All Roll Calls
Yes: 382 • No: 12
118-s-141118th Congress
Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act
Sponsored By: Senator Moran, Jerry [R-KS]
Became Law
Summary
Expands and funds veterans' access to community, home-based, and caregiver services while strengthening quality standards and oversight. It tightens community-care rules and scheduling, raises noninstitutional care caps, boosts caregiver mental-health support, and adds targeted housing and homelessness tools.
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- Veterans and families: Changes the Veterans Community Care Program so veterans and their referring clinicians make final eligibility determinations for a two-year period starting 90 days after enactment, requires stronger outreach, scheduling preferences, and industry-parity data standards, and authorizes rural ambulance reimbursement with a $46,000 lifetime cap. Mobile mammography gets $5.0 million for FY2025.
- Caregivers and home-based care: Raises the baseline noninstitutional alternative cap from 65% to 100% and creates new home- and community-based programs like Veteran-Directed Care and Homemaker and Home Health Aide services. Caregiver mental-health grants are funded at $10.0 million for each of FY2025 and FY2026.
- Housing, homelessness, education, and workforce: Reforms Native American direct-loan rules and authorizes a Native CDFI relending program with up to $5.0 million for FY2025. Homeless-veteran per diem rates increase and outreach gets $10.0 million each for FY2026 and FY2027. The law also creates a High Technology education program for up to 4,000 participants per year and expands pay and USERRA protections and remedies for VA staff and service members.
*Authorizes at least $50.0 million in new appropriations across FY2025–FY2027, increasing federal spending.*
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26 provisions identified: 25 benefits, 0 costs, 1 mixed.
Ambulance pay help for rural veterans
VA will pay or reimburse ambulance transport (including air) for eligible rural veterans who lack other travel coverage. A covered location is 100+ miles from the nearest VA medical center and in a high-RUCA rural area. Covered veterans must have a 0–30% service-connected rating and no other travel coverage. The maximum total per veteran is $46,000. This authority ends September 30, 2026.
More in-home care and caregiver help
The VA will create new in-home and community care programs and run pilots to expand homemaker and home health aide services. Caregivers will get a guaranteed minimum of 30 days of respite each year and annual wellness checks. The VA will give grants to expand caregiver mental health services and must publish a central website and a free navigator recognition process to help find services. The VA must set staffing models and report on how these programs will work and be funded.
Housing loans for Native veterans
The VA can make direct housing loans to Native American veterans to buy, build, or improve homes on trust land. The VA can also lend to Native community lenders at 1% to reloan to veterans. The VA may use up to $5 million in fiscal year 2025 for the relending program and set rules for refinancing and foreclosure protection.
Higher USERRA damages and interest
If you win a USERRA case, a court may order your employer to pay amounts owed plus 3% interest per year. If the employer knowingly broke the law, the court can require liquidated damages of at least $50,000 or the owed amount plus interest, whichever is larger.
Better community care access and scheduling
For two years, a veteran and their clinician can make final community-care eligibility choices and correct mistakes. VA will test provider incentives, give community providers free ways to exchange health records, record veterans' appointment preferences, and report quarterly on referral timing. VA must also review payment-rate waivers for Third Party Administrators and the Inspector General will assess VCCP performance.
Dental care studies and pilots
VA will run pilots and studies to expand dental care. That includes a two-year pilot for veterans with ischemic heart disease, a pilot to centralize dental treatment approvals, and Government Accountability Office and facility reports on dental capacity, IT, and provider satisfaction. Reports must show costs, barriers, and demographic details.
Faster disability claims and exams
The VA will require machine-readable disability forms and set IT plans within 180 days. Non-VA providers must send DBQ data in machine readable form. The VA must add automation for some temporary disability ratings within one year while keeping manual reviews available. Pilot exams must be done only by health care professionals, with annual reports on the pilot.
Help when caregiver program ends
If a veteran or family caregiver is denied or discharged from the family caregiver program, the VA must offer the caregiver general caregiver support if the veteran is a covered veteran. The VA must assess and record other home- and community-based services and provide a coordinated transition plan. These rules start for denials and discharges 180 days after enactment.
Higher per diem for homeless care
The VA raises the reference rate used for per diem payments to homeless veteran care and temporarily references a higher base through September 30, 2027. For fiscal years 2025–2027 the VA may waive limits and pay up to 200% for some providers, subject to appropriations and limits. The VA may not provide more than 12,000 per diem payments in any fiscal year.
Value-based care planning and pilot
VA must form a public working group to write a value-based care plan and start a three-year pilot in four regions. The plan must include metrics, workforce needs, IT recommendations, and cost estimates. VA will report annually and at pilot end on outcomes versus baseline.
Temporary emergency help for homeless veterans
From enactment until September 30, 2027, VA can provide emergency help to homeless veterans. That can include food, shelter, clothing, hygiene items, short-term transportation for health, and phones or tablets with service plans. VA may also let veterans live on Department land in managed spaces. VA must report to Congress within six months and yearly until the program ends.
New VA high-tech training benefit
The VA will create a High Technology Program giving approved training to up to 4,000 people per year. Payments to providers come in three parts: 25% at enrollment, 25% at graduation, and 50% after employment milestones. One month of entitlement may be charged per month of assistance if you have remaining entitlement.
Retro pay for some VA clinicians
VA may pay retroactive market-pay that was deferred for covered employees for work done between January 8, 2006 and December 31, 2017. These retro payments will be charged to the medical care appropriation for the fiscal year the work was performed. Retro pay will not count toward aggregate compensation caps for the payment year.
Stronger job-retaliation protections
USERRA gets stronger protections. The law bars broader retaliatory actions, makes injunctions easier to get when harm is likely, and makes attorney-fee awards mandatory in many Veterans' employment cases. That lowers the cost of bringing claims for service members and veterans.
VA clinician pay evaluations and waivers
VA adds optometrists to annual market-pay evaluations and must tell clinicians how evaluations affect pay. The Secretary can waive pay limits to recruit or keep critical direct patient care staff, with up to 300 waivers while the authority is active. VA must report on waivers and evaluations.
VA facility security and leadership
The VA must survey staff about facility security at each covered site within one year and annually for five years. The VA must report results and a written action plan within 30 days after the next full fiscal year ends and each year for five years. The VA must also notify Congress and appoint acting medical center directors on a set timetable and report on vacancies and waivers.
National veteran suicide data and reports
VA must publish a national veteran suicide prevention report within 18 months and then each year by September 30. The law funds independent contractor reviews of methods and data, requires a toolkit for coroners, and asks VA to report within three years which programs most reduce suicide.
VA care quality, data, and audits
The VA must update quality rules to match industry standards and add patient quality-of-life measures. The VA must hire private auditors within 180 days and report findings to Congress. The VA must update standards at least once every five years and report each update to Congress within 30 days.
GI Bill updates and school rules
The bill makes several GI Bill and school oversight changes. It treats final terms as full-time for Post-9/11 housing payments starting Jan 1, 2025. It temporarily expands Fry Scholarship eligibility and removes an expiration for surviving spouses. VA must improve school notifications, build a risk-surveys database, allow limited 36-month Title IV waivers, and update the GI Bill Comparison Tool with more data. The law also makes the person who failed to complete a transferred-benefits service obligation solely liable for overpayments.
Mobile mammography funding for women
Congress authorized $5 million for fiscal year 2025 for the VA Office of Women's Health. The money is for mobile mammography, advanced mammography equipment, and outreach to help women veterans get screened.
Two-VISN assisted living pilot
VA will run an assisted living pilot in two regions, each limited to up to 60 veterans. The pilot starts within two years and ends September 30, 2028 unless extended. VA will inspect facilities, limit payments below local nursing home averages, and report on results.
VA outreach and enrollment notices
The VA must tell veterans how to get and appeal care under named authorities when they enroll and at least every two years. The VA must post information in medical facilities and on its website and add it to outreach campaigns. The Government Accountability Office will report on outreach within two years.
Digital transcripts and foreign payments
Starting August 1, 2025, VA-approved schools must give eligible students an official digital transcript for terms starting then. Schools get 30 days to review feedback, and feedback must be kept in the GI Bill Comparison Tool for six years. The VA must also update its payment system within 90 days so it can send education payments electronically to eligible foreign schools without a U.S. bank account or EIN.
Interior job outreach pilot for veterans
The Department of the Interior will run a two-year pilot to tell veterans about conservation and resource jobs and help them apply. The pilot must report on implementation within one year and submit a final report after it ends.
State and Tribal outreach grants
The VA can award grants to States and Indian Tribes to expand outreach, help develop claims, and grow county or Tribal veterans service officer capacity. At least 5% of each year's funds must go to Indian Tribes. The law authorizes $10 million for FY2026 and $10 million for FY2027.
VA can supply State homes safety gear
VA may give medicines, personal protective equipment, and medical supplies to State veterans' homes. Examples include N-95 masks, gloves, gowns, goggles, and face shields. This starts on enactment and has no specific dollar amounts in the law.
Sponsors & CoSponsors
Sponsor
Moran, Jerry [R-KS]
KS • R
Cosponsors
Sen. Tester, Jon [D-MT]
MT • D
Sponsored 1/30/2023
Sen. Hassan, Margaret Wood [D-NH]
NH • D
Sponsored 1/30/2023
Sen. Blumenthal, Richard [D-CT]
CT • D
Sponsored 3/1/2023
Sen. Klobuchar, Amy [D-MN]
MN • D
Sponsored 3/14/2023
Sen. Casey, Robert P., Jr. [D-PA]
PA • D
Sponsored 3/27/2023
Sen. Cortez Masto, Catherine [D-NV]
NV • D
Sponsored 3/27/2023
Sen. Boozman, John [R-AR]
AR • R
Sponsored 3/28/2023
Sen. Scott, Rick [R-FL]
FL • R
Sponsored 3/30/2023
Sen. Capito, Shelley Moore [R-WV]
WV • R
Sponsored 4/19/2023
Sen. Rosen, Jacky [D-NV]
NV • D
Sponsored 4/20/2023
Sen. Welch, Peter [D-VT]
VT • D
Sponsored 4/20/2023
Sen. Kelly, Mark [D-AZ]
AZ • D
Sponsored 4/25/2023
Sen. Stabenow, Debbie [D-MI]
MI • D
Sponsored 4/25/2023
Sen. King, Angus S., Jr. [I-ME]
ME • I
Sponsored 4/25/2023
Rep. Sinema, Kyrsten [D-AZ-9]
AZ • D
Sponsored 4/25/2023
Sen. Coons, Christopher A. [D-DE]
DE • D
Sponsored 4/26/2023
Sen. Merkley, Jeff [D-OR]
OR • D
Sponsored 5/16/2023
Sen. Cruz, Ted [R-TX]
TX • R
Sponsored 5/30/2023
Sen. Whitehouse, Sheldon [D-RI]
RI • D
Sponsored 6/7/2023
Sen. Rounds, Mike [R-SD]
SD • R
Sponsored 6/8/2023
Sen. Padilla, Alex [D-CA]
CA • D
Sponsored 7/10/2023
Sen. Warnock, Raphael G. [D-GA]
GA • D
Sponsored 7/10/2023
Sen. Rubio, Marco [R-FL]
FL • R
Sponsored 7/25/2023
Sen. Kaine, Tim [D-VA]
VA • D
Sponsored 9/5/2023
Sen. Shaheen, Jeanne [D-NH]
NH • D
Sponsored 9/28/2023
Sen. Sullivan, Dan [R-AK]
AK • R
Sponsored 10/19/2023
Sen. Fetterman, John [D-PA]
PA • D
Sponsored 10/24/2023
Sen. Gillibrand, Kirsten E. [D-NY]
NY • D
Sponsored 3/12/2024
Sen. Peters, Gary C. [D-MI]
MI • D
Sponsored 9/12/2024
Sen. Van Hollen, Chris [D-MD]
MD • D
Sponsored 9/17/2024
Sen. Marshall, Roger [R-KS]
KS • R
Sponsored 9/25/2024
Sen. Cardin, Benjamin L. [D-MD]
MD • D
Sponsored 11/21/2024
Sen. Duckworth, Tammy [D-IL]
IL • D
Sponsored 12/11/2024
Roll Call Votes
house vote • 12/16/2024
On Motion to Suspend the Rules and Pass
Yes: 382 • No: 12