What This Bill Does
This bill requires the Secretary of Veterans Affairs to run a test program for three years to provide assisted living services (housing with personal care and supervision) to eligible veterans. The program tests whether assisted living works well for veterans and measures how satisfied veterans are with the services.
Who It Affects
Veterans who currently receive nursing home care through the Department of Veterans Affairs or are eligible to receive it. The Department of Veterans Affairs and facilities that provide assisted living services, including State homes. Congress committees that oversee veterans affairs.
Key Provisions
The Secretary must start the pilot program no later than one year after the bill becomes law and select at least six Veterans Integrated Service Networks (regional VA healthcare systems) to participate (Sec. 2(b)(1)(A)).
At least three of the selected networks must serve regions with the highest percentage of veterans currently in nursing homes who could use assisted living instead (Sec. 2(b)(1)(B)).
Facilities selected must be in different geographic areas, include at least two in rural areas, have at least one in each selected network, and include at least two State homes (Sec. 2(b)(2)(B)).
The Secretary may extend the program for three additional years if results from required reports show it is appropriate to do so (Sec. 2(a)(2)).
The Secretary must submit annual reports to Congress describing participants, costs, facility information, and feedback from veterans, and must inspect facilities at least annually (Sec. 2(f)).
What Changes
If this becomes law, the VA will begin offering assisted living services as an alternative to nursing home care for eligible veterans in selected areas. The VA will pay assisted living facilities less than what it pays for nursing home care. Veterans currently in the program will be able to continue receiving assisted living at the VA's expense if the program ends (Sec. 2(d)(1)).
Important Definitions
Assisted living services: Services that provide room, board, personal care, and supervision of residents for their health, safety and welfare (Sec. 2(i)(1)).
Eligible veteran: A veteran who is already receiving nursing home care paid by the VA, is eligible for it, or needs more care than the VA's domiciliary care but does not qualify for nursing home level care, and meets eligibility criteria the Secretary establishes (Sec. 2(i)(2)).
State home: Not defined in this bill text.
Effective Date
The pilot program must begin no later than one year after the date the bill becomes law (Sec. 2(a)(1)).
II
118TH CONGRESS
1ST SESSION
S. 495
To require the Secretary of Veterans Affairs to carry out a pilot program
to provide assisted living services to eligible veterans, and for other purposes.
IN THE SENATE OF THE UNITED STATES
FEBRUARY 16, 2023
Mr. TESTER (for himself, Mr. MORAN, Mrs. MURRAY, and Mr. ROUNDS) in-
troduced the following bill; which was read twice and referred to the Com-
mittee on Veterans’ Affairs
A BILL
To require the Secretary of Veterans Affairs to carry out
a pilot program to provide assisted living services to
eligible veterans, and for other purposes.
Be it enacted by the Senate and House of Representa-
1
tives of the United States of America in Congress assembled,
2
SECTION 1. SHORT TITLE.
3
This Act may be cited as the ‘‘Expanding Veterans’
4
Options for Long Term Care Act’’.
5
SEC. 2. PILOT PROGRAM ON ASSISTED LIVING SERVICES
6
FOR VETERANS.
7
(a) PROGRAM.—
8
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(1) IN
GENERAL.—Beginning not later than
1
one year after the date of the enactment of this Act,
2
the Secretary of Veterans Affairs shall carry out a
3
three-year pilot program to assess—
4
(A) the effectiveness of providing assisted
5
living services to eligible veterans, at the elec-
6
tion of such veterans; and
7
(B) the satisfaction with the pilot program
8
of veterans participating in the pilot program.
9
(2) EXTENSION.—The Secretary may extend
10
the duration of the pilot program under paragraph
11
(1) for an additional three-year period if the Sec-
12
retary, based on the results of the reports submitted
13
under subsection (f), determines that it is appro-
14
priate to do so.
15
(b) PROGRAM LOCATIONS.—
16
(1) VETERANS
INTEGRATED
SERVICE
NET-
17
WORKS.—
18
(A) IN GENERAL.—The Secretary shall se-
19
lect not fewer than six Veterans Integrated
20
Service Networks of the Department of Vet-
21
erans Affairs at which to carry out the pilot
22
program under subsection (a)(1).
23
(B) VETERANS RECEIVING NURSING HOME
24
CARE.—The Secretary shall ensure that not
25
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fewer than three Veterans Integrated Service
1
Networks selected under subparagraph (A)
2
serve regions with the top three highest per-
3
centage of veterans who are currently receiving
4
nursing home care through the Department and
5
would be eligible to receive assisted living serv-
6
ices under the pilot program.
7
(2) FACILITIES.—
8
(A) IN
GENERAL.—Within the Veterans
9
Integrated Service Networks selected under
10
paragraph (1), the Secretary shall select facili-
11
ties at which to carry out the pilot program
12
under subsection (a)(1).
13
(B) SELECTION
CRITERIA.—In selecting
14
facilities under subparagraph (A), the Secretary
15
shall ensure that—
16
(i) the locations of such facilities are
17
in geographically diverse areas;
18
(ii) not fewer than two such facilities
19
serve veterans in rural or highly rural
20
areas (as determined through the use of
21
the Rural-Urban Commuting Areas coding
22
system of the Department of Agriculture);
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(iii) not fewer than one such facility is
1
located in each Veterans Integrated Service
2
Network selected under paragraph (1); and
3
(iv) not fewer than two such facilities
4
are State homes.
5
(c) PROVISION OF ASSISTED LIVING SERVICES.—
6
(1) AGREEMENTS.—In carrying out the pilot
7
program under subsection (a)(1), the Secretary may
8
enter into agreements for the provision of assisted
9
living services on behalf of eligible veterans with—
10
(A) a provider participating under a State
11
plan or waiver under title XIX of the Social Se-
12
curity Act (42 U.S.C. 1396 et seq.); or
13
(B) a State home recognized and certified
14
under subpart B of part 51 of title 38, Code of
15
Federal Regulations, or successor regulations.
16
(2) STANDARDS.—The Secretary may not place,
17
transfer, or admit a veteran to any facility for as-
18
sisted living services under the pilot program under
19
subsection (a)(1) unless the Secretary determines
20
that—
21
(A) the facility meets the standards for
22
community residential care established under
23
sections 17.61 through 17.72 of title 38, Code
24
of Federal Regulations, or successor regula-
25
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•S 495 IS
tions, and any additional standards of care as
1
the Secretary may specify; or
2
(B) in the case of a facility that is a State
3
home, the State home meets such standards of
4
care as the Secretary may specify.
5
(3) INSPECTION.—The Secretary shall inspect
6
facilities at which veterans are placed under the pilot
7
program under subsection (a)(1)—
8
(A) with respect to a facility that is a
9
State home, not less frequently than annually
10
and in the same manner as the Secretary con-
11
ducts inspection of State homes under section
12
1742 of title 38, United States Code; and
13
(B) with respect to any other facility, not
14
less frequently than annually and in the same
15
manner as the Secretary conducts inspection of
16
facilities under section 1730 of such title.
17
(4) PAYMENT TO CERTAIN FACILITIES.—
18
(A) STATE HOMES.—In the case of a facil-
19
ity participating in the pilot program under
20
subsection (a)(1) that is a State home, the Sec-
21
retary shall pay to the State home a per diem
22
for each veteran participating in the pilot pro-
23
gram at a rate agreed to by the Secretary and
24
the State home.
25
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•S 495 IS
(B) COMMUNITY ASSISTED LIVING FACILI-
1
TIES.—In the case of a facility participating in
2
the pilot program under subsection (a)(1) that
3
is a community assisted living facility, the Sec-
4
retary shall—
5
(i) pay to the facility an amount that
6
is less than the average rate paid by the
7
Department for placement in a community
8
nursing home in the same Veterans Inte-
9
grated Service Network; and
10
(ii) re-evaluate payment rates annu-
11
ally to account for current economic condi-
12
tions and current costs of assisted living
13
services.
14
(d) CONTINUITY OF CARE.—Upon the termination of
15
the pilot program under subsection (a)(1), the Secretary
16
shall—
17
(1) provide to all veterans participating in the
18
pilot program at the time of such termination the
19
option to continue to receive assisted living services
20
at the site they were assigned to under the pilot pro-
21
gram, at the expense of the Department; and
22
(2) for such veterans who do not opt to con-
23
tinue to receive such services—
24
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(A) ensure such veterans do not experience
1
lapses in care; and
2
(B) provide such veterans with information
3
on, and enroll such veterans in, other extended
4
care services based on their preferences and
5
best medical interest.
6
(e) DETERMINATION OF QUALITY.—The Secretary
7
shall determine a method for assessment of quality of care
8
provided to veterans participating in the pilot program
9
under subsection (a)(1) and shall communicate that meth-
10
od to providers of services under the pilot program.
11
(f) ANNUAL REPORT.—Not later than one year after
12
the initiation of the pilot program under subsection (a)(1),
13
and annually thereafter for each year in which the pilot
14
program is carried out, the Secretary shall submit to the
15
Committee on Veterans’ Affairs of the Senate and the
16
Committee on Veterans’ Affairs of the House of Rep-
17
resentatives a report on the pilot program, including—
18
(1) an identification of Veterans Integrated
19
Services Networks and facilities of the Department
20
participating in the pilot program and assisted living
21
facilities and State homes at which veterans are
22
placed under the pilot program;
23
(2) the number of participants in the pilot pro-
24
gram, disaggregated by facility;
25
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•S 495 IS
(3) general demographic information of partici-
1
pants in the pilot program, including average age,
2
gender, and race or ethnicity;
3
(4) disability status of participants in the pilot
4
program;
5
(5) an identification of any barriers or chal-
6
lenges to enrolling veterans in the pilot program,
7
conducting oversight of the pilot program, or any
8
other barriers or challenges;
9
(6) the cost of care at each assisted living facil-
10
ity and State home participating in the pilot pro-
11
gram, including an analysis of any cost savings by
12
the Department when comparing that cost to the
13
cost of nursing home care;
14
(7) aggregated feedback from participants in
15
the pilot program, including from veteran resident
16
surveys and interviews; and
17
(8) such other matters the Secretary considers
18
appropriate.
19
(g) FINAL REPORT.—Not later than four years after
20
the initiation of the pilot program under subsection (a)(1),
21
or not later than seven years after the initiation of the
22
pilot program if the pilot program is extended under sub-
23
section (a)(2), the Secretary shall submit to the Com-
24
mittee on Veterans’ Affairs of the Senate and the Com-
25
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•S 495 IS
mittee on Veterans’ Affairs of the House of Representa-
1
tives a report on the pilot program that—
2
(1) includes the matters required under para-
3
graphs (1) through (8) of subsection (f);
4
(2) includes recommendations on whether the
5
model studied in the pilot program should be contin-
6
ued or adopted throughout the Department; and
7
(3) indicates whether the Secretary requests ac-
8
tion by Congress to make the pilot program perma-
9
nent.
10
(h) REPORT BY INSPECTOR GENERAL.—
11
(1) IN GENERAL.—Not later than three years
12
after the initiation of the pilot program under sub-
13
section (a)(1), the Inspector General of the Depart-
14
ment of Veterans Affairs shall submit to the Sec-
15
retary, the Committee on Veterans’ Affairs of the
16
Senate, and the Committee on Veterans’ Affairs of
17
the House of Representatives a report on the pilot
18
program.
19
(2) ELEMENTS.—The report required by para-
20
graph (1) shall include an assessment of—
21
(A) the quality of care provided to veterans
22
at facilities participating in the pilot program,
23
measured pursuant to the method determined
24
under subsection (e);
25
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•S 495 IS
(B) the oversight of such facilities, as con-
1
ducted by the Department, the Centers for
2
Medicare & Medicaid Services, State agencies,
3
and other relevant entities; and
4
(C) such other matters as the Inspector
5
General considers appropriate.
6
(3) FOLLOW-UP.—Not later than 90 days after
7
the submittal of the report required by paragraph
8
(1), the Secretary shall submit to the Committee on
9
Veterans’ Affairs of the Senate and the Committee
10
on Veterans’ Affairs of the House of Representatives
11
a plan to address the deficiencies identified in the
12
report, if any.
13
(i) DEFINITIONS.—In this section:
14
(1) ASSISTED
LIVING
SERVICES.—The term
15
‘‘assisted living services’’ means services of a facility
16
in providing room, board, and personal care for and
17
supervision of residents for their health, safety, and
18
welfare.
19
(2) ELIGIBLE
VETERAN.—The term ‘‘eligible
20
veteran’’ means a veteran who—
21
(A)(i) is already receiving nursing home
22
level care paid for by the Department;
23
(ii) is eligible to receive nursing home level
24
care paid for by the Department pursuant to
25
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•S 495 IS
section 1710A of title 38, United States Code;
1
or
2
(iii) requires a higher level of care than the
3
domiciliary care provided by the Department
4
but does not meet the requirements for nursing
5
home level care provided by the Department
6
pursuant to such section; and
7
(B)(i) is eligible for assisted living services,
8
as determined by the Secretary; or
9
(ii) meets such additional criteria for eligi-
10
bility for the pilot program under subsection
11
(a)(1) as the Secretary may establish.
12
(3) STATE HOME.—The term ‘‘State home’’ has
13
the meaning given that term in section 101(19) of
14
title 38, United States Code.
15
Æ
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