[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3155 Reported in House (RH)]

                                                 Union Calendar No. 122
111th CONGRESS
  1st Session
                                H. R. 3155

                          [Report No. 111-224]

To amend title 38, United States Code, to provide certain caregivers of 
   veterans with training, support, and medical care, and for other 
                               purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              July 9, 2009

 Mr. Michaud (for himself, Mr. Rodriguez, Mrs. Halvorson, Mr. Teague, 
 and Mr. Donnelly of Indiana) introduced the following bill; which was 
             referred to the Committee on Veterans' Affairs

                             July 23, 2009

 Additional sponsors: Ms. Corrine Brown of Florida, Mr. Crenshaw, Mr. 
        Smith of New Jersey, Mr. Klein of Florida, and Mr. Wolf

                             July 23, 2009

  Reported with an amendment, committed to the Committee of the Whole 
       House on the State of the Union, and ordered to be printed
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]
[For text of introduced bill, see copy of bill as introduced on July 9, 
                                 2009]





_______________________________________________________________________

                                 A BILL


 
To amend title 38, United States Code, to provide certain caregivers of 
   veterans with training, support, and medical care, 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 ``Caregiver Assistance and Resource 
Enhancement Act''.

SEC. 2. SUPPORT SERVICES FOR CAREGIVERS.

    (a) Definitions.--Section 1701 of title 38, United States Code, is 
amended by adding at the end the following new paragraphs:
            ``(10) The term `caregiver services' means noninstitutional 
        extended care (as used in paragraph (6)).
            ``(11) The term `caregiver' means an individual who--
                    ``(A) with respect to a disabled veteran who is 
                enrolled in the health care system established under 
                section 1705(a) of this title, provides caregiver 
                services to such veteran for such disability; and
                    ``(B) is not a member of the family (including 
                parents, spouses, children, siblings, step-family 
                members, and extended family members) of such veteran.
            ``(12) The term `family caregiver' means an individual 
        who--
                    ``(A) with respect to a disabled veteran who is 
                enrolled in the health care system established under 
                section 1705(a) of this title, provides caregiver 
                services to such veteran for such disability;
                    ``(B) is a member of the family (including parents, 
                spouses, children, siblings, step-family members, and 
                extended family members) of such veteran; and
                    ``(C) may or may not reside with such veteran.''.
    (b) Support Services.--
            (1) 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. 1720G. Support services for caregivers and family caregivers
    ``(a) Establishment of Program.--The Secretary shall develop and 
carry out a program for caregivers and family caregivers that includes 
the following:
            ``(1) The educational sessions, stipends, and access to 
        support services provided under this section.
            ``(2) Counseling and other services provided under section 
        1782 of this title.
            ``(3) Respite care provided under section 1720B of this 
        title.
            ``(4) With respect to family caregivers, medical care 
        provided under section 1781(e) of this title.
            ``(5) Travel expenses provided under section 111(e) of this 
        title.
    ``(b) Educational Sessions.--(1) The Secretary shall make available 
educational sessions for caregivers, family caregivers, and individuals 
described in paragraph (2). Such educational sessions shall--
            ``(A) be made available both in person and on an Internet 
        website;
            ``(B) incorporate available technology, including 
        telehealth technology to the extent practicable; and
            ``(C) teach techniques, strategies, and skills for caring 
        for a disabled veteran, including, at a minimum, a veteran 
        who--
                    ``(i) was deployed in support of Operation Enduring 
                Freedom or Operation Iraqi Freedom; and
                    ``(ii) has post-traumatic stress disorder, a 
                traumatic brain injury, or other severe injury or 
                illness.
    ``(2) Individuals described in this paragraph are individuals who 
provide caregivers and family caregivers with support under this 
chapter or through an aging network (as defined in section 102(5) of 
the Older Americans Act of 1965 (42 U.S.C. 3002(5)), including--
            ``(A) respite care providers;
            ``(B) nursing care providers; and
            ``(C) counselors.
    ``(c) Stipends.--(1) The Secretary shall provide monthly stipends 
to eligible family caregivers described in paragraph (2).
    ``(2) An eligible family caregiver described in this paragraph is a 
family caregiver who--
            ``(A) provides caregiver services to a veteran who--
                    ``(i) was deployed in support of Operation Enduring 
                Freedom or Operation Iraqi Freedom; and
                    ``(ii) for purposes of this subsection, is 
                determined by the Secretary--
                            ``(I) to have a service-connected 
                        disability or illness that is severe;
                            ``(II) to be in need of caregiver services, 
                        such that without such services, the veteran 
                        would require hospitalization, nursing home 
                        care, or other residential institutional care; 
                        and
                            ``(III) based on an examination by a 
                        physician employed by the Department (or, in 
                        areas where no such physician is available, by 
                        a physician carrying out such function under a 
                        contract or fee arrangement), to be unable to 
                        carry out the activities (including 
                        instrumental activities) of daily living;
            ``(B) with respect to such veteran, meets the definition of 
        the term `family caregiver' under section 1701(12) of this 
        title;
            ``(C) is designated by such veteran as the primary family 
        caregiver for such veteran; and
            ``(D) is not--
                    ``(i) employed by a home health care agency to 
                provide such caregiver services; or
                    ``(ii) otherwise receiving payment for such 
                services.
    ``(3) The authority of the Secretary to provide a stipend to an 
eligible family caregiver under this subsection shall expire on October 
1, 2012.
    ``(d) Access to Support Services.--The Secretary shall provide 
caregivers and family caregivers with information concerning public, 
private, and non-profit agencies that offer support to caregivers. In 
providing such information, the Secretary shall--
            ``(1) collaborate with the Assistant Secretary for Aging of 
        the Department of Health and Human Services in order to provide 
        caregivers and family caregivers access to aging and disability 
        resource centers under the Administration on Aging of the 
        Department of Health and Human Services; and
            ``(2) include on an Internet website that is dedicated to 
        caregivers and family caregivers--
                    ``(A) a directory of services available for 
                caregivers and family caregivers at the county level; 
                and
                    ``(B) tools that provide caregivers and family 
                caregivers with the ability to interact with each other 
                for the purpose of fostering peer support and creating 
                support networks.
    ``(e) Information and Outreach.--(1) The Secretary shall conduct 
outreach to inform disabled veterans and the families of such veterans 
of the following:
            ``(A) Medical care, educational sessions, stipends, and 
        other services available for caregivers and family caregivers 
        under this chapter.
            ``(B) The ability of a family caregiver to be trained and 
        certified by a home health care agency in order to be paid by 
        such agency for providing caregiver services.
    ``(2) Outreach under this subsection shall include, at a minimum, 
the following:
            ``(A) Public service announcements.
            ``(B) Brochures and pamphlets.
            ``(C) Full use of Internet-based outreach methods, 
        including such methods designed specifically for veterans and 
        the families of such veterans who reside in rural areas.
    ``(3) With respect to a Department employee providing case 
management services (as defined in section 1720C(b)(2) of this title) 
to a disabled veteran, the Secretary shall ensure that such employee 
provides a caregiver or family caregiver of such veteran with 
information on the services described in subparagraphs (A) and (B) of 
paragraph (1).''.
            (2) Clerical amendment.--The table of sections at the 
        beginning of chapter 17 of title 38, United States Code, is 
        amended by inserting after the item related to section 1720F 
        the following new item:

``1720G. Support services for caregivers and family caregivers.''.
    (c) Plan.--Not later than 180 days after the date of the enactment 
of this Act, the Secretary shall submit to the Committee on Veterans' 
Affairs of the House of Representatives and the Committee on Veterans' 
Affairs of the Senate a plan for carrying out section 1720G of title 
38, United States Code, as added by subsection (b) of this section.
    (d) Reports.--Not later than 180 days after the date on which the 
plan is submitted under subsection (c), and annually thereafter for the 
following five years, the Secretary shall submit to the Committee on 
Veterans' Affairs of the House of Representatives and the Committee on 
Veterans' Affairs of the Senate a report describing the implementation 
of the plan.

SEC. 3. COUNSELING AND MENTAL HEALTH SERVICES FOR CAREGIVERS AND FAMILY 
              CAREGIVERS.

    (a) In General.--Section 1782 of title 38, United States Code, is 
amended--
            (1) in the section heading, by adding at the end the 
        following: ``, caregivers, and family caregivers''; and
            (2) in subsection (c)--
                    (A) in paragraph (1), by striking ``; or'' and 
                inserting a semicolon;
                    (B) by redesignating paragraph (2) as paragraph 
                (3); and
                    (C) by inserting after paragraph (1) the following 
                new paragraph (2):
            ``(2) a caregiver or family caregiver of a veteran; or''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 17 of title 38, United States Code, is amended by striking the 
item relating to section 1782 and inserting the following new item:

``1782. Counseling, training, and mental health services for immediate 
                            family members, caregivers, and family 
                            caregivers.''.

SEC. 4. RESPITE CARE TO ASSIST FAMILY CAREGIVERS.

    Section 1720B of title 38, United States Code, is amended--
            (1) in subsection (a), by striking ``title.'' and inserting 
        ``title or who receives care from a family caregiver.''; and
            (2) by adding at the end the following new subsection:
    ``(d) In furnishing respite care services under this section, the 
Secretary shall ensure that such services--
            ``(1) fulfill the needs of the veteran receiving care 
        (including 24-hour in-home respite care); and
            ``(2) are appropriate for the veteran with respect to the 
        age of the veteran.''.

SEC. 5. MEDICAL CARE FOR FAMILY CAREGIVERS.

    Section 1781 of title 38, United States Code, is amended--
            (1) in subsection (a)--
                    (A) in paragraph (2), by striking ``and'' at the 
                end;
                    (B) in paragraph (3), by inserting ``and'' at the 
                end; and
                    (C) by inserting after paragraph (3) the following 
                new paragraph:
            ``(4) in accordance with subsection (e), a family 
        caregiver,'';
            (2) in the third sentence of subsection (b), by striking 
        ``dependent or survivor'' and inserting ``dependent, survivor, 
        or family caregiver''; and
            (3) by adding at the end the following new subsection:
    ``(e)(1) The Secretary shall provide medical care to a family 
caregiver under this section if the Secretary determines that the 
family caregiver is not entitled to care or services under a health-
plan contract as defined under section 1725(f)(2) of this title 
(determined, in the case of a health-plan contract as defined in 
subsection (f)(2)(B) or (f)(2)(C) of such section, without regard to 
any requirement or limitation relating to eligibility for care or 
services from any department or agency of the United States).
    ``(2) In this subsection, a family caregiver is an individual who--
            ``(A) provides caregiver services to a veteran who--
                    ``(i) was deployed in support of Operation Enduring 
                Freedom or Operation Iraqi Freedom; and
                    ``(ii) for purposes of this subsection, is 
                determined by the Secretary--
                            ``(I) to have a service-connected 
                        disability or illness that is severe;
                            ``(II) to be in need of caregiver services, 
                        such that without such services, the veteran 
                        would require hospitalization, nursing home 
                        care, or other residential institutional care; 
                        and
                            ``(III) based on an examination by a 
                        physician employed by the Department (or, in 
                        areas where no such physician is available, by 
                        a physician carrying out such function under a 
                        contract or fee arrangement), to be unable to 
                        carry out the activities (including 
                        instrumental activities) of daily living;
            ``(B) with respect to such veteran, meets the definition of 
        the term `family caregiver' under section 1701(12) of this 
        title; and
            ``(C) is designated by such veteran as the primary family 
        caregiver for such veteran.
    ``(3) The authority of the Secretary to provide medical care to a 
family caregiver under this section shall expire on October 1, 2012.''.

SEC. 6. LODGING AND SUBSISTENCE FOR FAMILY CAREGIVERS.

    Section 111(e) of title 38, United States Code, is amended--
            (1) by striking ``When'' and inserting the following: ``(1) 
        Except as provided in paragraph (2), when''; and
            (2) by adding at the end the following new paragraphs:
    ``(2) Without regard to whether a covered veteran entitled to 
mileage under this section requires an attendant in order to perform 
such travel, an attendant of such covered veteran may be allowed 
expenses of travel (including lodging and subsistence) upon the same 
basis as such veteran during--
            ``(A) the period of time in which such veteran is traveling 
        to and from a treatment facility; and
            ``(B) the duration of the treatment episode for such 
        veteran.
    ``(3) The Secretary may prescribe regulations to carry out this 
subsection. Such regulations may include provisions--
            ``(A) to limit the number of attendants that may receive 
        expenses of travel under paragraph (2) for a single treatment 
        episode of a covered veteran; and
            ``(B) to require such attendants to use certain travel 
        services.
    ``(4) In this subsection, the term `covered veteran' means a 
veteran who--
            ``(A) was deployed in support of Operation Enduring Freedom 
        or Operation Iraqi Freedom; and
            ``(B) for purposes of this subsection, is determined by the 
        Secretary--
                    ``(i) to have a service-connected disability or 
                illness that is severe;
                    ``(ii) to be in need of caregiver services, such 
                that without such services, the veteran would require 
                hospitalization, nursing home care, or other 
                residential institutional care; and
                    ``(iii) based on an examination by a physician 
                employed by the Department (or, in areas where no such 
                physician is available, by a physician carrying out 
                such function under a contract or fee arrangement), to 
                be unable to carry out the activities (including 
                instrumental activities) of daily living.''.

SEC. 7. SURVEY ON CAREGIVERS AND FAMILY CAREGIVERS.

    (a) In General.--Not later than 270 days after the date of the 
enactment of this Act, and not less than once in each three-year period 
thereafter, the Secretary of Veterans Affairs shall design and conduct 
a survey of caregivers and family caregivers. In carrying out the 
survey, the Secretary shall collect the following information:
            (1) The number of caregivers.
            (2) The number of family caregivers.
            (3) The number of veterans receiving caregiver services 
        from caregivers and family caregivers, including the era in 
        which each veteran served in the Armed Forces.
            (4) The range of caregiver services provided by caregivers 
        and family caregivers, including--
                    (A) the average schedule of such services; and
                    (B) the average amount of time a caregiver and 
                family caregiver has spent providing such services.
            (5) The average age of a caregiver and family caregiver.
            (6) The health care coverage of caregivers and family 
        caregivers, including the sources of such coverage.
            (7) The employment status of caregivers and family 
        caregivers.
            (8) Incidents of significant life changes related to being 
        a caregiver or family caregiver, including unemployment and 
        disenrollment from a course of education.
            (9) The number of family caregivers trained and certified 
        through a home health care agency.
            (10) Other information the Secretary considers appropriate.
    (b) Survey Sample.--In carrying out the survey required by 
subsection (a), the Secretary shall ensure that--
            (1) a statistically representative sample of caregivers and 
        family caregivers is included in the survey; and
            (2) such sample covers veterans in each Veterans Integrated 
        Service Network.
    (c) Findings.--The Secretary shall consider the findings of the 
survey when carrying out programs related to caregivers and family 
caregivers.
    (d) Reports.--Not later than 180 days after the date on which each 
survey is completed, the Secretary shall submit to the Committee on 
Veterans' Affairs of the House of Representatives and the Committee on 
Veterans' Affairs of the Senate a report on caregivers and family 
caregivers. Each such report shall include--
            (1) the findings of the survey required by subsection (a);
            (2) a summary of the services made available to caregivers 
        and family caregivers by the Secretary;
            (3) the number of caregivers and family caregivers who 
        receive such services;
            (4) the cost to the Department of Veterans Affairs of 
        providing each such service; and
            (5) other information the Secretary considers appropriate.
    (e) Definitions.--In this section:
            (1) The term ``caregiver'' has the meaning given such term 
        in section 1701(11) of title 38, United States Code, as added 
        by section 2(a) of this Act.
            (2) The term ``family caregiver'' has the meaning given 
        such term in section 1701(12) of title 38, United States Code, 
        as added by section 2(a) of this Act.
                                                 Union Calendar No. 122

111th CONGRESS

  1st Session

                               H. R. 3155

                          [Report No. 111-224]

_______________________________________________________________________

                                 A BILL

To amend title 38, United States Code, to provide certain caregivers of 
   veterans with training, support, and medical care, and for other 
                               purposes.

_______________________________________________________________________

                             July 23, 2009

  Reported with an amendment, committed to the Committee of the Whole 
       House on the State of the Union, and ordered to be printed