,,ii  #aah? ,,congress  #a/ ,session    
,s4 #ada  ,,9 ,,! ,,s5ate ,,( ,,!       
,,unit$ ,,/ates  ,janu>y #cj1 #bjbc,mr4 
,moran 7= himself1 ,mr4 ,te/]1 & ,ms4   
,hassan7 introduc$ ! foll[+ bill2 :i* 0 
read twice & ref]r$ to ! ,committee on  
,vet]ans' ,affairs  ,a ,,bill  ,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 ,act4  7b7 ,table (    
cont5ts ,! table ( cont5ts = ?is ,act is
 z foll[s3 ,sec4 #a4 ,%ort title2 table 
( cont5ts4,sec4 #b4 ,def9itions4,sec4   
#c4 ,increase ( exp5diture cap =        
non9/itutional c>e alt]natives to nurs+ 
home c>e4,sec4 #d4 ,coord9ation )       
,program ( ,all-,inclusive ,c>e = !     
,eld]ly4,sec4 #e4 ,home & community bas$

 s]vices3 programs4,sec4 #f4            
,coord9ation ) assi/ance & support      
s]vices = c>egiv]s4,sec4 #g4 ,developm5t
 ( c5traliz$ website = program          
in=mation4,sec4 #h4 ,improvem5ts relat+ 
to ,home ,mak] & ,home ,heal? ,aide     
program4,sec4 #i4 ,reviews & o!r        
improvem5ts relat+ to home & community  
bas$ s]vices4  #b4 ,def9itions ,9 ?is   
,act3 7#a7 ,c>egiv]2 ,family c>egiv] ,! 
t]ms c>egiv] & family c>egiv] h ! mean+s
 giv5 ^? t]ms "u section #agbj,k7g7 (   
title #ch1 ,unit$ ,/ates ,code 7z add$  
by section #e7;a77#a774  7#b7 ,cov]$    
program ,! t]m cov]$ program-- 7,a7     
means any program ( ! ,dep>tm5t = home &
 community bas$ s]vices2 &  7,b7        
includes ! programs specifi$ 9 section  
#agbj,k ( title #ch1 ,unit$ ,/ates ,code
 7z add$ by section #e7;a77#a774  7#c7  
,dep>tm5t ,! t]m ,dep>tm5t means !      
,dep>tm5t ( ,vet]ans ,affairs4  7#d7    
,home & community bas$ s]vices ,! 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         
#e7;a77#a774  7#e7 ,home ,bas$ ,prim>y  
,c>e program2 ,home ,mak] & ,home ,heal?
 ,aide program2 ,vet]an ,direct$ ,c>e   
program ,! t]ms ,home ,bas$ ,prim>y ,c>e
 program1 ,home ,mak] & ,home ,heal?    
,aide program1 & ,vet]an ,direct$ ,c>e  
program mean ! programs ( ! ,dep>tm5t   
specifi$ 9 subsections 7d71 7c71 & 7b7 (
 su* section #agbj,k1 respectively4     
7#f7 ,home heal? ag5cy2 ,home heal?     
aide2 ,native ,am]ican vet]an1 ,tribal  
heal? program2 ,urban ,indian           
organization ,! t]ms home heal? ag5cy1  
home heal? aide1 ,native ,am]ican       
vet]an1 tribal heal? program1 & ,urban  
,indian organization h ! mean+s giv5 ^? 
t]ms 9 subsection 7g7 ( su* section     
#agbj,k4  7#g7 ,secret>y ,! t]m         
,secret>y means ! ,secret>y ( ,vet]ans  
,affairs4  7#h7 ,vet]ans s]vice         
organization ,! t]m vet]ans s]vice      

organization means any organization     
recogniz$ by ! ,secret>y "u section     
#eijb ( title #ch1 ,unit$ ,/ates ,code4 
#c4 ,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 9 p>agraph 7#a71 z designat$ by  
p>agraph 7#a71 by /rik+ #fe p]c5t (2 &  
7#c7 by add+ at ! end ! foll[+ new      
p>agraph3  7#b7 ,! total co/ ( provid+  
s]vices or 9-k9d assi/ance 9 ! case (   
any vet]an = any fiscal ye> "u ! program
 may exce$ ! co/ t w\ld o!rwise h be5   
incurr$ z specifi$ 9 p>agraph 7#a7 if ! 
,secret>y det]m9es su* high] total co/  
is 9 ! be/ int]e/ ( ! vet]an4  4  7b7   
,applicability ,! am5dm5ts made by      
subsection 7a7 %all apply ) respect to  
any fiscal ye> beg9n+ on or aft] ! date 
( ! enactm5t ( ?is ,act4  #d4           
,coord9ation ) ,program (               

,all-,inclusive ,c>e = ! ,eld]ly        
,section #agbj;,c ( title #ch1 ,unit$   
,/ates ,code1 z am5d$ by section #c1 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   
e/abli% a p>tn]%ip ) ! ,,pace program   
op]at+ 9 t area = ! furni%+ ( su*       
s]vices4  4  #e4 ,home & community bas$ 
s]vices3 programs  7a7 ,programs  7#a7  
,9 g5]al ,sub*apt] ,,ii ( *apt] #ag (   
title #ch1 ,unit$ ,/ates ,code1 is am5d$
 by ins]t+ aft] section #agbj;,j !      
foll[+ new section3  #agbj,k4 ,home &   
community bas$ s]vices3 programs  7a7 ,9
 g5]al ,9 furni%+ non9/itutional        

alt]natives to nurs+ home c>e "u !      
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 program "u :i* ! ,secret>y
 ( ,vet]ans ,affairs may ent] into      
agreem5ts ) ! provid]s describ$ 9       
p>agraph 7#b7 to provide to eligible    
vet]ans funds 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 ,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$ical c5t] ( ! ,dep>tm5t ( ,vet]ans    
,affairs2  7,b7 ensure ! availability ( 
su* program 9 ,am]ican ,samoa1 ,guam1 ! 
,commonweal? ( ! ,nor!rn ,m>iana ,isl&s1
 ! ,commonweal? ( ,pu]to ,rico1 ! ,virg9
 ,isl&s ( ! ,unit$ ,/ates1 & any o!r    
t]ritory or possession ( ! ,unit$       
,/ates2 &  7,c7 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/em4  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$4  7c7 ,home ,mak] & ,home   
,heal? ,aide program  7#a7 ,! ,secret>y 
%all c>ry out a program to be kn[n z !  
,home ,mak] & ,home ,heal? ,aide program
 "u :i* ! ,secret>y may ent] into       
agreem5ts ) home heal? ag5cies to       
provide to eligible vet]ans su* home    
heal? aide s]vices z may be det]m9$     
appropriate by ! ,secret>y4  7#b7 ,9    
c>ry+ out ! ,home ,mak] & ,home ,heal?  
,aide program1 ! ,secret>y %all 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 physician ( ! ,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  
c>egiv] ( a vet]an p>ticipat+ 9 a       
program "u ?is section :o is a family   
c>egiv]1 ! ,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   
subject to p>agraph 7#b71 provide to su*
 c>egiv] n few] ?an #ad days ( cov]$    
respite c>e ea* ye>2 &  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 *eck (
 su* c>egiv]4  7#b7 ,! ,secret>y %all   

provide n few] ?an #cj days ( cov]$     
respite c>e ea* ye> to any resid5t      
c>egiv] :o provides s]vices fund$ "u !  
,vet]an ,direct$ ,c>e program "u        
subsection 7b74  7#c7 ,cov]$ respite c>e
 provid$ to a resid5t c>egiv] ( a vet]an
 "u p>agraph 7#a7 or 7#b71 z ! case may 
be1 may exce$ #ad days annually or #cj  
days annually1 respectively1 if an      
ext5sion is reque/$ by ! resid5t c>egiv]
 or vet]an & det]m9$ m$ically           
appropriate by ! ,secret>y4  7g7        
,def9itions ,9 ?is section3 7#a7 ,! t]ms
 ,ag+ & ,disability ,res\rce ,c5t]1 area
 ag5cy on ag+1 & ,/ate ag5cy h ! mean+s 
giv5 ^? t]ms 9 section #ajb ( ! ,old]   
,am]icans ,act ( #aife 7#db ,u4,s4,c4   
#cjjb74  7#b7 ,! t]ms c>egiv] & family  
c>egiv]1 ) respect to a vet]an1 h !     
mean+s giv5 ^? t]ms1 respectively1 "u   
subsection 7d7 ( section #agbj;,g ( ?is 
title ) respect to an eligible vet]an "u
 subsection 7a7 ( su* section or a cov]$
 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 means1 ) respect  
to a c>egiv] ( a vet]an1 respite c>e t--
 7,a7 includes #bd-;h\r p] day c>e ( !  
vet]an comm5surate ) ! c>e provid$ by ! 
c>egiv]2  7,b7 is m$ically &            
age-appropriate2 &  7,c7 includes 9-home
 c>e s]vices4  7#e7 ,! t]m eligible     
vet]an means any vet]an-- 7,a7 = :om !  
,secret>y det]m9es p>ticipation 9 a     
specific program "u ?is section is      
m$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? ag5cy has 
! mean+ giv5 t t]m 9 section #ahfa7o7 ( 
! ,social ,security ,act 7#db ,u4,s4,c4 
#aciex7o774  7#g7 ,! t]m home heal? aide
 means an individual employ$ by a home  
heal? ag5cy to provide 9-home c>e       
s]vices4  7#h7 ,! 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#i7 ,! t]m
 ,native ,am]ican vet]an has ! mean+    
giv5 t t]m 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]m resid5t c>egiv] means a  
c>egiv] or a family c>egiv] ( a vet]an  
:o resides ) ! vet]an4  7#ab7 ,! t]ms   
tribal heal? program & ,urban ,indian   
organization h ! mean+s giv5 ^? t]ms 9  
section #d ( ! ,indian ,heal? ,c>e      
,improvem5t ,act 7#be ,u4,s4,c4 #afjc74 
4  7#b7 ,cl]ical am5dm5t ,! table (     
sections at ! beg9n+ ( su* sub*apt] is  
am5d$ by ins]t+ aft] ! item relat+ to   
section #agbj;,j ! foll[+ new item3     
#agbj,k4 ,home & community bas$ s]vices3
 programs4  4  7b7 ,deadl9e = improv$   
adm9i/ration ,! ,secret>y %all ensure t 
! ,vet]an ,direct$ ,c>e program & !     

,home ,mak] & ,home ,heal? ,aide program
 are adm9i/]$ ?r\gh ea* m$ical c5t] ( ! 
,dep>tm5t 9 accordance ) section #agbj,k
 ( title #ch1 ,unit$ ,/ates ,code 7z    
add$ by subsection 7a77#a771 by n lat]  
?an two ye>s aft] ! date ( ! enactm5t ( 
?is ,act4  7c7 ,adm9i/ration ( ,vet]an  
,direct$ ,c>e program  7#a7 ,proc$ures  
,! ,secret>y %all e/abli% proc$ures to  
id5tify /aff+ ne$s = ! ,program & def9e 
! roles & responsibilities ( p]sonnel ( 
! ,program at ! national1 ,vet]ans      
,integrat$ ,s]vice ,network1 & facility 
levels1 includ+ responsibilities =      
engagem5t ) vet]ans p>ticipat+ 9 !      
,program1 vet]ans int]e/$ 9 ! ,program1 
& provid]s describ$ 9 section           
#agbj,k7b77#b71 z add$ by subsection    
7a77#a74  7#b7 ,/aff+ model  7,a7 ,9    
g5]al ,! ,secret>y %all e/abli% a /aff+ 
model = ! adm9i/ration ( ! ,program at  
ea* m$ical c5t] ( ! ,dep>tm5t4  7,b7    
,/aff+ ratio ,! ,secret>y %all e/abli% a
 /aff+ ratio = adm9i/ration ( ! ,program
 at ea* facility ( ! ,dep>tm5t at :i* ! 

,program is c>ri$ out1 :i* %all include 
a specifi$ numb] ( full-"t equival5t    
employees1 ) no collat]al duties1 p]    
numb] ( vet]ans s]v$ by ! ,program4     
7#c7 ,fund+ = program  7,a7 ,9 g5]al ,! 
,secret>y %all develop me?ods = track+ &
 report+ dem& by vet]ans = & use by     
vet]ans ( s]vices "u ! ,program to in=m 
ye>ly co/ e/imates = ! ,program4  7,b7  
,d$icat$ fund+ ,! ,secret>y %all ensure 
ea* m$ical c5t] ( ! ,dep>tm5t receives  
d$icat$ fund+ = adm9i/ration & /aff+ ( !
 ,program1 tailor$ to dem& = & use ( !  
,program at su* m$ical c5t]4  7,c7      
,sep>ate fund+ ,fund+ provid$ to c>ry   
out ! ,program %all be sep>ate f any o!r
 fund+ = ! pur*as$ long t]m s]vices &   
supports programs ( ! ,dep>tm5t4  7#d7  
,program def9$ ,9 ?is subsection1 ! t]m 
,program means ! ,vet]an ,direct$ ,c>e  
program4  #f4 ,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 ,! am5dm5t made by       
p>agraph 7#a7 %all apply ) respect to   
d5ials & dis*>ges describ$ 9 p>agraph   
7#ad7 ( su* section1 z add$ by p>agraph 
7#a71 occurr+ on or aft] ! date ( !     
enactm5t ( ?is ,act4  7b7 ,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  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  #g4      
,developm5t ( c5traliz$ website =       
program in=mation  7a7 ,c5traliz$       
website ,! ,secret>y %all develop &     
ma9ta9 a c5traliz$ & publicly 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 enables us]s to-- 7,a7 assess ! 

eligibility ( a vet]an1 or a c>egiv] ( a
 vet]an1 = any cov]$ program2 &  7,b7   
receive in=mation1 z a result ( su*     
assessm5t1 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  #h4         
,improvem5ts relat+ to ,home ,mak] &    
,home ,heal? ,aide program  7a7 ,pilot  
program = communities ) %ortage ( home  
heal? aides  7#a7 ,program ,! ,secret>y 
%all c>ry out a pilot program "u :i* !  
,secret>y %all provide home mak] & home 

heal? aide s]vices to vet]ans :o reside 
9 communities ) a %ortage ( home heal?  
aides4  7#b7 ,locations ,! ,secret>y    
%all select #aj 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>tm5t1 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      
,duration ,! pilot program "u p>agraph  
7#a7 %all be = a duration ( ?ree ye>s4  
7#e7 ,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$1 ! ,secret>y %all      
submit to ! ,committee on ,vet]ans'     
,affairs ( ! ,s5ate & ! ,committee on   
,vet]ans' ,affairs ( ! ,h\se (          
,repres5tatives a report on ! result ( !
 pilot program4  7b7 ,report on use (   
funds ,n lat] ?an "o ye> aft] ! date ( !
 enactm5t ( ?is ,act1 ! ,secret>y %all  
submit to ! ,committee on ,vet]ans'     
,affairs ( ! ,s5ate & ! ,committee on   
,vet]ans' ,affairs ( ! ,h\se (          
,repres5tatives a report conta9+1 )     
respect to ! p]iod beg9n+ 9 fiscal ye>  
#bjaa & end+ 9 fiscal ye> #bjbb1 !      
foll[+3 7#a7 ,an id5tification ( ! am\nt
 ( funds t 7 includ$ 9 a budget ( !     
,dep>tm5t dur+ su* p]iod = ! provision (
 9-home c>e to vet]ans "u ! ,home ,mak] 
& ,home ,heal? ,aide program 9 effect   

dur+ su* p]iod b 7 n exp5d$ = !         
provision ( su* c>e1 disaggregat$ by    
m$ical c5t] ( ! ,dep>tm5t = :i* su*     
unexp5d$ funds 7 budget$4  7#b7 ,an     
id5tification ( ! numb] ( vet]ans = :om1
 dur+ su* p]iod1 ! h\rs dur+ :i* a home 
heal? aide 0 au?oriz$ to provide s]vices
 to ! vet]an "u su* 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  7#a7 ,9 g5]al ,n lat] ?an "o   
ye> aft] ! date ( ! enactm5t ( ?is ,act1
 ! ,secret>y %all issue updat$ guidance 
= ! ,home ,mak] & ,home ,heal? ,aide    
program4  7#b7 ,matt]s ,to include      
,guidance updat$ "u p>agraph 7#a7 %all  
include ! foll[+3 7,a7 ,a process = !   
transition ( vet]ans f ! ,home ,mak] &  
,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 ! ,home ,mak] &
 ,home ,heal? ,aide program z a result (
 ! cl9ical ne$s or behavioral issues ( !
 vet]an4  #i4 ,reviews & o!r improvem5ts
 relat+ to home & community bas$ s]vices
  7a7 ,(fice ( ,g]iatric & ,ext5d$ ,c>e 
7#a7 ,review ( programs ,! ,"u ,secret>y
 = ,heal? ( ! ,dep>tm5t %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$s ,! ,secret>y   
%all conduct an assessm5t ( ! /aff+ ne$s
 ( ! ,(fice ( ,g]iatric & ,ext5d$ ,c>e (
 ! ,dep>tm5t1 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 ! ,committee on
 ,vet]ans' ,affairs ( ! ,s5ate & !      

,committee on ,vet]ans' ,affairs ( !    
,h\se ( ,repres5tatives 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 %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 ! ,committee on ,vet]ans'     
,affairs ( ! ,s5ate & ! ,committee on   
,vet]ans' ,affairs ( ! ,h\se (          
,repres5tatives 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 %all conduct a review ( ! use1
 availability1 & effectiv5ess ( !       
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 ,fe$back & recomm5dations 
on c>egiv] support  7,a7 ,fe$back &     
recomm5dations ,! ,secret>y %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 #e7;a77#a771 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#b7 ,collaboration = 
,native ,am]ican vet]ans ,! ,secret>y   
%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