Expanding Veterans’ Options for Long Term Care Act
Bill: S.4169 | Sponsor: Sen. Tester, Jon (D-MT)
Policy area: Armed Forces and National Security

Summary:
Expanding Veterans' Options for Long Term Care Act
This bill requires the Department of Veterans Affairs (VA) to implement a three-year pilot program to assess the effectiveness of providing assisted living services to eligible veterans, including by assessing the satisfaction of veterans participating in the pilot program. Eligible veterans are those who (1) are eligible for assisted living services as determined by the VA; and (2) are already receiving nursing home level care paid for by the VA, are eligible for such care from the VA, or exceed the requirements for domiciliary care paid for by the VA but do not meet the requirements for nursing home level care paid for by the VA.
The Inspector General of the VA must report to Congress on the pilot program, and the VA must submit a follow-up plan to address any deficiencies that are identified in the report.

To require the Secretary of Veterans Affairs to carry out a pilot 
 program to provide assisted living services to eligible veterans, and 
                          for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Expanding Veterans' Options for Long 
Term Care Act''.

SEC. 2. PILOT PROGRAM ON ASSISTED LIVING SERVICES FOR VETERANS.

    (a) Program.--
            (1) In general.--Beginning not later than one year after 
        the date of the enactment of this Act, the Secretary of 
        Veterans Affairs shall carry out a three-year pilot program to 
        assess--
                    (A) the effectiveness of providing assisted living 
                services to eligible veterans, at the election of such 
                veterans; and
                    (B) the satisfaction with the pilot program of 
                veterans participating in the pilot program.
            (2) Extension.--The Secretary may extend the duration of 
        the pilot program under paragraph (1) for an additional three-
        year period if the Secretary, based on the results of the 
        reports submitted under subsections (e) and (f), determines 
        that it is appropriate to do so.
    (b) Program Locations.--
            (1) Veterans integrated service networks.--
                    (A) In general.--The Secretary shall select not 
                fewer than six Veterans Integrated Service Networks of 
                the Department of Veterans Affairs at which to carry 
                out the pilot program under subsection (a)(1).
                    (B) Veterans receiving nursing home care.--The 
                Secretary shall ensure that not fewer than three 
                Veterans Integrated Service Networks selected under 
                subparagraph (A) serve areas with the highest 
                percentage of veterans who are currently receiving 
                nursing home care through the Department and would be 
                eligible to receive assisted living services under the 
                pilot program.
            (2) Facilities.--
                    (A) In general.--Within each Veterans Integrated 
                Service Network selected under paragraph (1), the 
                Secretary shall select facilities at which to carry out 
                the pilot program under subsection (a)(1).
                    (B) Selection criteria.--In selecting facilities 
                under subparagraph (A), the Secretary shall ensure 
                that--
                            (i) the locations of such facilities are in 
                        geographically diverse areas;
                            (ii) not fewer than two such facilities 
                        serve veterans in rural or highly rural areas 
                        (as determined through the use of the Rural-
                        Urban Commuting Areas coding system of the 
                        Department of Agriculture);
                            (iii) not fewer than one such facility is 
                        located in each Veterans Integrated Service 
                        Network selected under paragraph (1); and
                            (iv) not fewer than two such facilities are 
                        State homes.
    (c) Provision of Assisted Living Services.--
            (1) Agreements.--In carrying out the pilot program under 
        subsection (a)(1), the Secretary may enter into agreements for 
        the provision of assisted living services on behalf of eligible 
        veterans with--
                    (A) a provider participating under a State plan or 
                waiver under title XIX of the Social Security 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 assisted 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 regulations, 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 the standards for care established 
                under subpart E of part 51 of title 38, Code of Federal 
                Regulations, or successor regulations, and any 
                additional standards of care as the Secretary may 
                specify.
            (3) Inspection.--The Secretary shall inspect facilities at 
        which veterans are placed under the pilot program under 
        subsection (a)(1)--
                    (A) with respect to a facility that is a State 
                home, not less frequently than annually and in the same 
                manner as the Secretary conducts 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 facility 
                participating in the pilot program under subsection 
                (a)(1) that is a State home, the Secretary shall pay to 
                the State home a per diem for each veteran 
                participating in the pilot program at the State home 
                that is--
                            (i) greater than the per diem for 
                        domiciliary care at the State home, if 
                        applicable; and
                            (ii) less than the per diem for nursing 
                        home care at the State home.
                    (B) Community assisted living facilities.--In the 
                case of a facility participating in the pilot program 
                that is a community assisted living facility, the 
                Secretary shall 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 Integrated Service Network.
    (d) Continuity of Care.--Upon the termination of the pilot program 
under subsection (a)(1), the Secretary shall--
            (1) provide to all veterans participating in the pilot 
        program at the time of such termination the option to continue 
        to receive assisted living services at the site they were 
        assigned to under the pilot program, at the expense of the 
        Department; and
            (2) for such veterans who do not opt to continue to receive 
        such services--
                    (A) ensure such veterans do not experience lapses 
                in care; and
                    (B) provide such veterans with information on, and 
                enroll participants in, other long-term care options 
                based on their preferences and best medical interest.
    (e) Annual Report.--
            (1) In general.--Not later than one year after the 
        initiation of the pilot program under subsection (a)(1), and 
        annually thereafter for each year in which the pilot program is 
        carried out, the Secretary shall submit to the Committee on 
        Veterans' Affairs of the Senate and the Committee on Veterans' 
        Affairs of the House of Representatives a report on the pilot 
        program, including--
                    (A) 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;
                    (B) the number of participants in the pilot 
                program, disaggregated by facility;
                    (C) general demographic information of participants 
                in the pilot program, including average age, gender, 
                and race or ethnicity;
                    (D) disability status of participants in the pilot 
                program;
                    (E) an identification of any barriers or challenges 
                to enrolling veterans in the pilot program, conducting 
                oversight of the pilot program, or any other barriers 
                or challenges;
                    (F) the cost of care at each assisted living 
                facility and State home participating in the pilot 
                program, including an analysis of any cost savings by 
                the Department when comparing that cost to the cost of 
                nursing home care;
                    (G) aggregated feedback from participants in the 
                pilot program; and
                    (H) such other matters the Secretary considers 
                appropriate.
            (2) Final report.--As part of the final report submitted 
        under paragraph (1), the Secretary shall include 
        recommendations on whether the model studied in the pilot 
        program should be continued or adopted throughout the 
        Department.
    (f) Report by Inspector General.--
            (1) In general.--Not later than two years after the 
        initiation of the pilot program under subsection (a)(1), the 
        Inspector General of the Department of Veterans Affairs shall 
        submit to the Secretary, the Committee on Veterans' Affairs of 
        the Senate, and the Committee on Veterans' Affairs of the House 
        of Representatives a report on the pilot program.
            (2) Elements.--The report required by paragraph (1) shall 
        include an assessment of--
                    (A) the quality of care provided to veterans at 
                facilities participating in the pilot program;
                    (B) the oversight of such facilities, as conducted 
                by the Department, the Centers for Medicare & Medicaid 
                Services, State agencies, and other relevant entities; 
                and
                    (C) such other matters as the Inspector General 
                considers appropriate.
            (3) Follow-up.--Not later than 90 days after the submittal 
        of the report required by paragraph (1), the Secretary shall 
        submit to the Committee on Veterans' Affairs of the Senate and 
        the Committee on Veterans' Affairs of the House of 
        Representatives a plan to address the deficiencies identified 
        in the report, if any.
    (g) Definitions.--In this section:
            (1) Assisted living services.--The term ``assisted living 
        services'' means--
                    (A) services of a facility in providing room, 
                board, and personal care for and supervision of 
                residents for their health, safety, and welfare; and
                    (B) a level of care more intensive than domiciliary 
                care and less intensive than nursing home care.
            (2) Eligible veteran.--The term ``eligible veteran'' means 
        a veteran who--
                    (A)(i) is already receiving nursing home level care 
                paid for by the Department;
                    (ii) is eligible to receive nursing home level care 
                paid for by the Department; or
                    (iii) exceeds the requirements for domiciliary care 
                paid for by the Department but does not meet the 
                requirements for nursing home level care paid for by 
                the Department; and
                    (B) is eligible for assisted living services, as 
                determined by the Secretary.
            (3) State home.--The term ``State home'' has the meaning 
        given that term in section 101(19) of title 38, United States 
        Code.
                                 <all>