I
103D CONGRESS
1ST SESSION
H. R. 3122
To amend title 38, United States Code, to revise and improve the long-
term care programs of the Department of Veterans Affairs.
IN THE HOUSE OF REPRESENTATIVES
SEPTEMBER 22, 1993
Mr. STUMP (for himself, Mr. SMITH of New Jersey, Mr. BILIRAKIS, Mr.
HUTCHINSON, and Mr. LINDER) introduced the following bill; which was
referred to the Committee on Veterans’ Affairs
A BILL
To amend title 38, United States Code, to revise and improve
the long-term care programs of the Department of Veter-
ans Affairs.
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 ‘‘Veterans’ Long-Term
Care Act of 1993’’.
SEC. 2. DEFINITION OF LONG-TERM CARE.
Section 1701 of title 38, United States Code, is
amended by adding at the end the following:
‘‘(10) The term ‘long-term care’ means a continuum
of institutional and noninstitutional programs and services
that provide comprehensive restorative care and support
services through a time period generally exceeding 90
days. Such term includes the following care and services
authorized to be provided by the Secretary:
‘‘(A) Nursing home care.
‘‘(B) Domiciliary care.
‘‘(C) State home care.
‘‘(D) Hospital-based home care.
‘‘(E) Adult day health care.
‘‘(F) Hospice care.
‘‘(G) Respite care.
‘‘(H) Social support services.
‘‘(I) Non-institutional alternatives pilot pro-
gram.
‘‘(J) Community residential care.
‘‘(K) Rehabilitative services.
‘‘(L) Care provided through Geriatric Research,
Education, and Clinical Centers.
‘‘(M) Care provided through Geriatric Evalua-
tion and Management Programs.
‘‘(N) Provision of intermediate medicine.
‘‘(O) Any other services that the Secretary de-
termines to be needed on a long-term basis.’’.
SEC. 3. ELIGIBILITY CRITERIA FOR LONG-TERM CARE.
(a) IN GENERAL.—(1) Chapter 17 of title 38, United
States Code, is amended—
(A) by redesignating section 1711 as section
1710A; and
(B) by inserting after such section the following
new section 1711:
‘‘§ 1711. Eligibility for long-term care
‘‘(a) The Secretary shall furnish long-term care which
the Secretary determines is medically needed—
‘‘(1) to any veteran for a service-connected dis-
ability;
‘‘(2) to any veteran who has a service-connected
disability rated at 50 percent or more, for any dis-
ability;
‘‘(3) to any veteran who is eligible for pension
from the Department, for any disability; and
‘‘(4) to any veteran for any disability resulting
from treatment by the Department.
‘‘(b) The Secretary shall furnish long-term care which
the Secretary determines is medically needed to any vet-
eran enrolled in a long-term care coinsurance plan under
subsection (f).
‘‘(c) Subject to subsection (e), the Secretary shall fur-
nish long-term care which the Secretary determines is
medically needed—
‘‘(1) to any veteran who has a service-connected
disability rated at less than 50 percent, for any dis-
ability;
‘‘(2) to any veteran whose annual income (as
determined under section 1503 of this title) is less
than three times the maximum income amount for
eligibility of that veteran for pension, for any disabil-
ity;
‘‘(3) to any veteran who has a catastrophic ill-
ness (as determined by the Secretary) resulting from
a nonservice-connected disability;
‘‘(4) to any veteran who is a veterans’ continu-
ing care center resident under section 8119 of this
title, for treatment provided by the medical center
associated with that veterans’ continuing care center
to obviate the need for institutional care; and
‘‘(5) to any veteran who needs such care as a
follow-on to hospitalization in a Department medical
center, for a period not exceeding six months from
the termination of hospitalization.
‘‘(d) Subject to subsection (d), the Secretary may fur-
nish long-term care which the Secretary determines is
medically needed to any veteran not described in sub-
section (a), (b), or (c), subject to the availability of staff
and facilities.
‘‘(e)(1) The Secretary may not furnish long-term care
under this section to a veteran who is eligible for such
care under subsection (c) or (d) unless the veteran agrees
to pay to the United States the applicable long-term care
copayment prescribed under paragraph (2).
‘‘(2) The Secretary shall establish by regulation a
schedule of long-term care copayments for the purposes
of this section. A veteran who is furnished long-term care
under this section and who is required under paragraph
(1) to agree to pay a long-term care copayment to the
United States in order to be furnished such care shall be
liable to the United States for the amount applicable to
that veteran under the schedule prescribed under this sub-
section. In the case of a veteran enrolled in the long-term
care coinsurance plan under subsection (f), copayments
may be waived or may be lower than copayments for veter-
ans not so enrolled.
‘‘(3) A copayment required to be paid under this sec-
tion may be paid by the veteran from any insurance cov-
erage that would be available to the veteran if the care
for which the payment is required was provided in a non–
Government facility.
‘‘(f)(1) The Secretary shall establish by regulation a
long-term care coinsurance plan for the purposes of this
section. The plan shall provide for enrollment of veterans
and the assessment and collection of premiums from veter-
ans who are enrolled. The Secretary shall determine en-
rollment periods and the requirements for enrollment.
‘‘(2) The amount of the premiums under the coinsur-
ance plan shall be established by the Secretary taking into
consideration the needs of veterans and the needs of the
Department. The Secretary may establish different pre-
miums for veterans based upon such factors as the Sec-
retary determines appropriate, including cost-of-living dif-
ferences in different geographic regions and income level
of veterans. For veterans whose annual income is greater
than the maximum income amount for eligibility of that
veteran for pension, but less than three times that
amount, the Secretary shall establish a premium scale
based upon a veteran’s ability to pay.
‘‘(g)(1)(A) Notwithstanding any condition, limitation,
or other provision of title XVIII of the Social Security Act,
a facility of the Department through which long-term care
is provided shall be deemed for the purposes of this section
to be a Medicare participating provider with respect to
long-term care (as defined in section 1701(9) of this title),
and when such a facility provides long-term care covered
under title XVIII of the Social Security Act to a veteran
who is entitled to benefits under that title, amounts for
such care shall be paid to the Secretary as a Medicare
participating provider, but in accordance with rates deter-
mined under subparagraph (B).
‘‘(B) Reimbursement for long-term care provided
under this section shall be based upon a methodology
which is agreed upon by the Secretary and the Secretary
of Health and Human Services and which provides (i) ap-
propriate flexibility to the directors of the medical facilities
to take into account local conditions and needs and the
actual costs to the facility, and (ii) an overall reimburse-
ment applicable to each such facility for any fiscal year
that is less than the otherwise applicable amount that
would be allowed under title XVIII of the Social Security
Act for the care provided.
‘‘(2)(A) Notwithstanding any condition, limitation, or
other provision of title XIX of the Social Security Act,
if a facility of the Department is providing long-term care
to an individual who would be entitled to medical assist-
ance under a State plan under such title with respect to
such care if the care were provided by a qualified medicaid
participating provider, such facility shall be deemed for
the purposes of this section to be a qualified medicaid par-
ticipating provider with respect to such care. Amounts for
such care shall be paid in accordance with rates deter-
mined under subparagraph (B).
‘‘(B) Reimbursement for long-term care provided
under this section shall be based upon a methodology
which is agreed upon by the Secretary and the Secretary
of Health and Human Services and which provides (i) ap-
propriate flexibility to the directors of the medical facilities
to take into account local conditions and needs and the
actual costs to the facility, and (ii) an overall reimburse-
ment applicable to each such facility for any fiscal year
that is less than the otherwise applicable amount that
would be allowed under title XIX of the Social Security
Act for the care provided.
‘‘(h) Amounts received by the Secretary under this
section as premiums or copayments shall be deposited into
the Long-Term Care Revolving Fund.’’.
(2) The table of sections at the beginning of such
chapter is amended by striking out the item relating to
section 1711 and inserting in lieu thereof the following:
‘‘1710A. Care during examinations and in emergencies.
‘‘1711. Eligibility for long-term care.’’.
(3) The Secretary of Veterans Affairs and the Sec-
retary of Health and Human Services shall enter into an
agreement to establish methodologies for medicare and
medicaid reimbursement rates under subsection (g) of sec-
tion 1711 of title 38, United States Code, as added by
paragraph (1), not later than six months after the date
of the enactment of this Act.
(b) 
CONFORMING
AMENDMENTS
TO
SECTION
1710.—Section 1710 of such title is amended as follows:
(1) Subsection (a) is amended—
(A) in paragraph (1)(A), by striking out ‘‘,
and may furnish nursing home care,’’;
(B) in paragraph (2), by striking out ‘‘and
nursing home care’’; and
(C) in paragraph (3), by striking out ‘‘and
nursing home care’’ and ‘‘and may furnish such
nursing home care as authorized under section
1720 of this title’’.
(2) Subsection (b) is repealed.
(3) Subsection (c) is amended by striking out
‘‘or nursing home care’’ in the first sentence.
(4) Subsection (d) is repealed.
SEC. 4. CONTRACTS FOR LONG-TERM CARE.
(a) IN GENERAL.—Chapter 17 of title 38, United
States Code, is amended—
(1) by redesignating section 1704 as 1705; and
(2) by inserting after section 1703 the following
new section:
‘‘§ 1704. Contracts for long-term care in non-Depart-
ment facilities
‘‘(a) In carrying out section 1711 of this title, the
Secretary may contract for needed long-term care for vet-
erans eligible for long-term care under section 1711 of this
title when Department facilities are geographically inac-
cessible, lack sufficient capacity, or are otherwise not ca-
pable of furnishing needed care or when the Secretary de-
termines that it would be more economical to contract for
such care than to provide it through Department facilities.
The authority to enter into a contract under this section
shall be subject to the availability of appropriations.
‘‘(b) No veteran may be transferred or admitted to
any institution for long-term care under this chapter un-
less the institution has been determined by the Secretary
to meet such standards as the Secretary may prescribe.
The standards prescribed and any report of inspection of
institutions furnishing care to veterans under this section
made by or for the Secretary shall, to the extent possible,
be made available to all Federal, State, and local agencies
charged with the responsibility of licensing or otherwise
regulating or inspecting such institutions.
‘‘(c) In applying the provisions of section 2(b)(1) of
the Service Contract Act of 1965 (41 U.S.C. 351(b)(1))
with respect to any contract entered into under this sec-
tion to provide long-term care of veterans, the payment
of wages not less than those specified in section 6(b) of
the Fair Labor Standards Act of 1938 (29 U.S.C. 206(b))
shall be deemed to constitute compliance with such provi-
sions.
‘‘(d) In arranging to provide adult day health care
and other health-related services in noninstitutional set-
tings under section 1711 of this title, the Secretary may
provide in-kind assistance (through the services of Depart-
ment employees and the sharing of other Department re-
sources) to a facility furnishing such services to veterans
under this chapter. Any such in-kind assistance shall be
provided under a contract between the Secretary and the
facility concerned. The Secretary may provide such assist-
ance only for use solely in the furnishing of adult day
health care or other health-related services and only if,
under such contract, the Department receives reimburse-
ment for the full cost of such assistance, including the cost
of services and supplies and normal depreciation and am-
ortization of equipment. Such reimbursement may be
made by reduction in the charges to the United States
or by payment to the United States. Any funds received
through such reimbursement shall be credited to funds al-
lotted to the Department facility that provided the assist-
ance.’’.
(b) CLERICAL AMENDMENT.—The table of sections
at the beginning of such chapter is amended by striking
‘‘§ 8117. Veterans’ service areas for provision of long-
term care
‘‘(a) The Secretary shall designate geographic areas
(to be known as ‘veterans’ service areas’) throughout the
United States as areas in which the complete range of
long-term care services will be available to veterans. Such
areas shall be established based on the number of veterans
in an area and their health needs and on traveltime to
various facilities.
‘‘(b)(1) Not later than six months after the date of
the enactment of this section, the Secretary shall submit
to Congress a report on the Secretary’s plan for the imple-
mentation of this section and the provisions of chapter 17
of this title relating to long-term care. The Secretary shall
set forth in the report the plans of the Secretary for ensur-
ing by October 1, 1999, that there is available within each
service area designated under subsection (a) all of the
services considered to be long-term care for the purposes
of chapter 17 of this title and that such services are avail-
able in each such area in an appropriate balance of serv-
ices for the needs of veterans in that area.
‘‘(2) The Secretary shall use the authority provided
in section 1704 of this title as appropriate to ensure that
the plan is fully complied with.
‘‘(c)(1) The Secretary shall on a regular basis assess
the need for new long-term care facilities for the Depart-
ment in each veterans’ service area. In assessing the need
for construction or acquisition of new facilities for the De-
partment in any veterans’ service area, the Secretary shall
assess and take into consideration other Government fa-
cilities in the area and facilities available in the community
so as to avoid duplication of existing long-term care capac-
ity.
‘‘(2) The Secretary shall include the Secretary’s find-
ings and recommendations under paragraph (1) in each
report of the Secretary under section 8107 of this title.
‘‘(d) The Secretary shall ensure that not less than
one-third of the amount programmed for major construc-
tion projects in the budget of the Department for any fis-
cal year, and not less than one-third of the amount obli-
gated for minor construction projects in any fiscal year,
are for projects and activities relating to long-term care
until such time as the Secretary determines that the ap-
propriate mix of long-term care facilities and services are
available in each veterans’ service area.
‘‘§ 8118. Long-term care fund
‘‘(a) There is hereby established on the books of the
Treasury the Veterans’ Long-Term Care Fund. The fund
shall be administered by the Secretary of Veterans Affairs.
‘‘(b) Assets of the fund shall consist of amounts de-
posited in the fund pursuant to section 1711 of this title
and any amounts that may be appropriated to the fund.
‘‘(c) The Secretary may use the assets of the fund
for the provision of long-term care services to veterans and
for construction, acquisition, and alteration of long-term
care facilities (including site preparation).
‘‘(d) Obligations from the fund may only be made to
the extent provided in appropriation Acts.’’.
(b) CLERICAL AMENDMENT.—The table of sections
at the beginning of such chapter is amended by inserting
after the item relating to section 8116 the following new
item:
‘‘8117. Veterans’ service areas for provision of long-term care.
‘‘8118. Long-term care fund.’’.
SEC. 7. VETERANS’ CONTINUING CARE CENTERS.
(a) AUTHORITY TO ALLOW USE OF DEPARTMENT
PROPERTY.—Chapter 81 of title 38, United States Code,
is amended by inserting after section 8118 (as added by
section 6) the following new section:
‘‘§ 8119. Veterans’ continuing care centers
‘‘(a)(1) The Secretary, using the authority to enter
into enhanced-use leases under section 8162 of this title,
may enter into agreements to permit the establishment,
on property of the Department, of residential facilities for
veterans. Such agreements may be entered into with pri-
vate sector entities, with entities of State or local govern-
ment, or with other Federal departments or agencies.
‘‘(2) Such a facility shall be available as a residence—
‘‘(A) for veterans whose requirements for long-
term care are such that they would otherwise require
nursing home care (or another form of institutional
care), with consequent loss of functional independ-
ence; and
‘‘(B) for veterans with respect to whom the
Secretary determines, in any case, that the condition
of the veteran is such that the veteran would be
most appropriately served in the setting provided by
such a facility.
‘‘(3) In this section—
‘‘(A) a facility established on property of the
Department pursuant to this section is referred to
as a ‘veterans’ continuing care center’;
‘‘(B) an agreement under this section for the
establishment of such a facility is referred to as a
‘veterans’ continuing care center agreement’; and
‘‘(C) an entity with which the Secretary enters
into such an agreement is referred to as a ‘partici-
pating entity’.
‘‘(4) A veterans’ continuing care center agreement
shall provide for the colocation of the veterans’ continuing
care center covered by the agreement with a Department
medical center, outpatient clinic, or nursing home.
‘‘(b)(1) Each veterans’ continuing care center agree-
ment shall provide that residence in the veterans’ continu-
ing care center covered by the agreement shall, subject
to space limitations, be available to any veteran covered
by subsection (a)(2) who meets the financial qualification
requirements of the participating entity.
‘‘(2) Acceptance of a veteran for residence in a veter-
ans’ continuing care center shall include acceptance for
residence with the veteran of the veteran’s spouse (if any)
or other person designated by the veteran as the veteran’s
primary caretaker.
‘‘(c) Under a veterans’ continuing care center agree-
ment, the participating entity shall agree to—
‘‘(1) construct or otherwise establish on the
property covered by the agreement a residential fa-
cility that includes individual, handicap-accessible
apartment units;
‘‘(2) provide by contract with each resident for
specified nonmedical services (which may include
meals, housekeeping, recreation, security, 24-hour
monitoring, and transportation); and
‘‘(3) provide case management services to the
veteran’s spouse (or other primary caretaker des-
ignated under subsection (b)(2)) for the manage-
ment of necessary health care services required by
the spouse (or other designated primary caretaker)
from sources outside the Department.
‘‘(d) A veteran who is accepted for residence in a vet-
erans’ continuing care center shall enter into a lease
agreement with the participating entity for at least one
year.
‘‘(e) In entering into agreements under this section,
the Secretary shall, in order to make veterans’ continuing
care centers affordable to low-income veterans, give prior-
ity, in selecting participating entities, to agreements with
entities that would establish facilities through which public
housing subsidies would be available to residents.
‘‘(f) The Secretary shall establish, at each Depart-
ment facility that has colocated with it a veterans’ con-
tinuing care center, a team of primary care providers to
be known as the Veterans’ Continuing Care Center Health
team. Each such team shall, at a minimum, consist of a
physician and a home-health nurse and shall be respon-
sible for maintaining access of the veterans’ continuing
care center residents to appropriate health care services
and for home health visits at the center.
‘‘(g)(1) Before entering into any veterans’ continuing
care center agreement, the Secretary shall submit to the
congressional veterans’ affairs committees notice in writ-
ing of the Secretary’s intention to enter into the agree-
ment. Each such notice shall include the following:
(A) Identification of the property involved.
(B) A description of the proposed veterans’ con-
tinuing care center.
(C) A statement of the number of veterans who
would be residents at the proposed center.
(D) A statement of the projected costs of the
proposed center.
‘‘(2) If a proposed veterans’ continuing care center
agreement for which a notice is submitted under para-
graph (1) is not executed within one year from the date
on which such notice is submitted, the Secretary shall sub-
mit to the congressional veterans’ affairs committees no-
tice in writing that the proposed agreement has not been
executed. Any such notice shall include an identification
of the specific reasons why the agreement was not exe-
cuted.
‘‘(h) The Secretary shall submit to the congressional
veterans’ affairs committees a report on the first year’s
operation of each veterans’ continuing care center. Each
such report shall be submitted not later than 30 days after
the one-year anniversary of the date on which the veter-