Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Long-Term Care Vet-
erans Choice Act’’. 
SEC. 2. SECRETARY OF VETERANS AFFAIRS CONTRACT AU-
THORITY FOR PAYMENT OF CARE FOR VET-
ERANS IN NON-DEPARTMENT OF VETERANS 
AFFAIRS MEDICAL FOSTER HOMES. 
(a) AUTHORITY.— 
(1) IN
GENERAL.—Section 1720 of title 38, 
United States Code, is amended by adding at the 
end the following new subsection: 
‘‘(h)(1) During the five-year period beginning on the 
date of the enactment of the Long-Term Care Veterans 
Choice Act, and subject to paragraph (3)— 
‘‘(A) at the request of a veteran for whom the 
Secretary is required to provide nursing home care 
under section 1710A of this title, the Secretary may 
place the veteran in a medical foster home that 
meets Department standards, at the expense of the 
United States, pursuant to a contract, agreement, or 
other arrangement entered into between the Sec-
retary and the medical foster home for such purpose; 
and
‘‘(B) the Secretary may pay for care of a vet-
eran placed in a medical foster home before such 
date of enactment, if the home meets Department 
standards, pursuant to a contract, agreement, or 
other arrangement entered into between the Sec-
retary and the medical foster home for such purpose. 
‘‘(2) A veteran on whose behalf the Secretary pays 
for care in a medical foster home under paragraph (1) 
shall agree, as a condition of such payment, to accept 
home health services furnished by the Secretary under sec-
tion 1717 of this title. 
‘‘(3) In any year, not more than a daily average of 
900 veterans receiving care in a medical foster home, 
whether placed before, on, or after the date of the enact-
ment of the Long-Term Care Veterans Choice Act, may 
have their care covered at the expense of the United States 
under paragraph (1). 
‘‘(4) The prohibition under section 1730(b)(3) of this 
title shall not apply to a veteran whose care is covered 
at the expense of the United States under paragraph (1). 
‘‘(5) In this subsection, the term ‘medical foster 
home’ means a home designed to provide non-institutional, 
long-term, supportive care for veterans who are unable to 
live independently and prefer a family setting.’’.
(2) EFFECTIVE DATE.—Subsection (h) of sec-
tion 1720 of title 38, United States Code, as added 
by paragraph (1), shall take effect 90 days after the 
date of the enactment of this Act. 
(b) ONGOING MONITORING
OF MEDICAL FOSTER 
HOME PROGRAM.— 
(1) IN GENERAL.—The Secretary of Veterans 
Affairs shall create a system to monitor and assess 
the workload for the Department of Veterans Affairs 
in carrying out the authority under section 1720(h) 
of title 38, United States Code, as added by sub-
section (a)(1), including by tracking— 
(A) requests by veterans to be placed in a 
medical foster home under such section; 
(B) denials of such requests, including the 
reasons for such denials; 
(C) the total number of medical foster 
homes applying to participate under such sec-
tion, disaggregated by those approved and those 
denied approval by the Department to partici-
pate; 
(D) veterans receiving care at a medical 
foster home at the expense of the United 
States; and
(E) veterans receiving care at a medical 
foster home at their own expense. 
(2) REPORT.—Based on the monitoring and as-
sessments conducted under paragraph (1), the Sec-
retary shall identify and submit to Congress a report 
on such modifications to implementing section 
1720(h) of title 38, United States Code, as added by 
subsection (a)(1), as the Secretary considers nec-
essary to ensure the authority under such section is 
functioning as intended and care is provided to vet-
erans under such section as intended. 
(3) MEDICAL FOSTER HOME DEFINED.—In this 
subsection, the term ‘‘medical foster home’’ has the 
meaning given that term in section 1720(h) of title 
38, United States Code, as added by subsection 
(a)(1). 
(c) COMPTROLLER GENERAL REPORT.—Not later 
than each of three years and six years after the date of 
the enactment of this Act, the Comptroller General of the 
United States shall submit to Congress a report— 
(1) assessing the implementation of this section 
and the amendments made by this section; 
(2) assessing the impact of the monitoring and 
modifications under subsection (b) on care provided
under section 1720(h) of title 38, United States 
Code, as added by subsection (a)(1); and 
(3) setting forth recommendations for improve-
ments to the implementation of such section, as the 
Comptroller General considers appropriate. 
(d) MODIFICATION
OF CERTAIN HOUSING LOAN 
FEE.—The loan fee table in section 3729(b)(2) of title 38, 
United States Code, is amended by striking ‘‘January 14, 
2031’’ each place it appears and inserting ‘‘February 15, 
2031’’. 
SEC. 3. DETERMINATION OF BUDGETARY EFFECTS. 
The budgetary effects of this Act, for the purpose of 
complying with the Statutory Pay-As-You-Go Act of 2010, 
shall be determined by reference to the latest statement 
titled ‘‘Budgetary Effects of PAYGO Legislation’’ for this 
Act, submitted for printing in the Congressional Record 
by the Chairman of the House Budget Committee, pro-
vided that such statement has been submitted prior to the 
vote on passage. 
Passed the House of Representatives December 1, 
2022. 
Attest: 
Clerk.
117TH CONGRESS 
2D SESSION 
H. R. 7158 
AN ACT 
To amend title 38, United States Code, to author-
ize the Secretary of Veterans Affairs to enter 
into contracts and agreements for the payment of 
care in non-Department of Veterans Affairs med-
ical foster homes for certain veterans who are 
unable to live independently, and for other pur-
poses.