[House Report 111-224]
[From the U.S. Government Publishing Office]


111th Congress  }                                          {     Report
  1st Session   }       HOUSE OF REPRESENTATIVES           {    111-224
                                                    
======================================================================
 
           CAREGIVER ASSISTANCE AND RESOURCE ENHANCEMENT ACT 

                                _______
                                

 July 23, 2009.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

  Mr. Filner, from the Committee on Veterans' Affairs, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 3155]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 3155) to amend title 38, United States Code, to 
provide certain caregivers of veterans with training, support, 
and medical care, and for other purposes, having considered the 
same, report favorably thereon with an amendment and recommend 
that the bill as amended do pass.

                                CONTENTS

                                                                   Page
Amendment........................................................     2
Purpose and Summary..............................................     6
Background and Need for Legislation..............................     6
Hearings.........................................................     8
Subcommittee Consideration.......................................     8
Committee Consideration..........................................     9
Committee Votes..................................................     9
Committee Oversight Findings.....................................     9
Statement of General Performance Goals and Objectives............     9
New Budget Authority, Entitlement Authority, and Tax Expenditures     9
Earmarks and Tax and Tariff Benefits.............................     9
Committee Cost Estimate..........................................     9
Congressional Budget Office Estimate.............................     9
Federal Mandates Statement.......................................    13
Advisory Committee Statement.....................................    13
Constitutional Authority Statement...............................    13
Applicability to Legislative Branch..............................    14
Section-by-Section Analysis of the Legislation...................    14
Changes in Existing Law Made by the Bill as Reported.............    15

                               Amendment

    The amendment is as follows:
    Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Caregiver Assistance and Resource 
Enhancement Act''.

SEC. 2. SUPPORT SERVICES FOR CAREGIVERS.

  (a) Definitions.--Section 1701 of title 38, United States Code, is 
amended by adding at the end the following new paragraphs:
          ``(10) The term `caregiver services' means noninstitutional 
        extended care (as used in paragraph (6)).
          ``(11) The term `caregiver' means an individual who--
                  ``(A) with respect to a disabled veteran who is 
                enrolled in the health care system established under 
                section 1705(a) of this title, provides caregiver 
                services to such veteran for such disability; and
                  ``(B) is not a member of the family (including 
                parents, spouses, children, siblings, step-family 
                members, and extended family members) of such veteran.
          ``(12) The term `family caregiver' means an individual who--
                  ``(A) with respect to a disabled veteran who is 
                enrolled in the health care system established under 
                section 1705(a) of this title, provides caregiver 
                services to such veteran for such disability;
                  ``(B) is a member of the family (including parents, 
                spouses, children, siblings, step-family members, and 
                extended family members) of such veteran; and
                  ``(C) may or may not reside with such veteran.''.
  (b) Support Services.--
          (1) 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. 1720G. Support services for caregivers and family caregivers

  ``(a) Establishment of Program.--The Secretary shall develop and 
carry out a program for caregivers and family caregivers that includes 
the following:
          ``(1) The educational sessions, stipends, and access to 
        support services provided under this section.
          ``(2) Counseling and other services provided under section 
        1782 of this title.
          ``(3) Respite care provided under section 1720B of this 
        title.
          ``(4) With respect to family caregivers, medical care 
        provided under section 1781(e) of this title.
          ``(5) Travel expenses provided under section 111(e) of this 
        title.
  ``(b) Educational Sessions.--(1) The Secretary shall make available 
educational sessions for caregivers, family caregivers, and individuals 
described in paragraph (2). Such educational sessions shall--
          ``(A) be made available both in person and on an Internet 
        website;
          ``(B) incorporate available technology, including telehealth 
        technology to the extent practicable; and
          ``(C) teach techniques, strategies, and skills for caring for 
        a disabled veteran, including, at a minimum, a veteran who--
                  ``(i) was deployed in support of Operation Enduring 
                Freedom or Operation Iraqi Freedom; and
                  ``(ii) has post-traumatic stress disorder, a 
                traumatic brain injury, or other severe injury or 
                illness.
  ``(2) Individuals described in this paragraph are individuals who 
provide caregivers and family caregivers with support under this 
chapter or through an aging network (as defined in section 102(5) of 
the Older Americans Act of 1965 (42 U.S.C. 3002(5)), including--
          ``(A) respite care providers;
          ``(B) nursing care providers; and
          ``(C) counselors.
  ``(c) Stipends.--(1) The Secretary shall provide monthly stipends to 
eligible family caregivers described in paragraph (2).
  ``(2) An eligible family caregiver described in this paragraph is a 
family caregiver who--
          ``(A) provides caregiver services to a veteran who--
                  ``(i) was deployed in support of Operation Enduring 
                Freedom or Operation Iraqi Freedom; and
                  ``(ii) for purposes of this subsection, is determined 
                by the Secretary--
                          ``(I) to have a service-connected disability 
                        or illness that is severe;
                          ``(II) to be in need of caregiver services, 
                        such that without such services, the veteran 
                        would require hospitalization, nursing home 
                        care, or other residential institutional care; 
                        and
                          ``(III) based on an examination by a 
                        physician employed by the Department (or, in 
                        areas where no such physician is available, by 
                        a physician carrying out such function under a 
                        contract or fee arrangement), to be unable to 
                        carry out the activities (including 
                        instrumental activities) of daily living;
          ``(B) with respect to such veteran, meets the definition of 
        the term `family caregiver' under section 1701(12) of this 
        title;
          ``(C) is designated by such veteran as the primary family 
        caregiver for such veteran; and
          ``(D) is not--
                  ``(i) employed by a home health care agency to 
                provide such caregiver services; or
                  ``(ii) otherwise receiving payment for such services.
  ``(3) The authority of the Secretary to provide a stipend to an 
eligible family caregiver under this subsection shall expire on October 
1, 2012.
  ``(d) Access to Support Services.--The Secretary shall provide 
caregivers and family caregivers with information concerning public, 
private, and non-profit agencies that offer support to caregivers. In 
providing such information, the Secretary shall--
          ``(1) collaborate with the Assistant Secretary for Aging of 
        the Department of Health and Human Services in order to provide 
        caregivers and family caregivers access to aging and disability 
        resource centers under the Administration on Aging of the 
        Department of Health and Human Services; and
          ``(2) include on an Internet website that is dedicated to 
        caregivers and family caregivers--
                  ``(A) a directory of services available for 
                caregivers and family caregivers at the county level; 
                and
                  ``(B) tools that provide caregivers and family 
                caregivers with the ability to interact with each other 
                for the purpose of fostering peer support and creating 
                support networks.
  ``(e) Information and Outreach.--(1) The Secretary shall conduct 
outreach to inform disabled veterans and the families of such veterans 
of the following:
          ``(A) Medical care, educational sessions, stipends, and other 
        services available for caregivers and family caregivers under 
        this chapter.
          ``(B) The ability of a family caregiver to be trained and 
        certified by a home health care agency in order to be paid by 
        such agency for providing caregiver services.
  ``(2) Outreach under this subsection shall include, at a minimum, the 
following:
          ``(A) Public service announcements.
          ``(B) Brochures and pamphlets.
          ``(C) Full use of Internet-based outreach methods, including 
        such methods designed specifically for veterans and the 
        families of such veterans who reside in rural areas.
  ``(3) With respect to a Department employee providing case management 
services (as defined in section 1720C(b)(2) of this title) to a 
disabled veteran, the Secretary shall ensure that such employee 
provides a caregiver or family caregiver of such veteran with 
information on the services described in subparagraphs (A) and (B) of 
paragraph (1).''.
          (2) Clerical amendment.--The table of sections at the 
        beginning of chapter 17 of title 38, United States Code, is 
        amended by inserting after the item related to section 1720F 
        the following new item:

``1720G. Support services for caregivers and family caregivers.''.

  (c) Plan.--Not later than 180 days after the date of the enactment of 
this Act, the Secretary shall submit to the Committee on Veterans' 
Affairs of the House of Representatives and the Committee on Veterans' 
Affairs of the Senate a plan for carrying out section 1720G of title 
38, United States Code, as added by subsection (b) of this section.
  (d) Reports.--Not later than 180 days after the date on which the 
plan is submitted under subsection (c), and annually thereafter for the 
following five years, the Secretary shall submit to the Committee on 
Veterans' Affairs of the House of Representatives and the Committee on 
Veterans' Affairs of the Senate a report describing the implementation 
of the plan.

SEC. 3. COUNSELING AND MENTAL HEALTH SERVICES FOR CAREGIVERS AND FAMILY 
                    CAREGIVERS.

  (a) In General.--Section 1782 of title 38, United States Code, is 
amended--
          (1) in the section heading, by adding at the end the 
        following: ``, caregivers, and family caregivers''; and
          (2) in subsection (c)--
                  (A) in paragraph (1), by striking ``; or'' and 
                inserting a semicolon;
                  (B) by redesignating paragraph (2) as paragraph (3); 
                and
                  (C) by inserting after paragraph (1) the following 
                new paragraph (2):
          ``(2) a caregiver or family caregiver of a veteran; or''.
  (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 17 of title 38, United States Code, is amended by striking the 
item relating to section 1782 and inserting the following new item:

``1782. Counseling, training, and mental health services for immediate 
family members, caregivers, and family caregivers.''.

SEC. 4. RESPITE CARE TO ASSIST FAMILY CAREGIVERS.

  Section 1720B of title 38, United States Code, is amended--
          (1) in subsection (a), by striking ``title.'' and inserting 
        ``title or who receives care from a family caregiver.''; and
          (2) by adding at the end the following new subsection:
  ``(d) In furnishing respite care services under this section, the 
Secretary shall ensure that such services--
          ``(1) fulfill the needs of the veteran receiving care 
        (including 24-hour in-home respite care); and
          ``(2) are appropriate for the veteran with respect to the age 
        of the veteran.''.

SEC. 5. MEDICAL CARE FOR FAMILY CAREGIVERS.

  Section 1781 of title 38, United States Code, is amended--
          (1) in subsection (a)--
                  (A) in paragraph (2), by striking ``and'' at the end;
                  (B) in paragraph (3), by inserting ``and'' at the 
                end; and
                  (C) by inserting after paragraph (3) the following 
                new paragraph:
          ``(4) in accordance with subsection (e), a family 
        caregiver,'';
          (2) in the third sentence of subsection (b), by striking 
        ``dependent or survivor'' and inserting ``dependent, survivor, 
        or family caregiver''; and
          (3) by adding at the end the following new subsection:
  ``(e)(1) The Secretary shall provide medical care to a family 
caregiver under this section if the Secretary determines that the 
family caregiver is not entitled to care or services under a health-
plan contract as defined under section 1725(f)(2) of this title 
(determined, in the case of a health-plan contract as defined in 
subsection (f)(2)(B) or (f)(2)(C) of such section, without regard to 
any requirement or limitation relating to eligibility for care or 
services from any department or agency of the United States).
  ``(2) In this subsection, a family caregiver is an individual who--
          ``(A) provides caregiver services to a veteran who--
                  ``(i) was deployed in support of Operation Enduring 
                Freedom or Operation Iraqi Freedom; and
                  ``(ii) for purposes of this subsection, is determined 
                by the Secretary--
                          ``(I) to have a service-connected disability 
                        or illness that is severe;
                          ``(II) to be in need of caregiver services, 
                        such that without such services, the veteran 
                        would require hospitalization, nursing home 
                        care, or other residential institutional care; 
                        and
                          ``(III) based on an examination by a 
                        physician employed by the Department (or, in 
                        areas where no such physician is available, by 
                        a physician carrying out such function under a 
                        contract or fee arrangement), to be unable to 
                        carry out the activities (including 
                        instrumental activities) of daily living;
          ``(B) with respect to such veteran, meets the definition of 
        the term `family caregiver' under section 1701(12) of this 
        title; and
          ``(C) is designated by such veteran as the primary family 
        caregiver for such veteran.
  ``(3) The authority of the Secretary to provide medical care to a 
family caregiver under this section shall expire on October 1, 2012.''.

SEC. 6. LODGING AND SUBSISTENCE FOR FAMILY CAREGIVERS.

  Section 111(e) of title 38, United States Code, is amended--
          (1) by striking ``When'' and inserting the following: ``(1) 
        Except as provided in paragraph (2), when''; and
          (2) by adding at the end the following new paragraphs:
  ``(2) Without regard to whether a covered veteran entitled to mileage 
under this section requires an attendant in order to perform such 
travel, an attendant of such covered veteran may be allowed expenses of 
travel (including lodging and subsistence) upon the same basis as such 
veteran during--
          ``(A) the period of time in which such veteran is traveling 
        to and from a treatment facility; and
          ``(B) the duration of the treatment episode for such veteran.
  ``(3) The Secretary may prescribe regulations to carry out this 
subsection. Such regulations may include provisions--
          ``(A) to limit the number of attendants that may receive 
        expenses of travel under paragraph (2) for a single treatment 
        episode of a covered veteran; and
          ``(B) to require such attendants to use certain travel 
        services.
  ``(4) In this subsection, the term `covered veteran' means a veteran 
who--
          ``(A) was deployed in support of Operation Enduring Freedom 
        or Operation Iraqi Freedom; and
          ``(B) for purposes of this subsection, is determined by the 
        Secretary--
                  ``(i) to have a service-connected disability or 
                illness that is severe;
                  ``(ii) to be in need of caregiver services, such that 
                without such services, the veteran would require 
                hospitalization, nursing home care, or other 
                residential institutional care; and
                  ``(iii) based on an examination by a physician 
                employed by the Department (or, in areas where no such 
                physician is available, by a physician carrying out 
                such function under a contract or fee arrangement), to 
                be unable to carry out the activities (including 
                instrumental activities) of daily living.''.

SEC. 7. SURVEY ON CAREGIVERS AND FAMILY CAREGIVERS.

  (a) In General.--Not later than 270 days after the date of the 
enactment of this Act, and not less than once in each three-year period 
thereafter, the Secretary of Veterans Affairs shall design and conduct 
a survey of caregivers and family caregivers. In carrying out the 
survey, the Secretary shall collect the following information:
          (1) The number of caregivers.
          (2) The number of family caregivers.
          (3) The number of veterans receiving caregiver services from 
        caregivers and family caregivers, including the era in which 
        each veteran served in the Armed Forces.
          (4) The range of caregiver services provided by caregivers 
        and family caregivers, including--
                  (A) the average schedule of such services; and
                  (B) the average amount of time a caregiver and family 
                caregiver has spent providing such services.
          (5) The average age of a caregiver and family caregiver.
          (6) The health care coverage of caregivers and family 
        caregivers, including the sources of such coverage.
          (7) The employment status of caregivers and family 
        caregivers.
          (8) Incidents of significant life changes related to being a 
        caregiver or family caregiver, including unemployment and 
        disenrollment from a course of education.
          (9) The number of family caregivers trained and certified 
        through a home health care agency.
          (10) Other information the Secretary considers appropriate.
  (b) Survey Sample.--In carrying out the survey required by subsection 
(a), the Secretary shall ensure that--
          (1) a statistically representative sample of caregivers and 
        family caregivers is included in the survey; and
          (2) such sample covers veterans in each Veterans Integrated 
        Service Network.
  (c) Findings.--The Secretary shall consider the findings of the 
survey when carrying out programs related to caregivers and family 
caregivers.
  (d) Reports.--Not later than 180 days after the date on which each 
survey is completed, the Secretary shall submit to the Committee on 
Veterans' Affairs of the House of Representatives and the Committee on 
Veterans' Affairs of the Senate a report on caregivers and family 
caregivers. Each such report shall include--
          (1) the findings of the survey required by subsection (a);
          (2) a summary of the services made available to caregivers 
        and family caregivers by the Secretary;
          (3) the number of caregivers and family caregivers who 
        receive such services;
          (4) the cost to the Department of Veterans Affairs of 
        providing each such service; and
          (5) other information the Secretary considers appropriate.
  (e) Definitions.--In this section:
          (1) The term ``caregiver'' has the meaning given such term in 
        section 1701(11) of title 38, United States Code, as added by 
        section 2(a) of this Act.
          (2) The term ``family caregiver'' has the meaning given such 
        term in section 1701(12) of title 38, United States Code, as 
        added by section 2(a) of this Act.

                          Purpose and Summary

    H.R. 3155 was introduced by Representative Michael H. 
Michaud of Maine, Chairman of the Subcommittee on Health of the 
Committee on Veterans' Affairs, on July 9, 2009. H.R. 3155, as 
amended, would create a new caregiver program to help family 
and non-family members who provide care for disabled, ill, or 
injured veterans enrolled in the U.S. Department of Veterans 
Affairs (VA) health care system. The VA would also be required 
to conduct a survey on caregivers in order to better understand 
this population. Key components of the new caregiver program 
would include support services such as educational sessions, 
access to a comprehensive one-stop resource directory, 
counseling and mental health services, and respite care. In 
addition, this legislation would provide a monthly financial 
stipend, health care through the Civilian Health and Medical 
Program of the Department of Veterans Affairs (CHAMPVA), and 
lodging and subsistence to eligible caregivers of certain 
veterans.

                  Background and Need for Legislation

    Today, more servicemembers are surviving the wounds of war 
than those injured in previous conflicts. For example, the 
ratio of wounded to killed averaged approximately 1.7 wounded 
for every fatality for the first two World Wars. In Korea and 
Vietnam, the ratio improved to three wounded per fatality, 
largely due to air medical evacuation. In Operation Enduring 
Freedom and Operation Iraqi Freedom (OEF/OIF), improved body 
armor and superior battlefield medicine techniques have 
resulted in seven wounded per fatality. The increasing number 
of wounded OEF/OIF servicemembers surviving the war brings to 
the forefront the question of who will provide continuing care 
for these injured men and women once they transition to veteran 
status.
    It is estimated that for any given year there are more than 
50 million people who provide informal caregiving for a 
chronically ill, disabled, or aged family member or friend. 
These caregivers serve as the foundation of the country's long-
term care system. It is estimated that about 80 percent of 
adults living in the community and in need of long-term care 
depend on a family member or a friend, thereby avoiding costly 
institutional nursing home care. The majority of these 
caregivers are women. Caregiving exacts both a financial and 
physical toll on these individuals. For example, women 
caregivers are more than twice as likely to live in poverty and 
are five times more likely to receive Supplemental Security 
Income (SSI) than their non-caregiver counterparts. Also, 
individuals serving as caregivers for a family or friend report 
having a chronic health condition at twice the rate of non-
caregivers and those who provide 36 or more hours of weekly 
care are more likely to experience symptoms of depression and 
anxiety than non-caregivers.
    Because the VA does not collect data on this population, 
the number of family members and friends who provide care for 
veterans is unknown. However, the July 2007 report of the 
President's Commission on Care for America's Returning Wounded 
Warriors (Dole-Shalala Commission) found that of the 1,730 
injured OEF/OIF veterans surveyed, about 21 percent of active 
duty, 15 percent of the reserve, and 24 percent of retired or 
separated servicemembers had friends or family who gave up a 
job to be a caregiver. In order to better understand the 
caregiver population providing care to veterans, H.R. 3155 
would require the VA to conduct a caregivers survey at least 
once every three years to individuals caring for veterans 
enrolled in the VA health care system. It would also require a 
report to Congress providing the findings of the survey no 
later than 180 days after the date on which the survey is 
completed. The Committee believes that this study would be an 
essential component in meeting the needs of caregivers in the 
future.
    H.R. 3155 would establish a new caregiver program in order 
to provide coordinated support services to caregivers. 
Caregivers often have a poor understanding of the services they 
are eligible for, thereby resulting in an underutilization of 
caregiver support services available through the VA. H.R. 3155 
would require the VA to train existing case managers to also 
provide information about support services and benefits 
available to the caregivers of such veterans. This legislation 
would also require the VA to provide information and conduct 
outreach using all mediums of communication to spread the 
message about caregiver support services available through the 
VA, including new services made available through this Act.
    Although VA offers support services to caregivers of 
veterans, additional services are needed for those who forego 
their employment, education, or make other major life changes 
in order to care for their wounded veteran family member. The 
well-being of the caregiver is important as it affects the 
quality of care that the wounded veteran receives. Ensuring the 
best care for our veterans means equipping family caregivers 
with the right tools and support services. H.R. 3155 would 
provide a range of support services to help both family and 
non-family caregivers of veterans of all eras. This includes 
educational sessions for caregivers, a one-stop caregiver 
resource directory, and respite care which is age-appropriate 
and meets the needs of the veteran. This legislation would also 
provide counseling and mental health services, and include peer 
support groups to help caregivers cope with the daily stress of 
caregiving.
    H.R. 3155 would provide key benefits of lodging and 
subsistence, a financial stipend, and health care for a select 
group of caregivers of certain eligible veterans. The Committee 
believes that a family caregiver will be better positioned to 
care for the injured veteran by attending to their own health 
care needs and general wellness. This legislation would define 
certain eligible veterans as those who were deployed in support 
of OEF/OIF, are determined by the Secretary of VA to have a 
severe service-connected injury or illness, are unable to carry 
out activities of daily living (including instrumental 
activities), and are in need of caregiver services such that 
without them the veteran would require hospitalization, nursing 
home care, or other residential institutional care. This 
legislation would authorize the VA to reimburse caregivers for 
lodging and subsistence when they accompany certain eligible 
veterans on medical visits. Such caregivers must meet the 
definition of an attendant under the current statute. This 
would help to address the plight of some family caregivers who 
depend on the travel, meals, and lodging allowance provided by 
the Department of Defense (DoD), which is suddenly discontinued 
when the wounded warrior transitions to veteran status. This 
provision would be a step forward in establishing some parity 
and continuity in caregiver benefits provided by DoD and VA. 
This legislation would also provide a monthly financial stipend 
to primary family caregivers of certain eligible veterans 
through October 1, 2012. To be eligible, the caregiver may not 
be employed by a home health care agency to provide caregiver 
services to a family member veteran, or otherwise receive 
payment for such services. Finally, H.R. 3155 would provide 
health care through the CHAMPVA program through October 1, 
2012, to primary family caregivers of certain eligible veterans 
if they are without health insurance or are not eligible for 
other public health insurance options.

                                Hearings

    On June 4, 2009, the Subcommittee on Health held an 
oversight on ``Meeting the Needs of Family Caregivers of 
Veterans.'' The following witnesses testified: Anna Frese, 
Caregiver, Wounded Warrior Project; Commander Rene A. Campos, 
U.S. Navy (Ret.), Deputy Director, Government Relations, 
Military Officers Association of America; Barbara Cohoon, 
Ph.D., RN, Government Relations Deputy Director, National 
Military Family Association; Jill Kagan, MPH, Chair, ARCH 
National Respite Coalition; Suzanne G. Mintz, President and Co-
Founder, National Family Caregivers Association; Mark S. 
Heaney, President and Chief Executive Officer, Addus 
Healthcare, Inc., Home Care Aide Section Representative 
Officer, National Association for Home and Hospice Care; 
Madhulika Agarwal, M.D., MPH, Chief Patient Care Services 
Officer, Veterans Health Administration, U.S. Department of 
Veterans Affairs accompanied by Lucille Beck, Ph.D., Chief 
Consultant, Rehabilitation Services, Veterans Health 
Administration, U.S. Department of Veterans Affairs; Thomas E. 
Edes, MS, Director of Home and Community-Based Care, Office of 
Geriatrics and Extended Care, Veterans Health Administration, 
U.S. Department of Veterans Affairs; Thomas J. Kniffen, Chief, 
Regulations Staff, Compensation and Pension Service, Veterans 
Benefits Administration, U.S. Department of Veterans Affairs; 
Edwin L. Walker, Acting Assistant Secretary for Aging, 
Administration on Aging, U.S. Department of Health and Human 
Services; and, Noel Koch, Deputy Under Secretary, Office of 
Transition Policy and Care Coordination, U.S. Department of 
Defense. Adrian Atizado, Assistant National Legislative 
Director, Disabled American Veterans submitted a statement for 
the record.

                       Subcommittee Consideration

    On July 9, 2009, the Subcommittee on Health met in open 
markup session and ordered favorably forwarded to the full 
Committee H.R. 3155 by voice vote.

                        Committee Consideration

    On July 15, 2009, the full Committee met in an open markup 
session, a quorum being present, and ordered H.R. 3155, as 
amended, reported favorably to the House of Representatives, by 
voice vote. During consideration of the bill, the following 
amendment was considered:
          An amendment in the nature of a substitute by Mr. 
        Michaud of Maine to establish a new caregiver program 
        and to provide for a monthly stipend was agreed to by 
        voice vote.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list the record votes 
on the motion to report the legislation and amendments thereto. 
There were no record votes taken on amendments or in connection 
with ordering H.R. 3155 reported to the House. A motion by Mr. 
Buyer of Indiana to order H.R. 3155, as amended, reported 
favorably to the House of Representatives was agreed to by 
voice vote.

                      Committee Oversight Findings

    In compliance with clause 3(c)(1) of rule XIII and clause 
2(b)(1) of rule X of the Rules of the House of Representatives, 
the Committee's oversight findings and recommendations are 
reflected in the descriptive portions of this report.

         Statement of General Performance Goals and Objectives

    In accordance with clause 3(c)(4) of rule XIII of the Rules 
of the House of Representatives, the Committee's performance 
goals and objectives are reflected in the descriptive portions 
of this report.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee adopts as its 
own the estimate of new budget authority, entitlement 
authority, or tax expenditures or revenues contained in the 
cost estimate prepared by the Director of the Congressional 
Budget Office pursuant to section 402 of the Congressional 
Budget Act of 1974.

                  Earmarks and Tax and Tariff Benefits

    H.R. 3155 does not contain any congressional earmarks, 
limited tax benefits, or limited tariff benefits as defined in 
clause 9(d), 9(e), or 9(f) of rule XXI of the Rules of the 
House of Representatives.

                        Committee Cost Estimate

    The Committee adopts as its own the cost estimate on H.R. 
3155 prepared by the Director of the Congressional Budget 
Office pursuant to section 402 of the Congressional Budget Act 
of 1974.

               Congressional Budget Office Cost Estimate

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
for H.R. 3155 provided by the Congressional Budget Office 
pursuant to section 402 of the Congressional Budget Act of 
1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                     Washington, DC, July 23, 2009.
Hon. Bob Filner,
Chairman, Committee on Veterans' Affairs, House of Representatives, 
        Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 3155, the 
Caregiver Assistance and Resource Enhancement Act.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Sunita 
D'Monte.
            Sincerely,
                                         Robert A. Sunshine
                              (For Douglas W. Elmendorf, Director).
    Enclosure.

H.R. 3155--Caregiver Assistance and Resource Enhancement Act

    Summary: H.R. 3155 would authorize several programs for 
caregivers of disabled veterans. CBO estimates that 
implementing the bill would cost $193 million over the 2010-
2014 period, assuming appropriation of the estimated amounts. 
Enacting the bill would not affect direct spending or revenues.
    H.R. 3155 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act and 
would not affect the budgets of state, local, or tribal 
governments.
    Estimated cost to the Federal Government: The estimated 
budgetary impact of H.R. 3155 is shown in the following table. 
The costs of this legislation fall within budget function 700 
(veterans' benefits and services).
    Basis of estimate: For this estimate, CBO assumes the 
legislation will be enacted near the start of fiscal year 2010, 
that the estimated authorizations will be provided near the 
start of each fiscal year, and that outlays will follow 
historical patterns for similar and existing programs.

----------------------------------------------------------------------------------------------------------------
                                                                 By fiscal year, in millions of dollars--
                                                         -------------------------------------------------------
                                                            2010     2011     2012     2013     2014   2010-2014
----------------------------------------------------------------------------------------------------------------
                                  CHANGES IN SPENDING SUBJECT TO APPROPRIATIONRespite Care:
    Estimated Authorization Level.......................        6       12       25       26       27        96
    Estimated Outlays...................................        5       11       23       25       26        90
Support Services:
    Estimated Authorization Level.......................        5       11       23       24       25        88
    Estimated Outlays...................................        5       10       21       23       24        83
Stipends for Family Caregivers:
    Estimated Authorization Level.......................        2        4        8        0        0        14
    Estimated Outlays...................................        2        4        8        *        0        14
Lodging and Subsistence Benefits for Family Caregivers:
    Estimated Authorization Level.......................        *        *        1        1        1         3
    Estimated Outlays...................................        *        *        1        1        1         3
Survey:
    Estimated Authorization Level.......................        1        0        0        1        0         2
    Estimated Outlays...................................        1        *        0        1        *         2
Medical Care for Family Caregivers:
    Estimated Authorization Level.......................        *        *        1        0        0         1
    Estimated Outlays...................................        *        *        1        *        0         1
Total Changes:
    Estimated Authorization Level.......................       14       27       58       52       53       204
    Estimated Outlays...................................       13       25       54       50       51      193
----------------------------------------------------------------------------------------------------------------
Note: * = less than $500,000.

Respite care

    Section 4 of the bill would authorize the Department of 
Veterans Affairs (VA) to provide respite care to family members 
who are caregivers of disabled veterans enrolled in the VA 
health care system. CBO estimates that implementing that 
provision would cost $90 million over the 2010-2014 period, 
assuming appropriation of the necessary amounts.
    Under current law, caregivers of veterans who receive 
medical services, hospital care, nursing home care, or 
domiciliary care from VA are eligible for up to 30 days of 
respite care. The bill would extend eligibility for that 
benefit to family caregivers of enrolled veterans who do not 
receive such care. Based on information from VA, CBO estimates 
that the majority of disabled, enrolled veterans who require 
caregivers currently receive care from VA, and that about 1,200 
additional caregivers would become newly eligible for respite 
care in 2010 under this provision. CBO further estimates that 
VA would provide an average of 21 days of respite care to each 
caregiver--at a daily cost of $210 in 2010--for a cost of $5 
million that year. After adjusting for inflation and gradual 
implementation of the program, CBO estimates that by 2014 about 
5,100 caregivers would receive respite care at a cost of $26 
million.

Support services

    Several provisions in section 2 would require VA to provide 
various support services to caregivers of disabled veterans 
enrolled in the VA health care system and to individuals who 
provide support to those caregivers, such as counselors and 
providers of respite or nursing care. CBO estimates that 
implementing those provisions would cost $83 million over the 
2010-2014 period, assuming appropriation of the necessary 
amounts.
    Under the bill, VA would be required to:
     Provide education and training sessions on caring 
for disabled veterans,
     Establish an educational website to provide 
information on caring for disabled veterans and on other 
federal and private entities that support caregivers, and
     Inform disabled veterans and their families about 
its support services.
    VA has indicated that it would provide the required 
education and training sessions primarily through telehealth 
programs; caregivers would be able to access pre-recorded 
presentations through community-based outpatient clinics. 
Additional training would be provided a few times each year at 
VA's 153 medical centers. Based on information from VA, CBO 
estimates that in 2010 the department would provide training to 
about 4,400 caregivers at a cost of $1,000 per person. Total 
costs for that year would be $4 million. After adjusting for 
inflation and gradual implementation of the program, CBO 
estimates that by 2014 about 17,400 caregivers would receive 
training at a cost of $22 million that year. Costs to establish 
a Web site and conduct outreach would total between $1 million 
and $2 million a year, CBO estimates.

Stipends for family caregivers

    Section 2 also would require VA to pay a stipend to 
caregivers of certain veterans. CBO estimates that implementing 
that provision would cost $14 million over the 2010-2014 
period, assuming appropriation of the necessary amounts.
    Under the bill, VA would pay a monthly stipend to family 
members who care for certain veterans of Operation Iraqi 
Freedom and Operation Enduring Freedom (OIF/OEF). The bill 
specifies that those veterans must have a severe illness or 
disability connected to their military service, be unable to 
perform activities of daily living (such as bathing, feeding, 
and dressing), and require caregiver services to such an extent 
that without those services, they would require care in an 
institutional setting (such as a hospital or nursing home). The 
program would end in 2012.
    Based on data from VA on the number of covered veterans and 
from the Bureau of Labor Statistics on average hourly pay for 
home healthcare aides, CBO estimates that in 2010, VA would pay 
50 family caregivers a stipend of $3,500 a month (an hourly 
rate of $10.50 for an average of 340 hours a month), for a cost 
of $2 million in 2010. After adjusting for gradual 
implementation of the program over the 2010-2012 period and for 
inflation, CBO estimates that the number of family caregivers 
receiving stipends would grow to 180 in 2012, at a cost of $8 
million in that year.

Lodging and subsistence benefits for family caregivers

    Section 6 would authorize VA to pay transportation, 
lodging, and subsistence expenses of family caregivers of 
certain OIF/OEF veterans, on the same basis as those expenses 
are paid for such veterans. Over the 2010-2014 period, CBO 
estimates that implementing this provision would cost $3 
million, assuming appropriation of the necessary amounts.
    The population eligible for this benefit is identical to 
the population eligible for the monthly stipends under section 
2; however, CBO estimates that in any given year about 75 
percent of veterans would travel to VA facilities with their 
caregiver. CBO estimates that caregivers would either travel in 
the same vehicle with the veteran or would be deemed medically 
necessary attendants; VA is authorized under current law to pay 
transportation expenses in those instances.
    Lodging and subsistence expenses of caregivers are not 
reimbursable under current law. Based on information from VA, 
CBO estimates that in 2010 VA would reimburse $3,900 each to 35 
family caregivers (an average per diem rate of $130 for 30 days 
a year), for a cost of less than $500,000 in 2010. After 
adjusting for gradual implementation of the program over the 
2010-2012 period and for inflation, CBO estimates that the 
number of family caregivers receiving reimbursements would grow 
to 135 by 2012, at an annual cost thereafter of $1 million.

Survey

    Section 7 would require VA to design and conduct a survey 
of veterans' caregivers, once within a year of enactment of the 
bill and a second time over the following three-year period. 
Based on information from VA, CBO estimates that implementing 
that provision would cost $2 million over the 2010-2014 period, 
assuming the availability of appropriated funds.

Medical care for family caregivers

    Section 5 would authorize VA to provide medical care to 
family caregivers of certain OIF/OEF veterans, if such 
caregivers are not covered under other health plans. The 
program would end in 2012. CBO estimates that implementing the 
provision would cost $1 million over the 2010-2014 period, 
assuming availability of the necessary amounts.
    The population eligible for this benefit also is similar to 
the population eligible for the monthly stipend under section 
2; however, CBO estimates that only half the caregivers would 
be eligible (i.e. would not be covered under other health 
plans) and would seek medical care from VA. Based on 
information from VA on the cost of health care it provides to 
non-veterans, CBO estimates that in 2010 they would provide 
medical care to 25 family caregivers at an average cost of 
$6,000 each. After adjusting for inflation and gradual 
implementation of the program, CBO estimates that the number of 
family caregivers receiving medical care would grow to 90 by 
2012, at a cost of $1 million over the 2010-2014 period.
    Intergovernmental and private-sector impact: H.R. 3155 
contains no intergovernmental or private-sector mandates as 
defined in the Unfunded Mandates Reform Act and would not 
affect the budgets of state, local, or tribal governments.
    Estimate prepared by: Federal Costs: Sunita D'Monte; Impact 
on State, Local, and Tribal Governments: Lisa Ramirez-Branum; 
Impact on the Private Sector: Elizabeth Bass.
    Estimate approved by: Theresa Gullo, Deputy Assistant 
Director for Budget Analysis.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates regarding H.R. 3155 prepared by the Director of the 
Congressional Budget Office pursuant to section 423 of the 
Unfunded Mandates Reform Act.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act would be created by H.R. 
3155.

                   Constitutional Authority Statement

    Pursuant to clause 3(d)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that the 
Constitutional authority for H.R. 3155 is provided by Article 
I, section 8 of the Constitution of the United States.

                  Applicability to Legislative Branch

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

             Section-by-Section Analysis of the Legislation


Section 1. Short title

    This section provides the short title of H.R. 3155 as the 
``Caregiver Assistance and Resource Enhancement Act.''

Section 2. Support services for caregivers

    This section establishes a new caregiver program for family 
and non-family caregivers of veterans. The program is to be 
comprised of support services, a monthly financial stipend, 
counseling and mental health services, respite care, medical 
care, and reimbursements for certain travel expenses. The VA is 
required to train case managers of veterans so that they can 
inform caregivers of such veterans about the services and 
benefits available through the new caregiver program.
    Support services are to be provided to family and non-
family caregivers of veterans enrolled in the VA health care 
system. Such services include education sessions on how to be a 
better caregiver; one-stop access to support services via a 
dedicated caregiver support Internet website; and information 
and outreach. It also includes a monthly financial stipend to 
primary family caregivers of certain eligible OEF/OIF veterans, 
which is available through October 1, 2012. Caregivers may not 
receive the stipend if they are employed by a home health 
agency to provide care to a family member veteran or are 
otherwise receiving payment for such services.
    This section also requires the VA to submit to Congress an 
implementation plan no later than 180 days after the date of 
the enactment of the Act. In addition, the VA must submit to 
Congress a program report, which is due no later than 180 days 
after the date on which the implementation plan is submitted, 
as well as an annual program report for the following five 
years.

Section 3. Counseling and mental health services for caregivers and 
        family caregivers

    This section makes counseling and mental health services 
available to family and non-family caregivers of veterans 
enrolled in the VA health care system.

Section 4. Respite care to assist family caregivers

    This section requires the VA to ensure that respite care 
meets the needs of the veteran receiving care, including 24-
hour in-home respite care. It also requires the VA to ensure 
that respite care is appropriate for the veteran with respect 
to the age of the veteran.

Section 5. Medical care for family caregivers

    This section expands CHAMPVA to a primary family caregiver 
who provides caregiver services to certain eligible veterans, 
and who are without health insurance or are not eligible for 
other public health insurance options. Eligible veterans 
include those who were deployed in support of OEF/OIF and are 
determined by the Secretary of the VA to have a service-
connected disability or illness that is severe; to be in need 
of caregiver services so that without such services, the 
veteran would require hospitalization, nursing home care, or 
other residential institutional care; and to be unable to carry 
out the activities (including instrumental activities) of daily 
living by a VA physician. This authority expires on October 1, 
2012.

Section 6. Lodging and subsistence for family caregivers

    This section provides lodging and subsistence to family 
caregivers who accompany certain eligible veterans traveling 
for health care evaluation and treatments at VA facilities. 
Eligible veterans are those who meet the same criteria as those 
under the medical care coverage provision in this Act.

Section 7. Survey on caregivers and family caregivers

    This section requires the VA to design and conduct a survey 
of caregivers of veterans currently enrolled in the VA health 
care system no later than 270 days after the date of the 
enactment of the Act and at least once every three years 
thereafter. It also requires the VA to submit a report to 
Congress with the findings of the survey no later than 180 days 
after the date on which the survey is completed.

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italic, existing law in which no change is 
proposed is shown in roman):

TITLE 38, UNITED STATES CODE

           *       *       *       *       *       *       *



PART I--GENERAL PROVISIONS

           *       *       *       *       *       *       *


CHAPTER 1--GENERAL

           *       *       *       *       *       *       *



Sec. 111. Payments or allowances for beneficiary travel

  (a) * * *

           *       *       *       *       *       *       *

  (e) [When] (1) Except as provided in paragraph (2), when any 
person entitled to mileage under this section requires an 
attendant (other than an employee of the Department) in order 
to perform such travel, the attendant may be allowed expenses 
of travel upon the same basis as such person.
  (2) Without regard to whether a covered veteran entitled to 
mileage under this section requires an attendant in order to 
perform such travel, an attendant of such covered veteran may 
be allowed expenses of travel (including lodging and 
subsistence) upon the same basis as such veteran during--
          (A) the period of time in which such veteran is 
        traveling to and from a treatment facility; and
          (B) the duration of the treatment episode for such 
        veteran.
  (3) The Secretary may prescribe regulations to carry out this 
subsection. Such regulations may include provisions--
          (A) to limit the number of attendants that may 
        receive expenses of travel under paragraph (2) for a 
        single treatment episode of a covered veteran; and
          (B) to require such attendants to use certain travel 
        services.
  (4) In this subsection, the term ``covered veteran'' means a 
veteran who--
          (A) was deployed in support of Operation Enduring 
        Freedom or Operation Iraqi Freedom; and
          (B) for purposes of this subsection, is determined by 
        the Secretary--
                  (i) to have a service-connected disability or 
                illness that is severe;
                  (ii) to be in need of caregiver services, 
                such that without such services, the veteran 
                would require hospitalization, nursing home 
                care, or other residential institutional care; 
                and
                  (iii) based on an examination by a physician 
                employed by the Department (or, in areas where 
                no such physician is available, by a physician 
                carrying out such function under a contract or 
                fee arrangement), to be unable to carry out the 
                activities (including instrumental activities) 
                of daily living.

           *       *       *       *       *       *       *


PART II--GENERAL BENEFITS

           *       *       *       *       *       *       *


   CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE

                          SUBCHAPTER I--GENERAL

Sec.
1701. Definitions.
     * * * * * * *
     * * * * * * *

 SUBCHAPTER II--HOSPITAL, NURSING HOME, OR DOMICILIARY CARE AND MEDICAL 
                                TREATMENT

     * * * * * * *
1720G. Support services for caregivers and family caregivers.
     * * * * * * *

       SUBCHAPTER VIII--HEALTH CARE OF PERSONS OTHER THAN VETERANS

     * * * * * * *
[1782. Counseling, training, and mental health services for immediate 
          family members.]
1782. Counseling, training, and mental health services for immediate 
          family members, caregivers, and family caregivers.

                         SUBCHAPTER I--GENERAL

Sec. 1701. Definitions

  For the purposes of this chapter--
          (1) * * *

           *       *       *       *       *       *       *

          (10) The term ``caregiver services'' means 
        noninstitutional extended care (as used in paragraph 
        (6)).
          (11) The term ``caregiver'' means an individual who--
                  (A) with respect to a disabled veteran who is 
                enrolled in the health care system established 
                under section 1705(a) of this title, provides 
                caregiver services to such veteran for such 
                disability; and
                  (B) is not a member of the family (including 
                parents, spouses, children, siblings, step-
                family members, and extended family members) of 
                such veteran.
          (12) The term ``family caregiver'' means an 
        individual who--
                  (A) with respect to a disabled veteran who is 
                enrolled in the health care system established 
                under section 1705(a) of this title, provides 
                caregiver services to such veteran for such 
                disability;
                  (B) is a member of the family (including 
                parents, spouses, children, siblings, step-
                family members, and extended family members) of 
                such veteran; and
                  (C) may or may not reside with such veteran.

           *       *       *       *       *       *       *


SUBCHAPTER II--HOSPITAL, NURSING HOME, OR DOMICILIARY CARE AND MEDICAL 
TREATMENT

           *       *       *       *       *       *       *


Sec. 1720B. Respite care

  (a) The Secretary may furnish respite care services to a 
veteran who is enrolled to receive care under section 1710 of 
this [title.] title or who receives care from a family 
caregiver.

           *       *       *       *       *       *       *

  (d) In furnishing respite care services under this section, 
the Secretary shall ensure that such services--
          (1) fulfill the needs of the veteran receiving care 
        (including 24-hour in-home respite care); and
          (2) are appropriate for the veteran with respect to 
        the age of the veteran.

           *       *       *       *       *       *       *


Sec. 1720G. Support services for caregivers and family caregivers

  (a) Establishment of Program.--The Secretary shall develop 
and carry out a program for caregivers and family caregivers 
that includes the following:
          (1) The educational sessions, stipends, and access to 
        support services provided under this section.
          (2) Counseling and other services provided under 
        section 1782 of this title.
          (3) Respite care provided under section 1720B of this 
        title.
          (4) With respect to family caregivers, medical care 
        provided under section 1781(e) of this title.
          (5) Travel expenses provided under section 111(e) of 
        this title.
  (b) Educational Sessions.--(1) The Secretary shall make 
available educational sessions for caregivers, family 
caregivers, and individuals described in paragraph (2). Such 
educational sessions shall--
          (A) be made available both in person and on an 
        Internet website;
          (B) incorporate available technology, including 
        telehealth technology to the extent practicable; and
          (C) teach techniques, strategies, and skills for 
        caring for a disabled veteran, including, at a minimum, 
        a veteran who--
                  (i) was deployed in support of Operation 
                Enduring Freedom or Operation Iraqi Freedom; 
                and
                  (ii) has post-traumatic stress disorder, a 
                traumatic brain injury, or other severe injury 
                or illness.
  (2) Individuals described in this paragraph are individuals 
who provide caregivers and family caregivers with support under 
this chapter or through an aging network (as defined in section 
102(5) of the Older Americans Act of 1965 (42 U.S.C. 3002(5)), 
including--
          (A) respite care providers;
          (B) nursing care providers; and
          (C) counselors.
  (c) Stipends.--(1) The Secretary shall provide monthly 
stipends to eligible family caregivers described in paragraph 
(2).
  (2) An eligible family caregiver described in this paragraph 
is a family caregiver who--
          (A) provides caregiver services to a veteran who--
                  (i) was deployed in support of Operation 
                Enduring Freedom or Operation Iraqi Freedom; 
                and
                  (ii) for purposes of this subsection, is 
                determined by the Secretary--
                          (I) to have a service-connected 
                        disability or illness that is severe;
                          (II) to be in need of caregiver 
                        services, such that without such 
                        services, the veteran would require 
                        hospitalization, nursing home care, or 
                        other residential institutional care; 
                        and
                          (III) based on an examination by a 
                        physician employed by the Department 
                        (or, in areas where no such physician 
                        is available, by a physician carrying 
                        out such function under a contract or 
                        fee arrangement), to be unable to carry 
                        out the activities (including 
                        instrumental activities) of daily 
                        living;
          (B) with respect to such veteran, meets the 
        definition of the term ``family caregiver'' under 
        section 1701(12) of this title;
          (C) is designated by such veteran as the primary 
        family caregiver for such veteran; and
          (D) is not--
                  (i) employed by a home health care agency to 
                provide such caregiver services; or
                  (ii) otherwise receiving payment for such 
                services.
  (3) The authority of the Secretary to provide a stipend to an 
eligible family caregiver under this subsection shall expire on 
October 1, 2012.
  (d) Access to Support Services.--The Secretary shall provide 
caregivers and family caregivers with information concerning 
public, private, and non-profit agencies that offer support to 
caregivers. In providing such information, the Secretary 
shall--
          (1) collaborate with the Assistant Secretary for 
        Aging of the Department of Health and Human Services in 
        order to provide caregivers and family caregivers 
        access to aging and disability resource centers under 
        the Administration on Aging of the Department of Health 
        and Human Services; and
          (2) include on an Internet website that is dedicated 
        to caregivers and family caregivers--
                  (A) a directory of services available for 
                caregivers and family caregivers at the county 
                level; and
                  (B) tools that provide caregivers and family 
                caregivers with the ability to interact with 
                each other for the purpose of fostering peer 
                support and creating support networks.
  (e) Information and Outreach.--(1) The Secretary shall 
conduct outreach to inform disabled veterans and the families 
of such veterans of the following:
          (A) Medical care, educational sessions, stipends, and 
        other services available for caregivers and family 
        caregivers under this chapter.
          (B) The ability of a family caregiver to be trained 
        and certified by a home health care agency in order to 
        be paid by such agency for providing caregiver 
        services.
  (2) Outreach under this subsection shall include, at a 
minimum, the following:
          (A) Public service announcements.
          (B) Brochures and pamphlets.
          (C) Full use of Internet-based outreach methods, 
        including such methods designed specifically for 
        veterans and the families of such veterans who reside 
        in rural areas.
  (3) With respect to a Department employee providing case 
management services (as defined in section 1720C(b)(2) of this 
title) to a disabled veteran, the Secretary shall ensure that 
such employee provides a caregiver or family caregiver of such 
veteran with information on the services described in 
subparagraphs (A) and (B) of paragraph (1).

           *       *       *       *       *       *       *


      SUBCHAPTER VIII--HEALTH CARE OF PERSONS OTHER THAN VETERANS

Sec. 1781. Medical care for survivors and dependents of certain 
                    veterans

  (a) The Secretary is authorized to provide medical care, in 
accordance with the provisions of subsection (b) of this 
section, for--
          (1) * * *
          (2) the surviving spouse or child of a veteran who 
        (A) died as a result of a service-connected disability, 
        or (B) at the time of death had a total disability 
        permanent in nature, resulting from a service-connected 
        disability, [and]
          (3) the surviving spouse or child of a person who 
        died in the active military, naval, or air service in 
        the line of duty and not due to such person's own 
        misconduct, and
          (4) in accordance with subsection (e), a family 
        caregiver,
who are not otherwise eligible for medical care under chapter 
55 of title 10 (CHAMPUS).
  (b) In order to accomplish the purposes of subsection (a) of 
this section, the Secretary shall provide for medical care in 
the same or similar manner and subject to the same or similar 
limitations as medical care is furnished to certain dependents 
and survivors of active duty and retired members of the Armed 
Forces under chapter 55 of title 10 (CHAMPUS), by--
          (1) * * *

           *       *       *       *       *       *       *

In cases in which Department medical facilities are equipped to 
provide the care and treatment, the Secretary is also 
authorized to carry out such purposes through the use of such 
facilities not being utilized for the care of eligible 
veterans. A [dependent or survivor] dependent, survivor, or 
family caregiver receiving care under the preceding sentence 
shall be eligible for the same medical services as a veteran, 
including services under sections 1782 and 1783 of this title.

           *       *       *       *       *       *       *

  (e)(1) The Secretary shall provide medical care to a family 
caregiver under this section if the Secretary determines that 
the family caregiver is not entitled to care or services under 
a health-plan contract as defined under section 1725(f)(2) of 
this title (determined, in the case of a health-plan contract 
as defined in subsection (f)(2)(B) or (f)(2)(C) of such 
section, without regard to any requirement or limitation 
relating to eligibility for care or services from any 
department or agency of the United States).
  (2) In this subsection, a family caregiver is an individual 
who--
          (A) provides caregiver services to a veteran who--
                  (i) was deployed in support of Operation 
                Enduring Freedom or Operation Iraqi Freedom; 
                and
                  (ii) for purposes of this subsection, is 
                determined by the Secretary--
                          (I) to have a service-connected 
                        disability or illness that is severe;
                          (II) to be in need of caregiver 
                        services, such that without such 
                        services, the veteran would require 
                        hospitalization, nursing home care, or 
                        other residential institutional care; 
                        and
                          (III) based on an examination by a 
                        physician employed by the Department 
                        (or, in areas where no such physician 
                        is available, by a physician carrying 
                        out such function under a contract or 
                        fee arrangement), to be unable to carry 
                        out the activities (including 
                        instrumental activities) of daily 
                        living;
          (B) with respect to such veteran, meets the 
        definition of the term ``family caregiver'' under 
        section 1701(12) of this title; and
          (C) is designated by such veteran as the primary 
        family caregiver for such veteran.
  (3) The authority of the Secretary to provide medical care to 
a family caregiver under this section shall expire on October 
1, 2012.

Sec. 1782. Counseling, training, and mental health services for 
                    immediate family members, caregivers, and family 
                    caregivers

  (a) * * *

           *       *       *       *       *       *       *

  (c) Eligible Individuals.--Individuals who may be provided 
services under this subsection are--
          (1) the members of the immediate family or the legal 
        guardian of a veteran[; or];
          (2) a caregiver or family caregiver of a veteran; or
          [(2)] (3) the individual in whose household such 
        veteran certifies an intention to live.

           *       *       *       *       *       *       *


                                  
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