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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). 
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‘‘(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 
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‘‘(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. 
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‘‘(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. 
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‘‘(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 
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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— 
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‘‘(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-
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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- 
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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-
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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 
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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). 
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‘‘(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.— 
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(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— 
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(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). 
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(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 
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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 
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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)— 
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(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.’’. 
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(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— 
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‘‘(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— 
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‘‘(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. 
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‘‘(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. 
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‘‘(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 
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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 
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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 
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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). 
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(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— 
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(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 
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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 
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(ii) re-evaluate payment rates annu-
ally to account for current economic condi-
tions and current costs of assisted living 
services. 
(e) 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— 
(A) ensure such veterans do not experience 
lapses in care; and 
(B) provide such veterans with information 
on, and furnish such veterans with, other ex-
tended care services based on their preferences 
and best medical interest. 
(f) 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. 
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(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 
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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-
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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. 
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(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-
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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. 
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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. 
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