,,ii #aahth ,,congress #ast ,session ,s4 #ada ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,january #cj1 #bjbc,mr4 ,moran 7for himself1 ,mr4 ,tester1 and ,ms4 ,hassan7 introduced the following bill2 which was read twice and referred to the ,committee on ,veterans' ,affairs ,a ,,bill ,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 ,act4 7b7 ,table of contents ,the table of contents for this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4,sec4 #b4 ,definitions4,sec4 #c4 ,increase of expenditure cap for noninstitutional care alternatives to nursing home care4,sec4 #d4 ,coordination with ,program of ,all-,inclusive ,care for the ,elderly4,sec4 #e4 ,home and community based services3 programs4,sec4 #f4 ,coordination with assistance and support services for caregivers4,sec4 #g4 ,development of centralized website for program information4,sec4 #h4 ,improvements relating to ,home ,maker and ,home ,health ,aide program4,sec4 #i4 ,reviews and other improvements relating to home and community based services4 #b4 ,definitions ,in this ,act3 7#a7 ,caregiver2 ,family caregiver ,the terms caregiver and family caregiver have the meanings given those terms under section #agbj,k7g7 of title #ch1 ,united ,states ,code 7as added by section #e7;a77#a774 7#b7 ,covered program ,the term covered program-- 7,a7 means any program of the ,department 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 #e7;a77#a774 7#c7 ,department ,the term ,department means the ,department of ,veterans ,affairs4 7#d7 ,home and community based services ,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 #e7;a77#a774 7#e7 ,home ,based ,primary ,care program2 ,home ,maker and ,home ,health ,aide program2 ,veteran ,directed ,care program ,the terms ,home ,based ,primary ,care program1 ,home ,maker and ,home ,health ,aide program1 and ,veteran ,directed ,care program mean the programs of the ,department specified in subsections 7d71 7c71 and 7b7 of such section #agbj,k1 respectively4 7#f7 ,home health agency2 ,home health aide2 ,native ,american veteran1 ,tribal health program2 ,urban ,indian organization ,the terms home health agency1 home health aide1 ,native ,american veteran1 tribal health program1 and ,urban ,indian organization have the meanings given those terms in subsection 7g7 of such section #agbj,k4 7#g7 ,secretary ,the term ,secretary means the ,secretary of ,veterans ,affairs4 7#h7 ,veterans service organization ,the term veterans service organization means any organization recognized by the ,secretary under section #eijb of title #ch1 ,united ,states ,code4 #c4 ,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 in paragraph 7#a71 as designated by paragraph 7#a71 by striking #fe percent of2 and 7#c7 by adding at the end the following new paragraph3 7#b7 ,the total cost of providing services or in-kind assistance in the case of any veteran for any fiscal year under the program may exceed the cost that would otherwise have been incurred as specified in paragraph 7#a7 if the ,secretary determines such higher total cost is in the best interest of the veteran4 4 7b7 ,applicability ,the amendments made by subsection 7a7 shall apply with respect to any fiscal year beginning on or after the date of the enactment of this ,act4 #d4 ,coordination with ,program of ,all-,inclusive ,care for the ,elderly ,section #agbj;,c of title #ch1 ,united ,states ,code1 as amended by section #c1 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 establish a partnership with the ,,pace program operating in that area for the furnishing of such services4 4 #e4 ,home and community based services3 programs 7a7 ,programs 7#a7 ,in general ,subchapter ,,ii of chapter #ag of title #ch1 ,united ,states ,code1 is amended by inserting after section #agbj;,j the following new section3 #agbj,k4 ,home and community based services3 programs 7a7 ,in general ,in furnishing noninstitutional alternatives to nursing home care under 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 program under which the ,secretary of ,veterans ,affairs may enter into agreements with the providers described in paragraph 7#b7 to provide to eligible veterans funds 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 ,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 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 ,states2 and 7,c7 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 system4 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 ,home ,maker and ,home ,health ,aide program 7#a7 ,the ,secretary shall carry out a program to be known as the ,home ,maker 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 ,home ,maker and ,home ,health ,aide program1 the ,secretary shall 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 physician 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 caregiver of a veteran participating in a program under this section who is a family caregiver1 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 subject to paragraph 7#b71 provide to such caregiver not fewer than #ad days of covered respite care each year2 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 check of such caregiver4 7#b7 ,the ,secretary shall provide not fewer than #cj days of covered respite care each year to any resident caregiver who provides services funded under the ,veteran ,directed ,care program under subsection 7b74 7#c7 ,covered respite care provided to a resident caregiver of a veteran under paragraph 7#a7 or 7#b71 as the case may be1 may exceed #ad days annually or #cj days annually1 respectively1 if an extension is requested by the resident caregiver or veteran and determined medically appropriate by the ,secretary4 7g7 ,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 7d7 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 means1 with respect to a caregiver of a veteran1 respite care that-- 7,a7 includes #bd-;hour per day care of the veteran commensurate with the care provided by the caregiver2 7,b7 is medically and age-appropriate2 and 7,c7 includes in-home care services4 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 agency has the meaning given that term in section #ahfa7o7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7o774 7#g7 ,the term home health aide means an individual employed by a home health agency to provide in-home care services4 7#h7 ,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#i7 ,the term ,native ,american veteran has the meaning given that term 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 term resident caregiver means a caregiver or a family caregiver of a veteran who resides with the veteran4 7#ab7 ,the terms tribal health program and ,urban ,indian organization have the meanings given those terms in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc74 4 7#b7 ,clerical amendment ,the table of sections at the beginning of such subchapter is amended by inserting after the item relating to section #agbj;,j the following new item3 #agbj,k4 ,home and community based services3 programs4 4 7b7 ,deadline for improved administration ,the ,secretary shall ensure that the ,veteran ,directed ,care program and the ,home ,maker and ,home ,health ,aide program are administered through each medical center of the ,department in accordance with section #agbj,k of title #ch1 ,united ,states ,code 7as added by subsection 7a77#a771 by not later than two years after the date of the enactment of this ,act4 7c7 ,administration of ,veteran ,directed ,care program 7#a7 ,procedures ,the ,secretary shall establish procedures to identify staffing needs for the ,program and define the roles and responsibilities of personnel of the ,program at the national1 ,veterans ,integrated ,service ,network1 and facility levels1 including responsibilities for engagement with veterans participating in the ,program1 veterans interested in the ,program1 and providers described in section #agbj,k7b77#b71 as added by subsection 7a77#a74 7#b7 ,staffing model 7,a7 ,in general ,the ,secretary shall establish a staffing model for the administration of the ,program at each medical center of the ,department4 7,b7 ,staffing ratio ,the ,secretary shall establish a staffing ratio for administration of the ,program at each facility of the ,department at which the ,program is carried out1 which shall include a specified number of full-time equivalent employees1 with no collateral duties1 per number of veterans served by the ,program4 7#c7 ,funding for program 7,a7 ,in general ,the ,secretary shall develop methods for tracking and reporting demand by veterans for and use by veterans of services under the ,program to inform yearly cost estimates for the ,program4 7,b7 ,dedicated funding ,the ,secretary shall ensure each medical center of the ,department receives dedicated funding for administration and staffing of the ,program1 tailored to demand for and use of the ,program at such medical center4 7,c7 ,separate funding ,funding provided to carry out the ,program shall be separate from any other funding for the purchased long term services and supports programs of the ,department4 7#d7 ,program defined ,in this subsection1 the term ,program means the ,veteran ,directed ,care program4 #f4 ,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 amendment made by paragraph 7#a7 shall apply with respect to denials and discharges described in paragraph 7#ad7 of such section1 as added by paragraph 7#a71 occurring on or after the date of the enactment of this ,act4 7b7 ,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 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 #g4 ,development of centralized website for program information 7a7 ,centralized website ,the ,secretary shall develop and maintain a centralized and publicly 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 enables users to-- 7,a7 assess the eligibility of a veteran1 or a caregiver of a veteran1 for any covered program2 and 7,b7 receive information1 as a result of such assessment1 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 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 #h4 ,improvements relating to ,home ,maker and ,home ,health ,aide program 7a7 ,pilot program for communities with shortage of home health aides 7#a7 ,program ,the ,secretary shall carry out a pilot program under which the ,secretary shall provide home maker 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 #aj 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 ,department1 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 ,duration ,the pilot program under paragraph 7#a7 shall be for a duration of three years4 7#e7 ,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 ,committee on ,veterans' ,affairs of the ,senate and the ,committee on ,veterans' ,affairs of the ,house of ,representatives 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 shall submit to the ,committee on ,veterans' ,affairs of the ,senate and the ,committee on ,veterans' ,affairs of the ,house of ,representatives a report containing1 with respect to the period beginning in fiscal year #bjaa and ending in fiscal year #bjbb1 the following3 7#a7 ,an identification of the amount of funds that were included in a budget of the ,department during such period for the provision of in-home care to veterans under the ,home ,maker and ,home ,health ,aide program in effect during such period but were not expended for the provision of such care1 disaggregated by medical center of the ,department for which such unexpended funds were budgeted4 7#b7 ,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 such 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 7#a7 ,in general ,not later than one year after the date of the enactment of this ,act1 the ,secretary shall issue updated guidance for the ,home ,maker and ,home ,health ,aide program4 7#b7 ,matters ,to include ,guidance updated under paragraph 7#a7 shall include the following3 7,a7 ,a process for the transition of veterans from the ,home ,maker 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 ,home ,maker and ,home ,health ,aide program as a result of the clinical needs or behavioral issues of the veteran4 #i4 ,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 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 shall conduct an assessment of the staffing needs of the ,office of ,geriatric and ,extended ,care of the ,department1 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 ,committee on ,veterans' ,affairs of the ,senate and the ,committee on ,veterans' ,affairs of the ,house of ,representatives 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 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 ,committee on ,veterans' ,affairs of the ,senate and the ,committee on ,veterans' ,affairs of the ,house of ,representatives 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 shall conduct a review of the use1 availability1 and effectiveness 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 ,feedback and recommendations on caregiver support 7,a7 ,feedback and recommendations ,the ,secretary 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 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 #e7;a77#a771 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#b7 ,collaboration for ,native ,american veterans ,the ,secretary 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