This bill addresses home care and caregiver programs provided by the Department of Veterans Affairs (VA). Under the bill, the cost of providing noninstitutional alternatives to nursing home care generally may not exceed 100% of the cost that would have been incurred if a veteran had been furnished VA nursing home care. (Under current law, these expenditures are limited to 65% of the cost.) However, for specified veterans, the VA may exceed 100% of the cost if it determines the higher cost is in the best interest of such veterans (i.e., veterans with amyotrophic lateral sclerosis, a spinal cord injury, or a condition the Secretary determines to be similar to such conditions). Among other requirements, the VA must seek to enter into an agreement with the Program of All-Inclusive Care for the Elderly in certain areas to furnish noninstitutional alternatives to nursing home care; implement various programs (e.g., the Veteran Directed Care program) to expand access to home- and community-based services; provide specified support and benefits to caregivers of certain disabled veterans; implement a pilot program to provide homemaker and home health aide services to veterans who reside in communities with a shortage of home health aides; and ensure the availability of home and community-based services for Native American veterans. For veterans or family caregivers who are discharged from the Program of Comprehensive Assistance for Family Caregivers, a caregiver support coordinator must provide for a personalized transition to an appropriate program. The Veterans Health Administration must review programs administered through the Office of Geriatric and Extended Care to ensure consistency in program management, eliminate service gaps at the medical center level, and ensure the availability of and access to home and community-based services. The bill also extends certain loan fee rates through February 4, 2032, under the VA's home loan program.