article: 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.
summary: 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.