[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>