Wide-Ranging Veterans Bill Gets Agreement Between House and Senate

The Department of Veterans Affairs caregiver program, the beleaguered electronic health records program, veteran homelessness support and more would see changes under a bipartisan, bicameral agreement unveiled Tuesday to advance a slew of legislative efforts that had been stalled.

The Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act combines several bills that have been introduced this Congress seeking to bolster services for veterans and their families. The agreement -- which was negotiated by House Veterans Affairs Committee Chairman Mike Bost, R-Ill.; Senate Veterans Affairs Committee Chairman Jon Tester, D-Mont.; and Sen. Jerry Moran of Kansas, the top Republican on the Senate committee -- is expected to move through Congress this summer.

"Over the past year and a half, we have listened to veterans and stakeholders to find the gaps within VA's services and consider common sense legislation to improve them where we can," Bost said in a statement. "This bill would expand economic opportunities for veterans, give veterans more choice in where they choose to live out their sunset years or receive health care, improve mental health support for veteran caregivers, hold VA accountable to the taxpayers and veterans they serve, and so much more."

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An array of veterans legislation has been stalled this congressional session even though many of the bills have garnered bipartisan support, in part because lawmakers struggled to find ways to pay – or offsets, in congressional language – for the costs of the bills. In general, congressional rules require offsets for increases in what's known as mandatory spending.

The agreement unveiled this week is fully offset, negotiators touted in a summary, unlocking the stalled measures.

Among the negotiated package's more substantial changes is an expansion of VA-funded home- and community-based nursing care services so aging and disabled veterans can get those services through any VA medical center in the country.

The bill would also require the VA to offer alternative programs veterans' families can enroll in if they are kicked out of the Program of Comprehensive Assistance for Family Caregivers, which provides financial support for family members who act as caregivers. Potentially thousands of families are facing disqualification from the program under new eligibility rules, though the VA has paused any action until 2025 as it reviews the criteria.

The legislation would also create a grant program for family caregivers to get mental health care.

In addition, the bill would make several changes that aim to ease veterans' ability to get VA-funded health care from non-VA doctors. Specifically, it would ban the department from overriding a VA doctor's referral for their patient to get outside care and require the VA to conduct outreach to inform veterans of their ability to get outside care.

On the electronic health records program, the bill could allow the VA to pivot away from the troubled Oracle Cerner system. The VA paused rolling out the system at any more of its health care facilities to work on fixes after several scathing watchdog reports and growing lawmaker anger about patient safety issues resulting from system glitches.

The bill would allow the VA to proceed with updating its electronic health records system either by making changes to the Oracle Cerner program or "by establishing a new program," according to the bill text. It would also formally define the roles the deputy VA secretary, under secretary for health, and assistant secretary for information and technology have in overseeing the modernization program.

For veteran homelessness, the bill would revive through 2026 authorities the VA had during the COVID-19 public health emergency that were credited with helping reduce the number of unhoused veterans. Under the bill, the VA would again be able to provide homeless veterans with free transportation to get to medical appointments, jobs or support programs. The department would also be able to fund food, shelter, clothing, hygiene products, communications devices and other items homeless veterans need for their "safety and survival."

And the bill would increase the per diem rate the VA can pay to organizations providing short-term transitional housing from 115% of costs to 133%, as well as allow the department to go as high as 200% in particularly high-cost areas.

"In the past few years, we've done right by veterans by passing critical legislation like the PACT Act, but there's still work to be done to ensure we're fully honoring our commitment to them and their families," Tester said in a written statement. "By improving veterans' access to the care they need, bolstering long-term care options and assistance for homeless veterans, strengthening life-saving mental health services, and increasing transparency and oversight of VA's new electronic health record program, this package is a common sense step toward delivering veterans and their families the kind of support they earned and deserve."

Other provisions of the wide-ranging measure include extending and tweaking a high-tech job training program for veterans through 2026; ensuring that only veterans are responsible for paying back GI Bill benefits if they transferred the benefit to a dependent but become ineligible because of a less-than-honorable discharge or failure to complete their service obligation; and making it easier for the VA to automate disability claims decisions by requiring contractors to submit exam paperwork in a machine-readable format.

The bill is being formally introduced by Rep. Juan Ciscomani, R-Ariz.

In addition to bipartisan support from lawmakers, the bill has garnered endorsements from leading veterans service organizations, including the American Legion, Disabled American Veterans and Paralyzed Veterans of America, among others, according to a news release. The Elizabeth Dole Foundation, founded by the bill's namesake to support caregivers, is also endorsing the measure.

Related: VA Family Caregiver Benefits for 'Legacy' Veterans Extended Through 2025