II 110th CONGRESS 1st Session S. 1065 IN THE SENATE OF THE UNITED STATES March 29, 2007 Mrs. Clinton (for herself and Ms. Collins) introduced the following bill; which was read twice and referred to the Committee on Armed Services A BILL To improve the diagnosis and treatment of traumatic brain injury in members and former members of the Armed Forces, to review and expand telehealth and telemental health programs of the Department of Defense and the Department of Veterans Affairs, and for other purposes.
1.
Short title
This Act may be cited as the Heroes at Home Act of 2007.
2.
Protocol for assessment and documentation of cognitive functioning of each deployed members of the Armed Forces
(a)
Protocol required
The Secretary of Defense shall establish a protocol for the assessment and documentation of the cognitive (including memory) functioning of each member of the Armed Forces before each such member is deployed in Operation Enduring Freedom or Operation Iraqi Freedom, to facilitate the assessment of the cognitive (including memory) functioning of each such member upon returning from such deployment. (b)
Diagnosis of traumatic brain injury and post traumatic stress disorder
(1)
In general
The Secretary shall ensure that the protocol required by subsection (a) provides appropriate mechanisms to permit the differential diagnosis of traumatic brain injury (TBI) and post traumatic stress disorder (PTSD) in members of the Armed Forces who return from deployment in Operation Enduring Freedom or Operation Iraqi Freedom. (2)
Additional purposes
Except as provided in subsection (d), the Secretary may use the protocol for such other purposes as the Secretary considers appropriate. (c)
Neurocognitive assessments
(1)
In general
The protocol required by subsection (a) shall include the administration of computer-based neurocognitive assessments to members of the Armed Forces. (2)
Frequency
The assessments required by paragraph (1) shall be administered at least once to each member of the Armed Forces— (A)before deploying to Operation Enduring Freedom or Operation Iraqi Freedom; and (B)upon returning from such deployment. (3)
Development of assessment
In developing the computer-based assessment required by paragraph (1), the Secretary may use or adopt a current commercial product or develop a new computer-based assessment. (4)
Format of assessment
The format of the assessments required by paragraph (1) shall be the same for each administration described in paragraph (2). (d)
Prohibition on use of protocol To determine deployment readiness
The Secretary may not use the result of any assessment that is part of the protocol required by subsection (a) to determine the deployment readiness of any member of the Armed Forces. (e)
Availability of medical data
The Secretary shall make available such medical data on the cognitive (including memory) functioning of members of the Armed Forces who are deployed in Operation Enduring Freedom or Operation Iraqi Freedom that is obtained from the protocol required by subsection (a) as the Secretary considers appropriate to— (1)combat medics and other Department of Defense personnel who provide medical services to such members; and (2)such entities as the Secretary considers appropriate. (f)
Report
Not later than one year after the date of the enactment of this Act, the Secretary shall submit to Congress a report on the implementation of this section. (g)
Authorization of appropriations
There is authorized to be appropriated to the Department of Defense to carry out this section amounts as follows: (1)For fiscal year 2008, $3,750,000. (2)For fiscal years 2009 through 2012, such sums as may be necessary.
3.
Training and certification program for family caregiver personal care attendants for veterans and members of the Armed Forces with traumatic brain injury
(a)
Program on training and certification of family caregiver personal care attendants
The Secretary of Veterans Affairs shall establish a program on training and certification of family caregivers of veterans and members of the Armed Forces with traumatic brain injury as personal care attendants of such veterans and members. (b)
Location
The program required by subsection (a) shall be located in each of the polytrauma centers of the Department of Veterans Affairs designated as a Tier I polytrauma center. (c)
Training curricula
(1)
In general
The Secretary of Veterans Affairs shall, in collaboration with the Secretary of Defense, develop curricula for the training of personal care attendants described in subsection (a). Such curricula shall incorporate applicable standards and protocols utilized by certification programs of national brain injury care specialist organizations. (2)
Use of existing curricula
In developing the curricula required by paragraph (1), the Secretary of Veterans Affairs shall, to the extent practicable, utilize and expand upon training curricula developed pursuant to section 744(b) of the John Warner National Defense Authorization Act for Fiscal Year 2007 (Public Law 109–364; 120 Stat. 2308). (d)
Program participation
(1)
In general
The Secretary of Veterans Affairs shall determine the eligibility of a family member of a veteran or member of the Armed Forces for participation in the program required by subsection (a). (2)
Basis for determination
A determination made under paragraph (1) shall be based on the clinical needs of the veteran or member of the Armed Forces concerned, as determined by the physician of such veteran or member. (e)
Eligibility for compensation
A family caregiver of a veteran or member of the Armed Forces who receives certification as a personal care attendant under this section shall be eligible for compensation from the Department of Veterans Affairs for care provided to such veteran or member. (f)
Costs of training
(1)
Training of families of veterans
Any costs of training provided under the program under this section for family members of veterans shall be borne by the Secretary of Veterans Affairs. (2)
Training of families of members of the Armed Forces
The Secretary of Defense shall reimburse the Secretary of Veterans Affairs for any costs of training provided under the program under this section for family members of members of the Armed Forces. Amounts for such reimbursement shall be derived from amounts available for Defense Health Program for the TRICARE program. (g)
Construction
Nothing in this section shall be construed to require or permit the Secretary of Veterans Affairs to deny reimbursement for health care services provided to a veteran with a brain injury to a personal care attendant who is not a family member of such veteran.
4.
Telehealth and telemental health services of the Department of Defense and the Department of Veterans Affairs
(a)
Telehealth and telemental health demonstration project
(1)
In general
The Secretary of Defense and the Secretary of Veterans Affairs shall jointly establish a demonstration project to assess the feasibility and advisability of using telehealth technology to assess cognitive (including memory) functioning of members and former members of the Armed Forces who have sustained head trauma, in order to improve the diagnosis and treatment of traumatic brain injury. (2)
Location
(A)
In general
The Secretary of Defense and the Secretary of Veterans Affairs shall carry out the demonstration project required by paragraph (1) at one or more locations selected by the Secretaries for purposes of the demonstration project. (B)
Priority for rural areas
In selecting locations to carry out the demonstration project required by paragraph (1), the Secretary of Defense and the Secretary of Veterans Affairs shall give priority to locations that would provide service in a rural area. (3)
Requirements
The demonstration project required by paragraph (1) shall include the following: (A)The use of telehealth technology to assess the cognitive (including memory) functioning of a member or former member of the Armed Forces, including the following: (i)Obtaining information regarding the nature of any brain injury incurred by such member or former member. (ii)Assessing any symptoms of traumatic brain injury in such member or former member. (B)The use of telehealth technology to rehabilitate members or former members of the Armed Forces who have traumatic brain injury, and the use, to the extent practicable, of applicable standards and protocols used by certification programs of national brain injury care specialist organizations in order to assess progress in such rehabilitation. (C)The use of telehealth technology to disseminate education material to members and former members of the Armed Forces and the family members of such members on techniques, strategies, and skills for caring for and assisting such members, and to the extend practicable, such education materials shall incorporate training curricula developed pursuant to section 744(b) of the John Warner National Defense Authorization Act for Fiscal Year 2007 (Public Law 109–364; 120 Stat. 2308). (4)
Use of proven technologies
Any assessment administered as a part of the demonstration project required by paragraph (1) shall incorporate telemental health technology that has proven effective in the diagnosis and treatment of mental health conditions associated with traumatic brain injury. (5)
Administration
(A)
In general
The demonstration project required by paragraph (1) shall be administered under the joint incentives program and carried out pursuant to section 8111(d) of title 38, United States Code. (B)
Funding
Amounts to carry out the demonstration project shall be derived from amounts in the DOD–VA Health Care Sharing Incentive Fund established under paragraph (2) of such section. (6)
Report
(A)
In general
The Secretary of Defense and the Secretary of Veterans Affairs shall jointly submit to Congress a report on the demonstration project required by paragraph (1). (B)
Submission with annual joint report
The report required by subparagraph (A) shall be submitted to Congress at the same time as the annual joint report required by section 8111(f) of title 38, United States Code, for the fiscal year following the fiscal year of the date of the enactment of this Act. (b)
Ongoing study on telehealth and telemental health services
(1)
In general
The Secretary of Defense and the Secretary of Veterans Affairs shall, through the Joint Executive Council (JEC) of the Department of Defense and the Department of Veterans Affairs, conduct an ongoing study of all matters relating to the telehealth and telemental health services of the Department of Defense and the Department of Veterans Affairs. (2)
Matters studied
The matters studied under paragraph (1) shall include the following: (A)The number of members and former members of the Armed Forces who have used telehealth or telemental health services of the Department of Defense or the Department of Veterans Affairs. (B)The extent to which members of the National Guard and the Reserves are utilizing telehealth or telemental health services of the Department of Defense or the Department of Veterans Affairs. (C)The ways in which the Department of Defense and the Department of Veterans Affairs can improve the integration of telehealth and telemental health services with clinical medicine. (D)The extent to which telehealth and telemental health services of the Department of Defense and the Department of Veterans Affairs are provided in rural settings and through community-based outpatient clinics (CBOCs). (E)Best practices of civilian mental health providers and facilities with respect to the provision of telehealth and telemental health services, including how such practices can be adopted to improve telehealth and telemental health services of the Department of Defense and the Department of Veterans Affairs. (F)The feasability and advisability of partnering with civilian mental health facilities to provide telehealth and telemental health services to members and former members of the Armed Forces. (3)
Annual reports
Not later than one year after the date of the enactment of this Act, and annually thereafter, the Secretary of Defense and the Secretary of Veterans Affairs shall jointly submit to Congress a report on the findings of the Joint Executive Counsel under this subsection during the preceding year.
5.
Definitions
In this Act: (1)The term national brain injury care specialist organization means a national organization or association with demonstrated experience in providing training, education, and technical assistance in the provision of care for individuals with brain injury. (2)The term neurocognitive means of, relating to, or involving the central nervous system and cognitive or information processing abilities (thinking, memory, and reasoning), as well as sensory processing (sight, hearing, touch, taste, and smell), and communication (expression and understanding). (3)The term traumatic brain injury means an acquired injury to the brain, including brain injuries caused by anoxia due to trauma and such other injuries as the Secretary considers appropriate, except that such term excludes brain dysfunction caused by— (A)congenital or degenerative disorders; or (B)birth trauma.