[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 216 Introduced in Senate (IS)]
<DOC>
118th CONGRESS
1st Session
S. 216
To amend title 38, United States Code, to modify the family caregiver
program of the Department of Veterans Affairs to include services
related to mental health and neurological disorders, and for other
purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
February 1, 2023
Mr. Moran introduced the following bill; which was read twice and
referred to the Committee on Veterans' Affairs
_______________________________________________________________________
A BILL
To amend title 38, United States Code, to modify the family caregiver
program of the Department of Veterans Affairs to include services
related to mental health and neurological disorders, and for other
purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Reinforcing Enhanced Support through
Promoting Equity for Caregivers Act of 2023'' or the ``RESPECT Act of
2023''.
SEC. 2. MODIFICATION OF FAMILY CAREGIVER PROGRAM OF DEPARTMENT OF
VETERANS AFFAIRS TO INCLUDE SERVICES RELATED TO MENTAL
HEALTH AND NEUROLOGICAL DISORDERS.
(a) In General.--Section 1720G of title 38, United States Code, is
amended--
(1) in subsection (a)--
(A) in paragraph (2)(C)(ii), by striking
``neurological'' and inserting ``a neurological
disorder'';
(B) in paragraph (3)--
(i) in subparagraph (A)(ii)(II), by
inserting ``, including through public or
private entities'' before the semicolon; and
(ii) in subparagraph (C), by adding at the
end the following new clause:
``(v)(I) For purposes of determining the amount and degree of
personal care services provided under clause (i) with respect to a
veteran described in subclause (II), the Secretary shall take into
account relevant documentation evidencing the provision of personal
care services with respect to the veteran during the preceding three-
year period.
``(II) A veteran described in this subclause is a veteran whose
need for personal care services as described in paragraph (2)(C) is
based in whole or in part on--
``(aa) a diagnosis of mental illness or history of suicidal
ideation that puts the veteran at risk of self-harm; or
``(bb) a neurological disorder.''; and
(C) by adding at the end the following new
paragraph:
``(14) The Secretary shall establish a process and requirements for
clinicians of facilities of the Department--
``(A) to document incidents in which an eligible veteran
participating in the program established under paragraph (1)--
``(i) presents at such a facility for treatment for
an emergent or urgent mental health crisis; or
``(ii) is assessed by such a clinician to be at
risk for suicide; and
``(B) to provide such documentation, including any safety
plans developed and referrals made to a suicide prevention
coordinator of the Department, to such program.'';
(2) in subsection (b)(2)(B), by striking ``neurological''
and inserting ``a neurological disorder'';
(3) in subsection (d)--
(A) by redesignating paragraph (4) as paragraph
(5);
(B) by inserting after paragraph (3) the following
new paragraph (4):
``(4) the term `neurological disorder' means a disease of
the brain, spinal cord, nerves, or neuromuscular system.''; and
(C) in paragraph (5)(B), as redesignated by
subparagraph (A), by striking ``neurological'' and
inserting ``a neurological disorder''.
(b) Timing for Establishment of Requirements and Processes.--
(1) Report.--Not later than one year after the date of the
enactment of this Act, the Secretary of Veterans Affairs
shall--
(A) establish the process and requirements required
under paragraph (14) of section 1720G(a) of title 38,
United States Code, as added by subsection (a)(1)(B);
and
(B) submit to the Committee on Veterans' Affairs of
the Senate and the Committee on Veterans' Affairs of
the House of Representatives a description of such
process and requirements.
(2) Certification.--
(A) In general.--Not later than one year after the
date of the enactment of this Act, the Secretary of
Veterans Affairs shall require all clinicians of
facilities of the Department to certify to the
Secretary that the clinician understands the process
and requirements established under paragraph (1)(A).
(B) Facilities of the department defined.--In this
paragraph, the term ``facilities of the Department''
has the meaning given that term in section 1701 of
title 38, United States Code.
SEC. 3. REQUIREMENTS RELATING TO EVALUATIONS, ASSESSMENTS, AND
REASSESSMENTS RELATING TO ELIGIBILITY OF VETERANS AND
CAREGIVERS FOR FAMILY CAREGIVER PROGRAM.
(a) In General.--Subsection (a) of section 1720G of title 38,
United States Code, as amended by section 2(a)(1), is further amended
by adding at the end the following new paragraphs:
``(15)(A) For purposes of conducting evaluations and
assessments to determine eligibility of a veteran and caregiver
for the program established under paragraph (1) or conducting
reassessments to determine continued eligibility for such
program, the Secretary shall--
``(i) take into account relevant documentation and
medical records generated by Department and non-
Department health care providers, including qualified
mental health professionals and neurological
specialists;
``(ii) if the caregiver of the veteran claims that
the serious injury or need for personal care services
of the veteran as described in paragraph (2) is based
in whole or in part on psychological trauma or another
mental disorder, ensure--
``(I) a qualified mental health
professional that treats the veteran
participates in the evaluation process; and
``(II) a qualified mental health
professional participates in the assessment or
reassessment process; and
``(iii) if the caregiver of the veteran claims that
the serious injury or need for personal care services
of the veteran as described in paragraph (2) is based
in whole or in part on a neurological disorder,
ensure--
``(I) a neurological specialist that treats
the veteran participates in the evaluation
process; and
``(II) a neurological specialist
participates in the assessment or reassessment
process.
``(B)(i) The Secretary shall establish an appropriate time
limit during a 24-hour period for the active participation of a
veteran in an evaluation, assessment, or reassessment to
determine eligibility of the veteran for the program
established under paragraph (1).
``(ii) In determining an appropriate time limit for a
veteran under clause (i), the Secretary shall--
``(I) take into consideration necessary
accommodations for the veteran stemming from the
disability or medical condition of the veteran; and
``(II) consult with the primary care provider,
neurological specialist, or qualified mental health
professional that is treating the veteran.
``(C) The Secretary shall not require the presence of a
veteran during portions of an evaluation, assessment, or
reassessment to determine eligibility of the veteran for the
program established under paragraph (1) that only require the
active participation of the caregiver.
``(D)(i) The Secretary shall make reasonable efforts to
assist a caregiver and veteran in obtaining evidence necessary
to substantiate the claims of the caregiver and veteran in the
application process for evaluation, assessment, or reassessment
for the program established under paragraph (1).
``(ii)(I) As part of the assistance provided to a caregiver
or veteran under clause (i), the Secretary shall make
reasonable efforts to obtain relevant private records that the
caregiver or veteran adequately identifies to the Secretary.
``(II) Whenever the Secretary, after making reasonable
efforts under subclause (I), is unable to obtain all of the
relevant records sought, the Secretary shall notify the
caregiver and veteran that the Secretary is unable to obtain
records with respect to the claim, which shall include--
``(aa) an identification of the records the
Secretary is unable to obtain;
``(bb) a brief explanation of the efforts that the
Secretary made to obtain such records; and
``(cc) an explanation that the Secretary will make
a determination based on the evidence of record and
that this clause does not prohibit the submission of
records at a later date if such submission is otherwise
allowed.
``(III) The Secretary shall make not fewer than two
requests to a custodian of a private record in order for an
effort to obtain such record to be treated as reasonable under
subclause (I), unless it is made evident by the first request
that a second request would be futile in obtaining such record.
``(iii) Under regulations prescribed by the Secretary, the
Secretary--
``(I) shall encourage a caregiver and veteran to
submit relevant private medical records of the veteran
to the Secretary to substantiate the claims of the
caregiver and veteran in the application process for
evaluation, assessment, or reassessment for the program
established under paragraph (1) if such submission does
not burden the caregiver or veteran; and
``(II) may require the caregiver or veteran to
authorize the Secretary to obtain such relevant private
medical records if such authorization is required to
comply with Federal, State, or local law.
``(16)(A) The Secretary, in consultation with a health care
provider, neurological specialist, or qualified mental health
professional that is treating a veteran, shall waive the
reassessment requirement for the veteran for participation in
the program established under paragraph (1) if--
``(i) the serious injury of the veteran under
paragraph (2) is significantly caused by a degenerative
or chronic condition; and
``(ii) such condition is unlikely to improve the
dependency of the veteran for personal care services.
``(B) The Secretary shall require a health care provider,
neurological specialist, or qualified mental health
professional that is treating a veteran to certify at
appropriate intervals determined by the Secretary the clinical
decision of the provider, specialist, or professional under
subparagraph (A).
``(C) The Secretary may rescind a waiver under subparagraph
(A) with respect to a veteran and require a reassessment of the
veteran if a health care provider, neurological specialist, or
qualified mental health professional that is treating the
veteran makes a clinical determination that the level of
dependency of the veteran for personal care services has
diminished since the last certification of the clinical
decision of the provider, specialist, or professional under
subparagraph (B).''.
(b) Definitions.--Subsection (d) of such section, as amended by
section 2(a)(2), is further amended--
(1) by redesignating paragraph (5) as paragraph (6);
(2) by inserting after paragraph (4) the following new
paragraph (5):
``(5) The term `neurological specialist' means a
neurologist, neuropsychiatrist, physiatrist, geriatrician,
certified brain injury specialist, neurology nurse, neurology
nurse practitioner, neurology physician assistant, or such
other licensed medical professional as the Secretary considers
appropriate.''; and
(3) by adding at the end the following new paragraph:
``(7) The term `qualified mental health professional' means
a psychiatrist, psychologist, licensed clinical social worker,
psychiatric nurse, licensed professional mental health
counselor, or other licensed mental health professional as the
Secretary considers appropriate.''.
SEC. 4. AUTHORITY FOR SECRETARY OF VETERANS AFFAIRS TO AWARD GRANTS TO
ENTITIES TO IMPROVE PROVISION OF MENTAL HEALTH SUPPORT TO
FAMILY CAREGIVERS OF VETERANS.
(a) In General.--Subchapter II of chapter 17 of title 38, United
States Code, is amended by adding at the end the following new section:
``Sec. 1720K. Grants to provide mental health support to family
caregivers of veterans
``(a) Purpose.--It is the purpose of this section to provide for
assistance by the Secretary to entities to carry out programs that
improve the provision of mental health support to the family caregivers
of veterans participating in the family caregiver program.
``(b) Authority.--The Secretary may award grants to carry out,
coordinate, improve, or otherwise enhance mental health counseling,
treatment, or support to the family caregivers of veterans
participating in the family caregiver program.
``(c) Application.--(1) To be eligible for a grant under this
section, an entity shall submit to the Secretary an application
therefor at such time, in such manner, and containing such information
as the Secretary may require.
``(2) Each application submitted under paragraph (1) shall include
the following:
``(A) A detailed plan for the use of the grant.
``(B) A description of the programs or efforts through
which the entity will meet the outcome measures developed by
the Secretary under subsection (g).
``(C) A description of how the entity will distribute grant
amounts equitably among areas with varying levels of
urbanization.
``(D) A plan for how the grant will be used to meet the
unique needs of veterans residing in rural areas, American
Indian or Alaska Native veterans, elderly veterans, women
veterans, and veterans from other underserved communities.
``(d) Distribution.--The Secretary shall seek to ensure that grants
awarded under this section are equitably distributed among entities
located in States with varying levels of urbanization.
``(e) Priority.--The Secretary shall prioritize awarding grants
under this section that will serve the following areas:
``(1) Areas with high rates of veterans enrolled in the
family caregiver program.
``(2) Areas with high rates of--
``(A) suicide among veterans; or
``(B) referrals to the Veterans Crisis Line.
``(f) Required Activities.--Any grant awarded under this section
shall be used--
``(1) to expand existing programs, activities, and
services;
``(2) to establish new or additional programs, activities,
and services; or
``(3) for travel and transportation to facilitate carrying
out paragraph (1) or (2).
``(g) Outcome Measures.--(1) The Secretary shall develop and
provide to each entity that receives a grant under this section written
guidance on the following:
``(A) Outcome measures.
``(B) Policies of the Department.
``(2) In developing outcome measures under paragraph (1), the
Secretary shall consider the following goals:
``(A) Increasing the utilization of mental health services
among family caregivers of veterans participating in the family
caregiver program.
``(B) Reducing barriers to mental health services among
family caregivers of veterans participating in such program.
``(h) Tracking Requirements.--(1) The Secretary shall establish
appropriate tracking requirements with respect to the entities
receiving a grant under this section.
``(2) Not less frequently than annually, the Secretary shall submit
to Congress a report on such tracking requirements.
``(i) Performance Review.--The Secretary shall--
``(1) review the performance of each entity that receives a
grant under this section; and
``(2) make information regarding such performance publicly
available.
``(j) Remediation Plan.--(1) In the case of an entity that receives
a grant under this section and does not meet the outcome measures
developed by the Secretary under subsection (g), the Secretary shall
require the entity to submit to the Secretary a remediation plan under
which the entity shall describe how and when it plans to meet such
outcome measures.
``(2) The Secretary may not award a subsequent grant under this
section to an entity described in paragraph (1) unless the Secretary
approves the remediation plan submitted by the entity under such
paragraph.
``(k) Maximum Amount.--The amount of a grant awarded under this
section may not exceed 10 percent of amounts made available for grants
under this section for the fiscal year in which the grant is awarded.
``(l) Supplement, Not Supplant.--Any grant awarded under this
section shall be used to supplement and not supplant funding that is
otherwise available through the Department to provide mental health
support among family caregivers of veterans participating in the family
caregiver program.
``(m) Funding.--(1) Amounts for the activities of the Department
under this section shall be budgeted and appropriated through a
separate appropriation account.
``(2) In the budget justification materials submitted to Congress
in support of the budget of the Department for any fiscal year (as
submitted with the budget of the President under section 1105(a) of
title 31), the Secretary shall include a separate statement of the
amount requested to be appropriated for that fiscal year for the
account specified in paragraph (1).
``(n) Authorization of Appropriations.--There is authorized to be
appropriated to the Secretary for each of fiscal years 2023 through
2025 $50,000,000 to carry out this section.
``(o) Definitions.--In this section:
``(1) The terms `caregiver' and `family caregiver' have the
meanings given those terms in section 1720G(d) of this title.
``(2) The term `family caregiver program' means the program
of comprehensive assistance for family caregivers under section
1720G(a) of this title.
``(3) The term `Veterans Crisis Line' means the toll-free
hotline for veterans established under section 1720F(h) of this
title.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such subchapter is amended by adding at the end the following new item:
``1720K. Grants to provide mental health support to family caregivers
of veterans.''.
SEC. 5. COMPTROLLER GENERAL REPORT ON MENTAL HEALTH SUPPORT FOR
CAREGIVERS.
(a) Report Required.--Not later than one year after the date of the
enactment of this Act, the Comptroller General of the United States
shall submit to the Committee on Veterans' Affairs of the Senate and
the Committee on Veterans' Affairs of the House of Representatives a
report on the provision of mental health support to caregivers of
veterans.
(b) Contents.--The report submitted under subsection (a) shall
include the following:
(1) An assessment of the need for mental health support
among caregivers participating in the caregiver programs.
(2) An assessment of options for mental health support in
facilities of the Department of Veterans Affairs and in the
community for caregivers participating in the caregiver
programs.
(3) An assessment of the availability and accessibility of
mental health support in facilities of the Department and in
the community for caregivers participating in the caregiver
programs.
(4) An assessment of the awareness among caregivers of the
availability of mental health support in facilities of the
Department and in the community for caregivers participating in
the caregiver programs.
(5) An assessment of barriers to mental health support in
facilities of the Department and in the community for
caregivers participating in the caregiver programs.
(c) Definitions.--In this section:
(1) Caregiver.--The term ``caregiver'' has the meaning
given that term in section 1720G(d) of title 38, United States
Code.
(2) Caregiver programs.--The term ``caregiver programs''
means--
(A) the program of comprehensive assistance for
family caregivers under subsection (a) of section 1720G
of title 38, United States Code; and
(B) the program of support services for caregivers
under subsection (b) of such section.
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