[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]]
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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.
____________________