,,ii  #aah? ,,congress  #a/ ,session    
,h4 ,r4 #edb  ,,9 ,,! ,,s5ate ,,( ,,!   
,,unit$ ,,/ates  ,decemb] #f1           
#bjbc,receiv$  ,,an ,,act  ,to am5d     
title #ch1 ,unit$ ,/ates ,code1 to      
improve c]ta9 programs ( ! ,dep>tm5t (  
,vet]ans ,affairs = home- &             
community-bas$ s]vices = vet]ans1 & =   
o!r purposes4  #a4 ,%ort title2 table ( 
cont5ts  7a7 ,%ort title ,?is ,act may  
be cit$ z ! ,elizabe? ,dole ,home- &    
,community-,bas$ ,s]vices = ,vet]ans &  
,c>egiv]s ,act ( #bjbc or ! ,elizabe?   
,dole ,home ,c>e ,act ( #bjbc4  7b7     
,table ( cont5ts ,! table ( cont5ts =   
?is ,act is z foll[s3 ,sec4 #a4 ,%ort   
title2 table ( cont5ts4,sec4 #b4        
,increase ( exp5diture cap =            
non9/itutional c>e alt]natives to nurs+ 
home c>e4,sec4 #c4 ,coord9ation )       
,program ( ,all-,inclusive ,c>e = !     
,eld]ly4,sec4 #d4 ,home- &              
community-bas$ s]vices3 programs4,sec4  
#e4 ,coord9ation ) assi/ance & support  
s]vices = c>egiv]s4,sec4 #f4 ,developm5t

 ( c5traliz$ website = program          
in=mation4,sec4 #g4 ,improvem5ts relat+ 
to ,homemak] & ,home ,heal? ,aide       
program4,sec4 #h4 ,reviews & o!r        
improvem5ts relat+ to home- &           
community-bas$ s]vices4,sec4 #i4        
,modification ( c]ta9 h\s+ loan         
fees4,sec4 #aj4 ,def9itions4  #b4       
,increase ( exp5diture cap =            
non9/itutional c>e alt]natives to nurs+ 
home c>e  7a7 ,increase ( exp5diture cap
 ,section #agbj;,c7d7 ( title #ch1      
,unit$ ,/ates ,code1 is am5d$-- 7#a7 by 
/rik+ ,! total co/ & ins]t+ 7#a7 ,except
 z provid$ 9 p>agraph 7#b71 ! total co/2
  7#b7 by /rik+ #fe p]c5t & ins]t+ #ajj 
p]c5t2 &  7#c7 by add+ at ! end ! foll[+
 new p>agraph3  7#b7 7,a7 ,! total co/ (
 provid+ s]vices or 9-k9d assi/ance 9 ! 
case ( any vet]an describ$ 9 subp>agraph
 7,b7 = any fiscal ye> "u ! program may 
exce$ #ajj p]c5t ( ! co/ t w\ld o!rwise 
h be5 incurr$ z specifi$ 9 p>agraph 7#a7
 if ! ,secret>y det]m9es1 bas$ on a     
consid]ation ( cl9ical ne$1 geographic  

m>ket factors1 & su* o!r matt]s z !     
,secret>y may prescribe ?r\gh           
regulation1 t su* high] total co/ is 9 !
 be/ int]e/ ( ! vet]an4  7,b7 ,a vet]an 
describ$ 9 ?is subp>agraph is a vet]an )
 amyotrophic lat]al scl]osis1 a sp9al   
cord injury1 or a condition ! ,secret>y 
det]m9es to be simil> to su* conditions4
  4  7b7 ,applicability ,! am5dm5ts made
 by subsection 7a7 %all apply ) respect 
to fiscal ye>s beg9n+ on or aft] ! date 
( ! enactm5t ( ?is ,act4  #c4           
,coord9ation ) ,program (               
,all-,inclusive ,c>e = ! ,eld]ly        
,section #agbj;,c ( title #ch1 ,unit$   
,/ates ,code1 z am5d$ by section #b1 is 
fur!r am5d$ by add+ at ! end ! foll[+   
new subsection3  7f7 ,9 furni%+ s]vices 
to a vet]an "u ! program conduct$       
pursuant to subsection 7a71 if a m$ical 
c5t] ( ! ,dep>tm5t ?r\gh :i* su* program
 is adm9i/]$ is locat$ 9 a geographic   
area 9 :i* s]vices are available to !   
vet]an "u a ,,pace program 7z su* t]m is
 def9$ 9 sections #ahid7;a77#b7 &       

#aicd7;a77#b7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acie;eee7a77#b72       
#acifu-#d7;a77#b7771 ! ,secret>y %all   
seek to ent] into an agreem5t ) ! ,,pace
 program op]at+ 9 t area = ! furni%+ (  
su* s]vices4  4  #d4 ,home- &           
community-bas$ s]vices3 programs  7a7   
,programs ,*apt] #ag ( title #ch1 ,unit$
 ,/ates ,code1 is am5d$ by ins]t+ aft]  
section #agbj;,j ! foll[+ new section 7&
 con=m+ ! table ( sections at ! beg9n+ (
 su* *apt] accord+ly73  #agbj,k4 ,home- 
& community-bas$ s]vices3 programs  7a7 
,9 g5]al ,9 furni%+ non9/itutional      
alt]natives to nurs+ home c>e pursuant  
to ! au?ority ( section #agbj;,c ( ?is  
title 7or any o!r au?ority "u ?is *apt] 
or o!r provision ( law adm9i/]$ by !    
,secret>y ( ,vet]ans ,affairs71 !       
,secret>y %all c>ry out ea* ( ! programs
 specifi$ 9 ?is section 9 accordance )  
su* relevant au?orities except z o!rwise
 provid$ 9 ?is section4  7b7            
,vet]an-,direct$ ,c>e program  7#a7 ,!  
,secret>y ( ,vet]ans ,affairs1 9        

collaboration ) ! ,secret>y ( ,heal? &  
,human ,s]vices1 %all c>ry out a program
 to be kn[n z ! ,vet]an-,direct$ ,c>e   
program4 ,"u su* program1 ! ,secret>y ( 
,vet]ans ,affairs may ent] into         
agreem5ts ) ! provid]s describ$ 9       
p>agraph 7#b7 to provide to eligible    
vet]ans funds1 to ! ext5t practicable1  
to obta9 su* 9-home c>e s]vices & relat$
 items z may be det]m9$ appropriate by !
 ,secret>y ( ,vet]ans ,affairs & select$
 by ! vet]an1 includ+ ?r\gh ! vet]an    
hir+ individuals to provide su* s]vices 
& items or directly pur*as+ su* s]vices 
& items4  7#b7 ,! provid]s describ$ 9   
?is p>agraph are ! foll[+3 7,a7 ,an ,ag+
 & ,disability ,res\rce ,c5t]1 an area  
ag5cy on ag+1 or a ,/ate ag5cy4  7,b7 ,a
 c5t] = indep5d5t liv+4  7,c7 ,an       
,indian tribe or tribal organization    
receiv+ assi/ance "u title ,,vi ( !     
,old] ,am]icans ,act ( #aife 7#db       
,u4,s4,c4 #cjeg et seq474  7#c7 ,9 c>ry+
 out ! ,vet]an-,direct$ ,c>e program1 ! 
,secret>y ( ,vet]ans ,affairs %all--    

7,a7 adm9i/] su* program ?r\gh ea*      
m$ical c5t] ( ! ,dep>tm5t ( ,vet]ans    
,affairs2  7,b7 seek to ensure !        
availability ( su* program 9 ,am]ican   
,samoa1 ,guam1 ! ,commonweal? ( !       
,nor!rn ,m>iana ,isl&s1 ! ,commonweal? (
 ,pu]to ,rico1 ! ,virg9 ,isl&s ( !      
,unit$ ,/ates1 & any o!r t]ritory or    
possession ( ! ,unit$ ,/ates1 to ! ext5t
 practicable2 &  7,c7 seek to ensure !  
availability ( su* program = eligible   
vet]ans :o are ,native ,am]ican vet]ans 
receiv+ c>e & s]vices furni%$ by !      
,indian ,heal? ,s]vice1 a tribal heal?  
program1 an ,urban ,indian organization1
 or 79 ! case ( a ,native ,hawaiian     
vet]an7 a ,native ,hawaiian heal? c>e   
sy/em1 to ! ext5t practicable4  7#d7 ,if
 a vet]an p>ticipat+ 9 !                
,vet]an-,direct$ ,c>e program is        
cata/rophically disabl$1 ! vet]an may   
cont9ue to use funds "u ! program dur+ a
 p]iod ( hospitalization 9 ! same mann] 
t ! vet]an w\ld be au?oriz$ to use su*  
funds "u ! program if ! vet]an 7 n      

hospitaliz$4  7c7 ,homemak] & ,home     
,heal? ,aide program  7#a7 ,! ,secret>y 
%all c>ry out a program to be kn[n z !  
,homemak] & ,home ,heal? ,aide program  
"u :i* ! ,secret>y may ent] into        
agreem5ts ) home heal? ag5cies to       
provide to eligible vet]ans su* home    
heal? aide s]vices z may be det]m9$     
appropriate by ! ,secret>y4  7#b7 ,9    
c>ry+ out ! ,homemak] & ,home ,heal?    
,aide program1 ! ,secret>y %all1 to !   
ext5t practicable1 ensure ! availability
 ( su* program-- 7,a7 9 ! locations     
specifi$ 9 subp>agraph 7,b7 ( subsection
 7b77#c72 &  7,b7 = ! vet]an populations
 specifi$ 9 subp>agraph 7,c7 ( su*      
subsection4  7d7 ,home-,bas$ ,prim>y    
,c>e program ,! ,secret>y %all c>ry out 
a program to be kn[n z ! ,home-,bas$    
,prim>y ,c>e program "u :i* ! ,secret>y 
may furni% to eligible vet]ans 9-home   
heal? c>e1 ! provision ( :i* is ov]se5  
by a provid] ( ! ,dep>tm5t4  7e7        
,pur*as$ ,skill$ ,home ,c>e program ,!  
,secret>y %all c>ry out a program to be 

kn[n z ! ,pur*as$ ,skill$ ,home ,c>e    
program "u :i* ! ,secret>y may furni% to
 eligible vet]ans su* 9-home c>e s]vices
 z may be det]m9$ appropriate & select$ 
by ! ,secret>y = ! vet]an4  7f7 ,c>egiv]
 support  7#a7 ,) respect to a resid5t  
eligible c>egiv] ( a vet]an p>ticipat+ 9
 a program "u ?is section1 ! ,secret>y  
%all-- 7,a7 if ! vet]an meets !         
requirem5ts ( a cov]$ vet]an "u section 
#agbj;,g7b7 ( ?is title1 provide to su* 
c>egiv] ! option ( enroll+ 9 ! program (
 g5]al c>egiv] support s]vices "u su*   
section2  7,b7 provide to su* c>egiv]   
cov]$ respite c>e ( n less ?an #cj days 
annually2 &  7,c7 conduct on an annual  
basis 7&1 to ! ext5t practicable1 9     
connection ) 9-p]son s]vices provid$ "u 
! program 9 :i* ! vet]an is p>ticipat+71
 a wellness contact ( su* c>egiv]4  7#b7
 ,cov]$ respite c>e provid$ to a resid5t
 eligible c>egiv] ( a vet]an "u p>agraph
 7#a7 may exce$ #cj days annually if su*
 ext5sion is reque/$ by ! resid5t       
eligible c>egiv] or vet]an & det]m9$    

m$ically appropriate by ! ,secret>y4    
7g7 ,rule ( con/ruction ,no?+ 9 ?is     
section %all be con/ru$ to limit !      
au?ority ( ! ,secret>y to c>ry out      
programs provid+ home- & community-bas$ 
s]vices "u any o!r provision ( law4  7h7
 ,def9itions ,9 ?is section3 7#a7 ,!    
t]ms ,ag+ & ,disability ,res\rce ,c5t]1 
area ag5cy on ag+1 & ,/ate ag5cy h !    
mean+s giv5 ^? t]ms 9 section #ajb ( !  
,old] ,am]icans ,act ( #aife 7#db       
,u4,s4,c4 #cjjb74  7#b7 ,! t]ms c>egiv] 
& family c>egiv]1 ) respect to a vet]an1
 h ! mean+s giv5 ^? t]ms1 respectively1 
"u subsection 7e7 ( section #agbj;,g (  
?is title ) respect to an eligible      
vet]an "u subsection 7a7 ( su* section  
or a cov]$ vet]an "u subsection 7b7 (   
su* section1 z ! case may be4  7#c7 ,!  
t]m c5t] = indep5d5t liv+ has ! mean+   
giv5 t t]m 9 section #gjb ( !           
,rehabilitation ,act ( #aigc 7#bi       
,u4,s4,c4 #gif;a74  7#d7 ,! t]m cov]$   
respite c>e has ! mean+ giv5 su* t]m 9  
section #agbj;,g7d7 ( ?is title4  7#e7  

,! t]m eligible vet]an means any        
vet]an-- 7,a7 = :om ! ,secret>y det]m9es
 p>ticipation 9 a specific program "u   
?is section is m$ically necess>y to     
promote1 pres]ve1 or re/ore ! heal? ( ! 
vet]an2 &  7,b7 :o abs5t su*            
p>ticipation w\ld be at increas$ risk = 
hospitalization1 placem5t 9 a nurs+     
home1 or em]g5cy room c>e4  7#f7 ,! t]m 
home heal? aide means an individual     
employ$ by a home heal? ag5cy to provide
 9-home c>e s]vices4  7#g7 ,! t]m 9-home
 c>e s]vice means any s]vice1 includ+ a 
p]sonal c>e s]vice1 provid$ to enable ! 
recipi5t ( su* s]vice to live at home4  
7#h7 ,! t]ms ,indian tribe & tribal     
organization h ! mean+s giv5 ^? t]ms 9  
section #d ( ! ,indian                  
,self-,det]m9ation & ,education         
,assi/ance ,act 7#be ,u4,s4,c4 #ecjd74  
7#i7 ,! t]ms ,native ,am]ican & ,native 
,am]ican vet]an h ! mean+s giv5 ^? t]ms 
9 section #cgfe ( ?is title4  7#aj7 ,!  
t]ms ,native ,hawaiian & ,native        
,hawaiian heal? c>e sy/em h ! mean+s    

giv5 ^? t]ms 9 section #ab ( ! ,native  
,hawaiian ,heal? ,c>e ,improvem5t ,act  
7#db ,u4,s4,c4 #aagaa74  7#aa7 ,! t]ms  
tribal heal? programs & ,urban ,indian  
organizations h ! mean+s giv5 ^? t]ms 9 
section #d ( ! ,indian ,heal? ,c>e      
,improvem5t ,act 7#be ,u4,s4,c4 #afjc74 
7#ab7 ,! t]m resid5t eligible c>egiv]   
means an individual :o-- 7,a7 is a      
c>egiv]1 or a family c>egiv]1 ( a vet]an
 & resides ) t vet]an2 &  7,b7 has n    
ent]$ into a contract1 agreem5t1 or o!r 
arrangem5t = su* individual to act z a  
c>egiv] = t vet]an unless su* individual
 is a family memb] ( ! vet]an or is     
furni%+ c>egiv] s]vices ?r\gh a m$ical  
fo/] home4  4  7b7 ,deadl9e = improv$   
adm9i/ration ,! ,secret>y ( ,vet]ans    
,affairs %all ensure t !                
,vet]an-,direct$ ,c>e program & !       
,homemak] & ,home ,heal? ,aide program  
are adm9i/]$ ?r\gh ea* m$ical c5t] ( !  
,dep>tm5t ( ,vet]ans ,affairs 9         
accordance ) section #agbj,k ( title    
#ch1 ,unit$ ,/ates ,code 7z add$ by     

subsection 7a771 by n lat] ?an two ye>s 
aft] ! date ( ! enactm5t ( ?is ,act4    
#e4 ,coord9ation ) assi/ance & support  
s]vices = c>egiv]s  7a7 ,coord9ation )  
,program ( ,compreh5sive ,assi/ance =   
,family ,c>egiv]s  7#a7 ,coord9ation    
,section #agbj;,g7a7 ( title #ch1 ,unit$
 ,/ates ,code1 is am5d$ by add+ at ! end
 ! foll[+ new p>agraph3  7#ad7 7,a7 ,9 !
 case ( a vet]an or c>egiv] :o seeks    
s]vices "u ?is subsection & is d5i$ su* 
s]vices1 or a vet]an or ! family c>egiv]
 ( a vet]an :o is dis*>g$ f ! program "u
 ?is subsection1 ! ,secret>y %all-- 7i7 
if ! vet]an meets ! requirem5ts ( a     
cov]$ vet]an "u subsection 7b71 provide 
to su* c>egiv] ! option ( enroll+ 9 !   
program ( g5]al c>egiv] support s]vices 
"u su* subsection2  7ii7 assess ! vet]an
 or c>egiv] = p>ticipation 9 any o!r    
available program ( ! ,dep>tm5t = home- 
& community-bas$ s]vices 7includ+ !     
programs specifi$ 9 section #agbj,k (   
?is title7 = :i* ! vet]an or c>egiv] may
 be eligible &1 ) respect to ! vet]an1  

/ore 7& make accessible to ! vet]an7 !  
results ( su* assessm5t 9 ! electronic  
m$ical record ( ! vet]an2 &  7iii7      
provide to ! vet]an or c>egiv] writt5   
in=mation on any su* program id5tifi$   
pursuant to ! assessm5t "u clause 7ii71 
includ+ in=mation ab\t facilities1      
eligibility requirem5ts1 & relevant     
contact in=mation = ea* su* program4    
7,b7 ,= ea* vet]an or family c>egiv] :o 
is dis*>g$ f ! program "u ?is           
subsection1 a c>egiv] support coord9ator
 %all provide = a smoo? & p]sonaliz$    
transition f su* program to an          
appropriate program ( ! ,dep>tm5t =     
home- & community-bas$ s]vices 7includ+ 
! programs specifi$ 9 section #agbj,k ( 
?is title71 includ+ by integrat+ c>egiv]
 support across programs4  4  7#b7      
,applicability ,! am5dm5ts made by      
p>agraph 7#a7 %all apply ) respect to   
d5ials & dis*>ges occurr+ on or aft] !  
date t is #ahj days aft] ! date ( !     
enactm5t ( ?is ,act4  7#c7 ,te*nical &  
con=m+ am5dm5ts ,section #agbj;,g7d7 (  

su* title is am5d$-- 7,a7 by /rik+ or a 
cov]$ vet]an ea* place x appe>s & ins]t+
 1 a vet]an d5i$ or dis*>g$ z specifi$ 9
 p>agraph 7#ad7 ( su* subsection1 or a  
cov]$ vet]an2 &  7,b7 by /rik+ "u       
subsection 7a71 means ea* place x appe>s
 & ins]t+ "u subsection 7a7 or a vet]an 
d5i$ or dis*>g$ z specifi$ 9 p>agraph   
7#ad7 ( su* subsection1 means4  7b7     
,con=mity ( respite c>e across programs 
,section #agbj;,g ( title #ch1 ,unit$   
,/ates ,code1 z am5d$ by subsection     
7a77#c71 is fur!r am5d$-- 7#a7 9        
subsection 7a77#c7-- 7,a7 by am5d+      
subp>agraph 7,a77ii77,,iii7 to read z   
foll[s3  7,,iii7 cov]$ respite c>e ( n  
less ?an #cj days annually2  2 &  7,b7  
by /rik+ subp>agraph 7,b7 & r$esignat+  
subp>agraphs 7,c7 & 7,d7 z subp>agraphs 
7,b7 ?r\gh 7,c71 respectively2 &  7#b7  
by am5d+ subsection 7b77#c77;,a77iii7 to
 read z foll[s3  7iii7 ,cov]$ respite   
c>e ( n less ?an #cj days annually4  2 &
  7#c7 9 subsection 7d7-- 7,a7 by       
r$esignat+ p>agraphs 7#b7 ?r\gh 7#d7 z  

p>agraphs 7#c7 ?r\gh 7#e71 respectively2
 &  7,b7 by ins]t+ aft] p>agraph 7#a7 ! 
foll[+ new p>agraph3  7#b7 ,! t]m cov]$ 
respite c>e means1 ) respect to a       
c>egiv] ( a vet]an1 respite c>e "u      
section #agbj;,b ( ?is title t-- 7,a7 is
 m$ically & age appropriate = ! vet]an  
7includ+ #bd-;h\r p] day c>e ( ! vet]an 
comm5surate ) ! c>e provid$ by !        
c>egiv]72 &  7,b7 includes 9-home c>e4  
4  7c7 ,review relat+ to c>egiv] contact
 ,! ,secret>y %all conduct a review ( ! 
capacity ( ! ,dep>tm5t to e/abli% a     
/reaml9$ sy/em = contact+ all c>egiv]s  
enroll$ 9 ! program ( g5]al c>egiv]     
support s]vices "u section #agbj;,g7b7 (
 title #ch1 ,unit$ ,/ates ,code1 to     
provide to su* c>egiv]s program updates 
& al]ts relat+ to em]g+ s]vices = :i*   
su* c>egiv]s may be eligible4  #f4      
,developm5t ( c5traliz$ website =       
program in=mation  7a7 ,c5traliz$       
website ,! ,secret>y %all develop &     
ma9ta9 a c5traliz$ & publically         
accessible int]net website ( ! ,dep>tm5t

 z a cle>+h\se = in=mation & res\rces   
relat+ to cov]$ programs4  7b7 ,cont5ts 
,! website "u subsection 7a7 %all conta9
 ! foll[+3 7#a7 ,a description ( ea*    
cov]$ program4  7#b7 ,an in=mational    
assessm5t tool t-- 7,a7 expla9s !       
adm9i/rative eligibility1 if applicable1
 ( a vet]an1 or a c>egiv] ( a vet]an1 = 
any cov]$ program2 &  7,b7 provides     
in=mation1 z a result ( su* explanation1
 on any cov]$ program = :i* ! vet]an or 
c>egiv] 7z ! case may be7 may be        
eligible4  7#c7 ,a li/ ( requir$        
proc$ures = ! directors ( ! m$ical      
facilities ( ! ,dep>tm5t to foll[ 9     
det]m9+ ! eligibility & suitability (   
vet]ans = p>ticipation 9 a cov]$        
program1 includ+ proc$ures applicable to
 in/ances 9 :i* ! res\rce con/ra9ts ( a 
facility 7or ( a community 9 :i* a      
facility is locat$7 may result 9 !      
inability to address ! heal? ne$s ( a   
vet]an "u a cov]$ program 9 a timely    
mann]4  7c7 ,updates ,! ,secret>y %all  
ensure ! website "u subsection 7a7 is   

updat$ on a p]iodic basis4  #g4         
,improvem5ts relat+ to ,homemak] & ,home
 ,heal? ,aide program  7a7 ,pilot       
program = communities ) %ortage ( home  
heal? aides  7#a7 ,program ,beg9n+ n    
lat] ?an #ah mon?s aft] ! date ( !      
enactm5t ( ?is ,act1 ! ,secret>y %all   
c>ry out a ?ree-ye> pilot program "u :i*
 ! ,secret>y %all provide homemak] &    
home heal? aide s]vices to vet]ans :o   
reside 9 communities ) a %ortage ( home 
heal? aides4  7#b7 ,locations ,!        
,secret>y %all select n few] ?an five   
geographic locations 9 :i* ! ,secret>y  
det]m9es !re is a %ortage ( home heal?  
aides at :i* to c>ry out ! pilot program
 "u p>agraph 7#a74  7#c7 ,nurs+         
assi/ants  7,a7 ,9 g5]al ,9 c>ry+ out ! 
pilot program "u p>agraph 7#a71 !       
,secret>y may hire nurs+ assi/ants z new
 employees ( ! ,dep>tm5t ( ,vet]ans     
,affairs1 or reassign nurs+ assi/ants :o
 are exi/+ employees ( ! ,dep>tm5t1 to  
provide to vet]ans 9-home c>e s]vices   
7includ+ basic tasks au?oriz$ by ! ,/ate

 c]tification ( ! nurs+ assi/ant7 "u !  
pilot program1 9 lieu ( or 9 addition to
 ! provision ( su* s]vices ?r\gh        
non-,dep>tm5t home heal? aides4  7,b7   
,relation%ip to ,home-,bas$ ,prim>y ,c>e
 program ,nurs+ assi/ants hir$ or       
reassign$ "u subp>agraph 7,a7 may       
provide s]vices to a vet]an "u ! pilot  
program "u p>agraph 7#a7 :ile s]v+ z "p 
( a heal? c>e team = ! vet]an "u !      
,home-,bas$ ,prim>y ,c>e program4  7#d7 
,report to ,congress ,n lat] ?an "o ye> 
aft] ! date on :i* ! ,secret>y det]m9es 
! pilot program "u p>agraph 7#a7 has    
t]m9at$1 ! ,secret>y %all submit to !   
,committees on ,vet]ans' ,affairs ( !   
,h\se ( ,repres5tatives & ! ,s5ate a    
report on ! result ( ! pilot program4   
7b7 ,report on use ( funds ,n lat] ?an  
"o ye> aft] ! date ( ! enactm5t ( ?is   
,act1 ! ,secret>y ( ,vet]ans ,affairs   
%all submit to ! ,committees on         
,vet]ans' ,affairs ( ! ,h\se (          
,repres5tatives & ! ,s5ate a report     
conta9+1 ) respect to ! p]iod beg9n+ 9  

fiscal ye> #bjab & end+ 9 fiscal ye>    
#bjbc1 ! foll[+3 7#a7 ,an id5tification 
( ! am\nt ( funds t 7 includ$ 9 a budget
 ( ! ,dep>tm5t ( ,vet]ans ,affairs dur+ 
su* p]iod = ! provision ( 9-home c>e to 
vet]ans "u ! ,homemak] & ,home ,heal?   
,aide program b 7 n exp5d$ = su*        
provision1 disaggregat$ by m$ical c5t] (
 ! ,dep>tm5t = :i* su* unexp5d$ funds 7 
budget$ 7if su* disaggregation is       
possible74  7#b7 ,to ! ext5t            
practicable1 an id5tification ( ! numb] 
( vet]ans = :om1 dur+ su* p]iod1 ! h\rs 
dur+ :i* a home heal? aide 0 au?oriz$ to
 provide s]vices to ! vet]an "u !       
,homemak] & ,home ,heal? ,aide program 7
 r$uc$ = a reason o!r ?an a *ange 9 !   
heal? c>e ne$s ( ! vet]an1 & a detail$  
description ( ! reasons :y any su*      
r$uctions may h occurr$4  7c7 ,updat$   
guidance on program ,n lat] ?an "o ye>  
aft] ! date ( ! enactm5t ( ?is ,act1 !  
,secret>y %all issue updat$ guidance = !
 ,homemak] & ,home ,heal? ,aide program4
 ,su* updat$ guidance %all include !    

foll[+3 7#a7 ,a process = ! transition (
 vet]ans f ! ,homemak] & ,home ,heal?   
,aide program to o!r cov]$ programs4    
7#b7 ,a requirem5t = ! directors ( !    
m$ical facilities ( ! ,dep>tm5t to      
complete su* process :5ev] a vet]an )   
c>e ne$s has be5 d5i$ s]vices f home    
heal? ag5cies "u ! ,homemak] & ,home    
,heal? ,aide program z a result ( !     
cl9ical ne$s or behavioral issues ( !   
vet]an4  #h4 ,reviews & o!r improvem5ts 
relat+ to home- & community-bas$ s]vices
  7a7 ,(fice ( ,g]iatric & ,ext5d$ ,c>e 
7#a7 ,review ( programs ,! ,"u ,secret>y
 = ,heal? ( ! ,dep>tm5t ( ,vet]ans      
,affairs %all conduct a review ( ea*    
program adm9i/]$ ?r\gh ! ,(fice (       
,g]iatric & ,ext5d$ ,c>e ( ! ,dep>tm5t1 
or successor (fice1 to-- 7,a7 ensure    
consi/5cy 9 program managem5t2  7,b7    
elim9ate s]vice gaps at ! m$ical c5t]   
level2 &  7,c7 ensure ! availability (1 
& ! access by vet]ans to1 home- &       
community-bas$ s]vices4  7#b7 ,assessm5t
 ( /aff+ ne$s ,! ,secret>y ( ,vet]ans   

,affairs %all conduct an assessm5t ( !  
/aff+ ne$s ( ! ,(fice ( ,g]iatric &     
,ext5d$ ,c>e ( ! ,dep>tm5t ( ,vet]ans   
,affairs1 or successor (fice4  7#c7     
,goals = geographic alignm5t ( c>e  7,a7
 ,e/abli%m5t ( goals ,! ,director ( !   
,(fice ( ,g]iatric & ,ext5d$ ,c>e1 or   
successor (fice1 %all e/abli%           
quantitative goals to enable ag+ or     
disabl$ vet]ans :o are n locat$ ne>     
m$ical c5t]s ( ! ,dep>tm5t to access    
ext5d$ c>e s]vices 7includ+ by improv+  
access to home- & community-bas$ s]vices
 = su* vet]ans74  7,b7 ,implem5tation   
timel9e ,ea* goal e/abli%$ "u           
subp>agraph 7,a7 %all include a timel9e 
= ! implem5tation ( ! goal at ea* m$ical
 c5t] ( ! ,dep>tm5t4  7#d7 ,goals =     
9-home specialty c>e ,! ,director ( !   
,(fice ( ,g]iatric & ,ext5d$ ,c>e1 or   
successor (fice1 %all e/abli%           
quantitative goals to address !         
specialty c>e ne$s ( vet]ans ?r\gh      
9-home c>e1 includ+ by ensur+ !         
education ( home heal? aides & c>egiv]s 

( vet]ans 9 ! foll[+ areas3 7,a7        
,dem5tia c>e4  7,b7 ,c>e = sp9al cord   
injuries & diseases4  7,c7 ,v5tilator   
c>e4  7,d7 ,o!r speciality c>e areas z  
det]m9$ by ! ,secret>y4  7#e7 ,report to
 ,congress ,n lat] ?an "o ye> aft] !    
date ( ! enactm5t ( ?is ,act1 !         
,secret>y %all submit to ! ,committees  
on ,vet]ans' ,affairs ( ! ,h\se (       
,repres5tatives & ! ,s5ate a report     
conta9+ ! f9d+s ( ! review "u p>agraph  
7#a71 ! results ( ! assessm5t "u        
p>agraph 7#b71 & ! goals e/abli%$ "u    
p>agraphs 7#c7 & 7#d74  7b7 ,review (   
inc5tives & ef=ts relat+ to home- &     
community-,bas$ s]vices  7#a7 ,review ,!
 ,secret>y ( ,vet]ans ,affairs %all     
conduct a review ( ! foll[+3 7,a7 ,!    
f9ancial & organizational inc5tives = ! 
directors ( m$ical c5t]s ( ! ,dep>tm5t  
to e/abli% or exp& cov]$ programs at su*
 m$ical c5t]s4  7,b7 ,any inc5tives =   
su* directors to provide to vet]ans     
home- & community-bas$ s]vices 9 lieu ( 
in/itutional c>e4  7,c7 ,! ef=ts tak5 by

 ! ,secret>y to enhance sp5d+ ( !       
,dep>tm5t = ext5d$ c>e by %ift+ !       
balance ( su* sp5d+ f in/itutional c>e  
to home- & community-bas$ s]vices4  7,d7
 ,! plan ( ! ,"u ,secret>y = ,heal? ( ! 
,dep>tm5t to accel]ate ef=ts to enhance 
sp5d+ z specifi$ 9 subp>agraph 7,c71 to 
mat* ! progress ( simil> ef=ts tak5 by !
 ,adm9i/rator ( ! ,c5t]s = ,m$ic>e      
,m$icaid ,s]vices ) respect to sp5d+ ( !
 ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices =  
ext5d$ c>e4  7#b7 ,report to ,congress  
,n lat] ?an "o ye> aft] ! date ( !      
enactm5t ( ?is ,act1 ! ,secret>y %all   
submit to ! ,committees on ,vet]ans'    
,affairs ( ! ,h\se ( ,repres5tatives & !
 ,s5ate a report on ! f9d+s ( ! review  
"u p>agraph 7#a74  7c7 ,review ( respite
 c>e s]vices ,n lat] ?an two ye>s aft] !
 date ( ! enactm5t ( ?is ,act1 !        
,secret>y ( ,vet]ans ,affairs %all      
conduct a review ( ! use1 availability1 
& effectiv5ess1 ( ! respite c>e s]vices 
furni%$ by ! ,secret>y "u *apt] #ag (   
title #ch1 ,unit$ ,/ates ,code4  7d7    

,collaboration ,to improve home- &      
community-,bas$ s]vices  7#a7 ,report on
 expansion ( c]ta9 m5tal heal? s]vices  
7,a7 ,report ,n lat] ?an two ye>s aft] !
 date ( ! enactm5t ( ?is ,act1 !        
,secret>y ( ,vet]ans ,affairs1 9        
collaboration ) ! ,secret>y ( ,heal? &  
,human ,s]vices1 %all submit to !       
,committees on ,vet]ans' ,affairs ( !   
,h\se ( ,repres5tatives & ! ,s5ate a    
report conta9+ recomm5dations = !       
expansion ( m5tal heal? s]vices & relat$
 support to ! c>egiv]s ( vet]ans4  7,b7 
,matt]s includ$ ,! report "u subp>agraph
 7,a7 %all include an assessm5t ( !     
feasibility & advisability ( au?oriz+   
access to ,vet ,c5t]s by-- 7i7 family   
c>egiv]s enroll$ 9 a program "u section 
#agbj;,g ( title #ch1 ,unit$ ,/ates     
,code2 &  7ii7 family c>egiv]s ( vet]ans
 p>ticipat+ 9 a program specifi$ 9      
section #agbj,k ( su* title1 z add$ by  
section #d4  7#b7 ,recomm5dations  7,a7 
,developm5t ,! ,secret>y ( ,vet]ans     
,affairs %all develop recomm5dations z  

foll[s3 7i7 ,) respect to home- &       
community-bas$ s]vices = vet]ans1 !     
,secret>y ( ,vet]ans ,affairs %all      
develop recomm5dations reg>d+ new       
s]vices 79 addition to ^? furni%$ z ( ! 
date ( ! enactm5t ( ?is ,act7 9         
collaboration ) ! ,secret>y ( ,heal? &  
,human ,s]vices4  7ii7 ,) respect to !  
national %ortage ( home heal? aides1 !  
,secret>y ( ,vet]ans ,affairs %all      
develop recomm5dations reg>d+ me?ods to 
address su* %ortage 9 collaboration ) ! 
,secret>y ( ,heal? & ,human ,s]vices & !
 ,secret>y ( ,labor4  7,b7 ,submission  
to ,congress ,! ,secret>y ( ,vet]ans    
,affairs %all submit to ! ,committees on
 ,vet]ans' ,affairs ( ! ,h\se (         
,repres5tatives & ! ,s5ate a report     
conta9+ ! recomm5dations develop$ "u    
subp>agraph 7,a7 & an id5tification (   
any *anges 9 exi/+ law or new /atutory  
au?ority necess>y to implem5t !         
recomm5dations1 z det]m9$ by !          
,secret>y4  7,c7 ,consultation )        
,secret>y ( ,labor ,9 c>ry+ out ?is     

p>agraph1 ! ,secret>y ( ,vet]ans        
,affairs %all consult ) ! ,secret>y (   
,labor4  7#c7 ,fe$back & recomm5dations 
on c>egiv] support  7,a7 ,fe$back &     
recomm5dations ,! ,secret>y ( ,vet]ans  
,affairs %all solicit f ! entities      
describ$ 9 subp>agraph 7,b7 fe$back &   
recomm5dations reg>d+ opportunities = ! 
,secret>y to enhance home- &            
community-bas$ s]vices = vet]ans & !    
c>egiv]s ( vet]ans1 includ+ ?r\gh !     
pot5tial provision by ! entity ( c>e &  
respite s]vices to vet]ans & c>egiv]s :o
 may n be eligible = any program "u     
section #agbj;,g ( title #ch1 ,unit$    
,/ates ,code1 or section #agbj,k ( su*  
title 7z add$ by section #d71 b h a ne$ 
= assi/ance4  7,b7 ,cov]$ entities ,!   
entities describ$ 9 ?is subp>agraph are 
vet]ans s]vice organizations & nonpr(it 
organizations ) a focus on c>egiv]      
support 7z det]m9$ by ! ,secret>y74     
7#d7 ,collaboration = ,native ,am]ican  
vet]ans ,! ,secret>y ( ,vet]ans ,affairs
 %all collaborate ) ! ,director ( !     

,indian ,heal? ,s]vice & repres5tatives 
f tribal heal? programs & ,urban ,indian
 organizations to ensure ! availability 
( home- & community-bas$ s]vices =      
,native ,am]ican vet]ans1 includ+       
,native ,am]ican vet]ans receiv+ heal?  
c>e & m$ical s]vices "u multiple heal?  
c>e sy/ems4  #i4 ,modification ( c]ta9  
h\s+ loan fees ,! loan fee table 9      
section #cgbi7;b77#b7 ( title #ch1      
,unit$ ,/ates ,code1 is am5d$ by /rik+  
,novemb] #ae1 #bjca ea* place x appe>s &
 ins]t+ ,febru>y #d1 #bjcb4  #aj4       
,def9itions ,9 ?is ,act3 7#a7 ,! t]ms   
c>egiv] & family c>egiv] h ! mean+s giv5
 ^? t]ms "u section #agbj,k7h7 ( title  
#ch1 ,unit$ ,/ates ,code 7z add$ by     
section #d74  7#b7 ,! t]m cov]$         
program-- 7,a7 means any program ( !    
,dep>tm5t ( ,vet]ans ,affairs = home- & 
community-bas$ s]vices2 &  7,b7 includes
 ! programs specifi$ 9 section #agbj,k (
 title #ch1 ,unit$ ,/ates ,code 7z add$ 
by section #d74  7#c7 ,! t]m home- &    
community-bas$ s]vices-- 7,a7 means !   

s]vices ref]r$ to 9 section             
#agja7f77;,e7 ( title #ch1 ,unit$ ,/ates
 ,code2 &  7,b7 includes s]vices furni%$
 "u a program specifi$ 9 section #agbj,k
 ( su* title 7z add$ by section #d74    
7#d7 ,! t]ms ,home-,bas$ ,prim>y ,c>e   
program1 ,homemak] & ,home ,heal? ,aide 
program1 & ,vet]an-,direct$ ,c>e program
 mean ! programs ( ! ,dep>tm5t (        
,vet]ans ,affairs specifi$ 9 subsection 
7d71 7c71 & 7b7 ( su* section #agbj,k1  
respectively4  7#e7 ,! t]ms home heal?  
aide1 ,native ,am]ican1 ,native ,am]ican
 vet]an1 tribal heal? programs1 & ,urban
 ,indian organizations h ! mean+s giv5  
^? t]ms 9 subsection 7h7 ( su* section  
#agbj,k4  7#f7 ,! t]m ,vet ,c5t] has !  
mean+ giv5 t t]m 9 section #agab;,a7h7 (
 title #ch1 ,unit$ ,/ates ,code4  7#g7  
,! t]m vet]ans s]vice organization means
 any organization recogniz$ by !        
,secret>y "u section #eijb ( su* title4 
,pass$ ! ,h\se ( ,repres5tatives        
,decemb] #e1 #bjbc4,kev9 ,f4            
,mc,cumber1,cl]k4