IB 

Union Calendar No. 228 

118TH CONGRESS 

1ST SESSION H. R. 542 

[Report No. 118–284] 

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 

NOVEMBER 29, 2023 

Additional sponsors: Ms. DAVIDS of Kansas, Ms. DEAN of Pennsylvania, Mr. 

MCGOVERN, Ms. KUSTER, Ms. LOIS FRANKEL of Florida, Mr. KILMER, 

Ms. BARRAGA ́N, Mr. GOTTHEIMER, Mr. LIEU, Mrs. DINGELL, Mrs. 

CHERFILUS-MCCORMICK, Mr. KILDEE, Ms. MATSUI, Mr. TRONE, Mr. 

SABLAN, Ms. UNDERWOOD, Mr. LYNCH, Mr. CICILLINE, Mr. CASAR, Mr. 

SWALWELL, Ms. SHERRILL, Ms. BUDZINSKI, Ms. NORTON, Mr. MRVAN, 

Ms. CARAVEO, Mr. MORELLE, Ms. WILD, Mrs. NAPOLITANO, Ms. 

STRICKLAND, Mr. LATURNER, Mr. EVANS, Mr. LANDSMAN, Mr. LEVIN, 

Mrs. HAYES, Ms. DELBENE, Mr. DELUZIO, Ms. SCHAKOWSKY, Ms. 

TITUS, Ms. ROSS, Mr. MAGAZINER, Mr. LARSEN of Washington, Ms. 

WILLIAMS of Georgia, Ms. ESCOBAR, Mr. CASTRO of Texas, Mr. 

MOSKOWITZ, Ms. SALINAS, Mr. MCGARVEY, Mrs. GONZA ́LEZ-COLO ́N, Ms. 

JACOBS, Mr. FROST, Mr. CROW, Mrs. RADEWAGEN, Mr. RYAN, Mr. VAN

DREW, Mr. CARBAJAL, Ms. MOORE of Wisconsin, Mr. VAN ORDEN, Mr. 

VALADAO, Mrs. KIGGANS of Virginia, Ms. WEXTON, Ms. TOKUDA, Mr. 

ALLRED, Mrs. RAMIREZ, Mr. STANTON, Mr. MIKE GARCIA of California, 

Mr. HUIZENGA, Mr. MOULTON, Mr. FITZPATRICK, Mr. NEGUSE, Mr. 

ROUZER, Mr. KEATING, Mr. TONKO, Mr. CARL, Mr. TAKANO, and Mrs. 

FLETCHER

NOVEMBER 29, 2023 

Reported with an amendment, committed to the Committee of the Whole 

House on the State of the Union, and ordered to be printed 


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[Strike out all after the enacting clause and insert the part printed in italic] 

[For text of introduced bill, see copy of bill as introduced on January 26, 2023] 

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. 


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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 for 

6 Veterans and Caregivers Act of 2023’’ or the ‘‘Elizabeth 

7 Dole Home Care Act of 2023’’. 

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

9 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. 

10 SEC. 2. INCREASE OF EXPENDITURE CAP FOR NONINSTITU11 TIONAL CARE ALTERNATIVES TO NURSING 

12 HOME CARE. 

13 (a) INCREASE OF EXPENDITURE CAP.—Section 

14 1720C(d) of title 38, United States Code, is amended— 

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

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

17 cost’’; 

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

19 percent’’; and 


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1 (3) by adding at the end the following new para2 graph: 

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

4 assistance in the case of any veteran described in subpara5 graph (B) for any fiscal year under the program may ex6 ceed 100 percent of the cost that would otherwise have been 

7 incurred as specified in paragraph (1) if the Secretary de8 termines, based on a consideration of clinical need, geo9 graphic market factors, and such other matters as the Sec10 retary may prescribe through regulation, that such higher 

11 total cost is in the best interest of the veteran. 

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

13 veteran with amyotrophic lateral sclerosis, a spinal cord in14 jury, or a condition the Secretary determines to be similar 

15 to such conditions.’’. 

16 (b) APPLICABILITY.—The amendments made by sub17 section (a) shall apply with respect to fiscal years beginning 

18 on or after the date of the enactment of this Act. 

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

20 CARE FOR THE ELDERLY. 

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

22 amended by section 2, is further amended by adding at the 

23 end the following new subsection: 

24 ‘‘(f) In furnishing services to a veteran under the pro25 gram conducted pursuant to subsection (a), if a medical 


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1 center of the Department through which such program is 

2 administered is located in a geographic area in which serv3 ices are available to the veteran under a PACE program 

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

5 1934(a)(2) of the Social Security Act (42 U.S.C. 

6 1395eee(a)(2); 1396u–4(a)(2))), the Secretary shall seek to 

7 enter into an agreement with the PACE program operating 

8 in that area for the furnishing of such services.’’. 

9 SEC. 4. HOME- AND COMMUNITY-BASED SERVICES: PRO10 GRAMS. 

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

12 Code, is amended by inserting after section 1720J the fol13 lowing new section (and conforming the table of sections 

14 at the beginning of such chapter accordingly): 

15 ‘‘§ 1720K. Home- and community-based services: pro16 grams 

17 ‘‘(a) IN GENERAL.—In furnishing noninstitutional al18 ternatives to nursing home care pursuant to the authority 

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

20 this chapter or other provision of law administered by the 

21 Secretary of Veterans Affairs), the Secretary shall carry out 

22 each of the programs specified in this section in accordance 

23 with such relevant authorities except as otherwise provided 

24 in this section. 


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

2 Secretary of Veterans Affairs, in collaboration with the Sec3 retary of Health and Human Services, shall carry out a 

4 program to be known as the ‘Veteran-Directed Care pro5 gram’. Under such program, the Secretary of Veterans Af6 fairs may enter into agreements with the providers de7 scribed in paragraph (2) to provide to eligible veterans 

8 funds, to the extent practicable, to obtain such in-home care 

9 services and related items as may be determined appro10 priate by the Secretary of Veterans Affairs and selected by 

11 the veteran, including through the veteran hiring individ12 uals to provide such services and items or directly pur13 chasing such services and items. 

14 ‘‘(2) The providers described in this paragraph are the 

15 following: 

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

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

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

19 ‘‘(C) An Indian tribe or tribal organization re20 ceiving assistance under title VI of the Older Ameri21 cans Act of 1965 (42 U.S.C. 3057 et seq.). 

22 ‘‘(3) In carrying out the Veteran-Directed Care pro23 gram, the Secretary of Veterans Affairs shall— 

24 ‘‘(A) administer such program through each 

25 medical center of the Department of Veterans Affairs; 


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1 ‘‘(B) seek to ensure the availability of such pro2 gram in American Samoa, Guam, the Commonwealth 

3 of the Northern Mariana Islands, the Commonwealth 

4 of Puerto Rico, the Virgin Islands of the United 

5 States, and any other territory or possession of the 

6 United States, to the extent practicable; and 

7 ‘‘(C) seek to ensure the availability of such pro8 gram for eligible veterans who are Native American 

9 veterans receiving care and services furnished by the 

10 Indian Health Service, a tribal health program, an 

11 Urban Indian organization, or (in the case of a Na12 tive Hawaiian veteran) a Native Hawaiian health 

13 care system, to the extent practicable. 

14 ‘‘(4) If a veteran participating in the Veteran-Directed 

15 Care program is catastrophically disabled, the veteran may 

16 continue to use funds under the program during a period 

17 of hospitalization in the same manner that the veteran 

18 would be authorized to use such funds under the program 

19 if the veteran were not hospitalized. 

20 ‘‘(c) HOMEMAKER AND HOME HEALTH AIDE PRO21 GRAM.—(1) The Secretary shall carry out a program to be 

22 known as the ‘Homemaker and Home Health Aide program’ 

23 under which the Secretary may enter into agreements with 

24 home health agencies to provide to eligible veterans such 


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1 home health aide services as may be determined appropriate 

2 by the Secretary. 

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

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

5 practicable, ensure the availability of such program— 

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

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

8 ‘‘(B) for the veteran populations specified in sub9 paragraph (C) of such subsection. 

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

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

12 ‘Home-Based Primary Care program’ under which the Sec13 retary may furnish to eligible veterans in-home health care, 

14 the provision of which is overseen by a provider of the De15 partment. 

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

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

18 the ‘Purchased Skilled Home Care program’ under which 

19 the Secretary may furnish to eligible veterans such in-home 

20 care services as may be determined appropriate and selected 

21 by the Secretary for the veteran. 

22 ‘‘(f) CAREGIVER SUPPORT.—(1) With respect to a resi23 dent eligible caregiver of a veteran participating in a pro24 gram under this section, the Secretary shall— 


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1 ‘‘(A) if the veteran meets the requirements of a 

2 covered veteran under section 1720G(b) of this title, 

3 provide to such caregiver the option of enrolling in 

4 the program of general caregiver support services 

5 under such section; 

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

7 care of not less than 30 days annually; and 

8 ‘‘(C) conduct on an annual basis (and, to the ex9 tent practicable, in connection with in-person services 

10 provided under the program in which the veteran is 

11 participating), a wellness contact of such caregiver. 

12 ‘‘(2) Covered respite care provided to a resident eligible 

13 caregiver of a veteran under paragraph (1) may exceed 30 

14 days annually if such extension is requested by the resident 

15 eligible caregiver or veteran and determined medically ap16 propriate by the Secretary. 

17 ‘‘(g) RULE OF CONSTRUCTION.—Nothing in this sec18 tion shall be construed to limit the authority of the Sec19 retary to carry out programs providing home- and commu20 nity-based services under any other provision of law. 

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

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

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

24 have the meanings given those terms in section 102 of 

25 the Older Americans Act of 1965 (42 U.S.C. 3002). 


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1 ‘‘(2) The terms ‘caregiver’ and ‘family caregiver’, 

2 with respect to a veteran, have the meanings given 

3 those terms, respectively, under subsection (e) of sec4 tion 1720G of this title with respect to an eligible vet5 eran under subsection (a) of such section or a covered 

6 veteran under subsection (b) of such section, as the 

7 case may be. 

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

9 the meaning given that term in section 702 of the Re10 habilitation 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 indi2 vidual employed by a home health agency to provide 

3 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 section 

9 4 of the Indian Self-Determination and Education 

10 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. 11711). 

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

19 ‘Urban Indian organizations’ have the meanings 

20 given those terms in section 4 of the Indian Health 

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

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

23 means an individual who— 

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

25 of a veteran and resides with that veteran; and 


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1 ‘‘(B) has not entered into a contract, agree2 ment, or other arrangement for such individual 

3 to act as a caregiver for that veteran unless such 

4 individual is a family member of the veteran or 

5 is furnishing caregiver services through a med6 ical foster home.’’. 

7 (b) DEADLINE FOR IMPROVED ADMINISTRATION.—The 

8 Secretary of Veterans Affairs shall ensure that the Veteran9 Directed Care program and the Homemaker and Home 

10 Health Aide program are administered through each med11 ical center of the Department of Veterans Affairs in accord12 ance with section 1720K of title 38, United States Code (as 

13 added by subsection (a)), by not later than two years after 

14 the date of the enactment of this Act. 

15 SEC. 5. COORDINATION WITH ASSISTANCE AND SUPPORT 

16 SERVICES FOR CAREGIVERS. 

17 (a) COORDINATION WITH PROGRAM OF COMPREHEN18 SIVE ASSISTANCE FOR FAMILY CAREGIVERS.— 

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

20 38, United States Code, is amended by adding at the 

21 end the following new paragraph: 

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

23 services under this subsection and is denied such services, 

24 or a veteran or the family caregiver of a veteran who is 


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1 discharged from the program under this subsection, the Sec2 retary shall— 

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

4 covered veteran under subsection (b), provide to such 

5 caregiver the option of enrolling in the program of 

6 general caregiver support services under such sub7 section; 

8 ‘‘(ii) assess the veteran or caregiver for partici9 pation in any other available program of the Depart10 ment for home- and community-based services (in11 cluding the programs specified in section 1720K of 

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

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

14 make accessible to the veteran) the results of such as15 sessment in the electronic medical record of the vet16 eran; and 

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

18 information on any such program identified pursuant 

19 to the assessment under clause (ii), including infor20 mation about facilities, eligibility requirements, and 

21 relevant contact information for each such program. 

22 ‘‘(B) For each veteran or family caregiver who is dis23 charged from the program under this subsection, a caregiver 

24 support coordinator shall provide for a smooth and person25 alized transition from such program to an appropriate proVerDate Sep 11 2014 22:27 Nov 29, 2023 Jkt 049200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6203 E:\BILLS\H542.RH H542

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1 gram of the Department for home- and community-based 

2 services (including the programs specified in section 1720K 

3 of this title), including by integrating caregiver support 

4 across programs.’’. 

5 (2) APPLICABILITY.—The amendments made by 

6 paragraph (1) shall apply with respect to denials and 

7 discharges occurring on or after the date that is 180 

8 days after the date of the enactment of this Act. 

9 (3) TECHNICAL AND CONFORMING AMEND10 MENTS.—Section 1720G(d) of such title is amended— 

11 (A) by striking ‘‘or a covered veteran’’ each 

12 place it appears and inserting ‘‘, a veteran de13 nied or discharged as specified in paragraph 

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

15 and 

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

17 means’’ each place it appears and inserting 

18 ‘‘under subsection (a) or a veteran denied or dis19 charged as specified in paragraph (14) of such 

20 subsection, means’’. 

21 (b) CONFORMITY OF RESPITE CARE ACROSS PRO22 GRAMS.—Section 1720G of title 38, United States Code, as 

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

24 (1) in subsection (a)(3)— 


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

2 to read as follows: 

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

4 30 days annually;’’; and 

5 (B) by striking subparagraph (B) and re6 designating subparagraphs (C) and (D) as sub7 paragraphs (B) and (C), respectively; and 

8 (2) by amending subsection (b)(3)(A)(iii) to read 

9 as follows: 

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

11 days annually.’’; and 

12 (3) in subsection (d)— 

13 (A) by redesignating paragraphs (2) 

14 through (4) as paragraphs (3) through (5), re15 spectively; and 

16 (B) by inserting after paragraph (1) the fol17 lowing new paragraph: 

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

19 respect to a caregiver of a veteran, respite care under 

20 section 1720B of this title that— 

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

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

23 the veteran commensurate with the care provided 

24 by the caregiver); and 

25 ‘‘(B) includes in-home care.’’. 


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1 (c) REVIEW RELATING TO CAREGIVER CONTACT.—The 

2 Secretary shall conduct a review of the capacity of the De3 partment to establish a streamlined system for contacting 

4 all caregivers enrolled in the program of general caregiver 

5 support services under section 1720G(b) of title 38, United 

6 States Code, to provide to such caregivers program updates 

7 and alerts relating to emerging services for which such care8 givers may be eligible. 

9 SEC. 6. DEVELOPMENT OF CENTRALIZED WEBSITE FOR 

10 PROGRAM INFORMATION. 

11 (a) CENTRALIZED WEBSITE.—The Secretary shall de12 velop and maintain a centralized and publically accessible 

13 internet website of the Department as a clearinghouse for 

14 information and resources relating to covered programs. 

15 (b) CONTENTS.—The website under subsection (a) shall 

16 contain the following: 

17 (1) A description of each covered program. 

18 (2) An informational assessment tool that— 

19 (A) explains the administrative eligibility, 

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

21 veteran, for any covered program; and 

22 (B) provides information, as a result of 

23 such explanation, on any covered program for 

24 which the veteran or caregiver (as the case may 

25 be) may be eligible. 


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1 (3) A list of required procedures for the directors 

2 of the medical facilities of the Department to follow 

3 in determining the eligibility and suitability of vet4 erans for participation in a covered program, includ5 ing procedures applicable to instances in which the 

6 resource constraints of a facility (or of a community 

7 in which a facility is located) may result in the in8 ability to address the health needs of a veteran under 

9 a covered program in a timely manner. 

10 (c) UPDATES.—The Secretary shall ensure the website 

11 under subsection (a) is updated on a periodic basis. 

12 SEC. 7. IMPROVEMENTS RELATING TO HOMEMAKER AND 

13 HOME HEALTH AIDE PROGRAM. 

14 (a) PILOT PROGRAM FOR COMMUNITIES WITH SHORT15 AGE OF HOME HEALTH AIDES.— 

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

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

18 Secretary shall carry out a three-year pilot program 

19 under which the Secretary shall provide homemaker 

20 and home health aide services to veterans who reside 

21 in communities with a shortage of home health aides. 

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

23 fewer than five geographic locations in which the Sec24 retary determines there is a shortage of home health 


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1 aides at which to carry out the pilot program under 

2 paragraph (1). 

3 (3) NURSING ASSISTANTS.— 

4 (A) IN GENERAL.—In carrying out the pilot 

5 program under paragraph (1), the Secretary 

6 may hire nursing assistants as new employees of 

7 the Department of Veterans Affairs, or reassign 

8 nursing assistants who are existing employees of 

9 the Department, to provide to veterans in-home 

10 care services (including basic tasks authorized by 

11 the State certification of the nursing assistant) 

12 under the pilot program, in lieu of or in addi13 tion to the provision of such services through 

14 non-Department home health aides. 

15 (B) RELATIONSHIP TO HOME-BASED PRI16 MARY CARE PROGRAM.—Nursing assistants hired 

17 or reassigned under subparagraph (A) may pro18 vide services to a veteran under the pilot pro19 gram under paragraph (1) while serving as part 

20 of a health care team for the veteran under the 

21 Home-Based Primary Care program. 

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

23 year after the date on which the Secretary determines 

24 the pilot program under paragraph (1) has termi25 nated, the Secretary shall submit to the Committees 


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1 on Veterans’ Affairs of the House of Representatives 

2 and the Senate a report on the result of the pilot pro3 gram. 

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

5 year after the date of the enactment of this Act, the Sec6 retary of Veterans Affairs shall submit to the Committees 

7 on Veterans’ Affairs of the House of Representatives and 

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

9 beginning in fiscal year 2012 and ending in fiscal year 

10 2023, the following: 

11 (1) An identification of the amount of funds that 

12 were included in a budget of the Department of Vet13 erans Affairs during such period for the provision of 

14 in-home care to veterans under the Homemaker and 

15 Home Health Aide program but were not expended 

16 for such provision, disaggregated by medical center of 

17 the Department for which such unexpended funds 

18 were budgeted (if such disaggregation is possible). 

19 (2) To the extent practicable, an identification of 

20 the number of veterans for whom, during such period, 

21 the hours during which a home health aide was au22 thorized to provide services to the veteran under the 

23 Homemaker and Home Health Aide program were re24 duced for a reason other than a change in the health 

25 care needs of the veteran, and a detailed description 


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1 of the reasons why any such reductions may have oc2 curred. 

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 from 

9 the Homemaker and Home Health Aide program to 

10 other covered programs. 

11 (2) A requirement for the directors of the medical 

12 facilities of the Department to complete such process 

13 whenever a veteran with care needs has been denied 

14 services from home health agencies under the Home15 maker and Home Health Aide program as a result of 

16 the clinical needs or behavioral issues of the veteran. 

17 SEC. 8. REVIEWS AND OTHER IMPROVEMENTS RELATING 

18 TO HOME- AND COMMUNITY-BASED SERV19 ICES. 

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

21 (1) REVIEW OF PROGRAMS.—The Under Sec22 retary for Health of the Department of Veterans Af23 fairs shall conduct a review of each program adminis24 tered through the Office of Geriatric and Extended 

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


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1 (A) ensure consistency in program manage2 ment; 

3 (B) eliminate service gaps at the medical 

4 center level; and 

5 (C) ensure the availability of, and the access 

6 by veterans to, home- and community-based serv7 ices. 

8 (2) ASSESSMENT OF STAFFING NEEDS.—The Sec9 retary of Veterans Affairs shall conduct an assessment 

10 of the staffing needs of the Office of Geriatric and Ex11 tended Care of the Department of Veterans Affairs, or 

12 successor office. 

13 (3) GOALS FOR GEOGRAPHIC ALIGNMENT OF

14 CARE.— 

15 (A) ESTABLISHMENT OF GOALS.—The Di16 rector of the Office of Geriatric and Extended 

17 Care, or successor office, shall establish quan18 titative goals to enable aging or disabled veterans 

19 who are not located near medical centers of the 

20 Department to access extended care services (in21 cluding by improving access to home- and com22 munity-based services for such veterans). 

23 (B) IMPLEMENTATION TIMELINE.—Each 

24 goal established under subparagraph (A) shall 


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1 include a timeline for the implementation of the 

2 goal at each medical center of the Department. 

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

4 Director of the Office of Geriatric and Extended Care, 

5 or successor office, shall establish quantitative goals to 

6 address the specialty care needs of veterans through 

7 in-home care, including by ensuring the education of 

8 home health aides and caregivers of veterans in the 

9 following areas: 

10 (A) Dementia care. 

11 (B) Care for spinal cord injuries and dis12 eases. 

13 (C) Ventilator care. 

14 (D) Other speciality care areas as deter15 mined by the Secretary. 

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

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

18 Secretary shall submit to the Committees on Veterans’ 

19 Affairs of the House of Representatives and the Senate 

20 a report containing the findings of the review under 

21 paragraph (1), the results of the assessment under 

22 paragraph (2), and the goals established under para23 graphs (3) and (4). 

24 (b) REVIEW OF INCENTIVES AND EFFORTS RELATING

25 TO HOME- AND COMMUNITY-BASED SERVICES.— 


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1 (1) REVIEW.—The Secretary of Veterans Affairs 

2 shall conduct a review of the following: 

3 (A) The financial and organizational incen4 tives for the directors of medical centers of the 

5 Department to establish or expand covered pro6 grams at such medical centers. 

7 (B) Any incentives for such directors to pro8 vide to veterans home- and community-based 

9 services in lieu of institutional care. 

10 (C) The efforts taken by the Secretary to en11 hance spending of the Department for extended 

12 care by shifting the balance of such spending 

13 from institutional care to home- and commu14 nity-based services. 

15 (D) The plan of the Under Secretary for 

16 Health of the Department to accelerate efforts to 

17 enhance spending as specified in subparagraph 

18 (C), to match the progress of similar efforts taken 

19 by the Administrator of the Centers for Medicare 

20 & Medicaid Services with respect to spending of 

21 the Centers for Medicare & Medicaid Services for 

22 extended care. 

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

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

25 Secretary shall submit to the Committees on Veterans’ 


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•HR 542 RH

1 Affairs of the House of Representatives and the Senate 

2 a report on the findings of the review under para3 graph (1). 

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

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

6 the Secretary of Veterans Affairs shall conduct a review of 

7 the use, availability, and effectiveness, of the respite care 

8 services furnished by the Secretary under chapter 17 of title 

9 38, United States Code. 

10 (d) COLLABORATION TO IMPROVE HOME- AND COMMU11 NITY-BASED SERVICES.— 

12 (1) REPORT ON EXPANSION OF CERTAIN MENTAL

13 HEALTH SERVICES.— 

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

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

16 Secretary of Veterans Affairs, in collaboration 

17 with the Secretary of Health and Human Serv18 ices, shall submit to the Committees on Veterans’ 

19 Affairs of the House of Representatives and the 

20 Senate a report containing recommendations for 

21 the expansion of mental health services and re22 lated support to the caregivers of veterans. 

23 (B) MATTERS INCLUDED.—The report 

24 under subparagraph (A) shall include an assessVerDate Sep 11 2014 22:27 Nov 29, 2023 Jkt 049200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6203 E:\BILLS\H542.RH H542

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•HR 542 RH

1 ment of the feasibility and advisability of au2 thorizing access to Vet Centers by— 

3 (i) family caregivers enrolled in a pro4 gram under section 1720G of title 38, 

5 United States Code; and 

6 (ii) family caregivers of veterans par7 ticipating in a program specified in section 

8 1720K of such title, as added by section 4. 

9 (2) RECOMMENDATIONS.— 

10 (A) DEVELOPMENT.—The Secretary of Vet11 erans Affairs shall develop recommendations as 

12 follows: 

13 (i) With respect to home- and commu14 nity-based services for veterans, the Sec15 retary of Veterans Affairs shall develop rec16 ommendations regarding new services (in 

17 addition to those furnished as of the date of 

18 the enactment of this Act) in collaboration 

19 with the Secretary of Health and Human 

20 Services. 

21 (ii) With respect to the national short22 age of home health aides, the Secretary of 

23 Veterans Affairs shall develop recommenda24 tions regarding methods to address such 

25 shortage in collaboration with the Secretary 


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•HR 542 RH

1 of Health and Human Services and the Sec2 retary of Labor. 

3 (B) SUBMISSION TO CONGRESS.—The Sec4 retary of Veterans Affairs shall submit to the 

5 Committees on Veterans’ Affairs of the House of 

6 Representatives and the Senate a report con7 taining the recommendations developed under 

8 subparagraph (A) and an identification of any 

9 changes in existing law or new statutory author10 ity necessary to implement the recommendations, 

11 as determined by the Secretary. 

12 (C) CONSULTATION WITH SECRETARY OF

13 LABOR.—In carrying out this paragraph, the 

14 Secretary of Veterans Affairs shall consult with 

15 the Secretary of Labor. 

16 (3) FEEDBACK AND RECOMMENDATIONS ON

17 CAREGIVER SUPPORT.— 

18 (A) FEEDBACK AND RECOMMENDATIONS.— 

19 The Secretary of Veterans Affairs shall solicit 

20 from the entities described in subparagraph (B) 

21 feedback and recommendations regarding oppor22 tunities for the Secretary to enhance home- and 

23 community-based services for veterans and the 

24 caregivers of veterans, including through the po25 tential provision by the entity of care and resVerDate Sep 11 2014 22:27 Nov 29, 2023 Jkt 049200 PO 00000 Frm 00026 Fmt 6652 Sfmt 6203 E:\BILLS\H542.RH H542

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•HR 542 RH

1 pite services to veterans and caregivers who may 

2 not be eligible for any program under section 

3 1720G of title 38, United States Code, or section 

4 1720K of such title (as added by section 4), but 

5 have a need for assistance. 

6 (B) COVERED ENTITIES.—The entities de7 scribed in this subparagraph are veterans service 

8 organizations and nonprofit organizations with 

9 a focus on caregiver support (as determined by 

10 the Secretary). 

11 (4) COLLABORATION FOR NATIVE AMERICAN VET12 ERANS.—The Secretary of Veterans Affairs shall col13 laborate with the Director of the Indian Health Serv14 ice and representatives from tribal health programs 

15 and Urban Indian organizations to ensure the avail16 ability of home- and community-based services for 

17 Native American veterans, including Native Amer18 ican veterans receiving health care and medical serv19 ices under multiple health care systems. 

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

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

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

23 2031’’ each place it appears and inserting ‘‘January 26, 

24 2032’’. 


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•HR 542 RH

1 SEC. 10. DEFINITIONS. 

2 In this Act: 

3 (1) The terms ‘‘caregiver’’ and ‘‘family care4 giver’’ have the meanings given those terms under sec5 tion 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 serv15 ices’’— 

16 (A) means the services referred to in section 

17 1701(6)(E) of title 38, United States Code; and 

18 (B) includes services furnished under a pro19 gram specified in section 1720K of such title (as 

20 added by section 4). 

21 (4) The terms ‘‘Home-Based Primary Care pro22 gram’’, ‘‘Homemaker and Home Health Aide pro23 gram’’, and ‘‘Veteran-Directed Care program’’ mean 

24 the programs of the Department of Veterans Affairs 

25 specified in subsection (d), (c), and (b) of such section 

26 1720K, respectively. 


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•HR 542 RH

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

2 American’’, ‘‘Native American veteran’’, ‘‘tribal 

3 health programs’’, and ‘‘Urban Indian organizations’’ 

4 have the meanings given those terms in subsection (h) 

5 of such section 1720K. 

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

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

8 United States Code. 

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

10 means any organization recognized by the Secretary 

11 under section 5902 of such title. 


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Union Calendar No. 228 

118TH CONGRESS 

1ST SESSION H. R. 542 

[Report No. 118–284] 

A BILL 

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 

NOVEMBER 29, 2023 

Reported with an amendment, committed to the Comand ordered to be printed mittee of the Whole House on the State of the Union, 


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