 2. INCREASE OF EXPENDITURE CAP FOR NONINSTITU4 TIONAL CARE ALTERNATIVES TO NURSING 

5 HOME CARE. 

6 (a) INCREASE OF EXPENDITURE CAP.—Section 

7 1720C(d) of title 38, United States Code, is amended— 

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

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

10 cost’’; 

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

12 percent’’; and 

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

14 paragraph: 

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

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

17 under the program may exceed 100 percent of the cost 

18 that would otherwise have been incurred as specified in 

19 paragraph (1) if the Secretary determines, based on a con20 sideration of clinical need, geographic market factors, and 


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1 such other matters as the Secretary may prescribe 

2 through regulation, that such higher total cost is in the 

3 best interest of the veteran.’’. 

4 (b) APPLICABILITY.—The amendments made by sub5 section (a) shall apply with respect to fiscal years begin6 ning on or after the date of the enactment of this Act. 

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

8 CARE FOR THE ELDERLY. 

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

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

11 the end the following new subsection: 

12 ‘‘(f) In furnishing services to a veteran under the pro13 gram conducted pursuant to subsection (a), if a medical 

14 center of the Department through which such program is 

15 administered is located in a geographic area in which serv16 ices are available to the veteran under a PACE program 

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

18 1934(a)(2) of the Social Security Act (42 U.S.C. 

19 1395eee(a)(2); 1396u–4(a)(2))), the Secretary shall seek 

20 to enter into an agreement with the PACE program oper21 ating in that area for the furnishing of such services.’’. 

22 SEC. 4. HOME- AND COMMUNITY-BASED SERVICES: PRO23 GRAMS. 

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

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


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1 the following new section (and conforming the table of sec2 tions at the beginning of such chapter accordingly): 

3 ‘‘§ 1720K. Home- and community-based services: pro4 grams 

5 ‘‘(a) IN GENERAL.—In furnishing noninstitutional al6 ternatives to nursing home care pursuant to the authority 

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

8 this chapter or other provision of law administered by the 

9 Secretary of Veterans Affairs), the Secretary shall carry 

10 out each of the programs specified in this section in ac11 cordance with such relevant authorities except as other12 wise provided in this section. 

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

14 Secretary of Veterans Affairs, in collaboration with the 

15 Secretary of Health and Human Services, shall carry out 

16 a program to be known as the ‘Veteran-Directed Care pro17 gram’ under which the Secretary of Veterans Affairs may 

18 enter into agreements with the providers described in 

19 paragraph (2) to provide to eligible veterans funds to ob20 tain such in-home care services and related items as may 

21 be determined appropriate by the Secretary of Veterans 

22 Affairs and selected by the veteran, including through the 

23 veteran hiring individuals to provide such services and 

24 items or directly purchasing such services and items. 


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

2 the following: 

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

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

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

6 ‘‘(C) An Indian tribe or tribal organization re7 ceiving assistance under title VI of the Older Ameri8 cans Act of 1965 (42 U.S.C. 3057 et seq.). 

9 ‘‘(3) In carrying out the Veteran-Directed Care pro10 gram, the Secretary of Veterans Affairs shall— 

11 ‘‘(A) administer such program through each 

12 medical center of the Department of Veterans Af13 fairs; 

14 ‘‘(B) seek to ensure the availability of such pro15 gram in American Samoa, Guam, the Common16 wealth of the Northern Mariana Islands, the Com17 monwealth of Puerto Rico, the Virgin Islands of the 

18 United States, and any other territory or possession 

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

20 ‘‘(C) seek to ensure the availability of such pro21 gram for eligible veterans who are Native American 

22 veterans receiving care and services furnished by the 

23 Indian Health Service, a tribal health program, an 

24 Urban Indian organization, or (in the case of a NaVerDate Sep 11 2014 00:21 Mar 21, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H542.IH H542

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1 tive Hawaiian veteran) a Native Hawaiian health 

2 care system, to the extent practicable. 

3 ‘‘(4) If a veteran participating in the Veteran-Di4 rected Care program is catastrophically disabled, the vet5 eran may continue to use funds under the program during 

6 a period of hospitalization in the same manner that the 

7 veteran would be authorized to use such funds under the 

8 program if the veteran were not hospitalized. 

9 ‘‘(c) HOMEMAKER AND HOME HEALTH AIDE PRO10 GRAM.—(1) The Secretary shall carry out a program to 

11 be known as the ‘Homemaker and Home Health Aide pro12 gram’ under which the Secretary may enter into agree13 ments with home health agencies to provide to eligible vet14 erans such home health aide services as may be deter15 mined appropriate by the Secretary. 

16 ‘‘(2) In carrying out the Homemaker and Home 

17 Health Aide program, the Secretary shall ensure the avail18 ability of such program— 

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

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

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

22 subparagraph (C) of such subsection. 

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

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

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


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1 Secretary may furnish to eligible veterans in-home health 

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

3 the Department. 

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

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

6 the ‘Purchased Skilled Home Care program’ under which 

7 the Secretary may furnish to eligible veterans such in8 home care services as may be determined appropriate and 

9 selected by the Secretary for the veteran. 

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

11 resident eligible caregiver of a veteran participating in a 

12 program under this section, the Secretary shall— 

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

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

15 title, provide to such caregiver the option of enroll16 ing in the program of general caregiver support serv17 ices under such section; 

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

19 care of not less than 30 days annually; and 

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

21 extent practicable, in connection with in-person serv22 ices provided under the program in which the vet23 eran is participating), a wellness contact of such 

24 caregiver. 


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1 ‘‘(2) Covered respite care provided to a resident eligi2 ble caregiver of a veteran under paragraph (1) may exceed 

3 30 days annually if such extension is requested by the resi4 dent eligible caregiver or veteran and determined medi5 cally appropriate by the Secretary. 

6 ‘‘(g) RULE OF CONSTRUCTION.—Nothing in this sec7 tion shall be construed to limit the authority of the Sec8 retary to carry out programs providing home- and commu9 nity-based services under any other provision of law. 

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

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

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

13 have the meanings given those terms in section 102 

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

15 3002). 

16 ‘‘(2) The terms ‘caregiver’ and ‘family care17 giver’, with respect to a veteran, have the meanings 

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

19 of section 1720G of this title with respect to an eli20 gible veteran under subsection (a) of such section or 

21 a covered veteran under subsection (b) of such sec22 tion, as the case may be. 

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

24 has the meaning given that term in section 702 of 

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


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

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

3 title. 

4 ‘‘(5) The term ‘eligible veteran’ means any vet5 eran— 

6 ‘‘(A) for whom the Secretary determines 

7 participation in a specific program under this 

8 section is medically necessary to promote, pre9 serve, or restore the health of the veteran; and 

10 ‘‘(B) who absent such participation would 

11 be at increased risk for hospitalization, place12 ment in a nursing home, or emergency room 

13 care. 

14 ‘‘(6) The term ‘home health aide’ means an in15 dividual employed by a home health agency to pro16 vide in-home care services. 

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

18 service, including a personal care service, provided to 

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

20 ‘‘(8) The terms ‘Indian tribe’ and ‘tribal organi21 zation’ have the meanings given those terms in sec22 tion 4 of the Indian Self-Determination and Edu23 cation Assistance Act (25 U.S.C. 5304). 


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

2 American veteran’ have the meanings given those 

3 terms in section 3765 of this title. 

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

5 Hawaiian health care system’ have the meanings 

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

8 11711). 

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

10 ‘Urban Indian organizations’ have the meanings 

11 given those terms in section 4 of the Indian Health 

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

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

14 means an individual who— 

15 ‘‘(A) is a caregiver, or a family caregiver, 

16 of a veteran and resides with that veteran; and 

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

18 agreement, or other arrangement for such indi19 vidual to act as a caregiver for that veteran un20 less such individual is a family member of the 

21 veteran or is furnishing caregiver services 

22 through a medical foster home.’’. 

23 (b) DEADLINE FOR IMPROVED ADMINISTRATION.— 

24 The Secretary of Veterans Affairs shall ensure that the 

25 Veteran-Directed Care program and the Homemaker and 


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1 Home Health Aide program are administered through 

2 each medical center of the Department of Veterans Affairs 

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

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

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

6 SEC. 5. COORDINATION WITH ASSISTANCE AND SUPPORT 

7 SERVICES FOR CAREGIVERS. 

8 (a) COORDINATION WITH PROGRAM OF COMPREHEN9 SIVE ASSISTANCE FOR FAMILY CAREGIVERS.— 

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

11 38, United States Code, is amended by adding at 

12 the end the following new paragraph: 

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

14 seeks services under this subsection and is denied such 

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

16 who is discharged from the program under this subsection, 

17 the Secretary shall— 

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

19 covered veteran under subsection (b), provide to 

20 such caregiver the option of enrolling in the program 

21 of general caregiver support services under such sub22 section; 

23 ‘‘(ii) assess the veteran or caregiver for partici24 pation in any other available program of the Depart25 ment for home- and community-based services (inVerDate Sep 11 2014 00:21 Mar 21, 2023 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H542.IH H542

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1 cluding the programs specified in section 1720K of 

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

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

4 make accessible to the veteran) the results of such 

5 assessment in the electronic medical record of the 

6 veteran; and 

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

8 information on any such program identified pursu9 ant to the assessment under clause (ii), including in10 formation about facilities, eligibility requirements, 

11 and relevant contact information for each such pro12 gram. 

13 ‘‘(B) For each veteran or family caregiver who is dis14 charged from the program under this subsection, a care15 giver support coordinator shall provide for a smooth and 

16 personalized transition from such program to an appro17 priate program of the Department for home- and commu18 nity-based services (including the programs specified in 

19 section 1720K of this title), including by integrating care20 giver support across programs.’’. 

21 (2) APPLICABILITY.—The amendments made 

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

23 and discharges occurring on or after the date that 

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

25 Act. 


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1 (3) TECHNICAL AND CONFORMING AMEND2 MENTS.—Section 1720G(d) of such title is amend3 ed— 

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

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

6 denied or discharged as specified in paragraph 

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

8 and 

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

10 means’’ each place it appears and inserting 

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

12 discharged as specified in paragraph (14) of 

13 such subsection, means’’. 

14 (b) CONFORMITY OF RESPITE CARE ACROSS PRO15 GRAMS.—Section 1720G of title 38, United States Code, 

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

17 (1) in subsection (a)(3)— 

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

19 to read as follows: 

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

21 30 days annually;’’; and 

22 (B) by striking subparagraph (B) and re23 designating subparagraphs (C) and (D) as sub24 paragraphs (B) through (C), respectively; and 


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

2 read as follows: 

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

4 days annually.’’; and 

5 (3) in subsection (d)— 

6 (A) by redesignating paragraphs (2) 

7 through (4) as paragraphs (3) through (5), re8 spectively; and 

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

10 following new paragraph: 

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

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

13 under section 1720B of this title that— 

14 ‘‘(A) is medically and age appropriate for 

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

16 the veteran commensurate with the care pro17 vided by the caregiver); and 

18 ‘‘(B) includes in-home care.’’. 

19 (c) REVIEW RELATING TO CAREGIVER CONTACT.— 

20 The Secretary shall conduct a review of the capacity of 

21 the Department to establish a streamlined system for con22 tacting all caregivers enrolled in the program of general 

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

24 38, United States Code, to provide to such caregivers proVerDate Sep 11 2014 00:21 Mar 21, 2023 Jkt 039200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\H542.IH H542

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1 gram updates and alerts relating to emerging services for 

2 which such caregivers may be eligible. 

3 SEC. 6. DEVELOPMENT OF CENTRALIZED WEBSITE FOR 

4 PROGRAM INFORMATION. 

5 (a) CENTRALIZED WEBSITE.—The Secretary shall 

6 develop and maintain a centralized and publically acces7 sible internet website of the Department as a clearing8 house for information and resources relating to covered 

9 programs. 

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

11 shall contain the following: 

12 (1) A description of each covered program. 

13 (2) An informational assessment tool that— 

14 (A) explains the administrative eligibility, 

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

16 veteran, for any covered program; and 

17 (B) provides information, as a result of 

18 such explanation, on any covered program for 

19 which the veteran or caregiver (as the case may 

20 be) may be eligible. 

21 (3) A list of required procedures for the direc22 tors of the medical facilities of the Department to 

23 follow in determining the eligibility and suitability of 

24 veterans for participation in a covered program, in25 cluding procedures applicable to instances in which 


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1 the resource constraints of a facility (or of a commu2 nity in which a facility is located) may result in the 

3 inability to address the health needs of a veteran 

4 under a covered program in a timely manner. 

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

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

7 basis. 

8 SEC. 7. IMPROVEMENTS RELATING TO HOMEMAKER AND 

9 HOME HEALTH AIDE PROGRAM. 

10 (a) PILOT PROGRAM FOR COMMUNITIES WITH

11 SHORTAGE OF HOME HEALTH AIDES.— 

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

13 months after the date of the enactment of this Act, 

14 the Secretary shall carry out a three-year pilot pro15 gram under which the Secretary shall provide home16 maker and home health aide services to veterans 

17 who reside in communities with a shortage of home 

18 health aides. 

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

20 fewer than five geographic locations in which the 

21 Secretary determines there is a shortage of home 

22 health aides at which to carry out the pilot program 

23 under paragraph (1). 

24 (3) NURSING ASSISTANTS.— 


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

2 pilot program under paragraph (1), the Sec3 retary may hire nursing assistants as new em4 ployees of the Department of Veterans Affairs, 

5 or reassign nursing assistants who are existing 

6 employees of the Department, to provide to vet7 erans in-home care services (including basic 

8 tasks authorized by the State certification of 

9 the nursing assistant) under the pilot program, 

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

11 services through non-Department home health 

12 aides. 

13 (B) RELATIONSHIP TO HOME-BASED PRI14 MARY CARE PROGRAM.—Nursing assistants 

15 hired or reassigned under subparagraph (A) 

16 may provide services to a veteran under the 

17 pilot program under paragraph (1) while serv18 ing as part of a health care team for the vet19 eran under the Home-Based Primary Care pro20 gram. 

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

22 year after the date on which the Secretary deter23 mines the pilot program under paragraph (1) has 

24 terminated, the Secretary shall submit to the Com25 mittees on Veterans’ Affairs of the House of RepVerDate Sep 11 2014 00:21 Mar 21, 2023 Jkt 039200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\H542.IH H542

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1 resentatives and the Senate a report on the result of 

2 the pilot program. 

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

4 year after the date of the enactment of this Act, the Sec5 retary of Veterans Affairs shall submit to the Committees 

6 on Veterans’ Affairs of the House of Representatives and 

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

8 beginning in fiscal year 2012 and ending in fiscal year 

9 2023, the following: 

10 (1) An identification of the amount of funds 

11 that were included in a budget of the Department of 

12 Veterans Affairs during such period for the provision 

13 of in-home care to veterans under the Homemaker 

14 and Home Health Aide program but were not ex15 pended for such provision, disaggregated by medical 

16 center of the Department for which such unex17 pended funds were budgeted (if such disaggregation 

18 is possible). 

19 (2) To the extent practicable, an identification 

20 of the number of veterans for whom, during such pe21 riod, the hours during which a home health aide was 

22 authorized to provide services to the veteran under 

23 the Homemaker and Home Health Aide program 

24 were reduced for a reason other than a change in 

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


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1 description of the reasons why any such reductions 

2 may have occurred. 

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

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

5 the Secretary shall issue updated guidance for the Home6 maker and Home Health Aide program. Such updated 

7 guidance shall include the following: 

8 (1) A process for the transition of veterans 

9 from the Homemaker and Home Health Aide pro10 gram to other covered programs. 

11 (2) A requirement for the directors of the med12 ical facilities of the Department to complete such 

13 process whenever a veteran with care needs has been 

14 denied services from home health agencies under the 

15 Homemaker and Home Health Aide program as a 

16 result of the clinical needs or behavioral issues of the 

17 veteran. 

18 SEC. 8. REVIEWS AND OTHER IMPROVEMENTS RELATING 

19 TO HOME- AND COMMUNITY-BASED SERV20 ICES. 

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

22 (1) REVIEW OF PROGRAMS.—The Under Sec23 retary for Health of the Department of Veterans Af24 fairs shall conduct a review of each program adminVerDate Sep 11 2014 00:21 Mar 21, 2023 Jkt 039200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\H542.IH H542

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1 istered through the Office of Geriatric and Extended 

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

3 (A) ensure consistency in program man4 agement; 

5 (B) eliminate service gaps at the medical 

6 center level; and 

7 (C) ensure the availability of, and the ac8 cess by veterans to, home- and community9 based services. 

10 (2) ASSESSMENT OF STAFFING NEEDS.—The 

11 Secretary of Veterans Affairs shall conduct an as12 sessment of the staffing needs of the Office of Geri13 atric and Extended Care of the Department of Vet14 erans Affairs, or successor office. 

15 (3) GOALS FOR GEOGRAPHIC ALIGNMENT OF

16 CARE.— 

17 (A) ESTABLISHMENT OF GOALS.—The Di18 rector of the Office of Geriatric and Extended 

19 Care, or successor office, shall establish quan20 titative goals to enable aging or disabled vet21 erans who are not located near medical centers 

22 of the Department to access extended care serv23 ices (including by improving access to home24 and community-based services for such vet25 erans). 


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1 (B) IMPLEMENTATION TIMELINE.—Each 

2 goal established under subparagraph (A) shall 

3 include a timeline for the implementation of the 

4 goal at each medical center of the Department. 

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

6 The Director of the Office of Geriatric and Extended 

7 Care, or successor office, shall establish quantitative 

8 goals to address the specialty care needs of veterans 

9 through in-home care, including by ensuring the 

10 education of home health aides and caregivers of vet11 erans in the following areas: 

12 (A) Dementia care. 

13 (B) Care for spinal cord injuries and dis14 eases. 

15 (C) Ventilator care. 

16 (D) Other speciality care areas as deter17 mined by the Secretary. 

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

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

20 Secretary shall submit to the Committees on Vet21 erans’ Affairs of the House of Representatives and 

22 the Senate a report containing the findings of the 

23 review under paragraph (1), the results of the as24 sessment under paragraph (2), and the goals estab25 lished under paragraphs (3) and (4). 


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1 (b) REVIEW OF INCENTIVES AND EFFORTS RELAT2 ING TO HOME- AND COMMUNITY-BASED SERVICES.— 

3 (1) REVIEW.—The Secretary of Veterans Af4 fairs shall conduct a review of the following: 

5 (A) The financial and organizational incen6 tives for the directors of medical centers of the 

7 Department to establish or expand covered pro8 grams at such medical centers. 

9 (B) Any incentives for such directors to 

10 provide to veterans home- and community-based 

11 services in lieu of institutional care. 

12 (C) The efforts taken by the Secretary to 

13 enhance spending of the Department for ex14 tended care by shifting the balance of such 

15 spending from institutional care to home- and 

16 community-based services. 

17 (D) The plan of the Under Secretary for 

18 Health of the Department to accelerate efforts 

19 to enhance spending as specified in subpara20 graph (C), to match the progress of similar ef21 forts taken by the Administrator of the Centers 

22 for Medicare & Medicaid Services with respect 

23 to spending of the Centers for Medicare & Med24 icaid Services for extended care. 


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

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

3 Secretary shall submit to the Committees on Vet4 erans’ Affairs of the House of Representatives and 

5 the Senate a report on the findings of the review 

6 under paragraph (1). 

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

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

9 the Secretary of Veterans Affairs shall conduct a review 

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

11 care services furnished by the Secretary under chapter 17 

12 of title 38, United States Code. 

13 (d) COLLABORATION TO IMPROVE HOME- AND COM14 MUNITY-BASED SERVICES.— 

15 (1) REPORT ON EXPANSION OF CERTAIN MEN16 TAL HEALTH SERVICES.— 

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

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

19 Secretary of Veterans Affairs, in collaboration 

20 with the Secretary of Health and Human Serv21 ices, shall submit to the Committees on Vet22 erans’ Affairs of the House of Representatives 

23 and the Senate a report containing rec24 ommendations for the expansion of mental 


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•HR 542 IH

1 health services and related support to the care2 givers of veterans. 

3 (B) MATTERS INCLUDED.—The report 

4 under subparagraph (A) shall include an assess5 ment of the feasibility and advisability of au6 thorizing access to Vet Centers by— 

7 (i) family caregivers enrolled in a pro8 gram under section 1720G of title 38, 

9 United States Code; and 

10 (ii) family caregivers of veterans par11 ticipating in a program specified in section 

12 1720K of such title, as added by section 4. 

13 (2) RECOMMENDATIONS.— 

14 (A) DEVELOPMENT.—The Secretary of 

15 Veterans Affairs shall develop recommendations 

16 as follows: 

17 (i) With respect to home- and commu18 nity-based services for veterans, the Sec19 retary of Veterans Affairs shall develop 

20 recommendations regarding new services 

21 (in addition to those furnished as of the 

22 date of the enactment of this Act) in col23 laboration with the Secretary of Health 

24 and Human Services. 


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•HR 542 IH

1 (ii) With respect to the national short2 age of home health aides, the Secretary of 

3 Veterans Affairs shall develop rec4 ommendations regarding methods to ad5 dress such shortage in collaboration with 

6 the Secretary of Health and Human Serv7 ices and the Secretary of Labor. 

8 (B) SUBMISSION TO CONGRESS.—The Sec9 retary of Veterans Affairs shall submit to the 

10 Committees on Veterans’ Affairs of the House 

11 of Representatives and the Senate a report con12 taining the recommendations developed under 

13 subparagraph (A) and an identification of any 

14 changes in existing law or new statutory au15 thority necessary to implement the rec16 ommendations, as determined by the Secretary. 

17 (C) CONSULTATION WITH SECRETARY OF

18 LABOR.—In carrying out this paragraph, the 

19 Secretary of Veterans Affairs shall consult with 

20 the Secretary of Labor. 

21 (3) FEEDBACK AND RECOMMENDATIONS ON

22 CAREGIVER SUPPORT.— 

23 (A) FEEDBACK AND RECOMMENDA24 TIONS.—The Secretary of Veterans Affairs shall 

25 solicit from the entities described in subparaVerDate Sep 11 2014 00:21 Mar 21, 2023 Jkt 039200 PO 00000 Frm 00025 Fmt 6652 Sfmt 6201 E:\BILLS\H542.IH H542

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•HR 542 IH

1 graph (B) feedback and recommendations re2 garding opportunities for the Secretary to en3 hance home- and community-based services for 

4 veterans and the caregivers of veterans, includ5 ing through the potential provision by the entity 

6 of care and respite services to veterans and 

7 caregivers who may not be eligible for any pro8 gram under section 1720G of title 38, United 

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

10 added by section 4), but have a need for assist11 ance. 

12 (B) COVERED ENTITIES.—The entities de13 scribed in this subparagraph are veterans serv14 ice organizations and nonprofit organizations 

15 with a focus on caregiver support (as deter16 mined by the Secretary). 

17 (4) COLLABORATION FOR NATIVE AMERICAN

18 VETERANS.—The Secretary of Veterans Affairs shall 

19 collaborate with the Director of the Indian Health 

20 Service and representatives from tribal health pro21 grams and Urban Indian organizations to ensure the 

22 availability of home- and community-based services 

23 for Native American veterans, including Native 

24 American veterans receiving health care and medical 

25 services under multiple health care systems. 


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•HR 542 IH

1 SEC. 9. DEFINITIONS. 

2 In this Act: 

3 (1) The terms ‘‘caregiver’’ and ‘‘family care4 giver’’ have the meanings given those terms under 

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

6 added by section 4). 

7 (2) The term ‘‘covered program’’— 

8 (A) means any program of the Department 

9 of Veterans Affairs for home- and community10 based services; and 

11 (B) includes the programs specified in sec12 tion 1720K of title 38, United States Code (as 

13 added by section 4). 

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

15 services’’— 

16 (A) means the services referred to in sec17 tion 1701(6)(E) of title 38, United States Code; 

18 and 

19 (B) includes services furnished under a 

20 program specified in section 1720K of such title 

21 (as added by section 4). 

22 (4) The terms ‘‘Home-Based Primary Care pro23 gram’’, ‘‘Homemaker and Home Health Aide pro24 gram’’, and ‘‘Veteran-Directed Care program’’ mean 

25 the programs of the Department of Veterans Affairs 


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1 specified in subsection (d), (c), and (b) of such sec2 tion 1720K, respectively. 

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

4 American’’, ‘‘Native American veteran’’, ‘‘tribal 

5 health programs’’, and ‘‘Urban Indian organiza6 tions’’ have the meanings given those terms in sub7 section (h) of such section 1720K. 

8 (6) The term ‘‘Vet Center’’ has the meaning 

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

10 United States Code. 

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

12 means any organization recognized by the Secretary 

13 under section 5902 of such title. 

Æ 


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