Caregiver and Veterans Health Services Act of 2009 - Title I: Caregiver Support - (Sec. 101) Authorizes the Secretary of Veterans Affairs to waive charges for care provided by the Department of Veterans Affairs (VA) in emergency cases to attendants accompanying veterans severely injured while on active duty on or after September 11, 2001, while such veterans are receiving VA care for such injuries.
(Sec. 102) Directs the Secretary, as part of authorized VA home health services for veterans, to furnish family caregiver assistance to family members of veterans in need of personal care services due to a serious injury incurred or aggravated during active duty. Requires the Secretary to: (1) evaluate the services needed by each veteran; (2) provide training and approval to the caregivers; (3) designate a primary personal care attendant for each eligible veteran; (4) provide ongoing family caregiver assistance to such family members; (5) provide respite care for the veteran, in appropriate cases; (6) pay monthly caregiver stipends; (7) conduct oversight of the caregiver assistance program, including visits to each eligible veteran at least every six months; and (8) provide program outreach. Directs the Secretary to: (1) submit to the congressional veterans committees a plan for program implementation; and (2) report annually to such committees evaluating the program.
(Sec. 103) Directs the Secretary to reimburse attendants for travel expenses, including lodging and subsistence, in connection with authorized VA treatment for veterans.
(Sec. 104) Requires the Secretary to: (1) conduct a national survey of family caregivers of seriously disabled veterans and members of the Armed Forces to better understand the size and characteristics of their population and the types of care they provide; and (2) report survey results to Congress.
Title II: Rural Health Improvements - (Sec. 201) Revises the VA's health professional education debt reduction program to remove the $44,000-per-individual limit on loan repayments under the program. Directs the Secretary, in each offer of employment to a health professional, to provide notice of such individual's eligibility to participate in the program. Provides for the selection of program participants.
(Sec. 202) Directs the Secretary to establish and carry out a scholarship program of financial assistance for individuals who: (1) are accepted for, or currently enrolled in, a program of study leading to a degree or certificate in visual impairment or orientation and mobility, or both; and (2) enter into an agreement to serve, after program completion, as a full-time VA employee for three years within the first six years after program completion. Sets maximum assistance amounts of $15,000 per academic year and $45,000 total. Requires pro rata repayment for failure to satisfy education or service requirements, while allowing the Secretary to waive or suspend repayment when noncompliance is due to circumstances beyond the control of the participant, or when waiver or suspension is in the best interests of the United States.
(Sec. 203) Directs the Secretary to transfer specified amounts from Veterans Health Administration (VHA) accounts to the Secretary of Health and Human Services (HHS) in order to include VA facilities in the list of facilities eligible for assignment of participants in the National Health Service Corps Scholarship Program.
(Sec. 204) Requires the Secretary to carry out a program of: (1) teleconsultation for the provision of remote mental health and traumatic brain injury assessments in VA facilities not otherwise able to provide such assessments without contracting with third party providers or reimbursing providers through a fee-basis system; and (2) teleretinal imaging in each Veterans Integrated Services Network. Requires annual reports from the Secretary to Congress on each program.
Directs the Secretary to: (1) require each VA facility involved in the training of medical residents to work with each university concerned to develop an elective rotation in telemedicine for such residents; (2) modify the Veterans Equitable Resource Allocation (VERA) system to provide Veterans Integrated Services Networks with incentives to utilize teleconsultation, teleretinal imaging, telemedicine, and telehealth coordination services; and (3) modify the VERA system to require the inclusion of all telemedicine visits in the calculation of facility workload.
(Sec. 205) Authorizes the Secretary to carry out demonstration projects to examine the feasibility and advisability of alternatives for expanding care for veterans in rural areas. Requires the Secretary to report project results to the veterans and appropriations committees.
(Sec. 206) Requires the Secretary to establish a program to provide to veterans of Operations Iraqi Freedom and Enduring Freedom, particularly those who so served with the National Guard or reserves: (1) peer outreach services; (2) peer support services; (3) readjustment counseling and related services; and (4) mental health services. Requires the Secretary to establish a program to provide to immediate family members of such veterans, during the three-year period after the veteran's return from such deployment, education, support, counseling, and mental health services to assist in: (1) the veteran's readjustment to civilian life; (2) in the case of a veteran with an injury or illness incurred during such deployment, the recovery of the veteran; and (3) the readjustment of the family following the veteran's return. Directs the Secretary to contract with community mental health services and other qualified entities in areas not adequately served by other health care facilities or VA vet centers. Requires the appropriate training of veterans and clinicians for the provision of such services. Directs the Secretary to submit to the veterans committees an initial implementation report, as well as a subsequent status report.
(Sec. 207) Directs the Secretary to assign, at each of the 10 VA medical centers that serve the greatest number of Indian veterans per capita, a VA official or employee to act as the center's coordinator of health care for Indian veterans. Requires each such coordinator to: (1) improve outreach to tribal communities; (2) coordinate the medical needs of Indian veterans on Indian reservations with the VHA and the Indian Health Service (IHS); (3) expand the access and participation of the VA, IHS, and tribal members in the Department of Veterans Affairs Tribal Veterans Representative program; (4) act as an ombudsman for Indian veterans enrolled in the VHA health care system; and (5) advocate for the incorporation of traditional medicine and healing in VA treatment plans for Indian veterans. Directs the Secretaries of VA and HHS to enter into an agreement to ensure that health records of Indian veterans may be transferred electronically between facilities of the IHS and the VA. Authorizes the VA Secretary to transfer surplus medical and information technology equipment to the IHS. Requires a joint report from such Secretaries to Congress on the feasibility and advisability of the joint VA-IHS establishment and operation of health clinics on Indian reservations to serve the populations of such reservations, including Indian veterans.
(Sec. 208) Authorizes the Secretary to pay travel expenses for veterans receiving treatment at VA facilities at the rate of 41.5 cents per mile. (Under current law the rate is that provided to federal employees in connection with the performance of official duties.) Allows the Secretary, one year after the enactment of this Act, to adjust such rate to make it equal to the mileage reimbursement rate for the use of privately-owned vehicles by government employees on official business (requiring a justification to Congress if such adjustment causes a decrease from the previous rate). Includes within such reimbursement travel by air if it is the only practical way to reach a VA facility. Requires the Secretary, in considering whether travel by air is the only practical way, to consider the veteran's medical condition and any other impediments to their use of ground transportation.
(Sec. 209) Requires the VA's Director of the Office of Rural Health to develop a five-year strategic plan for such Office, which shall include specific goals for: (1) the recruitment and retention of health care personnel in rural areas; and (2) ensuring the timeliness and quality of health care delivery in rural communities.
(Sec. 210) Directs the Secretary to designate a rural outreach coordinator at each VA community-based outpatient clinic at which at least 50% of the enrolled veterans reside in a highly rural area. Requires the Secretary to adjust the compensation of VA health care providers, and provide certain incentives, to encourage such providers to achieve accreditation of their medical practice and to participate in peer review. Directs the Chief Quality and Performance Officer in each Veterans Integrated Services Network to take specified actions to effect the peer review of patient records by a VA facility.
(Sec. 211) Authorizes the VA to use volunteer counselors in the provision of readjustment counseling and related mental health services. Requires such volunteers to: (1) be licensed; (2) never have been named in a tort claim arising from counseling activities; and (3) be free from disciplinary action related to licensing or certification. Directs the Secretary to establish procedures for issuing credentials and privileges to volunteer counselors. Requires each VA vet center to develop an outreach plan for community awareness of the services offered by such center.
(Sec. 212) Directs the Secretary to establish and operate at least one and up to five centers of excellence for rural health research, education, and clinical activities, requiring geographic distribution in center selection. Authorizes appropriations.
(Sec. 213) Requires the Secretary to carry out a three-year pilot program on financial incentives for VA physicians who assume and maintain patient responsibilities at community hospitals in health professional shortage areas. Directs the Secretary to compensate participating physicians for such responsibilities carried out for which the physician would not otherwise be compensated by the VA. Requires a written agreement between the VA and the physician with respect to compensation amounts. Directs the Secretary to report annually to Congress on the pilot program during its duration.
(Sec. 214) Requires an annual report from the Secretary to Congress on certain matters related to care for veterans who reside in rural areas, as well as on the establishment and functions of the VA's Office of Rural Health.
(Sec. 215) Directs the Secretary to make grants to state veterans service agencies and veterans service organizations to provide innovative transportation options to veterans in highly rural areas. Limits each grant amount to $50,000. Authorizes appropriations.
Title III: Other Health Care Matters - (Sec. 301) Revises provisions concerning the authority of the Secretary to reimburse a veteran for the cost of emergency care provided in a non-VA facility to provide that, if the veteran has contractual or legal recourse against a third party that would, in part, extinguish the veteran's liability to the provider of the emergency treatment and payment for the treatment may be made by both the VA and the third party, the amount payable by the VA shall be that which exceeds the cost payable by the third party. Includes as third parties: (1) the HHS Secretary, with respect to the Medicare program under title XVIII of the Social Security Act; and (2) a state Medicaid agency with respect to payments made under a state plan for medical assistance approved under title XIX (Medicaid) of such Act. Authorizes the Secretary to provide reimbursement for such emergency care provided before the date of enactment of this Act if the Secretary determines it appropriate to do so.
(Sec. 302) Prohibits the Secretary from requiring a veteran who is catastrophically disabled from making any copayment for the receipt of VA hospital care or medical services.
Title IV: Construction and Naming Matters - (Sec. 401) Authorizes the Secretary to carry out a major medical facility construction project at the Department of Veterans Affairs Medical Center, Walla Walla, Washington, and authorizes appropriations for the project.
(Sec. 402) Designates the VA outpatient clinic in Havre, Montana, as the "Merril Lundman Department of Veterans Affairs Outpatient Clinic."
[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 801 Introduced in Senate (IS)]
111th CONGRESS
1st Session
S. 801
To amend title 38, United States Code, to waive charges for
humanitarian care provided by the Department of Veterans Affairs to
family members accompanying veterans severely injured after September
11, 2001, as they receive medical care from the Department and to
provide assistance to family caregivers, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
April 2, 2009
Mr. Akaka (for himself, Mr. Burr, Mr. Tester, Mr. Burris, and Mr.
Rockefeller) 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 waive charges for
humanitarian care provided by the Department of Veterans Affairs to
family members accompanying veterans severely injured after September
11, 2001, as they receive medical care from the Department and to
provide assistance to family caregivers, 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 ``Family Caregiver Program Act of
2009''.
SEC. 2. WAIVER OF CHARGES FOR HUMANITARIAN CARE PROVIDED TO FAMILY
MEMBERS ACCOMPANYING CERTAIN SEVERELY INJURED VETERANS AS
THEY RECEIVE MEDICAL CARE.
The text of section 1784 of title 38, United States Code, is
amended to read as follows:
``(a) In General.--The Secretary may furnish hospital care or
medical services as a humanitarian service in emergency cases.
``(b) Reimbursement.--Except as provided in subsection (c), the
Secretary shall charge for care and services provided under subsection
(a) at rates prescribed by the Secretary.
``(c) Waiver of Charges.--(1) Except as provided in paragraph (2),
the Secretary shall waive the charges required by subsection (b) for
care or services provided under subsection (a) to an attendant of a
covered veteran if such care or services are provided to such attendant
for an emergency that occurs while such attendant is accompanying such
veteran while such veteran is receiving approved inpatient or
outpatient treatment at--
``(A) a Department facility; or
``(B) a non-Department facility--
``(i) that is under contract with the Department;
or
``(ii) at which the veteran is receiving fee-basis
care.
``(2) If an attendant is entitled to care or services under a
health-plan contract (as that term is defined in section 1725(f) of
this title) or other contractual or legal recourse against a third
party that would, in part, extinguish liability by charges described by
subsection (b), the amount of such charges waived under paragraph (1)
shall be the amount by which such charges exceed the amount of such
charges covered by the health-plan contract or other contractual or
legal recourse against the third party.
``(d) Definitions.--In this section:
``(1) The term `attendant' includes, with respect to a
veteran, the following:
``(A) A family member of the veteran.
``(B) An individual eligible to receive ongoing
family caregiver assistance under section 1717A(e)(1)
of this title for the provision of personal care
services to the veteran.
``(C) Any other individual whom the Secretary
determines--
``(i) has a relationship with the veteran
sufficient to demonstrate a close affinity with
the veteran; and
``(ii) provides a significant portion of
the veteran's care.
``(2) The term `covered veteran' means any veteran with a
severe injury incurred or aggravated in the line of duty in the
active military, naval, or air service on or after September
11, 2001.
``(3) The term `family member' with respect to a veteran,
includes the following:
``(A) The spouse of the veteran.
``(B) The child of the veteran.
``(C) A parent of the veteran.
``(D) A sibling of the veteran.
``(E) A cousin of the veteran.
``(F) An aunt of the veteran.
``(G) An uncle of the veteran.
``(H) A grandparent of the veteran.
``(I) A grandchild of the veteran.
``(J) A stepparent of the veteran.
``(K) A stepchild of the veteran.
``(L) A stepsibling of the veteran.
``(M) A parent-in-law of the veteran.
``(N) A sister-in-law of the veteran.
``(O) A brother-in-law of the veteran.
``(P) A cousin of the spouse of the veteran.
``(Q) An aunt of the spouse of the veteran.
``(R) An uncle of the spouse of the veteran.
``(S) A grandparent of the spouse of the veteran.
``(T) A grandchild of the spouse of the veteran.
``(U) A stepparent of the spouse of the veteran.
``(V) A stepsibling of the spouse of the veteran.
``(W) Such other individuals as the Secretary shall
specify in regulations for purposes of this section.
``(4) The term `severe injury' means, in the case of a
covered veteran, any injury as follows:
``(A) A physiological condition of the veteran if
the condition is a permanent or temporary severely
disabling disorder that compromises the ability of the
veteran to carry out one or more independent activities
of daily living.
``(B) A psychological condition of the veteran if
the condition is rated at 30 or less on the Global
Assessment of Functioning (GAF) scale, as set forth in
the Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition Text Revision (DSM-IV-TR), or
the most recent edition if different than the Fourth
Edition Text Revision, of the American Psychiatric
Association.
``(C) An injury for which the veteran needs
supervision or protection based on symptoms or
residuals of neurological or other impairment.
``(D) Any other injury of the veteran that is
determined to be a severe injury in accordance with
regulations prescribed by the Secretary for purposes of
this section.''.
SEC. 3. FAMILY CAREGIVER ASSISTANCE.
(a) Requirement.--
(1) In general.--Subchapter II of chapter 17 of title 38,
United States Code, is amended by inserting after section 1717
the following new section:
``Sec. 1717A. Family caregiver assistance
``(a) In General.--(1) As part of home health services provided
under section 1717 of this title, the Secretary shall, upon the joint
application of an eligible veteran and a family member of such veteran
(or other individual designated by such veteran), furnish to such
family member (or designee) family caregiver assistance in accordance
with this section. The purpose of providing family caregiver assistance
under this section is--
``(A) to reduce the number of veterans who are receiving
institutional care, or who are in need of institutional care,
whose personal care service needs could be substantially
satisfied with the provision of such services by a family
member (or designee); and
``(B) to provide eligible veterans with additional options
so that they can choose the setting for the receipt of personal
care services that best suits their needs.
``(2) The Secretary shall only furnish family caregiver assistance
under this section to a family member of an eligible veteran (or other
individual designated by such veteran) if the Secretary determines it
is in the best interest of the eligible veteran to do so.
``(b) Eligible Veterans.--(1) For purposes of this section, an
eligible veteran is a veteran (or member of the Armed Forces undergoing
medical discharge from the Armed Forces)--
``(A) who has a serious injury (including traumatic brain
injury, psychological trauma, or other mental disorder)
incurred or aggravated in line of duty in the active military,
naval, or air service on or after the date described in
paragraph (2); and
``(B) whom the Secretary determines, in consultation with
the Secretary of Defense as necessary, is in need of personal
care services because of--
``(i) an inability to perform one or more
independent activities of daily living;
``(ii) a need for supervision or protection based
on symptoms or residuals of neurological or other
impairment or injury; or
``(iii) such other matters as the Secretary shall
establish in consultation with the Secretary of Defense
as appropriate.
``(2) The date described in this paragraph--
``(A) during the period beginning on the date of the
enactment of the Family Caregiver Program Act of 2009 and
ending two years after the date of the enactment of that Act,
is September 11, 2001; and
``(B) beginning on the first day after the date that is two
years after the date of the enactment of the Family Caregiver
Program Act of 2009, is the earliest date the Secretary
determines is appropriate to include the largest number of
veterans possible under this section without reducing the
quality of care provided to such veterans.
``(c) Evaluation of Eligible Veterans and Family Caregivers.--(1)
The Secretary shall evaluate each eligible veteran who makes a joint
application under subsection (a)(1)--
``(A) to identify the personal care services required by
such veteran; and
``(B) to determine whether such requirements could be
significantly or substantially satisfied with the provision of
personal care services from a family member (or other
individual designated by the veteran).
``(2) The Secretary shall evaluate each family member of an
eligible veteran (or other individual designated by the veteran) who
makes a joint application under subsection (a)(1) to determine--
``(A) the basic amount of instruction, preparation, and
training such family member (or designee) requires, if any, to
provide the personal care services required by such veteran;
and
``(B) the amount of additional instruction, preparation,
and training such family member (or designee) requires, if any,
to be the primary personal care attendant designated for such
veteran under subsection (e).
``(3) An evaluation carried out under paragraph (1) may be carried
out--
``(A) at a Department facility;
``(B) at a non-Department facility determined appropriate
by the Secretary for purposes of such evaluation; and
``(C) such other locations as the Secretary considers
appropriate.
``(d) Training and Certification.--(1) Except as provided in
subsection (a)(2), the Secretary shall provide each family member of an
eligible veteran (or other individual designated by the veteran) who
makes a joint application under subsection (a)(1) the basic
instruction, preparation, and training determined to be required by
such family member (or designee) under subsection (c)(2)(A).
``(2) The Secretary may provide to a family member of an eligible
veteran (or other individual designated by the veteran) the additional
instruction, preparation, and training determined to be required by
such family member (or designee) under subsection (c)(2)(B) if such
family member (or designee)--
``(A) is certified as a personal care attendant for the
veteran under paragraph (3); and
``(B) requests, with concurrence of the veteran, such
additional instruction, preparation, and training.
``(3) Upon the successful completion by a family member of an
eligible veteran (or other individual designated by the veteran) of
basic instruction, preparation, and training provided under paragraph
(1), the Secretary shall certify the family member as a personal care
attendant for the veteran.
``(4) If the Secretary determines that a primary personal care
attendant designated under subsection (e) requires additional training
to maintain such designation, the Secretary shall make such training
available to the primary personal care attendant.
``(5) The Secretary shall, subject to regulations the Secretary
shall prescribe, provide for necessary travel, lodging, and per diem
expenses incurred by a family member of an eligible veteran (or other
individual designated by the veteran) in undergoing training under this
subsection.
``(6) If the participation of a family member of an eligible
veteran (or other individual designated by the veteran) in training
under this subsection would interfere with the provision of personal
care services to the veteran, the Secretary shall, subject to
regulations as the Secretary shall prescribe and in consultation with
the eligible veteran, provide respite care to the eligible veteran
during the provision of such training to the family member so that such
family caregiver (or designee) can participate in such training without
interfering with the provision of such services.
``(e) Designation of Primary Personal Care Attendant.--(1) For each
eligible veteran with at least one family member (or other individual
designated by the veteran) who is described by subparagraphs (A)
through (E) of paragraph (2), the Secretary shall designate one family
member of such veteran (or other individual designated by the veteran)
as the primary personal care attendant for such veteran to be the
primary provider of personal care services for such veteran.
``(2) A primary personal care attendant designated for an eligible
veteran under paragraph (1) shall be selected from among family members
of such veteran (or other individuals designated by such veteran) who--
``(A) are certified under subsection (d)(3) as a personal
care attendant for such veteran;
``(B) complete all additional instruction, preparation, and
training, if any, provided under subsection (d)(2);
``(C) elect to provide the personal care services to such
veteran that the Secretary determines such veteran requires
under subsection (c)(1);
``(D) has the consent of such veteran to be the primary
provider of such services for such veteran; and
``(E) the Secretary considers competent to be the primary
provider of such services for such veteran.
``(3) An eligible veteran receiving personal care services from a
family member (or other individual designated by the veteran)
designated as the primary personal care attendant for the veteran under
paragraph (1) may revoke consent with respect to such family member (or
designee) under paragraph (2)(D) at any time.
``(4) If an individual designated as the primary personal care
attendant of an eligible veteran under paragraph (1) subsequently fails
to meet the requirements set forth in paragraph (2), the Secretary--
``(A) shall immediately revoke the individual's designation
under paragraph (1); and
``(B) may designate, in consultation with the eligible
veteran or the eligible veteran's surrogate appointed under
subsection (g), a new primary personal care attendant for the
veteran under such paragraph.
``(5) The Secretary shall take such actions as may be necessary to
ensure that the revocation of a designation under paragraph (1) does
not interfere with the provision of personal care services required by
a veteran.
``(f) Ongoing Family Caregiver Assistance.--(1) Except as provided
in subsection (a)(2) and subject to the provisions of this subsection,
the Secretary shall provide ongoing family caregiver assistance to
family members of eligible veterans (or other individuals designated by
such veterans) as follows:
``(A) To each family member of an eligible veteran (or
designee) who is certified under subsection (d)(3) as a
personal care attendant for the veteran the following:
``(i) Direct technical support consisting of
information and assistance to timely address routine,
emergency, and specialized caregiving needs.
``(ii) Counseling.
``(iii) Access to an interactive Internet website
on caregiver services that addresses all aspects of the
provision of personal care services under this section.
``(B) To each family member of an eligible veteran (or
designee) who is designated as the primary personal care
attendant for the veteran under subsection (e) the following:
``(i) The ongoing family caregiver assistance
described in subparagraph (A).
``(ii) Mental health services.
``(iii) Respite care of not less than 30 days
annually, including 24-hour per day care of the veteran
commensurate with the care provided by the family
caregiver to permit extended respite.
``(iv) Medical care under section 1781 of this
title.
``(v) A monthly personal caregiver stipend.
``(2)(A) The Secretary shall provide respite care under paragraph
(1)(B)(iii), at the election of the Secretary--
``(i) through facilities of the Department that are
appropriate for the veteran; or
``(ii) through contracts under section 1720B(c) of this
title.
``(B) If the primary personal care attendant of an eligible veteran
designated under subsection (e)(1) determines in consultation with the
veteran or the veteran's surrogate appointed under subsection (g), and
the Secretary concurs, that the needs of the veteran cannot be
accommodated through the facilities and contracts described in
subparagraph (A), the Secretary shall, in consultation with the primary
personal care attendant and the veteran (or the veteran's surrogate),
provide respite care through other facilities or arrangements that are
medically and age appropriate.
``(3)(A) The Secretary shall provide monthly personal caregiver
stipends under paragraph (1)(B)(v) in accordance with a schedule
established by the Secretary that specifies stipends provided based
upon the amount and degree of personal care services provided.
``(B) The Secretary shall ensure, to the extent practicable, that
the schedule required by subparagraph (A) specifies that the amount of
the personal caregiver stipend provided to a primary personal care
attendant designated under subsection (e)(1) for the provision of
personal care services to an eligible veteran is not less than the
amount the Secretary would pay a commercial home health care entity in
the geographic area of the veteran to provide equivalent personal care
services to the veteran.
``(C) If personal care services are not available from a commercial
provider in the geographic area of an eligible veteran, the Secretary
may establish the schedule required by subparagraph (A) with respect to
the veteran by considering the costs of commercial providers of
personal care services in geographic areas other than the geographic
area of the veteran with similar costs of living.
``(4) Provision of ongoing family caregiver assistance under this
subsection for provision of personal care services to an eligible
veteran shall terminate if the eligible veteran no longer requires the
personal care services.
``(g) Surrogates.--If an eligible veteran lacks the capacity to
submit an application, provide consent, make a request, or concur with
a request under this section, the Secretary may, in accordance with
regulations and policies of the Department regarding the appointment of
guardians or the use of powers of attorney, appoint a surrogate for the
veteran who may submit applications, provide consent, make requests, or
concur with requests on behalf of the veteran under this section.
``(h) Oversight.--(1) The Secretary shall enter into contracts with
appropriate entities to provide oversight of the provision of personal
care services by primary personal care attendants designated under
subsection (e)(1) under this section.
``(2) The Secretary shall ensure that each eligible veteran
receiving personal care services under this section from a primary
personal care attendant designated under subsection (e)(1) is visited
in the veteran's home by an entity providing oversight under paragraph
(1) at such frequency as the Secretary shall determine under paragraph
(3) to determine if the care received by the veteran under this section
meets the needs of the veteran.
``(3)(A) Except as provided in subparagraph (B), the Secretary
shall determine the manner of oversight provided under paragraph (1)
and the frequency of visits under paragraph (2) for an eligible veteran
as the Secretary considers commensurate with the needs of such eligible
veteran.
``(B) The frequency of visits under paragraph (2) for an eligible
veteran shall be not less frequent than once every six months.
``(4)(A) An entity visiting an eligible veteran under paragraph (2)
shall submit to the Secretary the findings of the entity with respect
to each visit, including whether the eligible veteran is receiving the
care the eligible veteran requires.
``(B) If an entity finds under subparagraph (A) that an eligible
veteran is not receiving the care the eligible veteran requires, the
entity shall submit to the Secretary a recommendation on the corrective
actions that should be taken to ensure that the eligible veteran
receives the care the eligible veteran requires, including, if the
entity considers appropriate, a recommendation for revocation of a
caregiver's certification under subsection (d)(3) or revocation of the
designation of an individual under subsection (e)(1).
``(5) After receiving findings and recommendations, if any, under
paragraph (4) with respect to an eligible veteran, the Secretary may
take such actions as the Secretary considers appropriate to ensure that
the eligible veteran receives the care the eligible veteran requires,
including the following:
``(A) Revocation of a caregiver's certification under
subsection (d)(3).
``(B) Revocation of the designation of an individual under
subsection (e)(1).
``(6) If the Secretary terminates the provision of ongoing family
caregiver assistance under subsection (f) to a family member of an
eligible veteran (or other individual designated by the veteran)
because of findings of an entity submitted to the Secretary under
paragraph (4) of this subsection, the Secretary may not provide
compensation to such entity for the provision of personal care services
to such veteran, unless the Secretary determines it would be in the
best interest of the eligible veteran to provide compensation to such
entity to provide such services.
``(i) Outreach.--The Secretary shall carry out a program of
outreach to inform eligible veterans and their family members of the
availability and nature of family caregiver assistance.
``(j) Construction.--A decision by the Secretary under this section
affecting the furnishing of family caregiver assistance shall be
considered a medical determination.
``(k) Definitions.--In this section:
``(1) The term `family caregiver assistance' includes the
instruction, preparation, training, and certification provided
under subsection (d) and the ongoing family caregiver
assistance provided under subsection (f).
``(2) The term `family member' includes, with respect to a
veteran, the following:
``(A) The spouse of the veteran.
``(B) The child of the veteran.
``(C) A parent of the veteran.
``(D) A sibling of the veteran.
``(E) A cousin of the veteran.
``(F) An aunt of the veteran.
``(G) An uncle of the veteran.
``(H) A grandparent of the veteran.
``(I) A grandchild of the veteran.
``(J) A stepparent of the veteran.
``(K) A stepchild of the veteran.
``(L) A stepsibling of the veteran.
``(M) A parent-in-law of the veteran.
``(N) A sister-in-law of the veteran.
``(O) A brother-in-law of the veteran.
``(P) A cousin of the spouse of the veteran.
``(Q) An aunt of the spouse of the veteran.
``(R) An uncle of the spouse of the veteran.
``(S) A grandparent of the spouse of the veteran.
``(T) A grandchild of the spouse of the veteran.
``(U) A stepparent of the spouse of the veteran.
``(V) A stepsibling of the spouse of the veteran.
``(W) Such other individuals as the Secretary shall
specify in regulations for purposes of this section.
``(3) The term `personal care services' includes the
following:
``(A) Supervision.
``(B) Protection.
``(C) Services to assist a veteran with one or more
independent activities of daily living.
``(D) Such other services as the Secretary
considers appropriate.''.
(2) Clerical amendment.--The table of sections at the
beginning of chapter 17 of such title is amended by inserting
after the item related to section 1717 the following new item:
``1717A. Family caregiver assistance.''.
(3) Authorization for provision of health care to personal
care attendants.--Section 1781(a) of such title is amended--
(A) by redesignating paragraphs (2) and (3) as
paragraphs (3) and (4), respectively; and
(B) by inserting after paragraph (1) the following
new paragraph (2):
``(2) a family member of a veteran (or other individual
designated by the veteran) designated as the primary personal
care attendant for such veteran under section 1717A(e) of this
title,''.
(4) Construction.--The furnishing of family caregiver
assistance under section 1717A of title 38, United States Code,
as added by paragraph (1), shall be construed to supplement and
not supplant the programs of the Department of Veterans Affairs
in existence on the date of the enactment of this Act.
(5) Effective date.--The amendments made by this subsection
shall take effect on the date that is 270 days after the date
of the enactment of this Act.
(b) Implementation Plan and Report.--
(1) In general.--Not later than 180 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall--
(A) develop a plan for the implementation of
section 1717A of title 38, United States Code, as added
by subsection (a)(1); and
(B) submit to the Committee on Veterans' Affairs of
the Senate and the Committee on Veterans' Affairs of
the House of Representatives a report on such plan.
(2) Consultation.--In developing the plan required by
paragraph (1)(A), the Secretary shall consult with the
following:
(A) Veterans described in section 1717A(b) of title
38, United States Code, as added by subsection (a)(1).
(B) Family members of veterans who provide personal
care services to such veterans.
(C) Veterans service organizations, as recognized
by the Secretary of Veterans Affairs for the
representation of veterans under section 5902 of title
38, United States Code.
(D) Relevant national organizations that specialize
in the provision of assistance to individuals with the
types of disabilities that personal care attendants
will encounter while providing personal care services
under section 1717A of title 38, United States Code, as
so added.
(E) Such other organizations with an interest in
the provision of care to veterans as the Secretary
considers appropriate.
(F) The Secretary of Defense with respect to
matters concerning personal care services for eligible
veterans who are members of the Armed Forces undergoing
medical discharge from the Armed Forces.
(3) Report contents.--The report required by paragraph
(1)(B) shall contain the following:
(A) The plan required by paragraph (1)(A).
(B) A description of the veterans, caregivers, and
organizations consulted by the Secretary under
paragraph (2).
(C) A description of such consultations.
(D) The recommendations of such veterans,
caregivers, and organizations, if any, that were not
incorporated into the plan required by paragraph
(1)(A).
(E) The reasons the Secretary did not incorporate
such recommendations into such plan.
(c) Annual Evaluation Report.--
(1) In general.--Not later than two years after the date
described in subsection (a)(4) and annually thereafter, the
Secretary shall submit to the Committee on Veterans' Affairs of
the Senate and the Committee on Veterans' Affairs of the House
of Representatives a comprehensive report on the implementation
of section 1717A of title 38, United States Code, as added by
subsection (a)(1).
(2) Contents.--The report required by paragraph (1) shall
include the following:
(A) The number of family members of veterans (or
other individuals designated by veterans) that received
family caregiver assistance under such section 1717A.
(B) A description of the outreach activities
carried out by the Secretary in accordance with
subsection (i) of such section 1717A.
(C) The resources expended by the Secretary under
such section 1717A.
(D) An assessment of the manner in which resources
are expended by the Secretary under such section 1717A,
particularly with respect to the provision of monthly
personal caregiver stipends under subsection (f) of
such section.
(E) A description of the outcomes achieved by, and
any measurable benefits of, carrying out the
requirements of such section 1717A.
(F) A justification of any determination made under
subsection (b)(2) of such section 1717A.
(G) An assessment of the effectiveness and the
efficiency of the implementation of such section 1717A.
(H) An assessment of how the provision of family
caregiver assistance fits into the continuum of home
health care services and benefits provided to veterans
in need of such services and benefits.
(I) Such recommendations, including recommendations
for legislative or administrative action, as the
Secretary considers appropriate in light of carrying
out the requirements of such section 1717A.
SEC. 4. LODGING AND SUBSISTENCE FOR ATTENDANTS.
Section 111(e) of title 38, United States Code, is amended--
(1) by striking ``When any'' and inserting ``(1) When
any'';
(2) in paragraph (1), as designated by paragraph (1) of
this subsection--
(A) by inserting ``(including lodging and
subsistence)'' after ``expenses of travel''; and
(B) by inserting before the period at the end the
following: ``for the period consisting of travel to and
from a treatment facility and the duration of the
treatment episode''; and
(3) by adding at the end the following:
``(2) The Secretary may prescribe regulations to carry out this
subsection. Such regulations may include provisions--
``(A) to limit the number of individuals that may receive
expenses of travel under paragraph (1) for a single treatment
episode of a person; and
``(B) to require attendants to use certain travel services.
``(3) In this subsection:
``(A) The term `attendant' includes, with respect to a
person described in paragraph (1), the following:
``(i) A family member of the person.
``(ii) An individual certified as a personal care
attendant under section 1717A(d)(3) of this title.
``(iii) Any other individual whom the Secretary
determines--
``(I) has a preexisting relationship with
the person; and
``(II) provides a significant portion of
the person's care.
``(B) The term `family member' includes, with respect to a
person described in paragraph (1), the following:
``(i) The spouse of the person.
``(ii) The child of the person.
``(iii) A parent of the person.
``(iv) A sibling of the person.
``(v) A cousin of the person.
``(vi) An aunt of the person.
``(vii) An uncle of the person.
``(viii) A grandparent of the person.
``(ix) A grandchild of the person.
``(x) A stepparent of the person.
``(xi) A stepchild of the person.
``(xii) A stepsibling of the person.
``(xiii) A parent-in-law of the person.
``(xiv) A sister-in-law of the person.
``(xv) A brother-in-law of the person.
``(xvi) A cousin of the spouse of the person.
``(xvii) An aunt of the spouse of the person.
``(xviii) An uncle of the spouse of the person.
``(xix) A grandparent of the spouse of the person.
``(xx) A grandchild of the spouse of the person.
``(xxi) A stepparent of the spouse of the person.
``(xxii) A stepsibling of the spouse of the person.
``(xxiii) Such other individuals as the Secretary
shall specify in regulations for purposes of this
subsection.''.
<all>
Introduced in Senate
Sponsor introductory remarks on measure. (CR S4349-4350)
Read twice and referred to the Committee on Veterans' Affairs. (text of measure as introduced: CR S4350-4353)
Committee on Veterans' Affairs. Hearings held. Hearings printed: S.Hrg. 111-76.
Committee on Veterans' Affairs. Ordered to be reported without amendment favorably.
Committee on Veterans' Affairs. Reported by Senator Akaka with an amendment in the nature of a substitute and an amendment to the title. With written report No. 111-80.
Committee on Veterans' Affairs. Reported by Senator Akaka with an amendment in the nature of a substitute and an amendment to the title. With written report No. 111-80.
Placed on Senate Legislative Calendar under General Orders. Calendar No. 167.
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