Federal

Elizabeth Dole Home Care Act of 2023

Source: Congress.gov · 6,319 words in original text

What This Bill Does

This bill, called the Elizabeth Dole Home and Community-Based Services for Veterans and Caregivers Act, expands and improves home care and community-based services available to veterans through the Department of Veterans Affairs. The bill makes changes to how much the VA can spend on alternatives to nursing home care and creates new programs to help veterans receive care at home instead of in institutions.

Who It Affects

Veterans who need long-term care or home health services. Family caregivers and other people who care for veterans. The Department of Veterans Affairs and its medical centers. Home health agencies that contract with the VA. Organizations like Aging and Disability Resource Centers, area agencies on aging, and centers for independent living that partner with VA programs.

Key Provisions

• The VA can now spend up to 100 percent of the cost that would be spent on nursing home care for veterans receiving non-institutional (home or community-based) care instead. For veterans with amyotrophic lateral sclerosis (a disease that damages nerve cells), spinal cord injuries, or similar conditions, the VA can spend more than 100 percent if it determines this is in the veteran's best interest. (Sec. 2) • The VA must establish four new home and community-based service programs: the Veteran-Directed Care program (which gives eligible veterans money to hire caregivers or purchase services of their choice), the Homemaker and Home Health Aide program, the Home-Based Primary Care program, and the Purchased Skilled Home Care program. (Sec. 4) • Veterans enrolled in these programs must receive at least 30 days of covered respite care (temporary relief care) annually for their family caregiver, which can include 24-hour in-home care. (Sec. 4) • The VA must create a centralized public website that explains all home and community-based service programs, includes an eligibility assessment tool, and lists procedures for determining which veterans qualify for different programs. (Sec. 6) • When a veteran is denied or discharged from the comprehensive caregiver assistance program, the VA must assess the veteran for other available home and community-based service programs and provide written information about those programs. (Sec. 5)

What Changes

The spending limit for home-based alternatives to nursing care changes from 65 percent of nursing home costs to 100 percent. Four new home and community-based service programs must be established and administered through each VA medical center. All caregivers of veterans in these programs become eligible for respite care. Veterans who are denied services in one program must now be evaluated for other available home and community programs. The VA must maintain a public website providing information about all home and community-based service options.

Important Definitions

"Eligible veteran" means any veteran for whom the Secretary determines participation in a specific program is medically necessary to promote or preserve health and who would otherwise be at increased risk for hospitalization, nursing home placement, or emergency room care. (Sec. 4) "Home health aide" means an individual employed by a home health agency to provide in-home care services. (Sec. 4) "In-home care service" means any service, including personal care, provided to enable a person to live at home. (Sec. 4) "Covered respite care" means respite care that is medically and age-appropriate for the veteran (including 24-hour per day care that matches what the caregiver normally provides) and includes in-home care. (Sec. 5) "Resident eligible caregiver" means a person who is a caregiver of a veteran, lives with that veteran, and is either a family member or provides care through a medical foster home (a private home licensed to provide care). (Sec. 4)

Effective Date

The changes to spending limits apply to fiscal years beginning on or after the date the law is enacted. (Sec. 2) The VA must implement the Veteran-Directed Care program and Homemaker and Home Health Aide program through each medical center by not later than two years after the law is enacted. (Sec. 4) Requirements for assessing veterans denied or discharged from programs apply to denials and discharges occurring 180 days or more after the law is enacted. (Sec. 5) Not specified in bill text for most other provisions.

II 118TH CONGRESS 1ST SESSION H. R. 542 IN THE SENATE OF THE UNITED STATES DECEMBER 6, 2023 Received AN ACT To amend title 38, United States Code, to improve certain programs of the Department of Veterans Affairs for home- and community-based services for 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 VerDate Sep 11 2014 22:26 Jan 06, 2025 Jkt 059200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H542.RDS H542 ssavage on LAPJG3WLY3PROD with BILLS 2 HR 542 RDS SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 1 (a) SHORT TITLE.—This Act may be cited as the 2 ‘‘Elizabeth Dole Home- and Community-Based Services 3 for Veterans and Caregivers Act of 2023’’ or the ‘‘Eliza- 4 beth Dole Home Care Act of 2023’’. 5 (b) TABLE OF CONTENTS.—The table of contents for 6 this Act is as follows: 7 Sec. 1. Short title; table of contents. Sec. 2. Increase of expenditure cap for noninstitutional care alternatives to nursing home care. Sec. 3. Coordination with Program of All-Inclusive Care for the Elderly. Sec. 4. Home- and community-based services: programs. Sec. 5. Coordination with assistance and support services for caregivers. Sec. 6. Development of centralized website for program information. Sec. 7. Improvements relating to Homemaker and Home Health Aide program. Sec. 8. Reviews and other improvements relating to home- and community- based services. Sec. 9. Modification of certain housing loan fees. Sec. 10. Definitions. SEC. 2. INCREASE OF EXPENDITURE CAP FOR NONINSTITU- 8 TIONAL CARE ALTERNATIVES TO NURSING 9 HOME CARE. 10 (a) INCREASE OF EXPENDITURE CAP.—Section 11 1720C(d) of title 38, United States Code, is amended— 12 (1) by striking ‘‘The total cost’’ and inserting 13 ‘‘(1) Except as provided in paragraph (2), the total 14 cost’’; 15 (2) by striking ‘‘65 percent’’ and inserting ‘‘100 16 percent’’; and 17 (3) by adding at the end the following new 18 paragraph: 19 VerDate Sep 11 2014 22:26 Jan 06, 2025 Jkt 059200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H542.RDS H542 ssavage on LAPJG3WLY3PROD with BILLS 3 HR 542 RDS ‘‘(2)(A) The total cost of providing services or in-kind 1 assistance in the case of any veteran described in subpara- 2 graph (B) for any fiscal year under the program may ex- 3 ceed 100 percent of the cost that would otherwise have 4 been incurred as specified in paragraph (1) if the Sec- 5 retary determines, based on a consideration of clinical 6 need, geographic market factors, and such other matters 7 as the Secretary may prescribe through regulation, that 8 such higher total cost is in the best interest of the veteran. 9 ‘‘(B) A veteran described in this subparagraph is a 10 veteran with amyotrophic lateral sclerosis, a spinal cord 11 injury, or a condition the Secretary determines to be simi- 12 lar to such conditions.’’. 13 (b) APPLICABILITY.—The amendments made by sub- 14 section (a) shall apply with respect to fiscal years begin- 15 ning on or after the date of the enactment of this Act. 16 SEC. 3. COORDINATION WITH PROGRAM OF ALL-INCLUSIVE 17 CARE FOR THE ELDERLY. 18 Section 1720C of title 38, United States Code, as 19 amended by section 2, is further amended by adding at 20 the end the following new subsection: 21 ‘‘(f) In furnishing services to a veteran under the pro- 22 gram conducted pursuant to subsection (a), if a medical 23 center of the Department through which such program is 24 administered is located in a geographic area in which serv- 25 VerDate Sep 11 2014 22:26 Jan 06, 2025 Jkt 059200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H542.RDS H542 ssavage on LAPJG3WLY3PROD with BILLS 4 HR 542 RDS ices are available to the veteran under a PACE program 1 (as such term is defined in sections 1894(a)(2) and 2 1934(a)(2) of the Social Security Act (42 U.S.C. 3 1395eee(a)(2); 1396u–4(a)(2))), the Secretary shall seek 4 to enter into an agreement with the PACE program oper- 5 ating in that area for the furnishing of such services.’’. 6 SEC. 4. HOME- AND COMMUNITY-BASED SERVICES: PRO- 7 GRAMS. 8 (a) PROGRAMS.—Chapter 17 of title 38, United 9 States Code, is amended by inserting after section 1720J 10 the following new section (and conforming the table of sec- 11 tions at the beginning of such chapter accordingly): 12 ‘‘§ 1720K. Home- and community-based services: pro- 13 grams 14 ‘‘(a) IN GENERAL.—In furnishing noninstitutional al- 15 ternatives to nursing home care pursuant to the authority 16 of section 1720C of this title (or any other authority under 17 this chapter or other provision of law administered by the 18 Secretary of Veterans Affairs), the Secretary shall carry 19 out each of the programs specified in this section in ac- 20 cordance with such relevant authorities except as other- 21 wise provided in this section. 22 ‘‘(b) VETERAN-DIRECTED CARE PROGRAM.—(1) The 23 Secretary of Veterans Affairs, in collaboration with the 24 Secretary of Health and Human Services, shall carry out 25 VerDate Sep 11 2014 22:26 Jan 06, 2025 Jkt 059200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H542.RDS H542 ssavage on LAPJG3WLY3PROD with BILLS 5 HR 542 RDS a program to be known as the ‘Veteran-Directed Care pro- 1 gram’. Under such program, the Secretary of Veterans Af- 2 fairs may enter into agreements with the providers de- 3 scribed in paragraph (2) to provide to eligible veterans 4 funds, to the extent practicable, to obtain such in-home 5 care services and related items as may be determined ap- 6 propriate by the Secretary of Veterans Affairs and selected 7 by the veteran, including through the veteran hiring indi- 8 viduals to provide such services and items or directly pur- 9 chasing such services and items. 10 ‘‘(2) The providers described in this paragraph are 11 the following: 12 ‘‘(A) An Aging and Disability Resource Center, 13 an area agency on aging, or a State agency. 14 ‘‘(B) A center for independent living. 15 ‘‘(C) An Indian tribe or tribal organization re- 16 ceiving assistance under title VI of the Older Ameri- 17 cans Act of 1965 (42 U.S.C. 3057 et seq.). 18 ‘‘(3) In carrying out the Veteran-Directed Care pro- 19 gram, the Secretary of Veterans Affairs shall— 20 ‘‘(A) administer such program through each 21 medical center of the Department of Veterans Af- 22 fairs; 23 ‘‘(B) seek to ensure the availability of such pro- 24 gram in American Samoa, Guam, the Common- 25 VerDate Sep 11 2014 22:26 Jan 06, 2025 Jkt 059200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H542.RDS H542 ssavage on LAPJG3WLY3PROD with BILLS 6 HR 542 RDS wealth of the Northern Mariana Islands, the Com- 1 monwealth of Puerto Rico, the Virgin Islands of the 2 United States, and any other territory or possession 3 of the United States, to the extent practicable; and 4 ‘‘(C) seek to ensure the availability of such pro- 5 gram for eligible veterans who are Native American 6 veterans receiving care and services furnished by the 7 Indian Health Service, a tribal health program, an 8 Urban Indian organization, or (in the case of a Na- 9 tive Hawaiian veteran) a Native Hawaiian health 10 care system, to the extent practicable. 11 ‘‘(4) If a veteran participating in the Veteran-Di- 12 rected Care program is catastrophically disabled, the vet- 13 eran may continue to use funds under the program during 14 a period of hospitalization in the same manner that the 15 veteran would be authorized to use such funds under the 16 program if the veteran were not hospitalized. 17 ‘‘(c) HOMEMAKER AND HOME HEALTH AIDE PRO- 18 GRAM.—(1) The Secretary shall carry out a program to 19 be known as the ‘Homemaker and Home Health Aide pro- 20 gram’ under which the Secretary may enter into agree- 21 ments with home health agencies to provide to eligible vet- 22 erans such home health aide services as may be deter- 23 mined appropriate by the Secretary. 24 VerDate Sep 11 2014 22:26 Jan 06, 2025 Jkt 059200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H542.RDS H542 ssavage on LAPJG3WLY3PROD with BILLS 7 HR 542 RDS ‘‘(2) In carrying out the Homemaker and Home 1 Health Aide program, the Secretary shall, to the extent 2 practicable, ensure the availability of such program— 3 ‘‘(A) in the locations specified in subparagraph 4 (B) of subsection (b)(3); and 5 ‘‘(B) for the veteran populations specified in 6 subparagraph (C) of such subsection. 7 ‘‘(d) HOME-BASED PRIMARY CARE PROGRAM.—The 8 Secretary shall carry out a program to be known as the 9 ‘Home-Based Primary Care program’ under which the 10 Secretary may furnish to eligible veterans in-home health 11 care, the provision of which is overseen by a provider of 12 the Department. 13 ‘‘(e) PURCHASED SKILLED HOME CARE PROGRAM.— 14 The Secretary shall carry out a program to be known as 15 the ‘Purchased Skilled Home Care program’ under which 16 the Secretary may furnish to eligible veterans such in- 17 home care services as may be determined appropriate and 18 selected by the Secretary for the veteran. 19 ‘‘(f) CAREGIVER SUPPORT.—(1) With respect to a 20 resident eligible caregiver of a veteran participating in a 21 program under this section, the Secretary shall— 22 ‘‘(A) if the veteran meets the requirements of 23 a covered veteran under section 1720G(b) of this 24 title, provide to such caregiver the option of enroll- 25 VerDate Sep 11 2014 22:26 Jan 06, 2025 Jkt 059200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H542.RDS H542 ssavage on LAPJG3WLY3PROD with BILLS 8 HR 542 RDS ing in the program of general caregiver support serv- 1 ices under such section; 2 ‘‘(B) provide to such caregiver covered respite 3 care of not less than 30 days annually; and 4 ‘‘(C) conduct on an annual basis (and, to the 5 extent practicable, in connection with in-person serv- 6 ices provided under the program in which the vet- 7 eran is participating), a wellness contact of such 8 caregiver. 9 ‘‘(2) Covered respite care provided to a resident eligi- 10 ble caregiver of a veteran under paragraph (1) may exceed 11 30 days annually if such extension is requested by the resi- 12 dent eligible caregiver or veteran and determined medi- 13 cally appropriate by the Secretary. 14 ‘‘(g) RULE OF CONSTRUCTION.—Nothing in this sec- 15 tion shall be construed to limit the authority of the Sec- 16 retary to carry out programs providing home- and commu- 17 nity-based services under any other provision of law. 18 ‘‘(h) DEFINITIONS.—In this section: 19 ‘‘(1) The terms ‘Aging and Disability Resource 20 Center’, ‘area agency on aging’, and ‘State agency’ 21 have the meanings given those terms in section 102 22 of the Older Americans Act of 1965 (42 U.S.C. 23 3002). 24 VerDate Sep 11 2014 22:26 Jan 06, 2025 Jkt 059200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H542.RDS H542 ssavage on LAPJG3WLY3PROD with BILLS 9 HR 542 RDS ‘‘(2) The terms ‘caregiver’ and ‘family care- 1 giver’, with respect to a veteran, have the meanings 2 given those terms, respectively, under subsection (e) 3 of section 1720G of this title with respect to an eli- 4 gible veteran under subsection (a) of such section or 5 a covered veteran under subsection (b) of such sec- 6 tion, as the case may be. 7 ‘‘(3) The term ‘center for independent living’ 8 has the meaning given that term in section 702 of 9 the Rehabilitation Act of 1973 (29 U.S.C. 796a). 10 ‘‘(4) The term ‘covered respite care’ has the 11 meaning given such term in section 1720G(d) of this 12 title. 13 ‘‘(5) The term ‘eligible veteran’ means any vet- 14 eran— 15 ‘‘(A) for whom the Secretary determines 16 participation in a specific program under this 17 section is medically necessary to promote, pre- 18 serve, or restore the health of the veteran; and 19 ‘‘(B) who absent such participation would 20 be at increased risk for hospitalization, place- 21 ment in a nursing home, or emergency room 22 care. 23 VerDate Sep 11 2014 22:26 Jan 06, 2025 Jkt 059200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H542.RDS H542 ssavage on LAPJG3WLY3PROD with BILLS 10 HR 542 RDS ‘‘(6) The term ‘home health aide’ means an in- 1 dividual employed by a home health agency to pro- 2 vide in-home care services. 3 ‘‘(7) The term ‘in-home care service’ means any 4 service, including a personal care service, provided to 5 enable the recipient of such service to live at home. 6 ‘‘(8) The terms ‘Indian tribe’ and ‘tribal organi- 7 zation’ have the meanings given those terms in sec- 8 tion 4 of the Indian Self-Determination and Edu- 9 cation Assistance Act (25 U.S.C. 5304). 10 ‘‘(9) The terms ‘Native American’ and ‘Native 11 American veteran’ have the meanings given those 12 terms in section 3765 of this title. 13 ‘‘(10) The terms ‘Native Hawaiian’ and ‘Native 14 Hawaiian health care system’ have the meanings 15 given those terms in section 12 of the Native Hawai- 16 ian Health Care Improvement Act (42 U.S.C. 17 11711). 18 ‘‘(11) The terms ‘tribal health programs’ and 19 ‘Urban Indian organizations’ have the meanings 20 given those terms in section 4 of the Indian Health 21 Care Improvement Act (25 U.S.C. 1603). 22 ‘‘(12) The term ‘resident eligible caregiver’ 23 means an individual who— 24 VerDate Sep 11 2014 22:26 Jan 06, 2025 Jkt 059200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H542.RDS H542 ssavage on LAPJG3WLY3PROD with BILLS 11 HR 542 RDS ‘‘(A) is a caregiver, or a family caregiver, 1 of a veteran and resides with that veteran; and 2 ‘‘(B) has not entered into a contract, 3 agreement, or other arrangement for such indi- 4 vidual to act as a caregiver for that veteran un- 5 less such individual is a family member of the 6 veteran or is furnishing caregiver services 7 through a medical foster home.’’. 8 (b) DEADLINE FOR IMPROVED ADMINISTRATION.— 9 The Secretary of Veterans Affairs shall ensure that the 10 Veteran-Directed Care program and the Homemaker and 11 Home Health Aide program are administered through 12 each medical center of the Department of Veterans Affairs 13 in accordance with section 1720K of title 38, United 14 States Code (as added by subsection (a)), by not later 15 than two years after the date of the enactment of this Act. 16 SEC. 5. COORDINATION WITH ASSISTANCE AND SUPPORT 17 SERVICES FOR CAREGIVERS. 18 (a) COORDINATION WITH PROGRAM OF COMPREHEN- 19 SIVE ASSISTANCE FOR FAMILY CAREGIVERS.— 20 (1) COORDINATION.—Section 1720G(a) of title 21 38, United States Code, is amended by adding at 22 the end the following new paragraph: 23 ‘‘(14)(A) In the case of a veteran or caregiver who 24 seeks services under this subsection and is denied such 25 VerDate Sep 11 2014 22:26 Jan 06, 2025 Jkt 059200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H542.RDS H542 ssavage on LAPJG3WLY3PROD with BILLS 12 HR 542 RDS services, or a veteran or the family caregiver of a veteran 1 who is discharged from t [Text truncated for display. Full text available on Congress.gov.]

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