[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 543 Introduced in Senate (IS)]

111th CONGRESS
  1st Session
                                 S. 543

To require a pilot program on training, certification, and support for 
  family caregivers of seriously disabled veterans and members of the 
    Armed Forces to provide caregiver services to such veterans and 
                    members, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 6, 2009

 Mr. Durbin (for himself, Mrs. Hutchison, Mr. Begich, and Mr. Udall of 
  New Mexico) introduced the following bill; which was read twice and 
             referred to the Committee on Veterans' Affairs

_______________________________________________________________________

                                 A BILL


 
To require a pilot program on training, certification, and support for 
  family caregivers of seriously disabled veterans and members of the 
    Armed Forces to provide caregiver services to such veterans and 
                    members, 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 ``Veteran and Servicemember Caregiver 
Support Act of 2009''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) Since September 11, 2001, at least 6,800 veterans have 
        been injured and are living with disabilities severe enough to 
        require in-home type care.
            (2) Even with their disability benefits, the majority of 
        seriously wounded veterans and their families are not in a 
        strong financial position.
            (3) In testimony before Congress in 2007, Donna Shalala, 
        cochair of the Dole-Shalala Commission, stated that ``families 
        are unprepared to provide 24/7 care. Those that try, wear out 
        quickly''.
            (4) The best quality private rehabilitation facilities have 
        expertise in training family members to provide appropriate 
        care.
            (5) Current in-home care programs have limited availability 
        and are severely underutilized. Patients who obtain in-home 
        care from such programs receive only about \2/3\ of the hours 
        of care to which they are entitled.

SEC. 3. PILOT PROGRAM ON THE TRAINING, CERTIFICATION, AND SUPPORT OF 
              FAMILY CAREGIVERS IN PROVISION OF CAREGIVER SERVICES TO 
              CERTAIN DISABLED VETERANS AND MEMBERS OF THE ARMED 
              FORCES.

    (a) In General.--The Secretary of Veterans Affairs shall, in 
collaboration with the Secretary of Defense, carry out a pilot program 
to assess the feasibility and advisability of providing training, 
certification, and support for eligible family caregivers of eligible 
veterans and members of the Armed Forces to provide caregiver services 
to such veterans and members.
    (b) Duration of Program.--The Secretary of Veterans Affairs shall 
commence the pilot program not later than 180 days after the date of 
the enactment of this Act and shall carry out the pilot program during 
the two-year period beginning on the date of such commencement.
    (c) Locations.--
            (1) In general.--The pilot program shall be carried out at 
        not fewer than 6 facilities of the Department of Veterans 
        Affairs or the Department of Defense, or other appropriate 
        entity, selected by the Secretary of Veterans Affairs for 
        purposes of the pilot program. Of the facilities so selected--
                    (A) at least one shall be a private facility with 
                expertise in providing rehabilitative care; and
                    (B) at least one shall be a Department of Veterans 
                Affairs Medical Center in a rural area that serves 
                eligible veterans.
            (2) Emphasis on polytrauma centers.--In selecting locations 
        for the pilot program at facilities of the Department of 
        Veterans Affairs, the Secretary shall give special emphasis to 
        the polytrauma centers of the Department designated as Tier I 
        polytrauma centers.
            (3) Private facilities.--The Secretary may not select a 
        private facility as a location for the pilot program unless the 
        facility is a licensed inpatient rehabilitation facility with 
        significant experience in traumatic brain injury, traumatic 
        spinal cord injury, burn, and amputee rehabilitation.
            (4) Collaboration.--Private facilities and facilities of 
        the Department of Defense selected for purposes of the pilot 
        program shall collaborate with nearby facilities of the 
        Department of Veterans Affairs.
    (d) Eligible Family Caregivers.--
            (1) In general.--For purposes of this section, an eligible 
        family caregiver of a veteran or member of the Armed Forces is 
        a family caregiver of an eligible veteran or member of the 
        Armed Forces who--
                    (A) agrees to provide caregiver services to such 
                eligible veteran or member;
                    (B) is accepted by such eligible veteran or member 
                as the veteran's or member's provider of caregiver 
                services; and
                    (C) is determined, under regulations prescribed by 
                the Secretary of Veterans Affairs or the Secretary of 
                Defense, as applicable, to be qualified to provide 
                caregiver services under the pilot program.
            (2) Replacement.--If the Secretary of Veterans Affairs or 
        the Secretary of Defense, as applicable, determines that a 
        family caregiver who is determined qualified under paragraph 
        (1)(C) to provide caregiver services to an eligible veteran or 
        member of the Armed Forces, as the case may be, is no longer 
        qualified to provide such services--
                    (A) such family caregiver shall no longer be 
                considered an eligible family caregiver for purposes of 
                the pilot program; and
                    (B) such Secretary may, with the agreement of the 
                veteran or member of the Armed Forces concerned, 
                designate as a provider of caregiver services for such 
                veteran or member for purposes of the pilot program any 
                other individual who qualifies as an eligible family 
                caregiver of such veteran or member under this 
                subsection.
            (3) Limitation.--The Secretary of Veterans Affairs and the 
        Secretary of Defense may not qualify more than one concurrent 
        family caregiver per eligible veteran or member of the Armed 
        Forces under paragraph (1)(C).
            (4) Construction.--Nothing in this section may be construed 
        to limit the authority of the Secretary of Veterans Affairs or 
        the Secretary of Defense to deny or discontinue participation 
        of a family caregiver in the pilot program if such action is in 
        the best interest of the veteran or member of the Armed Forces 
        concerned.
    (e) Eligible Veterans and Members of the Armed Forces.--For 
purposes of this section, an eligible veteran or member of the Armed 
Forces is a veteran or member of the Armed Forces--
            (1) who--
                    (A) has a service-connected disability that was 
                incurred or aggravated on or after September 11, 2001; 
                and
                    (B) requires caregiver services because of such 
                service-connected disability, as determined by the 
                Secretary of Veterans Affairs or the Secretary of 
                Defense as applicable;
            (2) who is otherwise determined to be eligible for the 
        pilot program by the Secretary of Veterans Affairs or the 
        Secretary of Defense, as applicable.
    (f) Identification and Notification of Eligible Veterans and 
Members of the Armed Forces.--
            (1) Identification and notification of eligible veterans.--
                    (A) Identification.--Not later than 180 days after 
                the date of the enactment of this Act, the Secretary of 
                Veterans Affairs shall conduct a review to identify 
                veterans eligible to participate in the pilot program.
                    (B) Notification.--The Secretary of Veterans 
                Affairs shall notify each veteran who is identified as 
                an eligible veteran pursuant to the review required by 
                subparagraph (A) of--
                            (i) the eligibility of the veteran to 
                        participate in the pilot program; and
                            (ii) the means by which the veteran may be 
                        accepted for participation in the pilot 
                        program.
            (2) Identification and notifications of eligible members of 
        the armed forces.--
                    (A) Identification.--Not later than 180 days after 
                the date of the enactment of this Act, the Secretary of 
                Defense shall conduct a review to identify members of 
                the Armed Forces eligible to participate in the pilot 
                program.
                    (B) Notification.--The Secretary of Defense shall 
                notify each member of the Armed Forces who is 
                identified as an eligible member of the Armed Forces 
                pursuant to the review required by subparagraph (A) 
                of--
                            (i) the eligibility of the member to 
                        participate in the pilot program; and
                            (ii) the means by which the member may be 
                        accepted into the pilot program.
    (g) Training and Certification.--
            (1) Provision of training and certification.--
                    (A) Training.--The Secretary of Veterans Affairs 
                shall provide training to each eligible family 
                caregiver participating in the pilot program in the 
                provision of family caregiver services. The training 
                shall utilize curricula developed under paragraph (2).
                    (B) Certification.--Upon the successful completion 
                by a family caregiver of training provided under 
                paragraph (1), the Secretary of Veterans Affairs shall 
                certify the family caregiver as a provider of family 
                caregiver services for purposes of the pilot program. 
                Successful completion of training shall be determined 
                utilizing certification criteria developed under 
                paragraph (2).
            (2) Training curricula and certification criteria.--
                    (A) In general.--The Secretary of Veterans Affairs 
                shall, in consultation with the individuals specified 
                in subparagraph (B), develop for purposes of the pilot 
                program the following:
                            (i) Curricula for the training of eligible 
                        family caregivers in the provision of family 
                        caregiver services, including training on 
                        techniques, skills, and strategies for the 
                        provision of such services.
                            (ii) Criteria for the evaluation of 
                        successful completion of such training for 
                        purposes of certification under paragraph 
                        (1)(B).
                    (B) Consultation.--The individuals specified in 
                this subparagraph are the following:
                            (i) The Secretary of Defense.
                            (ii) A representative of family caregivers 
                        or family caregiver associations.
                            (iii) A health or medical employee of the 
                        Department of Veterans Affairs with expertise 
                        in long-term care for seriously injured 
                        veterans.
                            (iv) A health or medical employee of the 
                        Department of Defense with expertise in long-
                        term care for seriously injured members of the 
                        Armed Forces.
                            (v) A psychologist or other individual with 
                        expertise in the provision of mental health 
                        care to individuals in need of home-based or 
                        nursing home care.
                            (vi) An expert in the development of 
                        training curricula.
                            (vii) A family member of a veteran in need 
                        of home-based or nursing home care.
                            (viii) A family member of a member of the 
                        Armed Forces in need of home-based or nursing 
                        home care.
                            (ix) A representative from a veterans 
                        service organization, as recognized by the 
                        Secretary of Veterans Affairs for the 
                        representation of veterans under section 5902 
                        of title 38, United States Code.
                            (x) Such other individuals as the Secretary 
                        of Veterans Affairs, in consultation with the 
                        Secretary of Defense, considers appropriate.
                    (C) Scope of curricula.--The Secretary of Veterans 
                Affairs shall ensure that the curricula developed under 
                subparagraph (A)(i)--
                            (i) is based on empirical research and 
                        validated techniques; and
                            (ii) provides for training that permits 
                        recipients of the training to tailor the 
                        provision of caregiving services to the unique 
                        circumstances of the veteran or member of the 
                        Armed Forces receiving such services.
                    (D) Use of existing curricula.--In developing 
                curricula under subparagraph (A)(i), 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. 2309).
            (3) Travel expenses.--The Secretary of Veterans Affairs may 
        provide for necessary travel, lodging, and per diem expenses 
        incurred by a family caregiver in undergoing certification and 
        training under paragraph (1).
    (h) Payment of Family Caregivers.--
            (1) In general.--An eligible family caregiver of an 
        eligible veteran or member of the Armed Forces certified under 
        subsection (g) in the provision of caregiver services under the 
        pilot program shall be paid by the Department of Veterans 
        Affairs for the provision of caregiver services to such veteran 
        or member, as the case may be, under the pilot program.
            (2) Amount of payment.--Payment provided a family caregiver 
        under paragraph (1) for care provided to a veteran or member of 
        the Armed Forces shall be in amounts the Secretary of Veterans 
        Affairs considers reasonable upon consideration of the 
        following:
                    (A) The amount of care and the intensity of the 
                care required by the veteran or member.
                    (B) The cost to the Department of Veterans Affairs 
                of otherwise providing such care through another 
                noninstitutional care provider.
                    (C) Low-utilization payment adjustment mechanisms 
                under the prospective payment system for home health 
                services established under section 1895 of the Social 
                Security Act (42 U.S.C. 1395fff) calculated for the 
                geographic area of the family caregiver.
                    (D) Such other factors as the Secretary considers 
                appropriate.
            (3) Coordination with state self-directed personal 
        assistance services program.--The Secretary of Veterans Affairs 
        may provide payment under paragraph (1) to an eligible family 
        caregiver in coordination with the self-directed personal 
        assistance services program of the State of the family 
        caregiver to the extent the State has elected to provide 
        medical assistance to an eligible veteran or member of the 
        Armed Forces under the State Medicaid program.
    (i) Respite Care.--
            (1) Review of respite care programs.--The Secretary of 
        Veterans Affairs shall review the respite care programs of the 
        Department of Veterans Affairs and the Secretary of Defense 
        shall review the respite care programs of the Department of 
        Defense that are available to family caregivers to assess the 
        adequacy, flexibility, and age-appropriateness of the 
        facilities under such programs. The review shall include a 
        particular focus on respite care programs for rural areas.
            (2) Study on enhancement of availability of respite care.--
        The Secretary shall carry out a study to identify appropriate 
        options for enhancing the availability of respite care for 
        family caregivers. The study shall include an assessment of the 
        advisability of allowing a veteran's primary treating physician 
        to approve respite care in excess of 30 days to make as-needed 
        respite care more available and convenient for family 
        caregivers.
            (3) Enhancement of availability of respite care.--The 
        Secretary shall take measures to enhance the availability of 
        respite care for family caregivers participating in the pilot 
        program, including the following:
                    (A) Training and certifying alternate family 
                caregivers using the curricula developed under 
                subsection (g)(2).
                    (B) Paying expenses incidental to training of 
                alternate family caregivers, including travel expenses.
                    (C) Such other measures as the Secretary considers 
                appropriate.
    (j) Psychological and Social Support Services.--
            (1) In general.--The Secretary of Veterans Affairs shall, 
        in collaboration with the Secretary of Defense, make available 
        to each eligible family caregiver participating in the pilot 
        program counseling and social services related to the provision 
        by the family caregiver of caregiving services to an eligible 
        veteran or member of the Armed Forces. Such counseling and 
        social services shall include the following:
                    (A) An assessment of individualized needs of the 
                family caregiver with respect to the family caregiver's 
                role as a family caregiver.
                    (B) Assistance with development of a plan for long-
                term care of the veteran or member concerned.
                    (C) Services and support relevant to any needs 
                identified under subparagraph (A) provided through--
                            (i) facilities of the Department of 
                        Veterans Affairs or the Department of Defense 
                        located in the community in which the family 
                        caregiver resides; or
                            (ii) in the case that no such facilities 
                        are available in a timely manner, community-
                        based organizations or publicly funded 
                        programs.
            (2) Use of existing tools.--In developing and administering 
        assessments under paragraph (1)(A), the Secretary shall, to the 
        extent practicable, use and expand upon caregiver assessment 
        tools already developed and in use by the Department of 
        Veterans Affairs or the Department of Defense.
    (k) Reports.--
            (1) Two-year report.--
                    (A) In general.--Not later than two years after the 
                date of the commencement of the pilot program, the 
                Secretary shall, in conjunction with the Secretary of 
                Defense, submit to the appropriate congressional 
                committees a report on the pilot program.
                    (B) Contents.--The report required by paragraph (1) 
                shall include the following:
                            (i) An assessment of the pilot program.
                            (ii) An accounting of the costs to the 
                        Department of Veterans Affairs and the 
                        Department of Defense of the pilot program.
                            (iii) A comparison of the costs to the 
                        Department of Veterans Affairs and the 
                        Department of Defense of the pilot program with 
                        the cost to the Departments of otherwise 
                        providing caregiver services to the veterans 
                        and members of the Armed Forces who received 
                        such services under the pilot program, 
                        including the cost of providing care to such 
                        veterans and members of the Armed Forces who 
                        would otherwise require inpatient care.
                            (iv) The recommendations of the Secretary 
                        with respect to--
                                    (I) the feasibility and 
                                advisability of extending the pilot 
                                program or making the pilot program 
                                permanent; and
                                    (II) modifying the pilot program.
                            (v) An assessment of the effect of the 
                        pilot program on--
                                    (I) the health of veterans 
                                receiving care under the pilot program; 
                                and
                                    (II) the financial burdens of 
                                family caregivers caused by the 
                                provision of caregiver services to 
                                veterans.
                            (vi) Any determinations made by the 
                        Secretary under subsection (o).
            (2) Bi-annual reports of medical facilities.--Not later 
        than 180 days after the date on which a medical facility is 
        selected as a location for the pilot program and not less 
        frequently than once every 180 days thereafter, the medical 
        facility shall submit to the director of the Veterans 
        Integrated Services Network (VISN) in which the facility is 
        located a report that describes--
                    (A) the number of veterans enrolled in the pilot 
                program through such facility; and
                    (B) if there is a waiting list to participate in 
                the pilot program through such facility--
                            (i) the number of people on such list; and
                            (ii) the average wait time before admission 
                        into the pilot program.
    (l) Funding.--
            (1) Costs of care provided to veterans.--Any expenditure 
        under the pilot program relating to the provision of caregiver 
        services to a veteran shall be borne by the Department of 
        Veterans Affairs.
            (2) Costs of care provided to members of the armed 
        forces.--
                    (A) In general.--The Secretary of Defense shall 
                reimburse the Secretary of Veterans Affairs for any 
                expenditure incurred by the Department of Veterans 
                Affairs under the pilot program relating to the 
                provision of caregiver services to members of the Armed 
                Forces.
                    (B) Source of funds.--Amounts for reimbursement 
                under subparagraph (A) shall be derived from amounts 
                made available to Defense Health Program for the 
                TRICARE program.
    (m) Limitation on Spending.--In providing for the provision of 
services under the pilot program, the Secretary of Veterans Affairs 
shall make payment for services only to the extent that payment for 
such services is not otherwise covered by another government or 
nongovernment entity or program.
    (n) Construction.--
            (1) Employment.--Nothing in this section shall be construed 
        to create an employment relationship between a family caregiver 
        and a veteran or member of the Armed Forces, the Department of 
        Veterans Affairs, or the Department of Defense.
            (2) Eligibility for benefits.--Nothing in this section 
        shall be construed to reduce, alter, or otherwise affect the 
        eligibility or entitlement of a veteran, member of the Armed 
        Forces, or dependent thereof, to any health care, disability, 
        or other benefit to which such veteran, member, or dependent 
        would otherwise be eligible or entitled under laws administered 
        by the Secretary of Veterans Affairs or the Secretary of 
        Defense.
    (o) National Expansion of Pilot Program.--Not later than the 
completion of the two-year period described in subsection (b), the 
Secretary of Veterans Affairs shall, in consultation with the Secretary 
of Defense, expand the pilot program to provide training, 
certification, and support for eligible family caregivers nationwide 
unless the Secretary of Veterans Affairs, in consultation with the 
Secretary of Defense, determines that such revision would be infeasible 
or inadvisable.

SEC. 4. SURVEY OF INFORMAL CAREGIVERS.

    (a) In General.--The Secretary of Veterans Affairs shall, in 
collaboration with the Secretary of Defense, 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 the 
population of such caregivers and the types of care they provide.
    (b) Report.--Not later than 540 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall, in 
collaboration with the Secretary of Defense, submit to Congress a 
report containing the findings of the Secretary with respect to the 
survey conducted under subsection (a). Results of the survey shall be 
disaggregated by the following:
            (1) Veterans and members of the Armed Forces.
            (2) Veterans and members of the Armed Forces who served in 
        Operation Iraqi Freedom or Operation Enduring Freedom.
            (3) Veterans and members of the Armed Forces who live in 
        rural areas.

SEC. 5. DEFINITIONS.

    In this Act:
            (1) Appropriate congressional committees.--The term 
        ``appropriate congressional committees'' means--
                    (A) the Committee on Veterans' Affairs, the 
                Committee on Armed Services, and the Committee on 
                Appropriations of the Senate; and
                    (B) the Committee on Veterans' Affairs, the 
                Committee on Armed Services, and the Committee on 
                Appropriations of the House of Representatives.
            (2) Caregiver services.--The term ``caregiver services'' 
        means noninstitutional extended care (as used in section 
        1701(6) of title 38, United States Code), including homemaker 
        and home health aid services.
            (3) Family caregiver.--The term ``family caregiver'' means, 
        with respect to a disabled veteran or member of the Armed 
        Forces, a family member of such veteran or member, or such 
        other individual of similar affinity to such veteran or member 
        as the Secretary prescribes, who is providing caregiver 
        services to such veteran or member for such disability.
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