I 
118TH CONGRESS 
1ST SESSION H. R. 1815 
To require the Secretary of Veterans Affairs to carry out a pilot program 
to provide assisted living services to eligible veterans, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 27, 2023 
Ms. SLOTKIN (for herself, Mr. STEIL, Mr. TRONE, and Ms. KUSTER) intro-
duced the following bill; which was referred to the Committee on Vet-
erans’ Affairs 
A BILL 
To require the Secretary of Veterans Affairs to carry out 
a pilot program to provide assisted living services to 
eligible veterans, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Expanding Veterans’ 
Options for Long Term Care Act’’. 
SEC. 2. PILOT PROGRAM ON ASSISTED LIVING SERVICES 
FOR VETERANS. 
(a) PROGRAM.— 
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(1) IN
GENERAL.—Beginning not later than 
one year after the date of the enactment of this Act, 
the Secretary of Veterans Affairs shall carry out a 
three-year pilot program to assess— 
(A) the effectiveness of providing assisted 
living services to eligible veterans, at the elec-
tion of such veterans; and 
(B) the satisfaction with the pilot program 
of veterans participating in the pilot program. 
(2) EXTENSION.—The Secretary may extend 
the duration of the pilot program under paragraph 
(1) for an additional three-year period if the Sec-
retary, based on the results of the reports submitted 
under subsection (f), determines that it is appro-
priate to do so. 
(b) PROGRAM LOCATIONS.— 
(1) VETERANS
INTEGRATED
SERVICE
NET-
WORKS.— 
(A) IN GENERAL.—The Secretary shall se-
lect not fewer than six Veterans Integrated 
Service Networks of the Department of Vet-
erans Affairs at which to carry out the pilot 
program under subsection (a)(1). 
(B) VETERANS RECEIVING NURSING HOME 
CARE.—The Secretary shall ensure that not 
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fewer than three Veterans Integrated Service 
Networks selected under subparagraph (A) 
serve regions with the top three highest per-
centage of veterans who are currently receiving 
nursing home care through the Department and 
would be eligible to receive assisted living serv-
ices under the pilot program. 
(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), the Secretary 
shall ensure that— 
(i) the locations of such facilities are 
in geographically diverse areas; 
(ii) not fewer than two such facilities 
serve 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); 
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(iii) not fewer than one such facility is 
located in each Veterans Integrated Service 
Network selected under paragraph (1); and 
(iv) not fewer than two such facilities 
are State homes. 
(c) 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-
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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. 
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(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 
(ii) re-evaluate payment rates annu-
ally to account for current economic condi-
tions and current costs of assisted living 
services. 
(d) CONTINUITY OF CARE.—Upon the termination of 
the pilot program under subsection (a)(1), the Secretary 
shall— 
(1) provide to all veterans participating in the 
pilot program at the time of such termination the 
option to continue to receive assisted living services 
at the site they were assigned to under the pilot pro-
gram, at the expense of the Department; and 
(2) for such veterans who do not opt to con-
tinue to receive such services— 
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(A) ensure such veterans do not experience 
lapses in care; and 
(B) provide such veterans with information 
on, and enroll such veterans in, other extended 
care services based on their preferences and 
best medical interest. 
(e) DETERMINATION OF QUALITY.—The Secretary 
shall determine a method for assessment of quality of care 
provided to veterans participating in the pilot program 
under subsection (a)(1) and shall communicate that meth-
od to providers of services under the pilot program. 
(f) ANNUAL REPORT.—Not later than one year after 
the initiation of the pilot program under subsection (a)(1), 
and annually thereafter for each year in which the pilot 
program is carried out, the Secretary 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 pilot program, including— 
(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; 
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(3) general demographic information of partici-
pants in the pilot program, including average age, 
gender, and race or ethnicity; 
(4) disability status of participants in the pilot 
program; 
(5) an identification of any barriers or chal-
lenges to enrolling veterans in 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. 
(g) FINAL REPORT.—Not later than four years after 
the initiation of the pilot program under subsection (a)(1), 
or not later than seven years after the initiation of the 
pilot program if the pilot program is extended under sub-
section (a)(2), the Secretary shall submit to the Com-
mittee on Veterans’ Affairs of the Senate and the Com-
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mittee on Veterans’ Affairs of the House of Representa-
tives a report on the pilot program that— 
(1) includes the matters required under para-
graphs (1) through (8) of subsection (f); 
(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. 
(h) REPORT BY INSPECTOR GENERAL.— 
(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 and the Committees on Veterans’ Affairs of 
the House of Representatives and the Senate a re-
port 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 (e); 
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(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) FOLLOW-UP.—Not later than 90 days after 
the submission of the report required by 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. 
(i) 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— 
(A)(i) is already receiving nursing home 
level care paid for by the Department; 
(ii) is eligible to receive nursing home level 
care paid for by the Department pursuant to 
section 1710A of title 38, United States Code; 
or 
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