,,ii #aahth ,,congress #ast ,session ,h4 ,r4 #edb ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,december #f1 #bjbc,received ,,an ,,act ,to amend title #ch1 ,united ,states ,code1 to improve certain programs of the ,department of ,veterans ,affairs for home- and community-based services for veterans1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,elizabeth ,dole ,home- and ,community-,based ,services for ,veterans and ,caregivers ,act of #bjbc or the ,elizabeth ,dole ,home ,care ,act of #bjbc4 7b7 ,table of contents ,the table of contents for this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4,sec4 #b4 ,increase of expenditure cap for noninstitutional care alternatives to nursing home care4,sec4 #c4 ,coordination with ,program of ,all-,inclusive ,care for the ,elderly4,sec4 #d4 ,home- and community-based services3 programs4,sec4 #e4 ,coordination with assistance and support services for caregivers4,sec4 #f4 ,development of centralized website for program information4,sec4 #g4 ,improvements relating to ,homemaker and ,home ,health ,aide program4,sec4 #h4 ,reviews and other improvements relating to home- and community-based services4,sec4 #i4 ,modification of certain housing loan fees4,sec4 #aj4 ,definitions4 #b4 ,increase of expenditure cap for noninstitutional care alternatives to nursing home care 7a7 ,increase of expenditure cap ,section #agbj;,c7d7 of title #ch1 ,united ,states ,code1 is amended-- 7#a7 by striking ,the total cost and inserting 7#a7 ,except as provided in paragraph 7#b71 the total cost2 7#b7 by striking #fe percent and inserting #ajj percent2 and 7#c7 by adding at the end the following new paragraph3 7#b7 7,a7 ,the total cost of providing services or in-kind assistance in the case of any veteran described in subparagraph 7,b7 for any fiscal year under the program may exceed #ajj percent of the cost that would otherwise have been incurred as specified in paragraph 7#a7 if the ,secretary determines1 based on a consideration of clinical need1 geographic market factors1 and such other matters as the ,secretary may prescribe through regulation1 that such higher total cost is in the best interest of the veteran4 7,b7 ,a veteran described in this subparagraph is a veteran with amyotrophic lateral sclerosis1 a spinal cord injury1 or a condition the ,secretary determines to be similar to such conditions4 4 7b7 ,applicability ,the amendments made by subsection 7a7 shall apply with respect to fiscal years beginning on or after the date of the enactment of this ,act4 #c4 ,coordination with ,program of ,all-,inclusive ,care for the ,elderly ,section #agbj;,c of title #ch1 ,united ,states ,code1 as amended by section #b1 is further amended by adding at the end the following new subsection3 7f7 ,in furnishing services to a veteran under the program conducted pursuant to subsection 7a71 if a medical center of the ,department through which such program is administered is located in a geographic area in which services are available to the veteran under a ,,pace program 7as such term is defined in sections #ahid7;a77#b7 and #aicd7;a77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;eee7a77#b72 #acifu-#d7;a77#b7771 the ,secretary shall seek to enter into an agreement with the ,,pace program operating in that area for the furnishing of such services4 4 #d4 ,home- and community-based services3 programs 7a7 ,programs ,chapter #ag of title #ch1 ,united ,states ,code1 is amended by inserting after section #agbj;,j the following new section 7and conforming the table of sections at the beginning of such chapter accordingly73 #agbj,k4 ,home- and community-based services3 programs 7a7 ,in general ,in furnishing noninstitutional alternatives to nursing home care pursuant to the authority of section #agbj;,c of this title 7or any other authority under this chapter or other provision of law administered by the ,secretary of ,veterans ,affairs71 the ,secretary shall carry out each of the programs specified in this section in accordance with such relevant authorities except as otherwise provided in this section4 7b7 ,veteran-,directed ,care program 7#a7 ,the ,secretary of ,veterans ,affairs1 in collaboration with the ,secretary of ,health and ,human ,services1 shall carry out a program to be known as the ,veteran-,directed ,care program4 ,under such program1 the ,secretary of ,veterans ,affairs may enter into agreements with the providers described in paragraph 7#b7 to provide to eligible veterans funds1 to the extent practicable1 to obtain such in-home care services and related items as may be determined appropriate by the ,secretary of ,veterans ,affairs and selected by the veteran1 including through the veteran hiring individuals to provide such services and items or directly purchasing such services and items4 7#b7 ,the providers described in this paragraph are the following3 7,a7 ,an ,aging and ,disability ,resource ,center1 an area agency on aging1 or a ,state agency4 7,b7 ,a center for independent living4 7,c7 ,an ,indian tribe or tribal organization receiving assistance under title ,,vi of the ,older ,americans ,act of #aife 7#db ,u4,s4,c4 #cjeg et seq474 7#c7 ,in carrying out the ,veteran-,directed ,care program1 the ,secretary of ,veterans ,affairs shall-- 7,a7 administer such program through each medical center of the ,department of ,veterans ,affairs2 7,b7 seek to ensure the availability of such program in ,american ,samoa1 ,guam1 the ,commonwealth of the ,northern ,mariana ,islands1 the ,commonwealth of ,puerto ,rico1 the ,virgin ,islands of the ,united ,states1 and any other territory or possession of the ,united ,states1 to the extent practicable2 and 7,c7 seek to ensure the availability of such program for eligible veterans who are ,native ,american veterans receiving care and services furnished by the ,indian ,health ,service1 a tribal health program1 an ,urban ,indian organization1 or 7in the case of a ,native ,hawaiian veteran7 a ,native ,hawaiian health care system1 to the extent practicable4 7#d7 ,if a veteran participating in the ,veteran-,directed ,care program is catastrophically disabled1 the veteran 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 hospitalized4 7c7 ,homemaker and ,home ,health ,aide program 7#a7 ,the ,secretary shall carry out a program to be known as the ,homemaker and ,home ,health ,aide program under which the ,secretary may enter into agreements with home health agencies to provide to eligible veterans such home health aide services as may be determined appropriate by the ,secretary4 7#b7 ,in carrying out the ,homemaker and ,home ,health ,aide program1 the ,secretary shall1 to the extent practicable1 ensure the availability of such program-- 7,a7 in the locations specified in subparagraph 7,b7 of subsection 7b77#c72 and 7,b7 for the veteran populations specified in subparagraph 7,c7 of such subsection4 7d7 ,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 care1 the provision of which is overseen by a provider of the ,department4 7e7 ,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 veteran4 7f7 ,caregiver support 7#a7 ,with respect to a resident eligible caregiver of a veteran participating in a program under this section1 the ,secretary shall-- 7,a7 if the veteran meets the requirements of a covered veteran under section #agbj;,g7b7 of this title1 provide to such caregiver the option of enrolling in the program of general caregiver support services under such section2 7,b7 provide to such caregiver covered respite care of not less than #cj days annually2 and 7,c7 conduct on an annual basis 7and1 to the extent practicable1 in connection with in-person services provided under the program in which the veteran is participating71 a wellness contact of such caregiver4 7#b7 ,covered respite care provided to a resident eligible caregiver of a veteran under paragraph 7#a7 may exceed #cj days annually if such extension is requested by the resident eligible caregiver or veteran and determined medically appropriate by the ,secretary4 7g7 ,rule of construction ,nothing in this section shall be construed to limit the authority of the ,secretary to carry out programs providing home- and community-based services under any other provision of law4 7h7 ,definitions ,in this section3 7#a7 ,the terms ,aging and ,disability ,resource ,center1 area agency on aging1 and ,state agency have the meanings given those terms in section #ajb of the ,older ,americans ,act of #aife 7#db ,u4,s4,c4 #cjjb74 7#b7 ,the terms caregiver and family caregiver1 with respect to a veteran1 have the meanings given those terms1 respectively1 under subsection 7e7 of section #agbj;,g of this title with respect to an eligible veteran under subsection 7a7 of such section or a covered veteran under subsection 7b7 of such section1 as the case may be4 7#c7 ,the term center for independent living has the meaning given that term in section #gjb of the ,rehabilitation ,act of #aigc 7#bi ,u4,s4,c4 #gif;a74 7#d7 ,the term covered respite care has the meaning given such term in section #agbj;,g7d7 of this title4 7#e7 ,the term eligible veteran means any veteran-- 7,a7 for whom the ,secretary determines participation in a specific program under this section is medically necessary to promote1 preserve1 or restore the health of the veteran2 and 7,b7 who absent such participation would be at increased risk for hospitalization1 placement in a nursing home1 or emergency room care4 7#f7 ,the term home health aide means an individual employed by a home health agency to provide in-home care services4 7#g7 ,the term in-home care service means any service1 including a personal care service1 provided to enable the recipient of such service to live at home4 7#h7 ,the terms ,indian tribe and tribal organization have the meanings given those terms in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd74 7#i7 ,the terms ,native ,american and ,native ,american veteran have the meanings given those terms in section #cgfe of this title4 7#aj7 ,the terms ,native ,hawaiian and ,native ,hawaiian health care system have the meanings given those terms in section #ab of the ,native ,hawaiian ,health ,care ,improvement ,act 7#db ,u4,s4,c4 #aagaa74 7#aa7 ,the terms tribal health programs and ,urban ,indian organizations have the meanings given those terms in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc74 7#ab7 ,the term resident eligible caregiver means an individual who-- 7,a7 is a caregiver1 or a family caregiver1 of a veteran and resides with that veteran2 and 7,b7 has not entered into a contract1 agreement1 or other arrangement for such individual to act as a caregiver for that veteran unless such individual is a family member of the veteran or is furnishing caregiver services through a medical foster home4 4 7b7 ,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 #agbj,k of title #ch1 ,united ,states ,code 7as added by subsection 7a771 by not later than two years after the date of the enactment of this ,act4 #e4 ,coordination with assistance and support services for caregivers 7a7 ,coordination with ,program of ,comprehensive ,assistance for ,family ,caregivers 7#a7 ,coordination ,section #agbj;,g7a7 of title #ch1 ,united ,states ,code1 is amended by adding at the end the following new paragraph3 7#ad7 7,a7 ,in the case of a veteran or caregiver who seeks services under this subsection and is denied such services1 or a veteran or the family caregiver of a veteran who is discharged from the program under this subsection1 the ,secretary shall-- 7i7 if the veteran meets the requirements of a covered veteran under subsection 7b71 provide to such caregiver the option of enrolling in the program of general caregiver support services under such subsection2 7ii7 assess the veteran or caregiver for participation in any other available program of the ,department for home- and community-based services 7including the programs specified in section #agbj,k of this title7 for which the veteran or caregiver may be eligible and1 with respect to the veteran1 store 7and make accessible to the veteran7 the results of such assessment in the electronic medical record of the veteran2 and 7iii7 provide to the veteran or caregiver written information on any such program identified pursuant to the assessment under clause 7ii71 including information about facilities1 eligibility requirements1 and relevant contact information for each such program4 7,b7 ,for each veteran or family caregiver who is discharged from the program under this subsection1 a caregiver support coordinator shall provide for a smooth and personalized transition from such program to an appropriate program of the ,department for home- and community-based services 7including the programs specified in section #agbj,k of this title71 including by integrating caregiver support across programs4 4 7#b7 ,applicability ,the amendments made by paragraph 7#a7 shall apply with respect to denials and discharges occurring on or after the date that is #ahj days after the date of the enactment of this ,act4 7#c7 ,technical and conforming amendments ,section #agbj;,g7d7 of such title is amended-- 7,a7 by striking or a covered veteran each place it appears and inserting 1 a veteran denied or discharged as specified in paragraph 7#ad7 of such subsection1 or a covered veteran2 and 7,b7 by striking under subsection 7a71 means each place it appears and inserting under subsection 7a7 or a veteran denied or discharged as specified in paragraph 7#ad7 of such subsection1 means4 7b7 ,conformity of respite care across programs ,section #agbj;,g of title #ch1 ,united ,states ,code1 as amended by subsection 7a77#c71 is further amended-- 7#a7 in subsection 7a77#c7-- 7,a7 by amending subparagraph 7,a77ii77,,iii7 to read as follows3 7,,iii7 covered respite care of not less than #cj days annually2 2 and 7,b7 by striking subparagraph 7,b7 and redesignating subparagraphs 7,c7 and 7,d7 as subparagraphs 7,b7 through 7,c71 respectively2 and 7#b7 by amending subsection 7b77#c77;,a77iii7 to read as follows3 7iii7 ,covered respite care of not less than #cj days annually4 2 and 7#c7 in subsection 7d7-- 7,a7 by redesignating paragraphs 7#b7 through 7#d7 as paragraphs 7#c7 through 7#e71 respectively2 and 7,b7 by inserting after paragraph 7#a7 the following new paragraph3 7#b7 ,the term covered respite care means1 with respect to a caregiver of a veteran1 respite care under section #agbj;,b of this title that-- 7,a7 is medically and age appropriate for the veteran 7including #bd-;hour per day care of the veteran commensurate with the care provided by the caregiver72 and 7,b7 includes in-home care4 4 7c7 ,review relating to caregiver contact ,the ,secretary shall conduct a review of the capacity of the ,department to establish a streamlined system for contacting all caregivers enrolled in the program of general caregiver support services under section #agbj;,g7b7 of title #ch1 ,united ,states ,code1 to provide to such caregivers program updates and alerts relating to emerging services for which such caregivers may be eligible4 #f4 ,development of centralized website for program information 7a7 ,centralized website ,the ,secretary shall develop and maintain a centralized and publically accessible internet website of the ,department as a clearinghouse for information and resources relating to covered programs4 7b7 ,contents ,the website under subsection 7a7 shall contain the following3 7#a7 ,a description of each covered program4 7#b7 ,an informational assessment tool that-- 7,a7 explains the administrative eligibility1 if applicable1 of a veteran1 or a caregiver of a veteran1 for any covered program2 and 7,b7 provides information1 as a result of such explanation1 on any covered program for which the veteran or caregiver 7as the case may be7 may be eligible4 7#c7 ,a list of required procedures for the directors of the medical facilities of the ,department to follow in determining the eligibility and suitability of veterans for participation in a covered program1 including procedures applicable to instances in which the resource constraints of a facility 7or of a community in which a facility is located7 may result in the inability to address the health needs of a veteran under a covered program in a timely manner4 7c7 ,updates ,the ,secretary shall ensure the website under subsection 7a7 is updated on a periodic basis4 #g4 ,improvements relating to ,homemaker and ,home ,health ,aide program 7a7 ,pilot program for communities with shortage of home health aides 7#a7 ,program ,beginning not later than #ah months after the date of the enactment of this ,act1 the ,secretary shall carry out a three-year pilot program under which the ,secretary shall provide homemaker and home health aide services to veterans who reside in communities with a shortage of home health aides4 7#b7 ,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 7#a74 7#c7 ,nursing assistants 7,a7 ,in general ,in carrying out the pilot program under paragraph 7#a71 the ,secretary may hire nursing assistants as new employees of the ,department of ,veterans ,affairs1 or reassign nursing assistants who are existing employees of the ,department1 to provide to veterans in-home care services 7including basic tasks authorized by the ,state certification of the nursing assistant7 under the pilot program1 in lieu of or in addition to the provision of such services through non-,department home health aides4 7,b7 ,relationship to ,home-,based ,primary ,care program ,nursing assistants hired or reassigned under subparagraph 7,a7 may provide services to a veteran under the pilot program under paragraph 7#a7 while serving as part of a health care team for the veteran under the ,home-,based ,primary ,care program4 7#d7 ,report to ,congress ,not later than one year after the date on which the ,secretary determines the pilot program under paragraph 7#a7 has terminated1 the ,secretary shall submit to the ,committees on ,veterans' ,affairs of the ,house of ,representatives and the ,senate a report on the result of the pilot program4 7b7 ,report on use of funds ,not later than one year after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall submit to the ,committees on ,veterans' ,affairs of the ,house of ,representatives and the ,senate a report containing1 with respect to the period beginning in fiscal year #bjab and ending in fiscal year #bjbc1 the following3 7#a7 ,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 expended for such provision1 disaggregated by medical center of the ,department for which such unexpended funds were budgeted 7if such disaggregation is possible74 7#b7 ,to the extent practicable1 an identification of the number of veterans for whom1 during such period1 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 veteran1 and a detailed description of the reasons why any such reductions may have occurred4 7c7 ,updated guidance on program ,not later than one year after the date of the enactment of this ,act1 the ,secretary shall issue updated guidance for the ,homemaker and ,home ,health ,aide program4 ,such updated guidance shall include the following3 7#a7 ,a process for the transition of veterans from the ,homemaker and ,home ,health ,aide program to other covered programs4 7#b7 ,a requirement for the directors of the medical 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 result of the clinical needs or behavioral issues of the veteran4 #h4 ,reviews and other improvements relating to home- and community-based services 7a7 ,office of ,geriatric and ,extended ,care 7#a7 ,review of programs ,the ,under ,secretary for ,health of the ,department of ,veterans ,affairs shall conduct a review of each program administered through the ,office of ,geriatric and ,extended ,care of the ,department1 or successor office1 to-- 7,a7 ensure consistency in program management2 7,b7 eliminate service gaps at the medical center level2 and 7,c7 ensure the availability of1 and the access by veterans to1 home- and community-based services4 7#b7 ,assessment of staffing needs ,the ,secretary of ,veterans ,affairs shall conduct an assessment of the staffing needs of the ,office of ,geriatric and ,extended ,care of the ,department of ,veterans ,affairs1 or successor office4 7#c7 ,goals for geographic alignment of care 7,a7 ,establishment of goals ,the ,director of the ,office of ,geriatric and ,extended ,care1 or successor office1 shall establish quantitative goals to enable aging or disabled veterans who are not located near medical centers of the ,department to access extended care services 7including by improving access to home- and community-based services for such veterans74 7,b7 ,implementation timeline ,each goal established under subparagraph 7,a7 shall include a timeline for the implementation of the goal at each medical center of the ,department4 7#d7 ,goals for in-home specialty care ,the ,director of the ,office of ,geriatric and ,extended ,care1 or successor office1 shall establish quantitative goals to address the specialty care needs of veterans through in-home care1 including by ensuring the education of home health aides and caregivers of veterans in the following areas3 7,a7 ,dementia care4 7,b7 ,care for spinal cord injuries and diseases4 7,c7 ,ventilator care4 7,d7 ,other speciality care areas as determined by the ,secretary4 7#e7 ,report to ,congress ,not later than one year after the date of the enactment of this ,act1 the ,secretary shall submit to the ,committees on ,veterans' ,affairs of the ,house of ,representatives and the ,senate a report containing the findings of the review under paragraph 7#a71 the results of the assessment under paragraph 7#b71 and the goals established under paragraphs 7#c7 and 7#d74 7b7 ,review of incentives and efforts relating to home- and community-,based services 7#a7 ,review ,the ,secretary of ,veterans ,affairs shall conduct a review of the following3 7,a7 ,the financial and organizational incentives for the directors of medical centers of the ,department to establish or expand covered programs at such medical centers4 7,b7 ,any incentives for such directors to provide to veterans home- and community-based services in lieu of institutional care4 7,c7 ,the efforts taken by the ,secretary to enhance spending of the ,department for extended care by shifting the balance of such spending from institutional care to home- and community-based services4 7,d7 ,the plan of the ,under ,secretary for ,health of the ,department to accelerate efforts to enhance spending as specified in subparagraph 7,c71 to match the progress of similar efforts taken by the ,administrator of the ,centers for ,medicare ,medicaid ,services with respect to spending of the ,centers for ,medicare ,medicaid ,services for extended care4 7#b7 ,report to ,congress ,not later than one year after the date of the enactment of this ,act1 the ,secretary shall submit to the ,committees on ,veterans' ,affairs of the ,house of ,representatives and the ,senate a report on the findings of the review under paragraph 7#a74 7c7 ,review of respite care services ,not later than two years after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall conduct a review of the use1 availability1 and effectiveness1 of the respite care services furnished by the ,secretary under chapter #ag of title #ch1 ,united ,states ,code4 7d7 ,collaboration ,to improve home- and community-,based services 7#a7 ,report on expansion of certain mental health services 7,a7 ,report ,not later than two years after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs1 in collaboration with the ,secretary of ,health and ,human ,services1 shall submit to the ,committees on ,veterans' ,affairs of the ,house of ,representatives and the ,senate a report containing recommendations for the expansion of mental health services and related support to the caregivers of veterans4 7,b7 ,matters included ,the report under subparagraph 7,a7 shall include an assessment of the feasibility and advisability of authorizing access to ,vet ,centers by-- 7i7 family caregivers enrolled in a program under section #agbj;,g of title #ch1 ,united ,states ,code2 and 7ii7 family caregivers of veterans participating in a program specified in section #agbj,k of such title1 as added by section #d4 7#b7 ,recommendations 7,a7 ,development ,the ,secretary of ,veterans ,affairs shall develop recommendations as follows3 7i7 ,with respect to home- and community-based services for veterans1 the ,secretary of ,veterans ,affairs shall develop recommendations regarding new services 7in addition to those furnished as of the date of the enactment of this ,act7 in collaboration with the ,secretary of ,health and ,human ,services4 7ii7 ,with respect to the national shortage of home health aides1 the ,secretary of ,veterans ,affairs shall develop recommendations regarding methods to address such shortage in collaboration with the ,secretary of ,health and ,human ,services and the ,secretary of ,labor4 7,b7 ,submission to ,congress ,the ,secretary of ,veterans ,affairs shall submit to the ,committees on ,veterans' ,affairs of the ,house of ,representatives and the ,senate a report containing the recommendations developed under subparagraph 7,a7 and an identification of any changes in existing law or new statutory authority necessary to implement the recommendations1 as determined by the ,secretary4 7,c7 ,consultation with ,secretary of ,labor ,in carrying out this paragraph1 the ,secretary of ,veterans ,affairs shall consult with the ,secretary of ,labor4 7#c7 ,feedback and recommendations on caregiver support 7,a7 ,feedback and recommendations ,the ,secretary of ,veterans ,affairs shall solicit from the entities described in subparagraph 7,b7 feedback and recommendations regarding opportunities for the ,secretary to enhance home- and community-based services for veterans and the caregivers of veterans1 including through the potential provision by the entity of care and respite services to veterans and caregivers who may not be eligible for any program under section #agbj;,g of title #ch1 ,united ,states ,code1 or section #agbj,k of such title 7as added by section #d71 but have a need for assistance4 7,b7 ,covered entities ,the entities described in this subparagraph are veterans service organizations and nonprofit organizations with a focus on caregiver support 7as determined by the ,secretary74 7#d7 ,collaboration for ,native ,american veterans ,the ,secretary of ,veterans ,affairs shall collaborate with the ,director of the ,indian ,health ,service and representatives from tribal health programs and ,urban ,indian organizations to ensure the availability of home- and community-based services for ,native ,american veterans1 including ,native ,american veterans receiving health care and medical services under multiple health care systems4 #i4 ,modification of certain housing loan fees ,the loan fee table in section #cgbi7;b77#b7 of title #ch1 ,united ,states ,code1 is amended by striking ,november #ae1 #bjca each place it appears and inserting ,february #d1 #bjcb4 #aj4 ,definitions ,in this ,act3 7#a7 ,the terms caregiver and family caregiver have the meanings given those terms under section #agbj,k7h7 of title #ch1 ,united ,states ,code 7as added by section #d74 7#b7 ,the term covered program-- 7,a7 means any program of the ,department of ,veterans ,affairs for home- and community-based services2 and 7,b7 includes the programs specified in section #agbj,k of title #ch1 ,united ,states ,code 7as added by section #d74 7#c7 ,the term home- and community-based services-- 7,a7 means the services referred to in section #agja7f77;,e7 of title #ch1 ,united ,states ,code2 and 7,b7 includes services furnished under a program specified in section #agbj,k of such title 7as added by section #d74 7#d7 ,the terms ,home-,based ,primary ,care program1 ,homemaker and ,home ,health ,aide program1 and ,veteran-,directed ,care program mean the programs of the ,department of ,veterans ,affairs specified in subsection 7d71 7c71 and 7b7 of such section #agbj,k1 respectively4 7#e7 ,the terms home health aide1 ,native ,american1 ,native ,american veteran1 tribal health programs1 and ,urban ,indian organizations have the meanings given those terms in subsection 7h7 of such section #agbj,k4 7#f7 ,the term ,vet ,center has the meaning given that term in section #agab;,a7h7 of title #ch1 ,united ,states ,code4 7#g7 ,the term veterans service organization means any organization recognized by the ,secretary under section #eijb of such title4 ,passed the ,house of ,representatives ,december #e1 #bjbc4,kevin ,f4 ,mc,cumber1,clerk4