text: SECTION 1. SHORT TITLE.
  
      This Act may be cited as the ``Veterans' Long-Term Care Enhancement 
  Act of 1999''.
  
  SEC. 2. CONTINUUM OF CARE FOR VETERANS.
  
      (a) Inclusion of Noninstitutional Extended Care Services in 
  Definition of Medical Services.--Section 1701 of title 38, United 
  States Code, is amended--
              (1) in paragraph (6)(A)(i), by inserting ``noninstitutional 
          extended care services,'' after ``preventive health 
          services,''; and
              (2) by adding at the end the following new paragraphs:
              ``(10) The term `noninstitutional extended care services' 
          includes--
                      ``(A) home-based primary care;
                      ``(B) adult day health care;
                      ``(C) respite care;
                      ``(D) palliative and end-of-life care; and
                      ``(E) homemaker or home health aide visits.
              ``(11) The term `respite care' means hospital or nursing 
          home care which--
                      ``(A) is of limited duration;
                      ``(B) is furnished on an intermittent basis to an 
                  individual who is suffering from a chronic illness and 
                  who resides primarily at home; and
                      ``(C) is furnished for the purpose of helping the 
                  individual to continue residing primarily at home.''.
      (b) Assisted Living.--Subchapter II of chapter 17 of such title is 
  amended by adding at the end the following new section:
  ``Sec. 1720F. Assisted living
      ``(a) The Secretary may, subject to subsection (b), provide 
  assisted living services to a veteran who is eligible to receive care 
  under section 1710 of this title and to the spouse of such veteran in 
  connection with the provision of such services to such veteran.
      ``(b) The Secretary may not provide assisted living services under 
  this section to a veteran eligible to receive care under section 
  1710(a)(3) of this title, or to a spouse of any veteran, unless such 
  veteran or spouse agrees to pay the United States an amount equal to 
  the cost, as determined in regulations prescribed by the Secretary, of 
  the provision of such services.
      ``(c) For purposes of this section, the term `assisted living 
  services' means services which provide personal care, activities, 
  health-related care, supervision, and other assistance on a 24-hour 
  basis within a residential or similar setting which--
              ``(1) maximizes flexibility in the provision of such care, 
          activities, supervision, and assistance;
              ``(2) maximizes the autonomy, privacy, and independence of 
          an individual; and
              ``(3) encourages family and community involvement with the 
          individual.''.
      (c) Conforming Amendments.--(1)(A) Section 1720 of such title is 
  amended by striking subsection (f).
      (B) The section heading of such section is amended by striking ``; 
  adult day health care''.
      (2) Section 1720B of such title is repealed.
      (d) Clerical Amendments.--The table of sections for chapter 17 of 
  such title is amended--
              (1) in the item relating to section 1720, by striking ``; 
          adult day health care'';
              (2) by striking the item relating to section 1720B; and
              (3) by inserting after the item relating to section 1720E 
          the following new item:
  
  ``1720F. Assisted living.''.
  
  SEC. 3. PILOT PROGRAMS RELATING TO LONG-TERM CARE OF VETERANS.
  
      (a) In General.--The Secretary of Veterans Affairs shall carry out 
  three pilot programs for the purpose of determining the feasibility and 
  practicability of a variety of methods of meeting the long-term care 
  needs of eligible veterans. The pilot programs shall be carried out in 
  accordance with the provisions of this section.
      (b) Locations of Pilot Programs.--(1) Each pilot program under this 
  section shall be carried out at two Veterans Integrated Service 
  Networks (VISNs) selected by the Secretary for purposes of this 
  section.
      (2) The Secretary may not carry out more than one pilot program in 
  any given Veterans Integrated Service Network.
      (c) Scope of Services Under Pilot Programs.--(1) The services 
  provided under the pilot programs under this section shall include a 
  comprehensive array of health care services and other services that 
  meet the long-term care needs of veterans, including--
              (A) inpatient long-term care in intermediate care beds, in 
          nursing homes, and in domiciliary care facilities;
              (B) noninstitutional long-term care, including hospital-
          based primary care, adult day care, personal assistance 
          services, respite care, and other community-based interventions 
          and care; and
              (C) assisted living services for veterans and their 
          families.
      (2) As part of the provision of services under the pilot programs, 
  the Secretary shall also provide appropriate case management services.
      (3) In providing services under the pilot programs, the Secretary 
  shall emphasize the provision of preventive care services, including 
  screening and education.
      (d) Direct Provision of Services.--Under one of the pilot programs 
  under this section, the Secretary shall provide long-term care services 
  to eligible veterans directly through facilities and personnel of the 
  Department of Veterans Affairs.
      (e) Provision of Services Through Cooperative Arrangements.--(1) 
  Under one of the pilot programs under this section, the Secretary shall 
  provide long-term care services to eligible veterans through a 
  combination (as determined by the Secretary) of--
              (A) services provided under cooperative arrangements with 
          appropriate public and private non-Governmental entities, 
          including community service organizations; and
              (B) services provided through facilities and personnel of 
          the Department.
      (2) The consideration provided by the Secretary for services 
  provided by entities under cooperative arrangements under paragraph 
  (1)(A) shall be limited to the provision by the Secretary of 
  appropriate in-kind services to such entities.
      (f) Provision of Services by Non-Department Entities.--(1) Under 
  one of the pilot programs under this section, the Secretary shall 
  provide long-term care services to eligible veterans through 
  arrangements with appropriate non-Department entities under which 
  arrangements the Secretary acts solely as the case manager for the 
  provision of such services.
      (2) Payment for services provided to veterans under the pilot 
  programs under this subsection shall be as follows:
              (A) By the medicare program or the medicaid program, but 
          only--
                      (i) if the veterans concerned are entitled to 
                  benefits under such programs; and
                      (ii) to the extent that payment for such services 
                  is provided for under such programs.
              (B) By the Department, to the extent that payment for such 
          services is not otherwise provided for under subparagraph (A).
      (g) Data Collection.--As part of each pilot program under this 
  section, the Secretary shall collect data regarding--
              (1) the cost-effectiveness of such program, including any 
          savings achieved under such program when compared with the 
          medicare program, medicaid program, or other Federal program 
          serving similar populations;
              (2) the quality of the services provided under such 
          program;
              (3) the satisfaction of participating veterans, non-
          Department, and non-Government entities with such program; and
              (4) the effect of such program on the ability of veterans 
          to carry out basic activities of daily living over the course 
          of such veterans' participation in such program.
      (h) Reports.--(1) The Secretary shall annually submit to Congress a 
  report on the pilot programs under this section.
      (2) Each report under paragraph (1) shall include the following:
              (A) A detailed description of activities under the pilot 
          programs during the one-year period ending on the date of the 
          report.
              (B) An evaluation of the data collected under subsection 
          (g) during that period.
              (C) Any other matters regarding the programs that the 
          Secretary considers appropriate.
      (i) Duration of Programs.--(1) The Secretary shall commence 
  carrying out the pilot programs required by this section not later than 
  90 days after the date of the enactment of this Act.
      (2) The authority of the Secretary to provide services under the 
  pilot programs shall cease on the date that is three years after the 
  date of the commencement of the pilot programs under paragraph (1).
      (j) Definitions.--In this section:
              (1) The term ``eligible veteran'' means the following:
                      (A) Any veteran entitled to hospital care and 
                  medical services under section 1710(a)(1) of title 38, 
                  United States Code.
                      (B) Any veteran (other than a veteran described in 
                  subparagraph (A)) if the veteran is enrolled in the 
                  system of annual patient enrollment under section 1705 
                  of title 38, United States Code.
              (2) The term ``long-term care needs'' means the need by an 
          individual for any of the following services:
                      (A) Personal care.
                      (B) Nursing home and home health care services.
                      (C) Habilitation and rehabilitation services.
                      (D) Adult day care services.
                      (E) Case management services.
                      (F) Social services.
                      (G) Assistive technology services.
                      (H) Home and community based services, including 
                  assistive living.
target: Veterans' Long-Term Care Enhancement Act of 1999 - Includes noninstitutional extended care services within the definition of medical services authorized to be provided to eligible veterans. 
  Authorizes the Secretary of Veterans Affairs to provide assisted living services to a veteran who is eligible to receive hospital, nursing home, and domiciliary care, and to the spouse of such veteran. Requires such veteran and spouse to agree to reimburse the United States for the cost of such care.  Repeals provisions authorizing respite care for such veterans. 
  Directs the Secretary to carry out three pilot programs to determine the feasibility and practicability of various methods of meeting the long-term care needs of eligible veterans.  Requires each program to be carried out at two Veterans Integrated Service Networks. Requires services provided to include a comprehensive array of health care services and other services that meet such needs, including case management services.  Directs the Secretary to emphasize the provision of preventive care services, including screening and education. 
  Requires one pilot program to be carried out: (1) directly through facilities and personnel of the Department of Veterans Affairs; (2) through a combination of Department facilities and personnel and services provided under cooperative arrangements with public and private nongovernmental entities; and (3) through cooperative arrangements with non-Department entities. 
  Outlines provisions concerning: (1) payment for services under the pilot programs; (2) required data collection; and (3) annual reports from the Secretary to Congress for the duration of the programs. Terminates such programs three years after their commencement.
feat_title: Veterans' Long-Term Care Enhancement Act of 1999