I 
118TH CONGRESS 
1ST SESSION 
H. R. 542 
To amend title 38, United States Code, to improve certain programs of 
the Department of Veterans Affairs for home- and community-based 
services for veterans, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JANUARY 26, 2023 
Ms. BROWNLEY (for herself and Mr. BERGMAN) introduced the following bill; 
which was referred to the Committee on Veterans’ Affairs 
A BILL 
To amend title 38, United States Code, to improve certain 
programs of the Department of Veterans Affairs for 
home- and community-based services for veterans, and 
for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Elizabeth Dole Home- and Community-Based Services 
for Veterans and Caregivers Act of 2023’’ or the ‘‘Eliza-
beth Dole Home Care Act of 2023’’. 
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(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. Increase of expenditure cap for noninstitutional care alternatives to 
nursing home care. 
Sec. 3. Coordination with Program of All-Inclusive Care for the Elderly. 
Sec. 4. Home- and community-based services: programs. 
Sec. 5. Coordination with assistance and support services for caregivers. 
Sec. 6. Development of centralized website for program information. 
Sec. 7. Improvements relating to Homemaker and Home Health Aide program. 
Sec. 8. Reviews and other improvements relating to home- and community- 
based services. 
Sec. 9. Definitions. 
SEC. 2. INCREASE OF EXPENDITURE CAP FOR NONINSTITU-
TIONAL 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) The total cost of providing services or in-kind 
assistance in the case of any veteran for any fiscal year 
under the program may exceed 100 percent of the cost 
that would otherwise have been incurred as specified in 
paragraph (1) if the Secretary determines, based on a con-
sideration of clinical need, geographic market factors, and 
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such other matters as the Secretary may prescribe 
through regulation, that such higher total cost is in the 
best interest of the veteran.’’. 
(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. 3. COORDINATION WITH PROGRAM OF ALL-INCLUSIVE 
CARE FOR THE ELDERLY. 
Section 1720C of title 38, United States Code, as 
amended by section 2, 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. 4. HOME- AND COMMUNITY-BASED SERVICES: PRO-
GRAMS. 
(a) PROGRAMS.—Chapter 17 of title 38, United 
States Code, is amended by inserting after section 1720J 
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the following new section (and conforming the table of sec-
tions at the beginning of such chapter accordingly): 
‘‘§ 1720K. 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 which the Secretary of Veterans Affairs may 
enter into agreements with the providers described in 
paragraph (2) to provide to eligible veterans funds to ob-
tain such in-home care services and related items as may 
be determined appropriate by the Secretary of Veterans 
Affairs and selected by the veteran, including through the 
veteran hiring individuals to provide such services and 
items or directly purchasing such services and items. 
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‘‘(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.). 
‘‘(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-
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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 catastrophically disabled, the vet-
eran may continue 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 ensure the avail-
ability of such program— 
‘‘(A) in the locations specified in subparagraph 
(B) of subsection (b)(3); and 
‘‘(B) for the veteran populations specified in 
subparagraph (C) of such subsection. 
‘‘(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 
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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. 
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‘‘(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). 
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‘‘(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). 
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‘‘(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 
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Home Health Aide program are administered through 
each medical center of the Department of Veterans Affairs 
in accordance with section 1720K 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. 
SEC. 5. 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-
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cluding the programs specified in section 1720K 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) 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 1720K 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. 
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(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 
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(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-
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gram updates and alerts relating to emerging services for 
which such caregivers may be eligible. 
SEC. 6. 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 
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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. 7. 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.— 
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(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 after the date on which the Secretary deter-
mines the pilot program under paragraph (1) has 
terminated, the Secretary shall submit to the Com-
mittees on Veterans’ Affairs of the House of Rep-
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resentatives and the Senate a report on the result of 
the pilot program. 
(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 
2023, 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 
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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. 8. 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-
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istered through the Office of Geriatric and Extended 
Care of the Department, or successor office, to— 
(A) ensure consistency in program man-
agement; 
(B) eliminate service gaps at the medical 
center level; and 
(C) ensure the availability of, and the ac-
cess by veterans to, home- and community- 
based services. 
(2) ASSESSMENT
OF
STAFFING
NEEDS.—The 
Secretary of Veterans Affairs shall conduct an as-
sessment of the staffing needs of the Office of Geri-
atric and Extended Care of the Department of Vet-
erans Affairs, or successor office. 
(3) GOALS
FOR
GEOGRAPHIC
ALIGNMENT
OF 
CARE.— 
(A) ESTABLISHMENT OF GOALS.—The Di-
rector of the Office of Geriatric and Extended 
Care, or successor office, shall establish quan-
titative goals to enable aging or disabled vet-
erans who are not located near medical centers 
of the Department to access extended care serv-
ices (including by improving access to home- 
and community-based services for such vet-
erans). 
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(B) IMPLEMENTATION
TIMELINE.—Each 
goal established under subparagraph (A) shall 
include a timeline for the implementation of the 
goal at each medical center of the Department. 
(4) GOALS FOR IN-HOME SPECIALTY CARE.— 
The Director of the Office of Geriatric and Extended 
Care, or successor office, shall establish quantitative 
goals to address the specialty care needs of veterans 
through in-home care, including by ensuring the 
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) 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). 
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(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 for the directors of medical centers of the 
Department to establish or expand covered pro-
grams at such medical centers. 
(B) Any incentives 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 shifting the balance of such 
spending from institutional care to home- and 
community-based 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. 
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(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, and effectiveness, of the respite 
care services furnished by the Secretary under chapter 17 
of title 38, United States Code. 
(d) COLLABORATION TO IMPROVE HOME- AND COM-
MUNITY-BASED SERVICES.— 
(1) REPORT ON EXPANSION OF CERTAIN MEN-
TAL HEALTH SERVICES.— 
(A) REPORT.—Not later than two years 
after the date of the enactment of this Act, the 
Secretary of Veterans Affairs, in collaboration 
with the Secretary of Health and Human Serv-
ices, shall submit to the Committees on Vet-
erans’ Affairs of the House of Representatives 
and the Senate a report containing rec-
ommendations for the expansion of mental 
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health services and related support to the care-
givers of veterans. 
(B) MATTERS
INCLUDED.—The report 
under subparagraph (A) shall include an assess-
ment of the feasibility and advisability of au-
thorizing access to Vet Centers by— 
(i) family caregivers enrolled in a pro-
gram under section 1720G of title 38, 
United States Code; and 
(ii) family caregivers of veterans par-
ticipating in a program specified in section 
1720K of such title, as added by section 4. 
(2) 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 the enactment of this Act) in col-
laboration with the Secretary of Health 
and Human Services. 
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(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. 
(3) FEEDBACK
AND
RECOMMENDATIONS
ON 
CAREGIVER SUPPORT.— 
(A) 
FEEDBACK
AND
RECOMMENDA-
TIONS.—The Secretary of Veterans Affairs shall 
solicit from the entities described in subpara-
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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 1720K of such title (as 
added by section 4), but have a need for assist-
ance. 
(B) COVERED ENTITIES.—The entities de-
scribed in this subparagraph are veterans serv-
ice organizations and nonprofit organizations 
with a focus on caregiver support (as deter-
mined by the Secretary). 
(4) COLLABORATION
FOR
NATIVE
AMERICAN 
VETERANS.—The Secretary of Veterans Affairs shall 
collaborate 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 Native American veterans, including Native 
American veterans receiving health care and medical 
services under multiple health care systems. 
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SEC. 9. DEFINITIONS. 
In this Act: 
(1) The terms ‘‘caregiver’’ and ‘‘family care-
giver’’ have the meanings given those terms under 
section 1720K(h) of title 38, United States Code (as 
added by section 4). 
(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 1720K of title 38, United States Code (as 
added by section 4). 
(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 1720K of such title 
(as added by section 4). 
(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 
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specified in subsection (d), (c), and (b) of such sec-
tion 1720K, 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 1720K. 
(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. 
Æ 
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