I 118th CONGRESS 1st Session H. R. 5002 IN THE HOUSE OF REPRESENTATIVES July 27, 2023 Mrs. Harshbarger introduced the following bill; which was referred to the Committee on Veterans' Affairs A BILL To direct the Secretary of Veterans Affairs to carry out a pilot program for the cognitive care of veterans, and for other purposes.

1. Short title This Act may be cited as the Innovative Cognitive Care for Veterans Act of 2023 . 2. Findings Congress finds the following: (1) According to a 2020 study by the Office of the Assistant Deputy Under Secretary for Health for Policy and Planning of the Department of Veterans Affairs, it is projected that the number of veterans with Alzheimer’s dementia will increase by 28.9 percent between fiscal year 2021 and fiscal year 2033, amounting to an estimated 48,000 new patients with cognitive impairments. (2) The cost of expenditures of the Department of Veterans Affairs for long-term care is growing rapidly, as demonstrated by a 2020 Government Accountability Office report that estimates such expenditures are projected to double to $14,300,000,000 by 2037. (3) As described in the report specified in paragraph (2), the Department of Veterans Affairs also faces both a current and incoming workforce shortage, in addition to other challenges relating to the provision of long-term care services to the more than 2,800,000 estimated veterans who are enrolled in the patient enrollment system of the Department established and operated under section 1705(a) of title 38, United States Code, and live in rural areas. (4) As observed by the Secretary of Veterans Affairs, veterans can also be prone to unique factors that increase the risk for future cognitive impairment. For example, it has been found that veterans who served during the Vietnam era and, while so serving, were exposed to Agent Orange are nearly twice as likely as those without such exposure to receive a diagnosis of dementia. (5) According to the Department of Veterans Affairs, more than 185,000 veterans enrolled in the health care system of the Department of Veterans Affairs have been diagnosed with at least one traumatic brain injury. Traumatic brain injury often affects the cognitive abilities of an individual and can disrupt normal brain function. Veterans with a traumatic brain injury are also 60 percent more likely to develop Alzheimer’s Disease or other forms of dementia. (6) This data compels the United States Government to do more for veterans and their cognitive care. 3. Pilot program of Department of Veterans Affairs for addressing cognitive disorders among veterans (a) Pilot program (1) Pilot program Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall carry out, as a part of the Veterans Community Care Program under section 1703 of title 38, and in accordance with the requirements of such program, a pilot program (in this section referred to as the pilot program ) under which the Secretary may enter into agreements with eligible entities to furnish to participating veterans telehealth, virtual training tools for home health aides, and other innovative services, that slow the progression of cognitive disorders. (2) Veterans Care Agreements In entering into agreements under paragraph (1), the Secretary may enter into a Veterans Care Agreement under section 1703A of title 38, United States Code, consistent with the requirements of such section. (b) Selection of entities (1) Eligible entities An entity is eligible for entry into an agreement under the pilot program if the entity— (A) furnishes telehealth, virtual training tools for home health aides, or other innovative services, that slow the progression of cognitive disorders; and (B) meets such other requirements as the Secretary may prescribe. (2) Priority In selecting eligible entities for entry into an agreement under the pilot program, the Secretary shall give priority to eligible entities with— (A) demonstrated experience in— (i) providing assistance to individuals with cognitive disorders; (ii) addressing behavioral and temperament issues, including through interactive engagement and stimulation solutions; (iii) caregiver or home health aid training; and (iv) working in the field of cognitive disorders, including through the treatment of, or rehabilitation for, traumatic brain injury or neurodegenerative conditions; and (B) the ability to provide services under the pilot program to veterans at locations other than a hospital, nursing home, or other medical facility, in accordance with subsection (d)(2). (3) List of selected entities The Secretary shall— (A) publish on an internet website of the Department a list identifying each eligible entity with which the Secretary has entered into an agreement under the pilot program; and (B) ensure such list is accessible to veterans selected for participation in the pilot program. (c) Selection of veterans In selecting veterans for participation in the pilot program, the Secretary— (1) shall ensure that not more than 500 veterans participate in the pilot program at any given time; and (2) may not take into consideration age or risk factors for cognitive disorders. (d) Services: self-Directed and in-Home nature Each veteran selected by the Secretary for participation in the pilot program— (1) may select, from among the entities listed under subsection (b)(3) that are accessible to the veteran, the entity from which services shall be received by the veteran under the pilot program; and (2) may elect to receive services under the pilot program at a location that is not a traditional medical setting, such as at the residence of the veteran, in lieu of receiving such services at a hospital, nursing home, or other medical facility. (e) Termination The pilot program shall terminate on the date that is five years after the date on which the pilot program commences. (f) Report Not later than 180 days after the date of termination under subsection (e), the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report on the pilot program. Such report shall include the following: (1) A detailed overview of each entity with which the Secretary entered into an agreement under the pilot program, and the services that entity provided to participating veterans pursuant to such agreement. (2) An identification of the types of technology that eligible entities with which the Secretary entered into an agreement under the pilot program used to provide services to participating veterans pursuant to such agreement. (3) An identification of the following: (A) The number of veterans that participated in the pilot program. (B) The number of veterans that applied to participate in the pilot program but were not selected for participation as a result of the limitation under subsection (c)(2). (C) Of the veterans who participated in the pilot program, the number who, for the duration of such participation, received services under the pilot program. (D) Of the veterans who participated in the pilot program, the number who suffered traumatic brain injury while serving in the Armed Forces, including, for each such veteran— (i) a classification of the traumatic brain injury so suffered as mild, moderate, or severe (as the case may be); and (ii) an identification of the mechanism of injury. (E) The percentage of veterans who participated in the pilot program (disaggregated by type of outcome specified in clauses (i) through (iii)) who reported that such participation resulted in the following outcomes, with respect to the individual veteran: (i) Quality of life improved. (ii) Quality of life was unaffected. (iii) Quality of life worsened. (F) A socioeconomic and demographic breakdown of veterans who participated in the pilot program. (G) The type of housing in which the veterans who participated in the pilot program reside. (H) Whether the veterans who participated in the pilot program have access to personal care services from a caregiver, and if so, whether such services were furnished by the Secretary (including through a non-Department of Veterans Affairs health care provider providing such services under the laws administered by the Secretary). (I) Such other information as may be determined relevant by the Secretary. (g) Source of funds Amounts required to carry out this Act shall be derived from unobligated amounts appropriated to the Veterans Health Administration and determined appropriate by the Secretary.