[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 216 Introduced in Senate (IS)]

<DOC>






118th CONGRESS
  1st Session
                                 S. 216

 To amend title 38, United States Code, to modify the family caregiver 
   program of the Department of Veterans Affairs to include services 
  related to mental health and neurological disorders, and for other 
                               purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            February 1, 2023

   Mr. Moran 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 modify the family caregiver 
   program of the Department of Veterans Affairs to include services 
  related to mental health and neurological disorders, 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 ``Reinforcing Enhanced Support through 
Promoting Equity for Caregivers Act of 2023'' or the ``RESPECT Act of 
2023''.

SEC. 2. MODIFICATION OF FAMILY CAREGIVER PROGRAM OF DEPARTMENT OF 
              VETERANS AFFAIRS TO INCLUDE SERVICES RELATED TO MENTAL 
              HEALTH AND NEUROLOGICAL DISORDERS.

    (a) In General.--Section 1720G of title 38, United States Code, is 
amended--
            (1) in subsection (a)--
                    (A) in paragraph (2)(C)(ii), by striking 
                ``neurological'' and inserting ``a neurological 
                disorder'';
                    (B) in paragraph (3)--
                            (i) in subparagraph (A)(ii)(II), by 
                        inserting ``, including through public or 
                        private entities'' before the semicolon; and
                            (ii) in subparagraph (C), by adding at the 
                        end the following new clause:
    ``(v)(I) For purposes of determining the amount and degree of 
personal care services provided under clause (i) with respect to a 
veteran described in subclause (II), the Secretary shall take into 
account relevant documentation evidencing the provision of personal 
care services with respect to the veteran during the preceding three-
year period.
    ``(II) A veteran described in this subclause is a veteran whose 
need for personal care services as described in paragraph (2)(C) is 
based in whole or in part on--
            ``(aa) a diagnosis of mental illness or history of suicidal 
        ideation that puts the veteran at risk of self-harm; or
            ``(bb) a neurological disorder.''; and
                    (C) by adding at the end the following new 
                paragraph:
    ``(14) The Secretary shall establish a process and requirements for 
clinicians of facilities of the Department--
            ``(A) to document incidents in which an eligible veteran 
        participating in the program established under paragraph (1)--
                    ``(i) presents at such a facility for treatment for 
                an emergent or urgent mental health crisis; or
                    ``(ii) is assessed by such a clinician to be at 
                risk for suicide; and
            ``(B) to provide such documentation, including any safety 
        plans developed and referrals made to a suicide prevention 
        coordinator of the Department, to such program.'';
            (2) in subsection (b)(2)(B), by striking ``neurological'' 
        and inserting ``a neurological disorder'';
            (3) in subsection (d)--
                    (A) by redesignating paragraph (4) as paragraph 
                (5);
                    (B) by inserting after paragraph (3) the following 
                new paragraph (4):
            ``(4) the term `neurological disorder' means a disease of 
        the brain, spinal cord, nerves, or neuromuscular system.''; and
                    (C) in paragraph (5)(B), as redesignated by 
                subparagraph (A), by striking ``neurological'' and 
                inserting ``a neurological disorder''.
    (b) Timing for Establishment of Requirements and Processes.--
            (1) Report.--Not later than one year after the date of the 
        enactment of this Act, the Secretary of Veterans Affairs 
        shall--
                    (A) establish the process and requirements required 
                under paragraph (14) of section 1720G(a) of title 38, 
                United States Code, as added by subsection (a)(1)(B); 
                and
                    (B) submit to the Committee on Veterans' Affairs of 
                the Senate and the Committee on Veterans' Affairs of 
                the House of Representatives a description of such 
                process and requirements.
            (2) Certification.--
                    (A) In general.--Not later than one year after the 
                date of the enactment of this Act, the Secretary of 
                Veterans Affairs shall require all clinicians of 
                facilities of the Department to certify to the 
                Secretary that the clinician understands the process 
                and requirements established under paragraph (1)(A).
                    (B) Facilities of the department defined.--In this 
                paragraph, the term ``facilities of the Department'' 
                has the meaning given that term in section 1701 of 
                title 38, United States Code.

SEC. 3. REQUIREMENTS RELATING TO EVALUATIONS, ASSESSMENTS, AND 
              REASSESSMENTS RELATING TO ELIGIBILITY OF VETERANS AND 
              CAREGIVERS FOR FAMILY CAREGIVER PROGRAM.

    (a) In General.--Subsection (a) of section 1720G of title 38, 
United States Code, as amended by section 2(a)(1), is further amended 
by adding at the end the following new paragraphs:
            ``(15)(A) For purposes of conducting evaluations and 
        assessments to determine eligibility of a veteran and caregiver 
        for the program established under paragraph (1) or conducting 
        reassessments to determine continued eligibility for such 
        program, the Secretary shall--
                    ``(i) take into account relevant documentation and 
                medical records generated by Department and non-
                Department health care providers, including qualified 
                mental health professionals and neurological 
                specialists;
                    ``(ii) if the caregiver of the veteran claims that 
                the serious injury or need for personal care services 
                of the veteran as described in paragraph (2) is based 
                in whole or in part on psychological trauma or another 
                mental disorder, ensure--
                            ``(I) a qualified mental health 
                        professional that treats the veteran 
                        participates in the evaluation process; and
                            ``(II) a qualified mental health 
                        professional participates in the assessment or 
                        reassessment process; and
                    ``(iii) if the caregiver of the veteran claims that 
                the serious injury or need for personal care services 
                of the veteran as described in paragraph (2) is based 
                in whole or in part on a neurological disorder, 
                ensure--
                            ``(I) a neurological specialist that treats 
                        the veteran participates in the evaluation 
                        process; and
                            ``(II) a neurological specialist 
                        participates in the assessment or reassessment 
                        process.
            ``(B)(i) The Secretary shall establish an appropriate time 
        limit during a 24-hour period for the active participation of a 
        veteran in an evaluation, assessment, or reassessment to 
        determine eligibility of the veteran for the program 
        established under paragraph (1).
            ``(ii) In determining an appropriate time limit for a 
        veteran under clause (i), the Secretary shall--
                    ``(I) take into consideration necessary 
                accommodations for the veteran stemming from the 
                disability or medical condition of the veteran; and
                    ``(II) consult with the primary care provider, 
                neurological specialist, or qualified mental health 
                professional that is treating the veteran.
            ``(C) The Secretary shall not require the presence of a 
        veteran during portions of an evaluation, assessment, or 
        reassessment to determine eligibility of the veteran for the 
        program established under paragraph (1) that only require the 
        active participation of the caregiver.
            ``(D)(i) The Secretary shall make reasonable efforts to 
        assist a caregiver and veteran in obtaining evidence necessary 
        to substantiate the claims of the caregiver and veteran in the 
        application process for evaluation, assessment, or reassessment 
        for the program established under paragraph (1).
            ``(ii)(I) As part of the assistance provided to a caregiver 
        or veteran under clause (i), the Secretary shall make 
        reasonable efforts to obtain relevant private records that the 
        caregiver or veteran adequately identifies to the Secretary.
            ``(II) Whenever the Secretary, after making reasonable 
        efforts under subclause (I), is unable to obtain all of the 
        relevant records sought, the Secretary shall notify the 
        caregiver and veteran that the Secretary is unable to obtain 
        records with respect to the claim, which shall include--
                    ``(aa) an identification of the records the 
                Secretary is unable to obtain;
                    ``(bb) a brief explanation of the efforts that the 
                Secretary made to obtain such records; and
                    ``(cc) an explanation that the Secretary will make 
                a determination based on the evidence of record and 
                that this clause does not prohibit the submission of 
                records at a later date if such submission is otherwise 
                allowed.
            ``(III) The Secretary shall make not fewer than two 
        requests to a custodian of a private record in order for an 
        effort to obtain such record to be treated as reasonable under 
        subclause (I), unless it is made evident by the first request 
        that a second request would be futile in obtaining such record.
            ``(iii) Under regulations prescribed by the Secretary, the 
        Secretary--
                    ``(I) shall encourage a caregiver and veteran to 
                submit relevant private medical records of the veteran 
                to the Secretary to substantiate the claims of the 
                caregiver and veteran in the application process for 
                evaluation, assessment, or reassessment for the program 
                established under paragraph (1) if such submission does 
                not burden the caregiver or veteran; and
                    ``(II) may require the caregiver or veteran to 
                authorize the Secretary to obtain such relevant private 
                medical records if such authorization is required to 
                comply with Federal, State, or local law.
            ``(16)(A) The Secretary, in consultation with a health care 
        provider, neurological specialist, or qualified mental health 
        professional that is treating a veteran, shall waive the 
        reassessment requirement for the veteran for participation in 
        the program established under paragraph (1) if--
                    ``(i) the serious injury of the veteran under 
                paragraph (2) is significantly caused by a degenerative 
                or chronic condition; and
                    ``(ii) such condition is unlikely to improve the 
                dependency of the veteran for personal care services.
            ``(B) The Secretary shall require a health care provider, 
        neurological specialist, or qualified mental health 
        professional that is treating a veteran to certify at 
        appropriate intervals determined by the Secretary the clinical 
        decision of the provider, specialist, or professional under 
        subparagraph (A).
            ``(C) The Secretary may rescind a waiver under subparagraph 
        (A) with respect to a veteran and require a reassessment of the 
        veteran if a health care provider, neurological specialist, or 
        qualified mental health professional that is treating the 
        veteran makes a clinical determination that the level of 
        dependency of the veteran for personal care services has 
        diminished since the last certification of the clinical 
        decision of the provider, specialist, or professional under 
        subparagraph (B).''.
    (b) Definitions.--Subsection (d) of such section, as amended by 
section 2(a)(2), is further amended--
            (1) by redesignating paragraph (5) as paragraph (6);
            (2) by inserting after paragraph (4) the following new 
        paragraph (5):
            ``(5) The term `neurological specialist' means a 
        neurologist, neuropsychiatrist, physiatrist, geriatrician, 
        certified brain injury specialist, neurology nurse, neurology 
        nurse practitioner, neurology physician assistant, or such 
        other licensed medical professional as the Secretary considers 
        appropriate.''; and
            (3) by adding at the end the following new paragraph:
            ``(7) The term `qualified mental health professional' means 
        a psychiatrist, psychologist, licensed clinical social worker, 
        psychiatric nurse, licensed professional mental health 
        counselor, or other licensed mental health professional as the 
        Secretary considers appropriate.''.

SEC. 4. AUTHORITY FOR SECRETARY OF VETERANS AFFAIRS TO AWARD GRANTS TO 
              ENTITIES TO IMPROVE PROVISION OF MENTAL HEALTH SUPPORT TO 
              FAMILY CAREGIVERS OF VETERANS.

    (a) 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. 1720K. Grants to provide mental health support to family 
              caregivers of veterans
    ``(a) Purpose.--It is the purpose of this section to provide for 
assistance by the Secretary to entities to carry out programs that 
improve the provision of mental health support to the family caregivers 
of veterans participating in the family caregiver program.
    ``(b) Authority.--The Secretary may award grants to carry out, 
coordinate, improve, or otherwise enhance mental health counseling, 
treatment, or support to the family caregivers of veterans 
participating in the family caregiver program.
    ``(c) Application.--(1) To be eligible for a grant under this 
section, an entity shall submit to the Secretary an application 
therefor at such time, in such manner, and containing such information 
as the Secretary may require.
    ``(2) Each application submitted under paragraph (1) shall include 
the following:
            ``(A) A detailed plan for the use of the grant.
            ``(B) A description of the programs or efforts through 
        which the entity will meet the outcome measures developed by 
        the Secretary under subsection (g).
            ``(C) A description of how the entity will distribute grant 
        amounts equitably among areas with varying levels of 
        urbanization.
            ``(D) A plan for how the grant will be used to meet the 
        unique needs of veterans residing in rural areas, American 
        Indian or Alaska Native veterans, elderly veterans, women 
        veterans, and veterans from other underserved communities.
    ``(d) Distribution.--The Secretary shall seek to ensure that grants 
awarded under this section are equitably distributed among entities 
located in States with varying levels of urbanization.
    ``(e) Priority.--The Secretary shall prioritize awarding grants 
under this section that will serve the following areas:
            ``(1) Areas with high rates of veterans enrolled in the 
        family caregiver program.
            ``(2) Areas with high rates of--
                    ``(A) suicide among veterans; or
                    ``(B) referrals to the Veterans Crisis Line.
    ``(f) Required Activities.--Any grant awarded under this section 
shall be used--
            ``(1) to expand existing programs, activities, and 
        services;
            ``(2) to establish new or additional programs, activities, 
        and services; or
            ``(3) for travel and transportation to facilitate carrying 
        out paragraph (1) or (2).
    ``(g) Outcome Measures.--(1) The Secretary shall develop and 
provide to each entity that receives a grant under this section written 
guidance on the following:
            ``(A) Outcome measures.
            ``(B) Policies of the Department.
    ``(2) In developing outcome measures under paragraph (1), the 
Secretary shall consider the following goals:
            ``(A) Increasing the utilization of mental health services 
        among family caregivers of veterans participating in the family 
        caregiver program.
            ``(B) Reducing barriers to mental health services among 
        family caregivers of veterans participating in such program.
    ``(h) Tracking Requirements.--(1) The Secretary shall establish 
appropriate tracking requirements with respect to the entities 
receiving a grant under this section.
    ``(2) Not less frequently than annually, the Secretary shall submit 
to Congress a report on such tracking requirements.
    ``(i) Performance Review.--The Secretary shall--
            ``(1) review the performance of each entity that receives a 
        grant under this section; and
            ``(2) make information regarding such performance publicly 
        available.
    ``(j) Remediation Plan.--(1) In the case of an entity that receives 
a grant under this section and does not meet the outcome measures 
developed by the Secretary under subsection (g), the Secretary shall 
require the entity to submit to the Secretary a remediation plan under 
which the entity shall describe how and when it plans to meet such 
outcome measures.
    ``(2) The Secretary may not award a subsequent grant under this 
section to an entity described in paragraph (1) unless the Secretary 
approves the remediation plan submitted by the entity under such 
paragraph.
    ``(k) Maximum Amount.--The amount of a grant awarded under this 
section may not exceed 10 percent of amounts made available for grants 
under this section for the fiscal year in which the grant is awarded.
    ``(l) Supplement, Not Supplant.--Any grant awarded under this 
section shall be used to supplement and not supplant funding that is 
otherwise available through the Department to provide mental health 
support among family caregivers of veterans participating in the family 
caregiver program.
    ``(m) Funding.--(1) Amounts for the activities of the Department 
under this section shall be budgeted and appropriated through a 
separate appropriation account.
    ``(2) In the budget justification materials submitted to Congress 
in support of the budget of the Department for any fiscal year (as 
submitted with the budget of the President under section 1105(a) of 
title 31), the Secretary shall include a separate statement of the 
amount requested to be appropriated for that fiscal year for the 
account specified in paragraph (1).
    ``(n) Authorization of Appropriations.--There is authorized to be 
appropriated to the Secretary for each of fiscal years 2023 through 
2025 $50,000,000 to carry out this section.
    ``(o) Definitions.--In this section:
            ``(1) The terms `caregiver' and `family caregiver' have the 
        meanings given those terms in section 1720G(d) of this title.
            ``(2) The term `family caregiver program' means the program 
        of comprehensive assistance for family caregivers under section 
        1720G(a) of this title.
            ``(3) The term `Veterans Crisis Line' means the toll-free 
        hotline for veterans established under section 1720F(h) of this 
        title.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such subchapter is amended by adding at the end the following new item:

``1720K. Grants to provide mental health support to family caregivers 
                            of veterans.''.

SEC. 5. COMPTROLLER GENERAL REPORT ON MENTAL HEALTH SUPPORT FOR 
              CAREGIVERS.

    (a) Report Required.--Not later than one year after the date of the 
enactment of this Act, the Comptroller General of the United States 
shall submit to the Committee on Veterans' Affairs of the Senate and 
the Committee on Veterans' Affairs of the House of Representatives a 
report on the provision of mental health support to caregivers of 
veterans.
    (b) Contents.--The report submitted under subsection (a) shall 
include the following:
            (1) An assessment of the need for mental health support 
        among caregivers participating in the caregiver programs.
            (2) An assessment of options for mental health support in 
        facilities of the Department of Veterans Affairs and in the 
        community for caregivers participating in the caregiver 
        programs.
            (3) An assessment of the availability and accessibility of 
        mental health support in facilities of the Department and in 
        the community for caregivers participating in the caregiver 
        programs.
            (4) An assessment of the awareness among caregivers of the 
        availability of mental health support in facilities of the 
        Department and in the community for caregivers participating in 
        the caregiver programs.
            (5) An assessment of barriers to mental health support in 
        facilities of the Department and in the community for 
        caregivers participating in the caregiver programs.
    (c) Definitions.--In this section:
            (1) Caregiver.--The term ``caregiver'' has the meaning 
        given that term in section 1720G(d) of title 38, United States 
        Code.
            (2) Caregiver programs.--The term ``caregiver programs'' 
        means--
                    (A) the program of comprehensive assistance for 
                family caregivers under subsection (a) of section 1720G 
                of title 38, United States Code; and
                    (B) the program of support services for caregivers 
                under subsection (b) of such section.
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