II 
118TH CONGRESS 
1ST SESSION 
H. R. 542 
IN THE SENATE OF THE UNITED STATES 
DECEMBER 6, 2023 
Received 
AN ACT 
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, 
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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’’. 
(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. Modification of certain housing loan fees. 
Sec. 10. 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: 
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‘‘(2)(A) The total cost of providing services or in-kind 
assistance in the case of any veteran described in subpara-
graph (B) for any fiscal year under the program may ex-
ceed 100 percent of the cost that would otherwise have 
been incurred as specified in paragraph (1) if the Sec-
retary determines, based on a consideration of clinical 
need, geographic market factors, and such other matters 
as the Secretary may prescribe through regulation, that 
such higher total cost is in the best interest of the veteran. 
‘‘(B) A veteran described in this subparagraph is a 
veteran with amyotrophic lateral sclerosis, a spinal cord 
injury, or a condition the Secretary determines to be simi-
lar to such conditions.’’. 
(b) APPLICABILITY.—The amendments made by sub-
section (a) shall apply with respect to fiscal years begin-
ning on or after the date of the enactment of this Act. 
SEC. 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-
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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 
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 
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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 as may be determined ap-
propriate 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.). 
‘‘(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-
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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 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. 
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‘‘(2) In carrying out the Homemaker and Home 
Health Aide program, the Secretary shall, to the extent 
practicable, ensure the availability 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 
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-
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ing in the program of general caregiver support serv-
ices under such section; 
‘‘(B) provide to such caregiver covered respite 
care of not less than 30 days annually; and 
‘‘(C) conduct on an annual basis (and, to the 
extent practicable, in connection with in-person serv-
ices provided under the program in which the vet-
eran is participating), a wellness contact of such 
caregiver. 
‘‘(2) Covered respite care provided to a resident eligi-
ble caregiver of a veteran under paragraph (1) may exceed 
30 days annually if such extension is requested by the resi-
dent eligible caregiver or veteran and determined medi-
cally appropriate by the Secretary. 
‘‘(g) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to limit the authority of the Sec-
retary to carry out programs providing home- and commu-
nity-based services under any other provision of law. 
‘‘(h) DEFINITIONS.—In this section: 
‘‘(1) The terms ‘Aging and Disability Resource 
Center’, ‘area agency on aging’, and ‘State agency’ 
have the meanings given those terms in section 102 
of the Older Americans Act of 1965 (42 U.S.C. 
3002). 
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‘‘(2) The terms ‘caregiver’ and ‘family care-
giver’, with respect to a veteran, have the meanings 
given those terms, respectively, under subsection (e) 
of section 1720G of this title with respect to an eli-
gible veteran under subsection (a) of such section or 
a covered veteran under subsection (b) of such sec-
tion, as the case may be. 
‘‘(3) The term ‘center for independent living’ 
has the meaning given that term in section 702 of 
the Rehabilitation Act of 1973 (29 U.S.C. 796a). 
‘‘(4) The term ‘covered respite care’ has the 
meaning given such term in section 1720G(d) of this 
title. 
‘‘(5) The term ‘eligible veteran’ means any vet-
eran— 
‘‘(A) for whom the Secretary determines 
participation in a specific program under this 
section is medically necessary to promote, pre-
serve, or restore the health of the veteran; and 
‘‘(B) who absent such participation would 
be at increased risk for hospitalization, place-
ment in a nursing home, or emergency room 
care. 
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‘‘(6) The term ‘home health aide’ means an in-
dividual employed by a home health agency to pro-
vide in-home care services. 
‘‘(7) The term ‘in-home care service’ means any 
service, including a personal care service, provided to 
enable the recipient of such service to live at home. 
‘‘(8) The terms ‘Indian tribe’ and ‘tribal organi-
zation’ have the meanings given those terms in sec-
tion 4 of the Indian Self-Determination and Edu-
cation Assistance Act (25 U.S.C. 5304). 
‘‘(9) The terms ‘Native American’ and ‘Native 
American veteran’ have the meanings given those 
terms in section 3765 of this title. 
‘‘(10) The terms ‘Native Hawaiian’ and ‘Native 
Hawaiian health care system’ have the meanings 
given those terms in section 12 of the Native Hawai-
ian Health Care Improvement Act (42 U.S.C. 
11711). 
‘‘(11) The terms ‘tribal health programs’ and 
‘Urban Indian organizations’ have the meanings 
given those terms in section 4 of the Indian Health 
Care Improvement Act (25 U.S.C. 1603). 
‘‘(12) The term ‘resident eligible caregiver’ 
means an individual who— 
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‘‘(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 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 
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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 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-
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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. 
(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’’. 
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(b) CONFORMITY OF RESPITE CARE ACROSS PRO-
GRAMS.—Section 1720G of title 38, United States Code, 
as amended by subsection (a)(3), is further amended— 
(1) in subsection (a)(3)— 
(A) by amending subparagraph (A)(ii)(III) 
to read as follows: 
‘‘(III) covered respite care of not less than 
30 days annually;’’; and 
(B) by striking subparagraph (B) and re-
designating subparagraphs (C) and (D) as sub-
paragraphs (B) through (C), respectively; and 
(2) by amending subsection (b)(3)(A)(iii) to 
read as follows: 
‘‘(iii) Covered respite care of not less than 30 
days annually.’’; and 
(3) in subsection (d)— 
(A) 
by 
redesignating 
paragraphs 
(2) 
through (4) as paragraphs (3) through (5), re-
spectively; and 
(B) by inserting after paragraph (1) the 
following new paragraph: 
‘‘(2) The term ‘covered respite care’ means, 
with respect to a caregiver of a veteran, respite care 
under section 1720B of this title that— 
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‘‘(A) is medically and age appropriate for 
the veteran (including 24-hour per day care of 
the veteran commensurate with the care pro-
vided by the caregiver); and 
‘‘(B) includes in-home care.’’. 
(c) REVIEW RELATING TO CAREGIVER CONTACT.— 
The Secretary shall conduct a review of the capacity of 
the Department to establish a streamlined system for con-
tacting all caregivers enrolled in the program of general 
caregiver support services under section 1720G(b) of title 
38, United States Code, to provide to such caregivers pro-
gram updates and alerts relating to emerging services for 
which such caregivers 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— 
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(A) explains the administrative eligibility, 
if applicable, of a veteran, or a caregiver of a 
veteran, for any covered program; and 
(B) provides information, as a result of 
such explanation, on any covered program for 
which the veteran or caregiver (as the case may 
be) may be eligible. 
(3) A list of required procedures for the direc-
tors of the medical facilities of the Department to 
follow in determining the eligibility and suitability of 
veterans for participation in a covered program, in-
cluding procedures applicable to instances in which 
the resource constraints of a facility (or of a commu-
nity in which a facility is located) may result in the 
inability to address the health needs of a veteran 
under a covered program in a timely manner. 
(c) UPDATES.—The Secretary shall ensure the 
website under subsection (a) is updated on a periodic 
basis. 
SEC. 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, 
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the Secretary shall carry out a three-year pilot pro-
gram under which the Secretary shall provide home-
maker and home health aide services to veterans 
who reside in communities with a shortage of home 
health aides. 
(2) LOCATIONS.—The Secretary shall select not 
fewer than five geographic locations in which the 
Secretary determines there is a shortage of home 
health aides at which to carry out the pilot program 
under paragraph (1). 
(3) NURSING ASSISTANTS.— 
(A) IN
GENERAL.—In carrying out the 
pilot program under paragraph (1), the Sec-
retary may hire nursing assistants as new em-
ployees of the Department of Veterans Affairs, 
or reassign nursing assistants who are existing 
employees of the Department, to provide to vet-
erans in-home care services (including basic 
tasks authorized by the State certification of 
the nursing assistant) under the pilot program, 
in lieu of or in addition to the provision of such 
services through non-Department home health 
aides. 
(B) RELATIONSHIP TO HOME-BASED PRI-
MARY
CARE
PROGRAM.—Nursing assistants 
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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-
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-
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