REQUIREMENT TO PROVIDE EXTENDED CARE SERVICES.

SEC. 101. REQUIREMENT TO PROVIDE EXTENDED CARE SERVICES. (a) Required Nursing Home Care.—(1) Chapter 17 is amended by inserting after section 1710 the following new section: “§1710A. Required nursing home care “(a) The Secretary shall provide nursing home care which the Secretary determines is needed (1) to any veteran in need of such 113 STAT. 1548 care for a service-connected disability, and (2) to any veteran who is in need of such care and who has a service-connected disability rated at 70 percent or more. “(b)(1)The Secretary shall that a veteran described in subsection (a) who continues to need nursing home care is not, after placement in a Department nursing home, transferred from the facility without the consent of the veteran, or, in the event the veteran cannot provide informed consent, the representative of the veteran. “(2) Nothing in subsection (a) may be construed as authorizing or requiring that a veteran who is receiving nursing home care in a Department nursing home on the date of the enactment of this section be displaced, transferred, or discharged from the facility. “(c) The provisions of subsection (a) shall terminate on December 31, 2003.”. (2) The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 1710 the following new item: “1710A. Required nursing home care.”. (b) Required Noninstitutional Extended Care Services.—Section 1701 is amended by adding at the end the following new paragraph: “(10) (A) During the period beginning on the date of the enactment of the Veterans Millennium Health Care and Benefits Act and ending on December 31, 2003, the term ‘medical services’ includes noninstitutional extended care services. “(B) For the purposes of subparagraph (A), the term ‘noninstitutional extended care services’ means such alternatives to institutional extended care which the Secretary may furnish (i) directly, (ii) by contract, or (iii) (through provision of case management) by another provider or payor.”. (c) Program of Extended Care Services.—(1)Chapter 17 is amended by inserting after section 1710A, as added by subsection (a), the following new section: “§ 1710B. Extended care services “(a) The Secretary (subject to section 1710(a)(4) of this title and subsection (c) of this section) shall operate and maintain a program to provide extended care services to eligible veterans in accordance with this section. Such services shall include the following: “(1) Geriatric evaluation. “(2) Nursing home care (A) in facilities operated by the Secretary, and (B) in community-based facilities through contracts under section 1720 of this title. “(3) Domiciliary services under section 1710(b) of this title. “(4) Adult day health care under section 1720(f) of this title. “(5) Such other noninstitutional alternatives to nursing home care as the Secretary may furnish as medical services under section 1701(10) of this title. “(6) Respite care under section 1720B of this title. “(b) The Secretary shall ensure that the staffing and level of extended care services provided by the Secretary nationally in facilities of the Department during any fiscal year is not less than 113 STAT. 1549 the staffing and level of such services provided nationally in facilities of the Department during fiscal year 1998. “(c)(1) Except as provided in paragraph (2), the Secretary may not furnish extended care services for a non-service-connected disability other than in the case of a veteran who has a compensable service-connected disability unless the veteran agrees to pay to the United States a copayment (determined in accordance with subsection (d)) for any period of such services in a year after the first 21 days of such services provided that veteran in that year. “(2) Paragraph (1) shall not apply— “(A) to a veteran whose annual income (determined under section 1503 of this title) is less than the amount in effect under section 1521(b) of this title; or “(B) with respect to an episode of extended care services that a veteran is being furnished by the Department on the date of the enactment of the Veterans Millennium Health Care and Benefits Act. “(d)(1)A veteran who is furnished extended care services under this chapter and who is required under subsection (c) to pay an amount to the United States in order to be furnished such services shall be liable to the United States for that amount. “(2) In implementing subsection (c), the Secretary shall develop a methodology for establishing the amount of the copayment for which a veteran described in subsection (c) is liable. That methodology shall provide for— “(A) establishing a maximum monthly copayment (based on all income and assets of the veteran and the spouse of such veteran); “(B) protecting the spouse of a veteran from financial hardship by not counting all of the income and assets of the veteran and spouse (in the case of a spouse who resides in the community) as available for determining the copayment obligation; and “(C) allowing the veteran to retain a monthly personal allowance. “(e)(1)There is established in the Treasury of the United States a revolving fund known as the Department of Veterans Affairs Extended Care Fund (hereafter in this section referred to as the ‘fund’). Amounts in the fund shall be available, without fiscal year limitation and without further appropriation, exclusively for the purpose of providing extended care services under subsection (a). “(2) All amounts received by the Department under this section shall be deposited in or credited to the fund.”. (2) The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 1710A, as added by subsection (a)(2), the following new item: “1710B. Extended care services.”. (d) Adult Day Health Care.—Section 1720(f)(1)(A) is amended to read as follows: “(f) (1)(A) The Secretary may furnish adult day health care services to a veteran enrolled under section 1705(a) of this title who would otherwise require nursing home care.”. (e) Respite Care Program.—Section 1720B is amended— (1) in subsection (a), by striking “eligible” and inserting “enrolled”; 113 STAT. 1550 (2) in subsection (b)— (A) by striking “the term ‘respite care’ means hospital or nursing home care” and inserting “the term ‘respite care services’ means care and services”; (B) by striking “is” at the beginning of each of paragraphs (1), (2), and (3) and inserting “are”; and (C) by striking “in a Department facility” in paragraph (2); and (3) by adding at the end the following new subsection: “(c) In furnishing respite care services, the Secretary may enter into contract arrangements.”. (f) Conforming Amendments.—Section 1710(a) is amended— (1) in paragraph (1), by striking “, and may furnish nursing home care,”; (2) in paragraph (2)(A), by inserting “or, with respect to nursing home care during any period during which the provisions of section 1710A(a) of this title are in effect, a compensable service-connected disability rated less than 70 percent” after “50 percent”; (3) in paragraph (4), by inserting “, and the requirement in section 1710B of this title that the Secretary provide a program of extended care services,” after “medical services”; and (4) by adding at the end the following new paragraph: “(5) During any period during which the provisions of section 1710A(a) of this title are not in effect, the Secretary may furnish nursing home care which the Secretary determines is needed to any veteran described in paragraph (1), with the priority for such care on the same basis as if provided under that paragraph.”. (g) State Homes.—Section 1741(a)(2) is amended by striking “adult day health care in a State home” and inserting “extended care services described in any of paragraphs (4) through (6) of section 1710B(a) of this title under a program administered by a State home”. (h)Effective Date.—(1)Except as provided in paragraph (2), the amendments made by this section shall take effect on the date of the enactment of this Act. (2) Subsection (c) of section 1710B of title 38, United States Code (as added by subsection (b)), shall take effect on the effective date of regulations prescribed by the Secretary of Veterans Affairs under subsections (c) and (d) of such section. The Secretary shall publish the effective date of such regulations in the Federal Register. (3) The provisions of section 1710(f) of title 38, United States Code, shall not apply to any day of nursing home care on or after the effective date of regulations under paragraph (2). (i) Report.—Not later than January 1, 2003, the Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and House of Representatives a report on the operation of this section (including the amendments made by this section). The Secretary shall include in the report— (1) the Secretary’s assessment of the experience of the Department under the provisions of this section; (2) the costs incurred by the Department under the provisions of this section and a comparison of those costs with the Secretary’s estimate of the costs that would have been 113 STAT. 1551 incurred by the Secretary for extended care services if this section had not been enacted; and (3) the Secretary’s recommendations, with respect to the provisions of section 1710A(a) of title 38, United States Code, as added by subsection (a), and with respect to the provisions of section 1701(10) of such title, as added by subsection (b), as to— (A) whether those provisions should be extended or made permanent; and (B) what modifications, if any, should be made to those provisions.