[Congressional Record Volume 162, Number 81 (Monday, May 23, 2016)]
[House]
[Pages H2914-H2916]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                  SUPPORT OUR MILITARY CAREGIVERS ACT

  Mr. MILLER of Florida. Mr. Speaker, I move to suspend the rules and 
pass the bill (H.R. 3989) to amend title 38, United States Code, to 
improve the process for determining the eligibility of caregivers of 
veterans to certain benefits administered by the Secretary of Veterans 
Affairs, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 3989

       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 ``Support Our Military 
     Caregivers Act''.

     SEC. 2. EXTERNAL CLINICAL REVIEW OF DENIED APPLICATIONS BY 
                   CAREGIVERS OF VETERANS.

       (a) In General.--Section 1720G of title 38, United States 
     Code, is amended--
       (1) by redesignating subsections (d) and (e) as subsections 
     (e) and (f), respectively; and
       (2) by inserting after subsection (c) the following new 
     subsection (d):
       ``(d) External Clinical Review of Applications.--(1) Using 
     amounts otherwise appropriated to carry out this section, an 
     individual may elect to have an independent contractor 
     described in paragraph (2) perform an external clinical 
     review of any of the following:
       ``(A) The denial by the Secretary of an application by an 
     individual to be a caregiver or family caregiver eligible for 
     the program of comprehensive assistance administered by the 
     Secretary pursuant to this section.
       ``(B) With respect to such an application that the 
     Secretary has granted, a determination by the Secretary of 
     the level or amount of personal care services that a veteran 
     requires.
       ``(C) A request by a caregiver or family caregiver for a 
     reconsideration of the level or amount of personal care 
     services that a veteran requires based on changes to the 
     health or abilities of the veteran occurring since the 
     Secretary granted such an application.
       ``(D) The revocation by the Secretary of assistance 
     administered by the Secretary pursuant to this section.
       ``(2) An independent contractor described in this paragraph 
     is an independent contractor that--
       ``(A) is awarded a contract by the Secretary to carry out 
     this section pursuant to full and open competition under the 
     Federal Acquisition Regulation;
       ``(B) has no direct or indirect financial relationship with 
     any non-Department provider of services to caregivers and 
     family caregivers pursuant to this title;
       ``(C) has not otherwise conducted an external clinical 
     review of benefits administered by the Secretary pursuant to 
     this title other than this section;
       ``(D) has sufficient training and expertise in medical 
     science and other appropriate health, educational, and 
     vocational training and legal matters to perform the reviews 
     described in paragraph (1); and
       ``(E) employs a panel of physicians or other appropriate 
     health care professionals who do not provide health care to 
     the individual who makes an election under paragraph (1).
       ``(3) Each external clinical review conducted pursuant to 
     paragraph (1) shall--
       ``(A) be based on applicable information included in the 
     application for assistance described in such paragraph, 
     including clinical expertise, medical, technical, and 
     scientific evidence;
       ``(B) include an opportunity for both the individual who 
     elects for such review and, to the extent possible, the 
     veteran for whom care is being provided to offer opinions and 
     supporting data as to the level of care required; and
       ``(C) include a review of the initial clinical review of 
     such veteran and any other review made by the Secretary.
       ``(4) In carrying out the external clinical reviews 
     pursuant to paragraph (1), the independent contractor shall, 
     as determined appropriate by the Secretary--

[[Page H2915]]

       ``(A) collect and maintain information required; and
       ``(B) share such information with the Secretary.
       ``(5) The Secretary shall take into account, but is not 
     bound by, any determination made by the independent 
     contractor pursuant to paragraph (1) in determining the final 
     decision with respect to the application for assistance. The 
     Secretary may make a final decision that is contrary to such 
     a determination if the Secretary includes clinically 
     supported documentation with the decision.
       ``(6) The Secretary shall ensure that each external 
     clinical review conducted by the independent contractor 
     pursuant to paragraph (1) is completed and the Department is 
     notified in writing of the results of the review by not later 
     than 120 days after the date on which the individual makes 
     the election under such paragraph. Not later than 30 days 
     after the delivery of the determination recommended by the 
     independent contractors, the Secretary shall ensure that the 
     veteran and the individual making the election under such 
     paragraph is notified in writing of the final decision of the 
     Secretary. In accordance with paragraph (5), such 
     notification shall include an explanation of the recommended 
     decision, a discussion of the facts and applicable 
     regulations, and an explanation of the clinical rationale for 
     the final decision.
       ``(7) The Secretary shall notify individuals who submit an 
     application to be a caregiver or family caregiver eligible 
     for the program of comprehensive assistance administered by 
     the Secretary pursuant to this section of the ability of the 
     individual to make an election under paragraph (1).
       ``(8) Nothing in this subsection may be construed to affect 
     claims made by veterans for disability compensation under 
     chapter 11 of this title.''.
       (b) Application.--The amendments made by subsection (a) 
     shall apply with respect to elections under subsection (d) of 
     section 1720G of title 38, United States Code, as added by 
     subsection (a)(2), that are for applications or revocations 
     for assistance for caregivers and family caregivers pursuant 
     to such section for which the Secretary of Veterans Affairs 
     has not made a final decision as of the date of the enactment 
     of this Act.

     SEC. 3. PROCESS TO DETERMINE ELIGIBILITY FOR CAREGIVERS OF 
                   VETERANS.

       (a) Directives.--The Secretary of Veterans Affairs shall 
     issue directives regarding the policies, procedures, and 
     operational requirements for the Family Caregiver Program, 
     including with respect to determining the eligibility of an 
     individual to participate in the Family Caregiver Program.
       (b) GAO Report.--The Comptroller General of the United 
     States shall submit to the Committees on Veterans' Affairs of 
     the House of Representatives and the Senate a report on the 
     processes of the Secretary of Veterans Affairs with respect 
     to--
       (1) determining the eligibility of an individual to 
     participate in the Family Caregiver Program;
       (2) adjudicating appeals to such determinations; and
       (3) the periodic eligibility reevaluation of an individual 
     participating in such program and the communication of any 
     changes as a result of such reevaluations to the veteran and 
     caregiver.
       (c) Family Caregiver Program Defined.--In this section, the 
     term ``Family Caregiver Program'' either the program of 
     comprehensive assistance for family caregivers or the program 
     of general caregiver support services established by section 
     1720G of title 38, United States Code.

     SEC. 4. MODIFICATION TO LIMITATION ON AWARDS AND BONUSES.

       Section 705 of the Veterans Access, Choice, and 
     Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 703 
     note) is amended to read as follows:

     ``SEC. 705. LIMITATION ON AWARDS AND BONUSES PAID TO 
                   EMPLOYEES OF DEPARTMENT OF VETERANS AFFAIRS.

       ``The Secretary of Veterans Affairs shall ensure that the 
     aggregate amount of awards and bonuses paid by the Secretary 
     in a fiscal year under chapter 45 or 53 of title 5, United 
     States Code, or any other awards or bonuses authorized under 
     such title or title 38, United States Code, does not exceed 
     the following amounts:
       ``(1) With respect to each of fiscal years 2017 through 
     2021, $230,000,000.
       ``(2) With respect to each of fiscal years 2022 through 
     2024, $360,000,000.''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Florida (Mr. Miller) and the gentlewoman from Florida (Ms. Brown) each 
will control 20 minutes.
  The Chair recognizes the gentleman from Florida.


                             General Leave

  Mr. MILLER of Florida. Mr. Speaker, I ask unanimous consent that all 
Members may have 5 legislative days within which to revise and extend 
their remarks.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Florida?
  There was no objection.
  Mr. MILLER of Florida. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I rise today in support of H.R. 3989, as amended, 
Support Our Military Caregivers Act.
  Congress created the Family Caregivers Program in 2010 to support 
those family members and friends who put their own lives and careers on 
hold to care for those veterans who have been gravely wounded in 
service to our Nation following September 11, 2001. At the time, VA 
expected 3,000 family caregivers would apply for the program. However, 
in fiscal year 2015 alone, more than 24,000 caregivers participated in 
and received at least one stipend payment through the program.
  Unsurprisingly, in 2014, the GAO found that staffing for the Family 
Caregivers Program was insufficient to meet higher-than-expected 
demand, and staffing shortages impeded the timeliness of the program 
and negatively impacted services to veterans and caregivers. This is 
unacceptable.
  H.R. 3989, as amended, would provide a safety valve for understaffed 
VA caregiver support coordinators by allowing veterans and caregivers 
to elect to have an independent entity provide a clinical review of 
eligibility for the Family Caregivers Program in certain instances. VA 
would be required to take the external clinical review into account and 
to provide clinical justification if VA's ultimate decision is contrary 
to the findings contained in the external clinical review.
  To increase transparency and ensure the program is functioning as 
Congress intended, it would also require VA to issue directives 
outlining the policies, procedures, and operational requirements for 
the Family Caregivers Program and would require GAO to report to 
Congress on VA's processes for determining eligibility for the Family 
Caregivers Program, adjudicating appeals for the Family Caregivers 
Program, and periodically reevaluating eligibility for program 
participants and communicating any changes that result from such 
reevaluation to the veteran or caregiver in question.
  Finally, the bill would also limit the amount of taxpayer dollars 
that VA can spend on awards and bonuses to VA employees.
  H.R. 3989, as amended, is sponsored by Congresswoman Elise Stefanik 
of New York, and I thank her for her hard work and advocacy in 
introducing this bill on behalf of our veterans and caregivers.
  Mr. Speaker, I reserve the balance of my time.
  Ms. BROWN of Florida. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I rise in support of H.R. 3989, as amended. I know 
firsthand how difficult it is to deal with the illness of a loved one. 
I was blessed with the continued vibrant presence of Big Mama, my 
grandmother, until just a few years ago. My mother is with me now in 
Florida.
  I want to say that the work of a caregiver is God's work. I cannot 
think of anything more rewarding, pleasing, tiring, exhausting or 
mentally draining than taking care of a family member.
  I was pleased to support the Caregiver Assistance and Resource 
Enhancement Act in the 111th Congress. President Obama signed into law 
the Caregivers and Veterans Omnibus Health Services Act on May 5, 2010.
  The law requires the Secretary of Veterans Affairs to establish 
caregiver support services to veterans. Family caregivers are the 
foundation of the long-term care system, with more than 50 million 
people who provide informal caregiving for a chronically ill, disabled, 
or aging family member or friend in any given year in the United 
States. In fact, it is estimated that about 80 percent of adults living 
in the community and in need of long-term care depend on family 
caregivers, therefore, costly institutional nursing home care.
  The one issue I have with the legislation is that the bill asks the 
VA to report on expanding the caregiver program. We all know about the 
program. It works.
  Why have another report when we should just expand the program?
  Let me repeat that. We already know that the program works. We don't 
need another report. What we need is to just expand the program.
  I would ask that the Speaker allow us to bring up H.R. 2894, the 
Caregivers Access and Responsible Expansion for All Veterans Act.

[[Page H2916]]

  


                              {time}  1645

  This bill expands the caregivers programs to veterans of all eras. 
The caregivers program works, and we need to expand the program.
  Mr. Speaker, I reserve the balance of my time.
  Mr. MILLER of Florida. Mr. Speaker, I yield such time as she may 
consume to the gentlewoman from the 21st District of New York (Ms. 
Stefanik), the sponsor of this important piece of legislation.
  Ms. STEFANIK. Mr. Speaker, I rise today regarding H.R. 3989, the 
Support Our Military Caregivers Act.
  After working with a constituent who was having trouble with the 
bureaucratic Military Caregiver system at the VA, I was proud to 
introduce this legislation last November.
  Military caregivers are loved ones who selflessly care for our 
Nation's heroes behind the scenes to enhance their everyday lives.
  Thankfully, the Family Caregiver Program, implemented in 2011, was 
designed to ensure caregivers were not forgotten. My bill would 
guarantee that those who dedicate their lives as caregivers receive the 
support they so desperately need and they so desperately deserve.
  My district has the largest veteran population of any district in New 
York State. This has provided me with a greater understanding of the 
selfless sacrifice our veterans and their families provide to our 
community and our Nation.
  Over the last 15 years of war, our servicemembers have served bravely 
and their families have sacrificed an immeasurable amount. So it is 
vital that we ensure they receive the best possible care available.
  Unfortunately, the VA has had a difficult time managing the high 
demand of Family Caregiver enrollees, which is much larger than 
originally accounted for.
  VA medical centers lack sufficient caregiver support coordinators and 
the necessary clinical staff to carry out medical assessments for 
eligibility. Application deadlines are not being met by their own 
internal standards, and the staff is still shorthanded.
  This bill would ensure that military caregivers have access to an 
objective third party to conduct clinical reviews in the event of an 
appeal. It also ensures that the process is transparent so that our 
veterans and caregivers are never left with an unanswered question.
  Military caregivers are truly silent heroes in our communities and 
deserve the respect and benefits proportionate to their significant 
contributions.
  Mr. Speaker, I am truly humbled to represent the veterans in my 
district and will continue to work to improve their lives.
  I want to thank Chairman Benishek of the Veterans' Affairs Health 
Subcommittee for working with me on this legislation as well as 
Chairman Miller and Ranking Member Brown for their leadership and 
bipartisan support of this bill.
  I urge all my colleagues to support this important bill to improve 
the lives of our veterans and their caregivers.
  Ms. BROWN of Florida. Mr. Speaker, I urge passage of H.R. 3989, as 
amended, a bill that is designated to create a process for external 
clinical review of the VA caregivers program.
  I am hoping that the chairman, as we move forward, will work with the 
Senate and try to come up with a way that we can at least have a pilot 
program to expand the caregivers program.
  Mr. Speaker, I yield back the balance of my time.
  Mr. MILLER of Florida. Mr. Speaker, I have one remaining speaker. I 
yield 1 minute to the gentleman from Iowa (Mr. Young).
  Mr. YOUNG of IOWA. Mr. Speaker, I rise today in support of the 
Support Our Military Caregivers Act, of which I am a proud cosponsor.
  Congress established the Family Caregiver Program to assist military 
caregivers and, yet, many face delays in getting the support they need 
to effectively care for our wounded veteran heroes.
  The Support Our Military Caregivers Act would streamline the process, 
allowing the Department of Veterans Affairs to contract with a third 
party to reduce the claims backlog.
  Rather than leave care to strangers, some family members choose to 
quit their job and make other significant life changes to care for 
their loved ones. We need to do more to support them.
  More and more of our veterans are returning from war with battle 
scars or invisible wounds of war. I often meet with Iowa veterans who 
have been wounded while serving our country. We have all met with them. 
These brave servicemembers deserve the best care and assistance we can 
give.
  I am proud to support this bill to support our wounded veterans and 
their dedicated caregivers. I urge my colleagues to join me in passing 
this bipartisan, important bill.
  I want to thank my colleague, Ms. Stefanik, for her bipartisan 
leadership on this bill.
  Mr. MILLER of Florida. Mr. Speaker, I have no further speakers at 
this time. So I would urge my colleagues to support this piece of 
legislation.
  I yield back the balance of my time.
  The SPEAKER pro tempore (Mr. Westerman). The question is on the 
motion offered by the gentleman from Florida (Mr. Miller) that the 
House suspend the rules and pass the bill, H.R. 3989, as amended.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill, as amended, was passed.
  The title of the bill was amended so as to read: ``A bill to amend 
title 38, United States Code, to improve the process for determining 
the eligibility of caregivers of veterans to certain benefits 
administered by the Secretary of Veterans Affairs, and for other 
purposes.''.
  A motion to reconsider was laid on the table.

                          ____________________