SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Senator 
Elizabeth 
Dole 
21st 
Century 
Veterans 
Healthcare and Benefits Improvement Act’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
TITLE I—HEALTH CARE MATTERS 
Subtitle A—Veterans Community Care Program Matters 
Sec. 101. Implementation of provision of care under Veterans Community Care 
Program upon determination of eligibility by veteran and vet-
eran’s referring clinician. 
Sec. 102. Outreach regarding care and services under Veterans Community 
Care Program. 
Sec. 103. Annual review and report on waivers of certain payment rates under 
Veterans Community Care Program. 
Sec. 104. Modification of requirements for standards for quality of care from 
Department of Veterans Affairs. 
Sec. 105. Pilot program to improve administration of care under Veterans 
Community Care Program. 
Sec. 106. Pilot program on consolidating approval process of Department of 
Veterans Affairs for covered dental care. 
Sec. 107. Strategic plan on value-based health care system for Veterans Health 
Administration; pilot program. 
Sec. 108. Plan on adoption of certain health information standards for Depart-
ment of Veterans Affairs and certain health care providers. 
Sec. 109. Report on use of value-based reimbursement models under Veterans 
Community Care Program. 
Sec. 110. Inspector General assessment of implementation of Veterans Commu-
nity Care Program. 
Sec. 111. Comptroller General report on dentistry under Veterans Community 
Care Program. 
Subtitle B—Matters Relating to Nursing Home and Other Long Term Care 
and Family Caregivers 
Sec. 120. Increase of expenditure cap for noninstitutional care alternatives to 
nursing home care. 
Sec. 121. Coordination with Program of All-Inclusive Care for the Elderly. 
Sec. 122. Authority for Secretary of Veterans Affairs to award grants or con-
tracts to entities to improve provision of mental health support 
to family caregivers of veterans. 
Sec. 123. Home- and community-based services: programs. 
Sec. 124. Coordination with assistance and support services for caregivers. 
Sec. 125. Improvements to program of comprehensive assistance for family 
caregivers.
Sec. 126. Improvements relating to Homemaker and Home Health Aide pro-
gram. 
Sec. 127. Pilot program to furnish assisted living services to certain veterans. 
Sec. 128. Provision of medicine, equipment, and supplies available to Depart-
ment of Veterans Affairs to State homes. 
Sec. 129. Recognition of organizations and individuals to assist veterans, family 
members, and caregivers navigating programs and services of 
Veterans Health Administration. 
Sec. 130. Reviews and other improvements relating to home- and community- 
based services. 
Sec. 131. GAO report on mental health support for caregivers. 
Sec. 132. Development of centralized website for program information. 
Sec. 133. Definitions. 
Subtitle C—Medical Treatment and Other Matters 
Sec. 140. Quarterly report on referrals for non-Department of Veterans Affairs 
health care. 
Sec. 141. Elimination of certain requirements for certain Department of Vet-
erans Affairs Assistant Under Secretaries. 
Sec. 142. Modification of pay limitation for physicians, podiatrists, optom-
etrists, and dentists of Department of Veterans Affairs. 
Sec. 143. Reimbursement of ambulance cost for care for certain rural veterans. 
Sec. 144. Pilot program to furnish dental care from the Department of Vet-
erans Affairs to certain veterans diagnosed with ischemic heart 
disease. 
Sec. 145. Documentation of preferences of veterans for scheduling of appoint-
ments for health care under laws administered by Secretary of 
Veterans Affairs. 
Sec. 146. Staffing model and performance metrics for certain employees of the 
Department of Veterans Affairs. 
Sec. 147. Online health education portal for veterans enrolled in patient enroll-
ment system of Department of Veterans Affairs. 
Sec. 148. Limitation on detail of directors of medical centers of Department of 
Veterans Affairs to different positions. 
Sec. 149. National Veteran Suicide Prevention Annual Report. 
Sec. 150. Report on physical infrastructure required by medical facilities of De-
partment of Veterans Affairs to provide dental care services. 
Sec. 151. Comptroller General report on certain oral health care programs 
under laws administered by Secretary of Veterans Affairs. 
Sec. 152. Review of workflows associated with processing referrals between fa-
cilities of the Veterans Health Administration. 
Sec. 153. Plan for timely scheduling of appointments at medical facilities of 
Department of Veterans Affairs. 
Sec. 154. Authorization of appropriations to support initiatives for mobile 
mammography services for veterans. 
TITLE II—ECONOMIC OPPORTUNITY MATTERS 
Subtitle A—Educational Assistance 
Sec. 201. Temporary expansion of eligibility for Marine Gunnery Sergeant John 
David Fry Scholarship. 
Sec. 202. Removal of expiration on entitlement to Marine Gunnery Sergeant 
John David Fry Scholarship for surviving spouses.
Sec. 203. Sole liability for transferred educational assistance by an individual 
who fails to complete a service agreement. 
Sec. 204. Notice to educational institutions of risk-based surveys. 
Sec. 205. Relationship of participation by an educational institution in certain 
Federal student financial aid programs to approval of such in-
stitution for purposes of Department of Veterans Affairs edu-
cational assistance programs. 
Sec. 206. Expansion of Department of Veterans Affairs oversight of certain 
educational institutions. 
Sec. 207. Requirement that educational institutions approved for purposes of 
Department of Veterans Affairs educational assistance pro-
grams provide digital official transcripts. 
Sec. 208. Payment of full monthly housing stipend for veterans enrolled in final 
semester using educational assistance under Post-9/11 Edu-
cational Assistance Program. 
Sec. 209. Modification of rules for approval of commercial driver education pro-
grams for purposes of educational assistance programs of the 
Department of Veterans Affairs. 
Sec. 210. Provision of certificates of eligibility and award letters using elec-
tronic means. 
Sec. 211. Retroactive effective date of law regarding charge to entitlement to 
educational assistance for individuals who do not transfer cred-
its from certain closed or disapproved programs of education. 
Sec. 212. Department of Veterans Affairs high technology program. 
Sec. 213. Notice of changes to Department of Veterans Affairs policies and 
guidance affecting the educational assistance programs of the 
Department. 
Sec. 214. Payment of VA educational assistance via electronic fund transfer to 
a foreign institution of higher education. 
Sec. 215. Improving transparency and accountability of educational institutions 
for purposes of veterans educational assistance. 
Subtitle B—Employment and Training 
Sec. 221. Improvements to reemployment rights of members of the Armed 
Forces. 
Sec. 222. Review of investigations manual of Veterans’ Employment and Train-
ing Service. 
Sec. 223. Warrior Training Advancement Course. 
Subtitle C—Home Loans 
Sec. 231. Improvements to program for direct housing loans made to Native 
American veterans by the Secretary of Veterans Affairs. 
Sec. 232. Native community development financial institution relending pro-
gram. 
TITLE III—DISABILITY AND MEMORIAL AFFAIRS MATTERS 
Sec. 301. Burial allowance for certain veterans who die at home while in receipt 
of hospice care furnished by Department of Veterans Affairs. 
Sec. 302. Authority for Secretary of Veterans Affairs to award grants to States 
and Indian Tribes to improve outreach to veterans. 
Sec. 303. Definition of surviving spouse.
Sec. 304. Ensuring only licensed health care professionals perform medical dis-
ability examinations under certain Department of Veterans Af-
fairs pilot program. 
Sec. 305. Provision of information regarding an agent or attorney to a licensed 
health care professional who performs a medical disability ex-
amination under certain Department of Veterans Affairs pilot 
program. 
Sec. 306. Modernization of Department of Veterans Affairs disability benefit 
questionnaires. 
Sec. 307. Department of Veterans Affairs automatic processing of certain 
claims for temporary disability ratings. 
TITLE IV—HOMELESSNESS MATTERS 
Sec. 401. Short title. 
Sec. 402. Per diem payments provided by the Secretary of Veterans Affairs for 
services furnished to homeless veterans. 
Sec. 403. Authorization for Secretary of Veterans Affairs to use of certain 
funds for improved flexibility in assistance to homeless vet-
erans. 
Sec. 404. Access to Department of Veterans Affairs telehealth services. 
TITLE V—OVERSIGHT AND INVESTIGATIONS MATTERS 
Sec. 501. Department of Veterans Affairs employee training regarding Office of 
Inspector General. 
Sec. 502. Annual review of security at covered facilities of the Department of 
Veterans Affairs. 
Sec. 503. Modification of certain housing loan fees. 
TITLE I—HEALTH CARE 
MATTERS 
Subtitle A—Veterans Community 
Care Program Matters 
SEC. 101. IMPLEMENTATION OF PROVISION OF CARE 
UNDER VETERANS COMMUNITY CARE PRO-
GRAM 
UPON 
DETERMINATION 
OF 
ELIGI-
BILITY BY VETERAN AND VETERAN’S REFER-
RING CLINICIAN. 
(a) IN GENERAL.—During the period specified in 
subsection (c), the Secretary of Veterans Affairs shall im-
plement section 1703(d)(1)(E) of title 38, United States
Code, in compliance with the implementing regulations for 
such section under section 17.4010(a)(5) of title 38, Code 
of Federal Regulations, such that the determination of eli-
gibility for care is final and shall be made by the veteran 
and the veteran’s referring clinician. 
(b) CORRECTION OF ERRORS.—A covered veteran 
and the referring clinician of such veteran may correct any 
errors made with respect to a determination described in 
subsection (a). 
(c) PERIOD SPECIFIED.—The period specified in this 
subsection is the two-year period beginning on the date 
that is 90 days after the date of the enactment of this 
Act. 
(d) REPORT.—Not later than one year and not later 
than two years after the commencement of the period 
specified by subsection (c), the Secretary of Veterans Af-
fairs shall submit to Congress a report on the care pro-
vided under section 1703(d)(1)(E) of title 38, United 
States Code, during the one-year period preceding the date 
of the report, including— 
(1) the number of instances of care provided; 
(2) the type of care provided; and 
(3) the cost of such care. 
(e) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to limit the Secretary’s authority
to prescribe, amend, or rescind regulations under section 
1703 of title 38, United States Code. 
(f) COVERED VETERAN DEFINED.—In this section, 
the term ‘‘covered veteran’’ has the meaning given that 
term in section 1703(b) of title 38, United States Code. 
SEC. 102. OUTREACH REGARDING CARE AND SERVICES 
UNDER VETERANS COMMUNITY CARE PRO-
GRAM. 
(a) REQUIREMENT.—Section 1703 of title 38, United 
States Code, is further amended— 
(1) by redesignating subsection (o) as sub-
section (p); and 
(2) by inserting after subsection (n) the fol-
lowing new subsection (o): 
‘‘(o) OUTREACH REGARDING AVAILABILITY OF CARE 
AND SERVICES.—(1) The Secretary shall conduct out-
reach to inform veterans of the following: 
‘‘(A) The conditions for care or services under 
subsections (d) and (e). 
‘‘(B) How to request such care or services. 
‘‘(C) How to appeal a denial of a request for 
such care or services using the clinical appeals proc-
ess of the Veterans Health Administration. 
‘‘(2) Upon enrollment of a veteran in the system of 
annual patient enrollment established and operated under
section 1705 of this title, and not less frequently than 
every two years thereafter, the Secretary shall inform the 
veteran of information described in paragraph (1). 
‘‘(3) The Secretary shall ensure that information de-
scribed in paragraph (1) is— 
‘‘(A) publicly displayed in each medical facility 
of the Department; 
‘‘(B) prominently displayed on a website of the 
Department; and 
‘‘(C) included in other outreach campaigns and 
activities conducted by the Secretary.’’. 
(b) SOLID START PROGRAM.—Section 6320(a)(2)(A) 
of title 38, United States Code, is amended by inserting 
‘‘, including how to enroll in the system of annual patient 
enrollment established and operated under section 1705 
of this title and the ability to seek care and services under 
sections 1703 and 1710 of this title’’ before the semicolon. 
(c) COMPTROLLER
GENERAL
REPORT
ON
OUT-
REACH.—Not later than two years after the date of the 
enactment of this Act, the Comptroller General of the 
United Stats shall submit to Congress a report on the ef-
forts of the Secretary of Veterans Affairs to ensure that 
veterans are informed of the conditions for eligibility for 
care and services under section 1703 of title 38, United 
States Code, including such efforts to conduct outreach
pursuant to subsection (q) of such section (as added by 
subsection (a)). 
SEC. 103. ANNUAL REVIEW AND REPORT ON WAIVERS OF 
CERTAIN PAYMENT RATES UNDER VETERANS 
COMMUNITY CARE PROGRAM. 
(a) IN GENERAL.—Section 1703 of title 38, United 
States Code, is further amended— 
(1) by redesignating subsection (p) as sub-
section (q); and 
(2) by inserting after subsection (p) the fol-
lowing new subsection (q): 
‘‘(q) ANNUAL REVIEW AND REPORT ON WAIVERS OF 
PAYMENT RATES.—(1) On an annual basis, the Secretary 
shall— 
‘‘(A) conduct a review of waivers of payment 
rates under subsection (i) for Third Party Adminis-
trators to identify whether such waivers help to al-
leviate community-specific challenges, including scar-
city of medical services associated with access to 
health care; and 
‘‘(B) submit to Congress a report on the results 
of such review. 
‘‘(2) Each report under paragraph (1)(B) shall in-
clude, with respect to the period covered by the report—
‘‘(A) a statement, disaggregated by region, of 
the total number of waivers described in subpara-
graph (A) of such paragraph requested by Third 
Party Administrators; 
‘‘(B) a statement of the total number of such 
waivers that were— 
‘‘(i) granted by the Secretary; 
‘‘(ii) denied by the Secretary; or 
‘‘(iii) withdrawn by a Third Party Admin-
istrator; 
‘‘(C) a description of the process for the review 
required under paragraph (1); 
‘‘(D) a statement, disaggregated by region, of 
the average time to process such waivers; 
‘‘(E) an assessment, disaggregated by region, of 
the extent to which such waivers that were granted 
by the Secretary improved access to health care for 
covered veterans; and 
‘‘(F) a description of trends, if any, identified 
by the Secretary with respect to such waivers. 
‘‘(3) In this subsection, the term ‘Third Party Ad-
ministrator’ has the meaning given such term in section 
1703B of this title.’’. 
(b) DEADLINE.—The Secretary shall submit the first 
report required under subsection (q) of section 1703 of
such title (as added by subsection (a)) not later than 180 
days after the date of the enactment of this Act. 
SEC. 104. MODIFICATION OF REQUIREMENTS FOR STAND-
ARDS FOR QUALITY OF CARE FROM DEPART-
MENT OF VETERANS AFFAIRS. 
(a) IN GENERAL.—Section 1703C of title 38, United 
States Code, is amended— 
(1) in subsection (a)— 
(A) in paragraph (2)— 
(i) by striking ‘‘In establishing’’ and 
inserting ‘‘(A) In establishing’’; and 
(ii) by adding at the end the following 
new subparagraph: 
‘‘(B) The Secretary shall ensure that the stand-
ards for quality established under paragraph (1) are 
comparable to industry standards to ensure there is 
adequate data transference between care furnished 
by the Department and care furnished by a non-De-
partment provider.’’; 
(B) in paragraph (3), by adding at the end 
the following new clause: 
‘‘(v) Outcomes relating to patient 
quality of life.’’; 
(C) in paragraph (4)—
(i) by striking ‘‘and the Centers for 
Medicare & Medicaid Services’’ and insert-
ing ‘‘the Centers for Medicare & Medicaid 
Services, and the Indian Health Service’’; 
and 
(ii) by striking ‘‘and other nongovern-
mental entities’’ and inserting ‘‘and other 
non-governmental entities including Third 
Party Administrators’’; and 
(D) by striking paragraph (5) and insert-
ing the following new paragraphs: 
‘‘(5) When collecting, considering, and applying data 
related to patient care for purposes of establishing stand-
ards for quality under paragraph (1), the Secretary shall 
ensure no metric is being over or under analyzed. 
‘‘(6) In establishing standards for quality under para-
graph (1), the Secretary shall— 
‘‘(A) utilize the most up-to-date practices for 
extracting and analyzing relevant data; 
‘‘(B) utilize all relevant data available to the 
Secretary; 
‘‘(C) ensure the most efficient use of time and 
resources related to the use of data scientists em-
ployed by the Department; and
‘‘(D) collaborate, as appropriate, with entities 
specified in paragraph (4). 
‘‘(7)(A) Not less frequently than once every five 
years, the Secretary shall update the standards for quality 
established under paragraph (1) pursuant to the require-
ments for the establishment of such standards under this 
subsection. 
‘‘(B) Not later than 30 days after any date on which 
the Secretary updates, pursuant to subparagraph (A), the 
standards for quality under paragraph (1), the Secretary 
shall submit to the appropriate committees of Congress 
a report on such updated standards for quality.’’; and 
(2) in subsection (b)— 
(A) in paragraph (1)— 
(i) by striking ‘‘Not later than 1 year 
after the date on which the Secretary es-
tablishes standards for quality under sub-
section (a)’’ and inserting ‘‘Not less fre-
quently than once every three years’’; and 
(ii) by inserting ‘‘pursuant to stand-
ards for quality under subsection (a)’’ 
after ‘‘medical facilities of the Depart-
ment’’; and 
(B) in paragraph (2), by inserting ‘‘or up-
dates’’ after ‘‘establishes’’.
(b) DEADLINE FOR UPDATE.—The Secretary, pursu-
ant to paragraph (7) of section 1703C(a) of title 38, 
United States Code (as added by subsection (a)), shall 
make the first update to the standards for quality estab-
lished under paragraph (1) of such section not later than 
the date that is five years after the date on which the Sec-
retary submits the report under paragraph (2) of sub-
section (d). 
(c) REPORT.—Not later than one year after the date 
of the enactment of this Act, the Secretary of Veterans 
Affairs shall submit to the appropriate committees of Con-
gress a report on how the Secretary— 
(1) has consulted with entities specified in para-
graph (4) of section 1703C(a) of title 38, United 
States Code, before the date of the enactment of this 
Act in establishing standards for quality under such 
section; 
(2) has continued to consult with those entities 
on and after such date of enactment; and 
(3) intends to leverage data sciences to improve 
standards for quality care furnished by the Depart-
ment of Veterans Affairs. 
(d) UPDATES TO QUALITY CARE METRICS.— 
(1) INITIAL REPORT.—Not later than one year 
after the date of the enactment of this Act, the Sec-
retary of Veterans Affairs shall submit to the appro-
priate committees of Congress a report on how the 
Secretary plans to implement the amendments made 
by subsections (a). 
(2) DEADLINE; SUMMARY REPORT.—Not later 
than two years after the date of the enactment of 
this Act, the Secretary shall— 
(A) implement the amendments made by 
subsection (a), including by updating the stand-
ards for quality established under section 
1703C of title 38, United States Code; and 
(B) submit to the appropriate committees 
of Congress a report detailing the standards for 
quality updated pursuant to such amendments. 
(e) AUDIT OF QUALITY CARE METRICS.— 
(1) IN
GENERAL.—Not later than 180 days 
after the date of the enactment of this Act, the Sec-
retary of Veterans Affairs shall enter into one or 
more contracts with a non-Department entity de-
scribed in paragraph (2) to conduct an audit on the 
quality of care from the Department of Veterans Af-
fairs, including through non-Department health care 
providers pursuant to section 1703 of title 38 
United States Code.
(2) NON-DEPARTMENT ENTITY DESCRIBED.—A 
non-Department entity described in this paragraph 
is an entity that— 
(A) specializes in analyzing large-scale or-
ganizational data collection and analysis efforts, 
especially with respect to the health care sector; 
and 
(B) has experience and proven outcomes in 
optimizing the accuracy and comprehensiveness 
of data collection and analysis related to the 
quality of health care services. 
(3) ELEMENTS.—The audit required under 
paragraph (1) shall include the following: 
(A) An assessment of the methodology 
used by the Department to collect and assess 
data on the quality of care furnished by the De-
partment, including any vulnerabilities in such 
methodology. 
(B) An assessment of the accuracy and re-
liability of the data sources used by the Depart-
ment to compile data on the quality of care fur-
nished by the Department. 
(C) The extent to which the standards the 
Department uses to assess the quality of care 
furnished by the Department are—
(i) comparable with industry stand-
ards; 
(ii) easily accessible to, and under-
stood by— 
(I) veterans; 
(II) employees of the Depart-
ment; and 
(III) other individuals, as the pri-
vate sector entity considers appro-
priate. 
(D) Any recommendations of such private 
sector entity with respect to improvements that 
the Secretary could administer to more accu-
rately capture the quality of care furnished by 
the Department. 
(4) REPORTS ON AUDIT.— 
(A) REPORT
ON
FINDINGS
AND
REC-
OMMENDATIONS.—Not later than 60 days after 
any date on which a private sector entity de-
scribed in paragraph (2) completes an audit 
under paragraph (1), such private sector entity 
shall submit to the Secretary, the Committee on 
Veterans’ Affairs of the Senate, and the Com-
mittee on Veterans’ Affairs of the House of 
Representatives a report that includes—
(i) the findings of such audit; and 
(ii) recommendations of such private 
sector entity with respect to such audit. 
(B) REPORT
ON
PLANNED
IMPROVE-
MENTS.—Not later than 60 days after any date 
on which the Secretary receives a report under 
subparagraph (A), the Secretary shall submit to 
the Committee on Veterans’ Affairs of the Sen-
ate and the Committee on Veterans’ Affairs of 
the House of Representatives a report on how 
the Secretary plans to improve the standards 
for quality of care of the Department. 
(f) APPROPRIATE COMMITTEES OF CONGRESS DE-
FINED.—In this section, the term ‘‘appropriate commit-
tees of Congress’’ has the meaning given such term in sec-
tion 1703C of title 38, United States Code. 
SEC. 105. PILOT PROGRAM TO IMPROVE ADMINISTRATION 
OF CARE UNDER VETERANS COMMUNITY 
CARE PROGRAM. 
(a) ESTABLISHMENT.—Pursuant to section 1703E of 
title 38, United States Code, the Secretary of Veterans 
Affairs, acting through the Center for Innovation for Care 
and Payment established under such section, shall carry 
out a pilot program to seek to develop and implement a 
plan—
(1) to provide monetary and non-monetary in-
centives to a covered health care provider— 
(A) to allow the Secretary to see the sched-
uling system of the provider, to assess the avail-
ability of, and to assist in scheduling appoint-
ments for, veterans under the Veterans Com-
munity Care Program under section 1703 of 
such title, including through synchronous, asyn-
chronous, and asynchronous assisted digital 
scheduling; 
(B) to complete continuing professional 
educational training available through the VHA 
TRAIN program (or any successor program or 
initiative) regarding veteran cultural com-
petency, the opioid safety initiative (or any suc-
cessor program or initiative), and other subjects 
determined appropriate by the Secretary; 
(C) to improve methods of accounting for 
non-Department training that is equivalent or 
substantially similar to the continuing profes-
sional educational training described in sub-
paragraph (B); 
(D) to improve the rate of the timely re-
turn to the Secretary of medical record docu-
scribed in subparagraph (D) of subsection 
(a)(1) has improved; 
(C) the timeliness and quality of the deliv-
ery of care and services described in subpara-
graph (E) of such subsection has improved; and 
(D) the frequency of no-show appointments 
described in paragraph (2) of such subsection 
decreased; 
(2) a list of the continuing professional edu-
cational training courses under subparagraph (B) of 
such subsection available to covered health care pro-
viders; 
(3) the rate of participation in such continuing 
professional education training courses; and 
(4) any other matter the Secretary determines 
appropriate. 
(c) DEFINITIONS.—In this section: 
(1) The term ‘‘covered health care provider’’ 
means a health care provider— 
(A) described in subsection (c) of section 
1703 of title 38, United States Code, that fur-
nishes care or services under the Veterans Com-
munity Care Program pursuant to a contract or 
agreement with a Third Party Administrator; 
or
(B) that otherwise furnishes care or serv-
ices outside of Department facilities pursuant 
to a contract or agreement with the Secretary 
of Veterans Affairs. 
(2) The term ‘‘opioid safety initiative’’ means 
the programs, processes, and guidelines of the Vet-
erans Health Administration of the Department of 
Veterans Affairs relating to the management of 
opioid therapy and chronic pain. 
(3) The term ‘‘Third Party Administrator’’ 
means an entity that manages a network of health 
care providers and performs administrative services 
related to such network under section 1703 of such 
title. 
(4) The term ‘‘VHA TRAIN program’’ means 
the free program of the Veterans Health Adminis-
tration that offers veteran-specific continuing med-
ical education courses. 
SEC. 106. PILOT PROGRAM ON CONSOLIDATING APPROVAL 
PROCESS OF DEPARTMENT OF VETERANS AF-
FAIRS FOR COVERED DENTAL CARE. 
(a) IN GENERAL.—Not later than 180 days after the 
date of the enactment of this Act, the Secretary of Vet-
erans Affairs, acting through the Center for Innovation 
for Care and Payment established under section 1703E
of title 38, United States Code, shall carry out a pilot pro-
gram under which the Secretary shall hire— 
(1) general dentists at medical facilities of the 
Department of Veterans Affairs to manage approval 
by the Department of treatment plans requested by 
dental providers in providing covered dental care; 
and 
(2) dental specialists at Veterans Integrated 
Service Networks of the Department to manage ap-
proval by the Department of treatment plans for 
specialty dental care requested by dental providers 
in providing covered dental care. 
(b) LOCATIONS.—The Secretary shall carry out the 
pilot program in not fewer than two Veterans Integrated 
Service Networks of the Department. 
(c) REPORTS.— 
(1) INITIAL REPORT.—Not later than one year 
after the date of the commencement of such pilot 
program, the Secretary shall submit to the Commit-
tees on Veterans’ Affairs of the Senate and the 
House of Representatives a report on the pilot pro-
gram, that includes— 
(A) an identification of the Veterans Inte-
grated Service Networks participating in such 
pilot program;
(B) a description of the implementation of 
such pilot program; 
(C) an identification of any barriers or 
challenges to implementing such pilot program; 
(D) an assessment of the efficacy of hiring 
general dentists and dental specialists pursuant 
to such pilot program; 
(E) aggregated feedback with respect to 
such pilot program from dentists of the Depart-
ment in Veterans Integrated Service Networks 
participating in such pilot program; and 
(F) aggregated feedback from dental pro-
viders providing covered dental care within such 
Veterans Integrated Service Networks regard-
ing any changes in the timeliness of treatment 
plan approvals by the Department. 
(2) FINAL REPORT.—Not later than 90 days 
before the date of the completion of such pilot pro-
gram, the Secretary shall submit to the Committees 
on Veterans’ Affairs of the Senate and the House of 
Representatives a report on the pilot program that— 
(A) includes, with respect to the period 
covered by the report, each element of the re-
port required under paragraph (1) described in
subparagraphs (A) through (F) of such para-
graph; 
(B) includes recommendations of the Sec-
retary on whether the pilot program should 
be— 
(i) extended; 
(ii) expanded; or 
(iii) adopted throughout the Depart-
ment; and 
(C) indicates whether the Secretary re-
quests action by Congress to make the pilot 
program permanent. 
(d) SUNSET.—The authority to carry out the pilot 
program under this section shall terminate on the date 
that is two years after the date of the enactment of this 
Act. 
(e) COVERED DENTAL CARE DEFINED.—In this sec-
tion, the term ‘‘covered dental care’’ means dental care 
provided— 
(1) under section 1703 of title 38, United 
States Code; or 
(2) pursuant to a Veterans Care Agreement 
under section 1703A of such title.
SEC. 107. STRATEGIC PLAN ON VALUE-BASED HEALTH 
CARE SYSTEM FOR VETERANS HEALTH AD-
MINISTRATION; PILOT PROGRAM. 
(a) ESTABLISHMENT OF WORKING GROUP.— 
(1) IN
GENERAL.—Not later than one year 
after the date of the enactment of this Act, the Sec-
retary of Veterans Affairs shall— 
(A) establish a working group on value- 
based care; and 
(B) submit to the Committees on Veterans’ 
Affairs of the House of Representatives and the 
Senate the strategic plan developed by the 
working group pursuant to subsection (b). 
(2) MEMBERSHIP.— 
(A) REQUIRED
MEMBERS.—The working 
group shall include, at a minimum, the fol-
lowing members: 
(i) The Under Secretary for Health of 
the Department of Veterans Affairs. 
(ii) The Director of the Office of Men-
tal Health and Suicide Prevention of the 
Department of Veterans Affairs (or any 
successor office). 
(iii) The Director of the Office of In-
tegrated Veteran Care of the Department 
(or any successor office).
(iv) The Director of the Office of 
Rural Health of the Department (or any 
successor office). 
(v) The Director of the Office of Con-
nected Care of the Department (or any 
successor office). 
(vi) The Assistant Secretary for the 
Office of Information Technology (or any 
successor office). 
(vii) The Chief Officer of the Office of 
Healthcare Innovation and Learning of the 
Office of Discovery, Education, and Affil-
iate Networks of the Veterans Health Ad-
ministration (or any successor office). 
(viii) An individual designated by the 
Secretary from the Center for Innovation 
for Care and Payment of the Department 
under section 1703E of title 38, United 
States Code. 
(ix) An individual designated by the 
Administrator of the Centers for Medicare 
& Medicaid Services from the Center for 
Medicare and Medicaid Innovation. 
(x) An individual designated by the 
Secretary of Health and Human Services
from the Federal Office of Rural Health 
Policy of the Health Resources and Serv-
ices Administration. 
(xi) The Chief of Human Capital 
Management for the Veterans Health Ad-
ministration. 
(xii) An individual designated by the 
Secretary of Defense that is a representa-
tive of the Defense Health Agency. 
(xiii) An individual selected by the 
Secretary of Veterans Affairs from the spe-
cial medical advisory group established 
under section 7312 of title 38, United 
States Code. 
(B) OPTIONAL MEMBERS.—The Secretary 
of Veterans Affairs may appoint any of the fol-
lowing individuals as members of the working 
group: 
(i) An individual representing the 
Health and Medicine Division of the Na-
tional Academies of Sciences, Engineering, 
and Medicine. 
(ii) Three individuals representing a 
private health care system that has made 
the transition to value-based care.
(2) An assessment of the capacity needs of the 
Veterans Health Administration during the five-year 
period beginning on the date of the enactment of 
this Act. 
(3) An analysis of the leadership of the Vet-
erans Health Administration, including an assess-
ment of leadership acumen and ability to implement 
a clear, shared vision and effective change manage-
ment and care coordination. 
(4) An identification of goals for the future of 
the Veterans Health Administration. 
(5) An identification and classification of the 
current capabilities, capacity, and gaps in access and 
quality of the health care system of the Department 
of Veterans Affairs. 
(6) An analysis of value-based care models, in-
cluding— 
(A) a selection of potential models that 
would best work for the Veterans Health Ad-
ministration; 
(B) the capacity and capabilities of each 
such model; and 
(C) a thorough justification of the selection 
of each selected model, including an summary
of the ability of such model to improve the 
metrics described under paragraph (9). 
(7) A definition of what quality means with re-
spect to— 
(A) access to health care under the laws 
administered by the Secretary of Veterans Af-
fairs; and 
(B) delivery of such health care. 
(8) A definition of what value means with re-
spect to care furnished by the Veterans Health Ad-
ministration, 
(9) A system for measuring value within the 
Veterans 
Health 
Administration 
that 
includes 
metrics for— 
(A) outcomes; 
(B) safety; 
(C) service; 
(D) access; 
(E) productivity; 
(F) capacity; and 
(G) total cost of patient care. 
(10) With respect to the system described in 
subparagraph (H), an analysis of variable value with 
respect to patient outcomes across different health 
care types and specialties.
(11) An assessment of— 
(A) previous or ongoing assessments of the 
current information technology infrastructure of 
the Veterans Health Administration, includ-
ing— 
(i) such assessments conducted pursu-
ant to the Electronic Health Record Mod-
ernization program of the Department of 
Veterans Affairs; and 
(ii) any other ongoing information 
technology modernization programs of such 
Department and any unimplemented rel-
evant recommendations from such assess-
ments; 
(B) the information technology infrastruc-
ture of the Veterans Health Administration in 
effect as of the date of the enactment of this 
Act; 
(C) the value-driven framework of the De-
partment, in effect as of the date of the enact-
ment of this Act, for evaluating health care in-
novations, and how improvements in such 
framework could be used to encourage innova-
tion; and
(D) workforce challenges and needs of the 
Veterans Health Administration based on— 
(i) reviews of workforce assessment 
data available as of the date of the enact-
ment of this Act; and 
(ii) the findings of— 
(I) the report required by section 
301(d) 
of 
the 
Veterans 
Access, 
Choice, and Accountability Act of 
2014 (Public Law 113–146); 
(II) the reports required by sec-
tion 505 of the John S. McCain III, 
Daniel K. Akaka and Samuel R. 
Johnson VA Maintaining Internal 
Systems 
and 
Strengthening 
Inte-
grated Outside Networks Act of 2018 
(Public Law 115–182); 
(III) the report required by sec-
tion 301 of the VA Choice and Qual-
ity Employment Act of 2017 (Public 
Law 115–46); and 
(IV) any comprehensive health 
care inspection conducted by the In-
spector General of the Department of
Veterans Affairs as of the date of the 
enactment of this Act. 
(12) Any recommendations of the working 
group with respect to improving the information 
technology infrastructure described in clause (i) of 
subparagraph (J). 
(13) An analysis of how the value-driven frame-
work described in clause (iii) of such subparagraph 
could be used to improve the model of care delivery 
by the Department. 
(14) A description of how a value-based care 
system would apply to primary care, inpatient and 
outpatient mental health care, and inpatient and 
outpatient substance use treatment, spinal cord in-
jury disorder care, and polytrauma care furnished by 
the Veterans Health Administration. 
(15) With respect to legislative or administra-
tive action necessary to incorporate value-based care 
models into the Veterans Health Administration, a 
description of the estimated timelines, effect on 
workforce, and costs. 
(c) PILOT PROGRAM.— 
(1) IN
GENERAL.—Not later than 180 days 
after the submission of the strategic plan pursuant 
to subsection (b), the Secretary of Veterans Affairs,
acting through the Center for Innovation for Care 
and Payment established under section 1703E of 
title 38, United States Code, shall commence a 
three-year pilot program under which the Secretary 
shall implement the elements of such strategic plan 
relating to the delivery, by the Veterans Health Ad-
ministration, of primary care, inpatient and out-
patient mental health treatment, inpatient and out-
patient substance abuse treatment, spinal cord in-
jury disorder care, and polytrauma care. 
(2) LOCATIONS.—The Secretary shall carry out 
such pilot program in four Veterans Integrated 
Service Networks that are geographically dispersed 
and shall include the following: 
(A) A Veterans Integrated Service Net-
work that predominately serves veterans in 
rural and highly rural areas. 
(B) A Veterans Integrated Service Net-
work that predominately serves veterans in 
urban areas. 
(C) A Veterans Integrated Service Net-
work that has a high rate of suicide among vet-
erans.
(D) A Veterans Integrated Service Net-
work that has a high rate of substance use dis-
order among veterans. 
(E) A Veterans Integrated Service Net-
work that has access or productivity challenges. 
(3) REPORTS TO CONGRESS.— 
(A) ANNUAL REPORT.—Not later than one 
year after the commencement of the pilot pro-
gram, and annually thereafter during the dura-
tion of the pilot program, the Secretary shall 
submit to Congress a report on the pilot pro-
gram. 
(B) FINAL REPORT.—Not later than 90 
days before the conclusion of the pilot program, 
the Secretary shall submit to Congress a final 
report on the pilot program that includes— 
(i) lessons learned during the adminis-
tration of such pilot program; and 
(ii) specific health outcomes in veteran 
patient care compared to the Veterans 
Health Administration system of care in 
effect as of the date of the enactment of 
this Act.
SEC. 108. PLAN ON ADOPTION OF CERTAIN HEALTH INFOR-
MATION STANDARDS FOR DEPARTMENT OF 
VETERANS AFFAIRS AND CERTAIN HEALTH 
CARE PROVIDERS. 
(a) PLAN
FOR CERTAIN HEALTH INFORMATION 
STANDARDS.— 
(1) IN GENERAL.—The Secretary of Veterans 
Affairs, in consultation with the Secretary of Health 
and Human Services, the Administrator of the Cen-
ters for Medicare & Medicaid Services, and the Na-
tional Coordinator for Health Information Tech-
nology of the Department of Health and Human 
Services, shall create and implement a plan to adopt, 
as rapidly and to the most comprehensive extent fea-
sible, national health information interoperability 
standards for the Department of Veterans Affairs 
and community care providers with respect to— 
(A) coordination of— 
(i) care; and 
(ii) benefits; 
(B) patient identity matching; 
(C) measurement and reporting of quality; 
(D) population health; and 
(E) public health.
(2) CONSIDERATION.—In developing the plan 
under paragraph (1), the Secretary of Veterans Af-
fairs shall consider challenges faced by— 
(A) small community care providers; and 
(B) community care providers located in 
rural areas. 
(b) PLAN ON ELECTRONIC HEALTH RECORD EX-
CHANGE.— 
(1) IN
GENERAL.—Not later than one year 
after the date of enactment of this Act, the Sec-
retary shall submit to the Committees on Veterans’ 
Affairs of the Senate and the House of Representa-
tives a plan to provide, at no cost, to community 
care providers of the Department, through Third 
Party Administrators, a capability to facilitate the 
electronic direct exchange, between such providers 
and the Department, of— 
(A) the health records of veterans; and 
(B) documents relating to health care of 
veterans, clinical notes, and any other informa-
tion the Secretary determines necessary. 
(2) PRIORITIZATION.—In developing the plan 
required under paragraph (1), the Secretary shall 
prioritize providing the capability described in such 
paragraph to community care providers that—
(A) provide care under the laws adminis-
tered by the Secretary to— 
(i) a lower volume of veterans; and 
(ii) veterans who are located in rural 
areas; and 
(B) are unable or unwilling to exchange 
the records and documents described in sub-
paragraphs (A) and (B) of such paragraph with 
the Department through standards-based or di-
rect exchange mechanisms in effect as of the 
date of the enactment of this Act. 
(c) REPORTS
ON PLAN
FOR INTEROPERABILITY 
STANDARDS.— 
(1) INITIAL REPORT.—Not later than one year 
after the date of the enactment of this Act, the Sec-
retary of Veterans Affairs shall submit to the Com-
mittees on Veterans’ Affairs of the Senate and the 
House of Representatives— 
(A) the plan required by subsection (a); 
and 
(B) a report that includes— 
(i) an analysis of gaps, if any, be-
tween the use, by the Department and 
other agencies, health information ex-
changes, and technology companies, of na-
tional health information interoperability 
standards and the potential, or optimal, 
use of such national health information 
interoperability standards; 
(ii) an analysis and description of the 
participation by the Department, commu-
nity care providers, and other relevant en-
tities in the Trusted Exchange Framework 
and Common Agreement program of the 
Department of Health and Human Serv-
ices as of the date of the enactment of this 
Act; 
(iii) recommendations of the Secretary 
with respect to development of health in-
formation interoperability standards; 
(iv) timelines or schedules to imple-
ment the plan required by subsection (a); 
and 
(v) an identification of any legislative 
authorities or resources the Secretary re-
quires to implement such plan. 
(2) RECURRING REPORT REQUIREMENT.— 
(A) IN
GENERAL.—Not later than 18 
months after the date of the enactment of this 
Act, and every 180 days thereafter for four
years, the Secretary of Veterans Affairs shall 
submit to Committees on Veterans’ Affairs of 
the Senate and the House of Representatives a 
report on the status of implementation of the 
plan required under subsection (a). 
(B) ELEMENTS
OF
SUBSEQUENT
RE-
PORTS.—Each report under subparagraph (A) 
submitted after the date on which the first re-
port required by such subparagraph is sub-
mitted shall include a description of any revi-
sions to— 
(i) the plan required by subsection (a) 
made during the period covered by the re-
port; and 
(ii) the analysis, recommendations, 
timelines, and legislative authorities re-
ported pursuant to paragraph (1). 
(d) DEFINITIONS.—In this section: 
(1) The term ‘‘community care provider’’ means 
a non-Department health care provider providing 
care (including dental care)— 
(A) under section 1703 of title 38, United 
States Code; 
(B) pursuant to a Veterans Care Agree-
ment under section 1703A of such title; or
(C) under any other law administered by 
the Secretary of Veterans Affairs. 
(2) The term ‘‘Third Party Administrator’’ 
means an entity that manages a provider network 
and performs administrative services related to such 
network under section 1703 of title 38, United 
States Code. 
SEC. 109. REPORT ON USE OF VALUE-BASED REIMBURSE-
MENT MODELS UNDER VETERANS COMMU-
NITY CARE PROGRAM. 
(a) REPORT
ON VALUE-BASED REIMBURSEMENT 
MODELS.—Not later than one year after the date of the 
enactment of this Act, the Secretary of Veterans Affairs, 
in consultation with the Center for Innovation for Care 
and Payment of the Department of Veterans Affairs under 
section 1703E of title 38 United States Code, the Office 
of Integrated Veteran Care of the Department, or suc-
cessor office, and Third Party Administrators, shall sub-
mit to the Committees on Veterans’ Affairs of the House 
of Representatives and the Senate a report containing— 
(1) an assessment of the efforts of the Depart-
ment pursuant to section 1703(i)(5) of such title, to 
incorporate value-based reimbursement models under 
the Veterans Community Care Program to promote 
the provision of high-quality care to veterans; and
(2) such recommendations for legislative or ad-
ministrative action as the Secretary considers appro-
priate regarding the use of value-based reimburse-
ment models throughout the Veterans Community 
Care Program under section 1703 of such title. 
(b) RULE OF CONSTRUCTION.—This section shall not 
be construed to be a pilot program subject to the require-
ments of section 1703E of title 38, United States Code. 
(c) THIRD PARTY ADMINISTRATOR DEFINED.—In 
this section, the term ‘‘Third Party Administrator’’ means 
an entity that manages a provider network and performs 
administrative services related to such network under sec-
tion 1703 of title 38, United States Code. 
SEC. 110. INSPECTOR GENERAL ASSESSMENT OF IMPLE-
MENTATION 
OF 
VETERANS 
COMMUNITY 
CARE PROGRAM. 
(a) IN GENERAL.—Not later than 18 months after 
the date of the enactment of this Act, and periodically 
thereafter, the Inspector General shall assess the perform-
ance of the Department of Veterans Affairs in— 
(1) appropriately identifying veterans eligible 
for care and services under section 1703 of title 38, 
United States Code; 
(2) informing veterans of their eligibility for 
such care and services; and
(3) delivering such care and services in a timely 
manner. 
(b) BRIEFING ON ASSESSMENTS.—Upon the submis-
sion of the assessment required by subsection (a), the In-
spector General of the Department of Veterans Affairs 
shall provide to the Committees on Veterans Affairs of the 
House of Representatives and the Senate a briefing on the 
results of such assessment. 
SEC. 111. COMPTROLLER GENERAL REPORT ON DENTISTRY 
UNDER VETERANS COMMUNITY CARE PRO-
GRAM. 
(a) IN GENERAL.—Not later than one year after the 
date of the enactment of this Act, the Comptroller General 
of the United States shall submit to the Committees on 
Veterans’ Affairs of the Senate and the House of Rep-
resentatives a report on dental care furnished by the Sec-
retary of Veterans Affairs under the Veterans Community 
Care Program under section 1703 of title 38, United 
States Code, that includes a review of— 
(1) the impact current reimbursement rates 
provided by the Department of Veterans Affairs to 
dental providers under such program have on— 
(A) the availability of dental care for vet-
erans; and
(B) the ability of Third Party Administra-
tors to meet their contractual obligations for 
network adequacy; 
(2) the satisfaction of dental providers pro-
viding dental care under such program with the 
processes of the Department for approving dental 
care under such program; and 
(3) the current processes of the Department for 
approving emergent dental care under such program. 
(b) THIRD PARTY ADMINISTRATOR DEFINED.—In 
this section, the term ‘‘Third Party Administrator’’ means 
an entity that manages a provider network and performs 
administrative services related to such network under sec-
tion 1703 of title 38, United States Code. 
Subtitle B—Matters Relating to 
Nursing Home and Other Long 
Term Care and Family Care-
givers 
SEC. 120. INCREASE OF EXPENDITURE CAP FOR NON-
INSTITUTIONAL 
CARE 
ALTERNATIVES 
TO 
NURSING HOME CARE. 
(a) INCREASE
OF
EXPENDITURE
CAP.—Section 
1720C(d) of title 38, United States Code, is amended—
(1) by striking ‘‘The total cost’’ and inserting 
‘‘(1) Except as provided in paragraph (2), the total 
cost’’; 
(2) by striking ‘‘65 percent’’ and inserting ‘‘100 
percent’’; and 
(3) by adding at the end the following new 
paragraph: 
‘‘(2)(A) The total cost of providing services or in-kind 
assistance in the case of any veteran described in subpara-
graph (B) for any fiscal year under the program may ex-
ceed 100 percent of the cost that would otherwise have 
been incurred as specified in paragraph (1) if the Sec-
retary determines, based on a consideration of clinical 
need, geographic market factors, and such other matters 
as the Secretary may prescribe through regulation, that 
such higher total cost is in the best interest of the veteran. 
‘‘(B) A veteran described in this subparagraph is a 
veteran with amyotrophic lateral sclerosis, a spinal cord 
injury, or a condition the Secretary determines to be simi-
lar to such conditions.’’. 
(b) APPLICABILITY.—The amendments made by sub-
section (a) shall apply with respect to fiscal years begin-
ning on or after the date of the enactment of this Act.
SEC. 121. COORDINATION WITH PROGRAM OF ALL-INCLU-
SIVE CARE FOR THE ELDERLY. 
Section 1720C of title 38, United States Code, as 
amended by section 120, is further amended by adding 
at the end the following new subsection: 
‘‘(f) In furnishing services to a veteran under the pro-
gram conducted pursuant to subsection (a), if a medical 
center of the Department through which such program is 
administered is located in a geographic area in which serv-
ices are available to the veteran under a PACE program 
(as such term is defined in sections 1894(a)(2) and 
1934(a)(2) of the Social Security Act (42 U.S.C. 
1395eee(a)(2); 1396u–4(a)(2))), the Secretary shall seek 
to enter into an agreement with the PACE program oper-
ating in that area for the furnishing of such services.’’. 
SEC. 122. AUTHORITY FOR SECRETARY OF VETERANS AF-
FAIRS TO AWARD GRANTS OR CONTRACTS TO 
ENTITIES TO IMPROVE PROVISION OF MEN-
TAL HEALTH SUPPORT TO FAMILY CARE-
GIVERS OF VETERANS. 
Subchapter II of chapter 17 of title 38, United States 
Code, is amended by adding at the end the following new 
section (and conforming the table of sections at the begin-
ning of such chapter accordingly):
‘‘§ 1720K. Grants or contracts to provide mental 
health support to family caregivers of 
veterans 
‘‘(a) AUTHORITY.—The Secretary may award grants 
to carry out, coordinate, improve, or otherwise enhance 
mental health counseling, treatment, or support to the 
family caregivers of veterans participating in the family 
caregiver program. 
‘‘(b) APPLICATION.—(1) To be eligible for a grant or 
contract under this section, an entity shall submit to the 
Secretary an application therefor at such time, in such 
manner, and containing such information as the Secretary 
may require. 
‘‘(2) Each application submitted under paragraph (1) 
shall include the following: 
‘‘(A) A detailed plan for the use of the grant 
or contract. 
‘‘(B) A description of the programs or efforts 
through which the entity will meet the outcome 
measures developed by the Secretary under sub-
section (g). 
‘‘(C) A description of how the entity will dis-
tribute grant or contract amounts equitably among 
areas with varying levels of urbanization. 
‘‘(D) A plan for how the grant or contract will 
be used to meet the unique needs of veterans resid-
ing in rural areas, Native American, Native Hawai-
ian, or Alaska Native veterans, elderly veterans, 
women veterans, and veterans from other under-
served communities. 
‘‘(c) DISTRIBUTION.—The Secretary shall seek to en-
sure that grants and contracts awarded under this section 
are equitably distributed among entities located in States 
with varying levels of urbanization. 
‘‘(d) PRIORITY.—The Secretary shall prioritize 
awarding grants or contracts under this section that will 
serve the following areas: 
‘‘(1) Areas with high rates of veterans enrolled 
in the family caregiver program. 
‘‘(2) Areas with high rates of— 
‘‘(A) suicide among veterans; or 
‘‘(B) referrals to the Veterans Crisis Line. 
‘‘(e) REQUIRED ACTIVITIES.—Any grant or contract 
awarded under this section shall be used— 
‘‘(1) to expand existing programs, activities, 
and services; 
‘‘(2) to establish new or additional programs, 
activities, and services; or 
‘‘(3) for travel and transportation to facilitate 
carrying out paragraph (1) or (2).
‘‘(f) OUTCOME MEASURES.—(1) The Secretary shall 
develop and provide to each entity that receives a grant 
or contract under this section written guidance on the fol-
lowing: 
‘‘(A) Outcome measures. 
‘‘(B) Policies of the Department. 
‘‘(2) In developing outcome measures under para-
graph (1), the Secretary shall consider the following goals: 
‘‘(A) Increasing the utilization of mental health 
services among family caregivers of veterans partici-
pating in the family caregiver program. 
‘‘(B) Reducing barriers to mental health serv-
ices among family caregivers of veterans partici-
pating in such program. 
‘‘(g) TRACKING REQUIREMENTS.—(1) The Secretary 
shall establish appropriate tracking requirements with re-
spect to the entities receiving a grant or contract under 
this section. 
‘‘(2) Not less frequently than annually, the Secretary 
shall submit to Congress a report on such tracking re-
quirements. 
‘‘(h) 
PERFORMANCE
REVIEW.—The 
Secretary 
shall— 
‘‘(1) review the performance of each entity that 
receives a grant or contract under this section; and
‘‘(2) make information regarding such perform-
ance publicly available. 
‘‘(i) REMEDIATION PLAN.—(1) In the case of an enti-
ty that receives a grant or contract under this section and 
does not meet the outcome measures developed by the Sec-
retary under subsection (g), the Secretary shall require the 
entity to submit to the Secretary a remediation plan under 
which the entity shall describe how and when it plans to 
meet such outcome measures. 
‘‘(2) The Secretary may not award a subsequent 
grant or contract under this section to an entity described 
in paragraph (1) unless the Secretary approves the reme-
diation plan submitted by the entity under such para-
graph. 
‘‘(j) MAXIMUM AMOUNT.—The amount of a grant or 
contract awarded under this section may not exceed 10 
percent of amounts made available for grants or contracts 
under this section for the fiscal year in which the grant 
or contract is awarded. 
‘‘(k) SUPPLEMENT, NOT SUPPLANT.—Any grant or 
contract awarded under this section shall be used to sup-
plement and not supplant funding that is otherwise avail-
able through the Department to provide mental health 
support among family caregivers of veterans participating 
in the family caregiver program.
‘‘(l) OUTREACH TO FAMILY CAREGIVERS.—The Sec-
retary shall include, in the outreach materials regularly 
provided to a family caregiver who participates in the fam-
ily caregiver program, notice of mental health support pro-
vided by recipients of grants or contracts under this sec-
tion that are located in the relevant Veterans Integrated 
Service Network. 
‘‘(m) FUNDING.—(1) Amounts for the activities of 
the Department under this section shall be budgeted and 
appropriated through a separate appropriation account. 
‘‘(2) In the budget justification materials submitted 
to Congress in support of the budget of the Department 
for any fiscal year (as submitted with the budget of the 
President under section 1105(a) of title 31), the Secretary 
shall include a separate statement of the amount re-
quested to be appropriated for that fiscal year for the ac-
count specified in paragraph (1). 
‘‘(n) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to the Secretary, for each 
of fiscal years 2025 and 2026, $10,000,000 to carry out 
this section. 
‘‘(o) DEFINITIONS.—In this section: 
‘‘(1) The terms ‘caregiver’ and ‘family care-
giver’ have the meanings given those terms in sec-
tion 1720G of this title.
‘‘(2) The term ‘family caregiver program’ 
means the program of comprehensive assistance for 
family caregivers under section 1720G of this title. 
‘‘(3) The term ‘Veterans Crisis Line’ means the 
toll-free hotline for veterans established under sec-
tion 1720F of this title.’’. 
SEC. 123. HOME- AND COMMUNITY-BASED SERVICES: PRO-
GRAMS. 
(a) PROGRAMS.—Such subchapter is further amend-
ed by inserting after section 1720K (as added by section 
122) the following new section (and conforming the table 
of sections at the beginning of such chapter accordingly): 
‘‘§ 1720L. Home- and community-based services: pro-
grams 
‘‘(a) IN GENERAL.—In furnishing noninstitutional al-
ternatives to nursing home care pursuant to the authority 
of section 1720C of this title (or any other authority under 
this chapter or other provision of law administered by the 
Secretary of Veterans Affairs), the Secretary shall carry 
out each of the programs specified in this section in ac-
cordance with such relevant authorities except as other-
wise provided in this section. 
‘‘(b) VETERAN-DIRECTED CARE PROGRAM.—(1) The 
Secretary of Veterans Affairs, in collaboration with the 
Secretary of Health and Human Services, shall carry out
a program to be known as the ‘Veteran-Directed Care pro-
gram’. Under such program, the Secretary of Veterans Af-
fairs may enter into agreements with the providers de-
scribed in paragraph (2) to provide to eligible veterans 
funds, to the extent practicable, to obtain such in-home 
care services and related items that support clinical need 
and improve quality of life, as may be determined appro-
priate by the Secretary of Veterans Affairs and selected 
by the veteran, including through the veteran hiring indi-
viduals to provide such services and items or directly pur-
chasing such services and items. 
‘‘(2) The providers described in this paragraph are 
the following: 
‘‘(A) An Aging and Disability Resource Center, 
an area agency on aging, or a State agency. 
‘‘(B) A center for independent living. 
‘‘(C) An Indian tribe or tribal organization re-
ceiving assistance under title VI of the Older Ameri-
cans Act of 1965 (42 U.S.C. 3057 et seq.). 
‘‘(D) Any other entity that the Secretary, in 
consultation with the Secretary of Health and 
Human Services, determines appropriate. 
‘‘(3) In carrying out the Veteran-Directed Care pro-
gram, the Secretary of Veterans Affairs shall—
‘‘(A) administer such program through each 
medical center of the Department of Veterans Af-
fairs; 
‘‘(B) seek to ensure the availability of such pro-
gram in American Samoa, Guam, the Common-
wealth of the Northern Mariana Islands, the Com-
monwealth of Puerto Rico, the Virgin Islands of the 
United States, and any other territory or possession 
of the United States, to the extent practicable; and 
‘‘(C) seek to ensure the availability of such pro-
gram for eligible veterans who are Native American 
veterans receiving care and services furnished by the 
Indian Health Service, a tribal health program, an 
Urban Indian organization, or (in the case of a Na-
tive Hawaiian veteran) a Native Hawaiian health 
care system, to the extent practicable. 
‘‘(4) If a veteran participating in the Veteran-Di-
rected Care program is hospitalized, the veteran may con-
tinue to use funds under the program during a period of 
hospitalization in the same manner that the veteran would 
be authorized to use such funds under the program if the 
veteran were not hospitalized. 
‘‘(c) HOMEMAKER AND HOME HEALTH AIDE PRO-
GRAM.—(1) The Secretary shall carry out a program to 
be known as the ‘Homemaker and Home Health Aide pro-
gram’ under which the Secretary may enter into agree-
ments with home health agencies to provide to eligible vet-
erans such home health aide services as may be deter-
mined appropriate by the Secretary. 
‘‘(2) In carrying out the Homemaker and Home 
Health Aide program, the Secretary shall— 
‘‘(A) administer such program in the locations 
specified in subparagraph (A) of subsection (b)(3); 
‘‘(B) seek to ensure the availability of such pro-
gram in the locations specified in subparagraph (B) 
of subsection (b)(3); and 
‘‘(C) seek to ensure the availability of such pro-
gram for the veteran populations specified in sub-
paragraph (C) of subsection (b)(3). 
‘‘(d) HOME-BASED PRIMARY CARE PROGRAM.—The 
Secretary shall carry out a program to be known as the 
‘Home-Based Primary Care program’ under which the 
Secretary may furnish to eligible veterans in-home health 
care, the provision of which is overseen by a provider of 
the Department. 
‘‘(e) PURCHASED SKILLED HOME CARE PROGRAM.— 
The Secretary shall carry out a program to be known as 
the ‘Purchased Skilled Home Care program’ under which 
the Secretary may furnish to eligible veterans such in-
home care services as may be determined appropriate and 
selected by the Secretary for the veteran. 
‘‘(f) CAREGIVER SUPPORT.—(1) With respect to a 
resident eligible caregiver of a veteran participating in a 
program under this section, the Secretary shall— 
‘‘(A) if the veteran meets the requirements of 
a covered veteran under section 1720G(b) of this 
title, provide to such caregiver the option of enroll-
ing in the program of general caregiver support serv-
ices under such section; 
‘‘(B) provide to such caregiver covered respite 
care of not less than 30 days annually; and 
‘‘(C) conduct on an annual basis (and, to the 
extent practicable, in connection with in-person serv-
ices provided under the program in which the vet-
eran is participating), a wellness contact of such 
caregiver. 
‘‘(2) Covered respite care provided to a resident eligi-
ble caregiver of a veteran under paragraph (1) may exceed 
30 days annually if such extension is requested by the resi-
dent eligible caregiver or veteran and determined medi-
cally appropriate by the Secretary. 
‘‘(g) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to limit the authority of the Sec-
retary to carry out programs providing home- and commu-
nity-based services under any other provision of law. 
‘‘(h) DEFINITIONS.—In this section: 
‘‘(1) The terms ‘Aging and Disability Resource 
Center’, ‘area agency on aging’, and ‘State agency’ 
have the meanings given those terms in section 102 
of the Older Americans Act of 1965 (42 U.S.C. 
3002). 
‘‘(2) The terms ‘caregiver’ and ‘family care-
giver’, with respect to a veteran, have the meanings 
given those terms, respectively, under subsection (e) 
of section 1720G of this title with respect to an eli-
gible veteran under subsection (a) of such section or 
a covered veteran under subsection (b) of such sec-
tion, as the case may be. 
‘‘(3) The term ‘center for independent living’ 
has the meaning given that term in section 702 of 
the Rehabilitation Act of 1973 (29 U.S.C. 796a). 
‘‘(4) The term ‘covered respite care’ has the 
meaning given such term in section 1720G(d) of this 
title. 
‘‘(5) The term ‘eligible veteran’ means any vet-
eran— 
‘‘(A) for whom the Secretary determines 
participation in a specific program under this
section is medically necessary to promote, pre-
serve, or restore the health of the veteran; and 
‘‘(B) who absent such participation would 
be at increased risk for hospitalization, place-
ment in a nursing home, or emergency room 
care. 
‘‘(6) The term ‘home health aide’ means an in-
dividual employed by a home health agency to pro-
vide in-home care services. 
‘‘(7) The term ‘in-home care service’ means any 
service, including a personal care service, provided to 
enable the recipient of such service to live at home. 
‘‘(8) The terms ‘Indian tribe’ and ‘tribal organi-
zation’ have the meanings given those terms in sec-
tion 4 of the Indian Self-Determination and Edu-
cation Assistance Act (25 U.S.C. 5304). 
‘‘(9) The terms ‘Native American’ and ‘Native 
American veteran’ have the meanings given those 
terms in section 3765 of this title. 
‘‘(10) The terms ‘Native Hawaiian’ and ‘Native 
Hawaiian health care system’ have the meanings 
given those terms in section 12 of the Native Hawai-
ian Health Care Improvement Act (42 U.S.C. 
11711).
‘‘(11) The terms ‘tribal health programs’ and 
‘Urban Indian organizations’ have the meanings 
given those terms in section 4 of the Indian Health 
Care Improvement Act (25 U.S.C. 1603). 
‘‘(12) The term ‘resident eligible caregiver’ 
means an individual who— 
‘‘(A) is a caregiver, or a family caregiver, 
of a veteran and resides with that veteran; and 
‘‘(B) has not entered into a contract, 
agreement, or other arrangement for such indi-
vidual to act as a caregiver for that veteran un-
less such individual is a family member of the 
veteran or is furnishing caregiver services 
through a medical foster home.’’. 
(b) DEADLINE FOR IMPROVED ADMINISTRATION.— 
The Secretary of Veterans Affairs shall ensure that the 
Veteran-Directed Care program and the Homemaker and 
Home Health Aide program are administered through 
each medical center of the Department of Veterans Affairs 
in accordance with section 1720L of title 38, United 
States Code (as added by subsection (a)), by not later 
than two years after the date of the enactment of this Act. 
(c) ADMINISTRATION OF VETERAN-DIRECTED CARE 
PROGRAM.— 
(1) PROCEDURES.—
(A) The Secretary shall establish proce-
dures to— 
(i) identify the staffing needs for the 
Veteran-Directed Care program of the De-
partment of Veterans Affairs under such 
section (as added by subsection (a)); and 
(ii) define the roles and responsibil-
ities for personnel of the Department re-
sponsible for the administration of such 
program, including such personnel em-
ployed at the national, Veterans Integrated 
Service Network, or medical facility level. 
(B) The responsibilities described in clause 
(ii) of subparagraph (A) shall include respon-
sibilities for engagement with— 
(i) veterans participating in such pro-
gram; 
(ii) veterans interested in partici-
pating in such program; and 
(iii) providers described in section 
1720L(b)(2) (as added by subsection (a)). 
(2) STAFFING
MODEL; REPORT.—Not later 
than two years after enactment of this Act, the Sec-
retary of Veterans Affairs shall—
(A) establish a staffing model for the ad-
ministration of such program at each medical 
facility of the Department of Veterans Affairs; 
and 
(B) submit to the Committees on Veterans’ 
Affairs of the House of Representatives and the 
Senate a report containing the following: 
(i) A description of— 
(I) the staffing model described 
in subparagraph (A); and 
(II) the rationale for such staff-
ing model. 
(ii) An identification of the ratio of 
staff required to administer such program 
to the number of veterans served by such 
program, disaggregated by each medical 
facility of the Department of Veterans Af-
fairs. 
(iii) A description of budgetary re-
sources or other support, if any, required 
to accommodate an increase in staffing at 
medical facilities of the Department of 
Veterans Affairs pursuant to the require-
ments of the staffing model described in 
subparagraph (A).
(iv) Such other matters as the Sec-
retary of Veterans Affairs determines ap-
propriate. 
SEC. 124. COORDINATION WITH ASSISTANCE AND SUPPORT 
SERVICES FOR CAREGIVERS. 
(a) COORDINATION WITH PROGRAM OF COMPREHEN-
SIVE ASSISTANCE FOR FAMILY CAREGIVERS.— 
(1) COORDINATION.—Section 1720G(a) of title 
38, United States Code, is amended by adding at 
the end the following new paragraph: 
‘‘(14)(A) In the case of a veteran or caregiver who 
seeks services under this subsection and is denied such 
services, or a veteran or the family caregiver of a veteran 
who is discharged from the program under this subsection, 
the Secretary shall— 
‘‘(i) if the veteran meets the requirements of a 
covered veteran under subsection (b), provide to 
such caregiver the option of enrolling in the program 
of general caregiver support services under such sub-
section; 
‘‘(ii) assess the veteran or caregiver for partici-
pation in any other available program of the Depart-
ment for home- and community-based services (in-
cluding the programs specified in section 1720L of 
this title) for which the veteran or caregiver may be
eligible and, with respect to the veteran, store (and 
make accessible to the veteran) the results of such 
assessment in the electronic medical record of the 
veteran; and 
‘‘(iii) provide to the veteran or caregiver written 
information on any such program identified pursu-
ant to the assessment under clause (ii), including in-
formation about facilities, eligibility requirements, 
and relevant contact information for each such pro-
gram. 
‘‘(B) The Secretary shall, to the extent practicable, 
provide to a veteran or family caregiver the option of ob-
taining clinically appropriate services under any other 
available program of the Department for home- and com-
munity-based services (including the programs specified in 
section 1720L of this title) for which the veteran or family 
caregiver may be eligible prior to discharging the veteran 
or family caregiver from the program under this sub-
section. 
‘‘(C) For each veteran or family caregiver who is dis-
charged from the program under this subsection, a care-
giver support coordinator shall provide for a smooth and 
personalized transition from such program to an appro-
priate program of the Department for home- and commu-
nity-based services (including the programs specified in
section 1720L of this title), including by integrating care-
giver support across programs.’’. 
(2) APPLICABILITY.—The amendments made 
by paragraph (1) shall apply with respect to denials 
and discharges occurring on or after the date that 
is 180 days after the date of the enactment of this 
Act. 
(3) TECHNICAL
AND
CONFORMING
AMEND-
MENTS.—Section 1720G(d) of such title is amend-
ed— 
(A) by striking ‘‘or a covered veteran’’ 
each place it appears and inserting ‘‘, a veteran 
denied or discharged as specified in paragraph 
(14) of such subsection, or a covered veteran’’; 
and 
(B) by striking ‘‘under subsection (a), 
means’’ each place it appears and inserting 
‘‘under subsection (a) or a veteran denied or 
discharged as specified in paragraph (14) of 
such subsection, means’’. 
(b) CONFORMITY OF RESPITE CARE ACROSS PRO-
GRAMS.—Section 1720G of title 38, United States Code, 
as amended by subsection (a)(3), is further amended— 
(1) in subsection (a)(3)—
(A) by amending subparagraph (A)(ii)(III) 
to read as follows: 
‘‘(III) covered respite care of not less than 
30 days annually;’’; and 
(B) by striking subparagraph (B) and re-
designating subparagraphs (C) and (D) as sub-
paragraphs (B) through (C), respectively; and 
(2) by amending subsection (b)(3)(A)(iii) to 
read as follows: 
‘‘(iii) Covered respite care of not less than 30 
days annually.’’; and 
(3) in subsection (d)— 
(A) 
by 
redesignating 
paragraphs 
(2) 
through (4) as paragraphs (3) through (5), re-
spectively; and 
(B) by inserting after paragraph (1) the 
following new paragraph: 
‘‘(2) The term ‘covered respite care’ means, 
with respect to a caregiver of a veteran, respite care 
under section 1720B of this title that— 
‘‘(A) is medically and age appropriate for 
the veteran (including 24-hour per day care of 
the veteran commensurate with the care pro-
vided by the caregiver); and 
‘‘(B) includes in-home care.’’.
(c) REVIEW RELATING TO CAREGIVER CONTACT.— 
The Secretary shall conduct a review of the capacity of 
the Department to establish a streamlined system for con-
tacting all caregivers enrolled in the program of general 
caregiver support services under section 1720G(b) of title 
38, United States Code, to provide to such caregivers pro-
gram updates and alerts relating to emerging services for 
which such caregivers or the veterans for which they pro-
vide care may be eligible. 
SEC. 125. IMPROVEMENTS TO PROGRAM OF COMPREHEN-
SIVE ASSISTANCE FOR FAMILY CAREGIVERS. 
Section 1720G(a) of title 38, United States Code, as 
amended by section 124, is further amended— 
(1) in paragraph (12)— 
(A) in subparagraph (A), by inserting ‘‘, 
which shall include all criteria used to deter-
mine eligibility for such assistance and, in the 
case of a completed evaluation, how such cri-
teria were used to evaluate information pro-
vided in assessments to determine such eligi-
bility’’ before the period at the end; and 
(B) in subparagraph (C)(i), by striking 
‘‘who submits’’ and all that follows through the 
end of the clause and inserting the following: 
‘‘who—
‘‘(I) submits an application for the pro-
gram established under paragraph (1); or 
‘‘(II) is being reassessed for eligibility to 
continue in such program.’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(15)(A) Not less frequently than annually, the Sec-
retary shall submit to the Committees on Veterans’ Affairs 
of the Senate and the House of Representatives a com-
prehensive report on the program required by paragraph 
(1) that includes, with respect to one-year period pre-
ceding the date of the submission of such report, the fol-
lowing: 
‘‘(i) The number of applications received for 
such program. 
‘‘(ii) The number, disaggregated by race, sex, 
and era and branch of service in the Armed Forces 
of the applicant, of— 
‘‘(I) approvals of such applications; and 
‘‘(II) denials of such applications. 
‘‘(iii) The number of reassessments conducted 
for such program. 
‘‘(iv) An identification of each decision made 
with respect to a reassessment conducted for such 
program, disaggregated by decisions resulting in—
‘‘(I) disenrollment, including removal, dis-
charge, or voluntary withdrawal; 
‘‘(II) tier reduction; and 
‘‘(III) tier continuation. 
‘‘(v) The number of appeals of decisions made 
with respect to such program, disaggregated by type 
of appeal. 
‘‘(vi) With respect to each appeal described in 
clause (v), the decision rendered, if any. 
‘‘(vii) A description of all tools used in assess-
ments conducted for such program, including an ex-
planation of how and by whom such tools are admin-
istered. 
‘‘(viii) A description of procedures used under 
such program for reviewing and integrating clinical 
records from health care providers that includes an 
explanation of how such records are used in deter-
minations of eligibility for such program. 
‘‘(ix) A description of procedures available 
under such program for health care providers to 
communicate medical opinions to the teams con-
ducting assessments to determine eligibility for such 
program, including health care providers in the pri-
vate sector and health care providers specified in 
subsection (c) of section 1703 of this title.
‘‘(x) A description of information technology 
systems and processes used under such program to 
upload and integrate all clinical records from all 
non-Department providers, including providers in 
the private sector and providers under the Veterans 
Community Care Program established under such 
section. 
‘‘(B) The Secretary shall ensure that all data in-
cluded in a report under subparagraph (A)— 
‘‘(i) relating to a decision made under the pro-
gram required by paragraph (1), are disaggregated 
by the specific reason for the decision; 
‘‘(ii) relating to a veteran, include comprehen-
sive demographic information of the veteran, includ-
ing the time period of the injuries, if any, of the vet-
eran and the Veterans Integrated Service Network 
in which the veteran is located; and 
‘‘(iii) with respect to eligibility determinations 
relating to a serious injury of a veteran, specify— 
‘‘(I) how many such determinations relate 
to the ability of the veteran to perform activi-
ties of daily living; and 
‘‘(II) how many such determinations relate 
to the need of a veteran for supervision and 
protection.
‘‘(C) The Secretary shall provide the data under 
paragraph (B) pursuant to Federal laws and in a manner 
that is wholly consistent with applicable Federal privacy 
and confidentiality laws, including but the Privacy Act (5 
U.S.C. 552a), the Health Insurance Portability and Ac-
countability Act (Public Law 104–191; 42 U.S.C. 201 
note) and regulations (title 45, Code of Federal Regula-
tions, parts 160 and 164, or successor regulations), and 
sections 5701, 5705, and 7332 of this title to ensure that 
the provided data, or some portion of the data, will not 
undermine the anonymity of a veteran.’’. 
SEC. 126. IMPROVEMENTS RELATING TO HOMEMAKER AND 
HOME HEALTH AIDE PROGRAM. 
(a) PILOT
PROGRAM
FOR
COMMUNITIES
WITH 
SHORTAGE OF HOME HEALTH AIDES.— 
(1) PROGRAM.—Beginning not later than 18 
months after the date of the enactment of this Act, 
the Secretary shall carry out a three-year pilot pro-
gram under which the Secretary shall provide home-
maker and home health aide services to veterans 
who reside in communities with a shortage of home 
health aides. 
(2) LOCATIONS.—The Secretary shall select not 
fewer than five geographic locations in which the 
Secretary determines there is a shortage of home
health aides at which to carry out the pilot program 
under paragraph (1). 
(3) NURSING ASSISTANTS.— 
(A) IN
GENERAL.—In carrying out the 
pilot program under paragraph (1), the Sec-
retary may hire nursing assistants as new em-
ployees of the Department of Veterans Affairs, 
or reassign nursing assistants who are existing 
employees of the Department, to provide to vet-
erans in-home care services (including basic 
tasks authorized by the State certification of 
the nursing assistant) under the pilot program, 
in lieu of or in addition to the provision of such 
services through non-Department home health 
aides. 
(B) RELATIONSHIP TO HOME-BASED PRI-
MARY
CARE
PROGRAM.—Nursing assistants 
hired or reassigned under subparagraph (A) 
may provide services to a veteran under the 
pilot program under paragraph (1) while serv-
ing as part of a health care team for the vet-
eran under the Home-Based Primary Care pro-
gram. 
(4) REPORT TO CONGRESS.—Not later than one 
year before the date of the termination of the pilot
program under paragraph (1), the Secretary shall 
submit to the Committees on Veterans’ Affairs of 
the House of Representatives and the Senate a re-
port that includes— 
(A) a statement of the results of such pilot 
program; and 
(B) an assessment of the feasibility and 
advisability of— 
(i) extending such pilot program; or 
(ii) making such pilot program a per-
manent program of the Department of 
Veterans Affairs. 
(b) REPORT ON USE OF FUNDS.—Not later than one 
year after the date of the enactment of this Act, the Sec-
retary of Veterans Affairs shall submit to the Committees 
on Veterans’ Affairs of the House of Representatives and 
the Senate a report containing, with respect to the period 
beginning in fiscal year 2012 and ending in fiscal year 
2024, the following: 
(1) An identification of the amount of funds 
that were included in a budget of the Department of 
Veterans Affairs during such period for the provision 
of in-home care to veterans under the Homemaker 
and Home Health Aide program but were not ex-
pended for such provision, disaggregated by medical
center of the Department for which such unex-
pended funds were budgeted (if such disaggregation 
is possible). 
(2) To the extent practicable, an identification 
of the number of veterans for whom, during such pe-
riod, the hours during which a home health aide was 
authorized to provide services to the veteran under 
the Homemaker and Home Health Aide program 
were reduced for a reason other than a change in 
the health care needs of the veteran, and a detailed 
description of the reasons why any such reductions 
may have occurred. 
(c) UPDATED GUIDANCE ON PROGRAM.—Not later 
than one year after the date of the enactment of this Act, 
the Secretary shall issue updated guidance for the Home-
maker and Home Health Aide program. Such updated 
guidance shall include the following: 
(1) A process for the transition of veterans 
from the Homemaker and Home Health Aide pro-
gram to other covered programs. 
(2) A requirement for the directors of the med-
ical facilities of the Department to complete such 
process whenever a veteran with care needs has been 
denied services from home health agencies under the 
Homemaker and Home Health Aide program as a
result of the clinical needs or behavioral issues of the 
veteran. 
SEC. 127. PILOT PROGRAM TO FURNISH ASSISTED LIVING 
SERVICES TO CERTAIN VETERANS. 
(a) ESTABLISHMENT.—Beginning not later than two 
years after the date of the enactment of this Act, the Sec-
retary of Veterans Affairs shall carry out a pilot program 
to assess— 
(1) the effectiveness of providing assisted living 
services to eligible veterans, at the election of such 
veterans; and 
(2) the satisfaction with the pilot program of 
veterans participating in such pilot program. 
(b) PROGRAM LOCATIONS.— 
(1) VETERANS
INTEGRATED
SERVICE
NET-
WORKS.—The Secretary shall select two Veterans 
Integrated Service Networks of the Department of 
Veterans Affairs at which to carry out the pilot pro-
gram under subsection (a). 
(2) FACILITIES.— 
(A) IN
GENERAL.—Within the Veterans 
Integrated Service Networks selected under 
paragraph (1), the Secretary shall select facili-
ties at which to carry out the pilot program 
under subsection (a)(1).
(B) SELECTION
CRITERIA.—In selecting 
facilities under subparagraph (A) at which to 
carry out the pilot program under subsection 
(a)(1), the Secretary shall ensure that— 
(i) the locations of such facilities are 
in geographically diverse areas; 
(ii) not fewer than one such facility 
serves veterans in rural or highly rural 
areas (as determined through the use of 
the Rural-Urban Commuting Areas coding 
system of the Department of Agriculture); 
(iii) not fewer than one such facility is 
located in each Veterans Integrated Service 
Network selected under paragraph (1); and 
(iv) not fewer than one such facility is 
a State home. 
(c) PROGRAM PARTICIPANTS.—Not more than 60 eli-
gible veterans may participate in the pilot program under 
subsection (a)(1) in each Veterans Integrated Service Net-
work selected under subsection (b)(1). 
(d) PROVISION OF ASSISTED LIVING SERVICES.— 
(1) AGREEMENTS.—In carrying out the pilot 
program under subsection (a)(1), the Secretary may 
enter into agreements for the provision of assisted 
living services on behalf of eligible veterans with—
(A) a provider participating under a State 
plan or waiver under title XIX of the Social Se-
curity Act (42 U.S.C. 1396 et seq.); or 
(B) a State home recognized and certified 
under subpart B of part 51 of title 38, Code of 
Federal Regulations, or successor regulations. 
(2) STANDARDS.—The Secretary may not place, 
transfer, or admit a veteran to any facility for as-
sisted living services under the pilot program under 
subsection (a)(1) unless the Secretary determines 
that— 
(A) the facility meets the standards for 
community residential care established under 
sections 17.61 through 17.72 of title 38, Code 
of Federal Regulations, or successor regula-
tions, and any additional standards of care as 
the Secretary may specify; or 
(B) in the case of a facility that is a State 
home, the State home meets such standards of 
care as the Secretary may specify. 
(3) INSPECTION.—The Secretary shall inspect 
facilities at which veterans are placed under the pilot 
program under subsection (a)(1)— 
(A) with respect to a facility that is a 
State home, not less frequently than annually
and in the same manner as the Secretary con-
ducts inspection of State homes under section 
1742 of title 38, United States Code; and 
(B) with respect to any other facility, not 
less frequently than annually and in the same 
manner as the Secretary conducts inspection of 
facilities under section 1730 of such title. 
(4) PAYMENT TO CERTAIN FACILITIES.— 
(A) STATE HOMES.—In the case of a facil-
ity participating in the pilot program under 
subsection (a)(1) that is a State home, the Sec-
retary shall pay to the State home a per diem 
for each veteran participating in the pilot pro-
gram at a rate agreed to by the Secretary and 
the State home. 
(B) COMMUNITY ASSISTED LIVING FACILI-
TIES.—In the case of a facility participating in 
the pilot program under subsection (a)(1) that 
is a community assisted living facility, the Sec-
retary shall— 
(i) pay to the facility an amount that 
is less than the average rate paid by the 
Department for placement in a community 
nursing home in the same Veterans Inte-
grated Service Network; and
(g) ANNUAL REPORT.—Not later than one year after 
the initiation of the pilot program under subsection (a)(1), 
and annually thereafter for the duration of such pilot pro-
gram, the Secretary shall submit to the Committees on 
Veterans’ Affairs of the House of Representatives and the 
Senate a report on the pilot program that includes— 
(1) an identification of Veterans Integrated 
Services Networks and facilities of the Department 
participating in the pilot program and assisted living 
facilities and State homes at which veterans are 
placed under the pilot program; 
(2) the number of participants in the pilot pro-
gram, disaggregated by facility; 
(3) general demographic information of partici-
pants in the pilot program, including average age, 
sex, and race or ethnicity; 
(4) disability status of participants in the pilot 
program; 
(5) an identification of any barriers or chal-
lenges to furnishing care to veterans under the pilot 
program, conducting oversight of the pilot program, 
or any other barriers or challenges; 
(6) the cost of care at each assisted living facil-
ity and State home participating in the pilot pro-
gram, including an analysis of any cost savings by
the Department when comparing that cost to the 
cost of nursing home care; 
(7) aggregated feedback from participants in 
the pilot program, including from veteran resident 
surveys and interviews; and 
(8) such other matters the Secretary considers 
appropriate. 
(h) FINAL REPORT.—Not later than one year after 
the pilot program terminates under subsection (j), the 
Secretary shall submit to the Committees on Veterans’ Af-
fairs of the House of Representatives and the Senate a 
report on the pilot program that— 
(1) includes the matters required under para-
graphs (1) through (8) of subsection (g); 
(2) includes recommendations on whether the 
model studied in the pilot program should be contin-
ued or adopted throughout the Department; and 
(3) indicates whether the Secretary requests ac-
tion by Congress to make the pilot program perma-
nent. 
(i) INSPECTOR GENERAL REPORT.— 
(1) IN GENERAL.—Not later than three years 
after the initiation of the pilot program under sub-
section (a)(1), the Inspector General of the Depart-
ment of Veterans Affairs shall submit to the Sec-
retary of Veterans Affairs and the Committees on 
Veterans’ Affairs of House of Representatives and 
the Senate a report on the pilot program. 
(2) ELEMENTS.—The report required by para-
graph (1) shall include an assessment of— 
(A) the quality of care provided to veterans 
at facilities participating in the pilot program, 
measured pursuant to the method determined 
under subsection (f); 
(B) the oversight of such facilities, as con-
ducted by the Department, the Centers for 
Medicare & Medicaid Services, State agencies, 
and other relevant entities; and 
(C) such other matters as the Inspector 
General considers appropriate. 
(3) PLAN REQUIRED.—Not later than 90 days 
after the submission of the report under paragraph 
(1), the Secretary shall submit to the Committees on 
Veterans’ Affairs of the House of Representatives 
and the Senate a plan to address the deficiencies 
identified in the report, if any. 
(j) TERMINATION.— 
(1) IN GENERAL.—Subject to paragraph (2), 
the pilot program under subsection (a)(1) shall ter-
minate on September 30, 2026.
(2) EXTENSION.—The Secretary may extend 
the duration of the pilot program for an additional 
two-year period if the Secretary, based on the results 
of the reports submitted under subsection (g), deter-
mines such an extension is appropriate. 
(k) DEFINITIONS.—In this section: 
(1) The term ‘‘assisted living services’’ means 
services of a facility in providing room, board, and 
personal care for and supervision of residents for 
their health, safety, and welfare. 
(2) The term ‘‘eligible veteran’’ means a vet-
eran who is— 
(A) receiving nursing home care paid for 
by the Department of Veterans Affairs, eligible 
to receive such care pursuant to section 1710A 
of title 38, United States Code, or requires a 
higher level of care than the domiciliary care 
provided by the Department of Veterans Af-
fairs, but does not meet the requirements for 
nursing home level care provided by the Depart-
ment pursuant to such section; and 
(B) eligible for assisted living services, as 
determined by the Secretary or meets such ad-
ditional criteria for eligibility for the pilot pro-
gram under subsection (a)(1) as the Secretary 
may establish. 
(3) The term ‘‘State home’’ has the meaning 
given that term in section 101 of title 38, United 
States Code. 
SEC. 128. PROVISION OF MEDICINE, EQUIPMENT, AND SUP-
PLIES AVAILABLE TO DEPARTMENT OF VET-
ERANS AFFAIRS TO STATE HOMES. 
(a) PROVISION AUTHORIZED.—The Secretary of Vet-
erans Affairs may provide to State homes medicine, per-
sonal protective equipment, medical supplies, and any 
other equipment, supplies, and assistance available to the 
Department of Veterans Affairs. 
(b) DEFINITION.—In this section: 
(1) The term ‘‘personal protective equipment’’ 
means any protective equipment required to prevent 
the wearer from contracting an infectious disease, 
including gloves, N–95 respirator masks, gowns, 
goggles, face shields, or other equipment required 
for safety. 
(2) The term ‘‘State home’’ has the meaning 
given such term in section 101 of title 38, United 
States Code.
SEC. 129. RECOGNITION OF ORGANIZATIONS AND INDIVID-
UALS TO ASSIST VETERANS, FAMILY MEM-
BERS, AND CAREGIVERS NAVIGATING PRO-
GRAMS 
AND 
SERVICES 
OF 
VETERANS 
HEALTH ADMINISTRATION. 
(a) IN GENERAL.—Not later than one year after the 
date of the enactment of this Act, the Secretary of Vet-
erans Affairs shall establish a process through which the 
Department of Veterans Affairs may recognize organiza-
tions and individuals to assist a veteran, a family member 
of a veteran, or a caregiver of a veteran (as defined in 
section 1720G(d) of title 38, United States Code) in navi-
gating the programs and services of the Veterans Health 
Administration. 
(b) SOLICITATION
OF FEEDBACK.—The Secretary 
shall solicit feedback and recommendations in the creation 
of the process under subsection (a) from such organiza-
tions as the Secretary may consider relevant. 
(c) LIMITATION.—The Secretary may not recognize 
an organization or individual pursuant to the process es-
tablished under subsection (a) unless the organization or 
individual has certified to the Secretary that no fee or 
compensation of any nature will be charged to any indi-
vidual for services rendered in providing assistance pursu-
ant to such subsection.
SEC. 130. REVIEWS AND OTHER IMPROVEMENTS RELATING 
TO HOME- AND COMMUNITY-BASED SERV-
ICES. 
(a) OFFICE OF GERIATRIC AND EXTENDED CARE.— 
(1) REVIEW OF PROGRAMS.—The Under Sec-
retary for Health of the Department of Veterans Af-
fairs shall conduct a review of each program admin-
istered through the Office of Geriatric and Extended 
Care of the Department and the Caregiver Support 
Program Office of the Department, or any successor 
offices, to— 
(A) eliminate service gaps at the medical 
center level; and 
(B) ensure— 
(i) the clinical needs of veterans are 
met; 
(ii) consistency in program manage-
ment; 
(iii) the availability of, and the access 
by veterans to, home- and community- 
based services, including for veterans living 
in rural areas; and 
(iv) proper coordination between cov-
ered programs. 
(2) ASSESSMENT
OF
STAFFING
NEEDS.—The 
Secretary of Veterans Affairs shall conduct an as-
education of home health aides and caregivers of vet-
erans in the following areas: 
(A) Dementia care. 
(B) Care for spinal cord injuries and dis-
eases. 
(C) Ventilator care. 
(D) Other speciality care areas as deter-
mined by the Secretary. 
(5) INPUT
ON
GOALS.—To the extent prac-
ticable, the head of the Caregiver Support Program 
Office, or successor office, shall provide to the Direc-
tor of the Office of Geriatric and Extended Care, or 
successor office, input with respect to the establish-
ment of the goals under paragraphs (3) and (4). 
(6) REPORT TO CONGRESS.—Not later than one 
year after the date of the enactment of this Act, the 
Secretary shall submit to the Committees on Vet-
erans’ Affairs of the House of Representatives and 
the Senate a report containing the findings of the 
review under paragraph (1), the results of the as-
sessment under paragraph (2), and the goals estab-
lished under paragraphs (3) and (4). 
(b) REVIEW OF INCENTIVES AND EFFORTS RELAT-
ING TO HOME- AND COMMUNITY-BASED SERVICES.—
(1) REVIEW.—The Secretary of Veterans Af-
fairs shall conduct a review of the following: 
(A) The financial and organizational incen-
tives or disincentives for the directors of med-
ical centers of the Department to establish or 
expand covered programs at such medical cen-
ters. 
(B) Any incentives or disincentives for 
such directors to provide to veterans home- and 
community-based services in lieu of institutional 
care. 
(C) The efforts taken by the Secretary to 
enhance spending of the Department for ex-
tended care by balancing spending between in-
stitutional care and home- and community- 
based services consistent with the demand for 
such services. 
(D) The plan of the Under Secretary for 
Health of the Department to accelerate efforts 
to enhance spending as specified in subpara-
graph (C), to match the progress of similar ef-
forts taken by the Administrator of the Centers 
for Medicare & Medicaid Services with respect 
to spending of the Centers for Medicare & Med-
icaid Services for extended care.
(2) REPORT TO CONGRESS.—Not later than one 
year after the date of the enactment of this Act, the 
Secretary shall submit to the Committees on Vet-
erans’ Affairs of the House of Representatives and 
the Senate a report on the findings of the review 
under paragraph (1). 
(c) REVIEW OF RESPITE CARE SERVICES.—Not later 
than two years after the date of the enactment of this Act, 
the Secretary of Veterans Affairs shall conduct a review 
of the use, availability, cost,and effectiveness, of the res-
pite care services furnished by the Secretary under chapter 
17 of title 38, United States Code, including— 
(1) the frequency at which the Department of 
Veterans Affairs is unable to meet demand for such 
services; 
(2) a detailed description of— 
(A) the reasons the Department of Vet-
erans Affairs is unable to meet the demand for 
such services; and 
(B) any actions, or planned actions, of the 
Secretary of Veterans Affairs to ensure such 
demand is met. 
(d) COLLABORATION TO IMPROVE HOME- AND COM-
MUNITY-BASED SERVICES.— 
(1) RECOMMENDATIONS.—
(A) DEVELOPMENT.—The Secretary of 
Veterans Affairs shall develop recommendations 
as follows: 
(i) With respect to home- and commu-
nity-based services for veterans, the Sec-
retary of Veterans Affairs shall develop 
recommendations regarding new services 
(in addition to those furnished as of the 
date of enactment of this Act) in collabora-
tion with the Secretary of Health and 
Human Services. 
(ii) With respect to the national short-
age of home health aides, the Secretary of 
Veterans 
Affairs 
shall 
develop 
rec-
ommendations regarding methods to ad-
dress such shortage in collaboration with 
the Secretary of Health and Human Serv-
ices and the Secretary of Labor. 
(B) SUBMISSION TO CONGRESS.—The Sec-
retary of Veterans Affairs shall submit to the 
Committees on Veterans’ Affairs of the House 
of Representatives and the Senate a report con-
taining the recommendations developed under 
subparagraph (A) and an identification of any 
changes in existing law or new statutory au-
thority 
necessary 
to 
implement 
the 
rec-
ommendations, as determined by the Secretary. 
(C) CONSULTATION WITH SECRETARY OF 
LABOR.—In carrying out this paragraph, the 
Secretary of Veterans Affairs shall consult with 
the Secretary of Labor. 
(2) FEEDBACK
AND
RECOMMENDATIONS
ON 
CAREGIVER SUPPORT.— 
(A) 
FEEDBACK
AND
RECOMMENDA-
TIONS.—The Secretary of Veterans Affairs shall 
solicit from the entities described in subpara-
graph (B) feedback and recommendations re-
garding opportunities for the Secretary to en-
hance home- and community-based services for 
veterans and the caregivers of veterans, includ-
ing through the potential provision by the entity 
of care and respite services to veterans and 
caregivers who may not be eligible for any pro-
gram under section 1720G of title 38, United 
States Code, or section 1720L of such title (as 
added by section 124), but have a need for as-
sistance. 
(B) COVERED ENTITIES.—The entities de-
scribed in this subparagraph are veterans serv-
ice organizations and nonprofit organizations
with a focus on caregiver support or long term 
care (as determined by the Secretary). 
(3) 
COLLABORATION
FOR
CERTAIN
VET-
ERANS.—The Secretary of Veterans Affairs shall col-
laborate with the Director of the Indian Health 
Service and representatives from tribal health pro-
grams and Urban Indian organizations to ensure the 
availability of home- and community-based services 
for— 
(A) Native American veterans, including 
Native American veterans receiving health care 
and medical services under multiple health care 
systems; and 
(B) Native Hawaiian veterans, including 
Native Hawaiian veterans receiving health care 
and medical services under the Native Hawaiian 
health care system. 
SEC. 131. GAO REPORT ON MENTAL HEALTH SUPPORT FOR 
CAREGIVERS. 
(a) REPORT REQUIRED.—Not later than one year 
after the date of the enactment of this Act, the Comp-
troller General of the United States shall submit to the 
Committee on Veterans’ Affairs of the Senate and the 
Committee on Veterans’ Affairs of the House of Rep-
resentatives a report on the provision of mental health 
support to caregivers of veterans. 
(b) CONTENTS.—The report submitted under sub-
section (a) shall include the following: 
(1) An assessment of the need for mental 
health support among caregivers participating in the 
caregiver programs. 
(2) An assessment of options for mental health 
support in facilities of the Department of Veterans 
Affairs and in the community for caregivers partici-
pating in the caregiver programs. 
(3) An assessment of the availability and acces-
sibility of mental health support in facilities of the 
Department and in the community for caregivers 
participating in the caregiver programs. 
(4) An assessment of the awareness among 
caregivers of the availability of mental health sup-
port in facilities of the Department and in the com-
munity for caregivers participating in the caregiver 
programs. 
(5) An assessment of barriers to mental health 
support in facilities of the Department and in the 
community for caregivers participating in the care-
giver programs. 
(c) DEFINITIONS.—In this section:
(1) The term ‘‘caregiver’’ has the meaning 
given that term in section 1720G of title 38, United 
States Code. 
(2) The term ‘‘caregiver programs’’ means— 
(A) the program of comprehensive assist-
ance for family caregivers under subsection (a) 
of section 1720G of title 38, United States 
Code; and 
(B) the program of support services for 
caregivers under subsection (b) of such section. 
SEC. 132. DEVELOPMENT OF CENTRALIZED WEBSITE FOR 
PROGRAM INFORMATION. 
(a) CENTRALIZED WEBSITE.—The Secretary shall 
develop and maintain a centralized and publically acces-
sible internet website of the Department as a clearing-
house for information and resources relating to covered 
programs. 
(b) CONTENTS.—The website under subsection (a) 
shall contain the following: 
(1) A description of each covered program. 
(2) An informational assessment tool that— 
(A) explains the administrative eligibility, 
if applicable, of a veteran, or a caregiver of a 
veteran, for any covered program; and
(B) provides information, as a result of 
such explanation, on any covered program for 
which the veteran or caregiver (as the case may 
be) may be eligible. 
(3) A list of required procedures for the direc-
tors of the medical facilities of the Department to 
follow in determining the eligibility and suitability of 
veterans for participation in a covered program, in-
cluding procedures applicable to instances in which 
the resource constraints of a facility (or of a commu-
nity in which a facility is located) may result in the 
inability to address the health needs of a veteran 
under a covered program in a timely manner. 
(c) UPDATES.—The Secretary shall ensure the 
website under subsection (a) is updated on a periodic 
basis. 
SEC. 133. DEFINITIONS. 
In this title: 
(1) The terms ‘‘caregiver’’ and ‘‘family care-
giver’’ have the meanings given those terms under 
section 1720L(h) of title 38, United States Code (as 
added by section 123). 
(2) The term ‘‘covered program’’—
(A) means any program of the Department 
of Veterans Affairs for home- and community- 
based services; and 
(B) includes the programs specified in sec-
tion 1720L of title 38, United States Code (as 
added by section 123). 
(3) The term ‘‘home- and community-based 
services’’— 
(A) means the services referred to in sec-
tion 1701(6)(E) of title 38, United States Code; 
and 
(B) includes services furnished under a 
program specified in section 1720L of such title 
(as added by section 123). 
(4) The terms ‘‘Home-Based Primary Care pro-
gram’’, ‘‘Homemaker and Home Health Aide pro-
gram’’, and ‘‘Veteran-Directed Care program’’ mean 
the programs of the Department of Veterans Affairs 
specified in subsection (d), (c), and (b) of such sec-
tion 1720L, respectively. 
(5) The terms ‘‘home health aide’’, ‘‘Native 
American’’, ‘‘Native American veteran’’, ‘‘tribal 
health programs’’, and ‘‘Urban Indian organiza-
tions’’ have the meanings given those terms in sub-
section (h) of such section 1720L.
(6) The term ‘‘Vet Center’’ has the meaning 
given that term in section 1712A(h) of title 38, 
United States Code. 
(7) The term ‘‘veterans service organization’’ 
means any organization recognized by the Secretary 
under section 5902 of such title. 
Subtitle C—Medical Treatment and 
Other Matters 
SEC. 140. QUARTERLY REPORT ON REFERRALS FOR NON- 
DEPARTMENT 
OF 
VETERANS 
AFFAIRS 
HEALTH CARE. 
Subchapter I of chapter 5 of title 38, United States 
Code, is amended by adding at the end the following new 
section (and amending the table of sections at the begin-
ning of such chapter accordingly): 
‘‘§ 534. Quarterly report on referrals for non-Depart-
ment health care 
‘‘Not later than 180 days after the date of the enact-
ment of this section, and not less frequently than quarterly 
thereafter, the Secretary shall submit to the Committees 
on Veterans’ Affairs of the Senate and the House of Rep-
resentatives a report containing, with respect to referrals 
for non-Department health care originating from a med-
ical facility of the Department during the quarter pre-