II 118th CONGRESS 1st Session S. 495 IN THE SENATE OF THE UNITED STATES February 16, 2023 Mr. Tester (for himself, Mr. Moran , Mrs. Murray , and Mr. Rounds ) introduced the following bill; which was read twice and referred to the Committee on Veterans' Affairs A BILL 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.

1. Short title This Act may be cited as the Expanding Veterans’ Options for Long Term Care Act . 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 subsection (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 regions with the top three 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 the Veterans Integrated Service Networks 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 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 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 a rate agreed to by the Secretary and the State home. (B) Community assisted living facilities In the case of a facility participating in the pilot program under subsection (a)(1) that is a community assisted living facility, the Secretary 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 Integrated Service Network; and (ii) re-evaluate payment rates annually to account for current economic conditions and current costs of assisted living services. (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 such veterans in, other extended care services based on their preferences and best medical interest. (e) 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 method to providers of services under the pilot program. (f) Annual report 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— (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 program, disaggregated by facility; (3) general demographic information of participants in the pilot program, including average age, gender, and race or ethnicity; (4) disability status of participants in the pilot program; (5) 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; (6) 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; (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. (g) Final report Not later than four years after the initiation of the pilot program under subsection (a)(1), or not later than seven years after the initiation of the pilot program if the pilot program is extended under subsection (a)(2), 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 that— (1) includes the matters required under paragraphs (1) through (8) of subsection (f); (2) includes recommendations on whether the model studied in the pilot program should be continued or adopted throughout the Department; and (3) indicates whether the Secretary requests action by Congress to make the pilot program permanent. (h) Report by Inspector General (1) In general Not later than three 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, measured pursuant to the method determined under subsection (e); (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. (i) Definitions In this section: (1) Assisted living services 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) 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 pursuant to section 1710A of title 38, United States Code; or (iii) requires a higher level of care than the domiciliary care provided by the Department but does not meet the requirements for nursing home level care provided by the Department pursuant to such section; and (B) (i) is eligible for assisted living services, as determined by the Secretary; or (ii) meets such additional criteria for eligibility for the pilot program under subsection (a)(1) as the Secretary may establish. (3) State home The term State home has the meaning given that term in section 101(19) of title 38, United States Code.