II 

117TH CONGRESS 

2D SESSION S. 3964 

To amend title 38, United States Code, to modify the family caregiver 

program of the Department of Veterans Affairs to include services related 

to mental health and neurological disorders, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MARCH 30, 2022 

Mr. MORAN introduced the following bill; which was read twice and referred 

to the Committee on Veterans’ Affairs 

A BILL 

To amend title 38, United States Code, to modify the family 

caregiver program of the Department of Veterans Affairs 

to include services related to mental health and neurological disorders, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Reinforcing Enhanced 

5 Support through Promoting Equity for Caregivers Act of 

6 2022’’ or the ‘‘RESPECT Act of 2022’’. 


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1 SEC. 2. MODIFICATION OF FAMILY CAREGIVER PROGRAM 

2 OF DEPARTMENT OF VETERANS AFFAIRS TO 

3 INCLUDE SERVICES RELATED TO MENTAL 

4 HEALTH AND NEUROLOGICAL DISORDERS. 

5 (a) IN GENERAL.—Section 1720G of title 38, United 

6 States Code, is amended— 

7 (1) in subsection (a)— 

8 (A) in paragraph (2)(C)— 

9 (i) in clause (iii), by striking ‘‘; or’’ 

10 and inserting a semicolon; 

11 (ii) by redesignating clause (iv) as 

12 clause (v); and 

13 (iii) by inserting after clause (iii) the 

14 following new clause (iv): 

15 ‘‘(iv) a diagnosed mental illness or history 

16 of suicidal ideation within the past three years 

17 that puts the veteran at risk of self-harm; or’’; 

18 (B) in paragraph (3)— 

19 (i) in subparagraph (A)(ii)(VI)— 

20 (I) in item (aa), by striking ‘‘; 

21 and’’ and inserting a semicolon; 

22 (II) in item (bb), by striking the 

23 period at the end and inserting ‘‘; 

24 and’’; and 

25 (III) by adding at the end the 

26 following new item: 


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1 ‘‘(cc) mental health treatment and 

2 counseling services.’’; and 

3 (ii) in subparagraph (C)— 

4 (I) in clause (iii)— 

5 (aa) in the matter preceding 

6 subclause (I)— 

7 (AA) by striking ‘‘or 

8 regular instruction’’ and in9 serting ‘‘, regular instruc10 tion’’; and 

11 (BB) by inserting ‘‘or a 

12 diagnosis of mental illness 

13 or history of suicidal idea14 tion that puts the veteran at 

15 risk of self-harm under 

16 paragraph (2)(C)(iv),’’ be17 fore ‘‘the Secretary shall’’; 

18 (bb) in subclause (II), by in19 serting before the period at the 

20 end the following: ‘‘, or assist21 ance relating to the risk of self22 harm of the veteran, as the case 

23 may be’’; and 

24 (cc) in subclause (III), by 

25 striking ‘‘such supervision, proVerDate Sep 11 2014 16:11 Apr 01, 2022 Jkt 029200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S3964.IS S3964

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1 tection, or instruction to the vet2 eran’’ and inserting ‘‘to the vet3 eran such supervision, protection, 

4 or instruction, or assistance re5 lating to the risk of self-harm of 

6 the veteran, as the case may be’’; 

7 and 

8 (II) by adding at the end the fol9 lowing new clauses: 

10 ‘‘(v)(I) For purposes of determining the amount and 

11 degree of personal care services provided under clause (i) 

12 with respect to a veteran described in subclause (II), the 

13 Secretary shall take into account relevant documentation 

14 evidencing the provision of personal care services with re15 spect to the veteran during the preceding three-year pe16 riod. 

17 ‘‘(II) A veteran described in this subclause is a vet18 eran whose need for personal care services as described 

19 in paragraph (2)(C) is based in whole or in part on— 

20 ‘‘(aa) a diagnosis of mental illness or history of 

21 suicidal ideation that puts the veteran at risk of self22 harm under clause (iv) of such paragraph; or 

23 ‘‘(bb) a neurological disorder.’’; and 

24 (C) by adding at the end the following new 

25 paragraph: 


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1 ‘‘(14) The Secretary shall establish a process and re2 quirements for clinicians of facilities of the Department— 

3 ‘‘(A) to document incidents in which an eligible 

4 veteran presents at such a facility for treatment for 

5 an emergent or urgent mental health crisis or an eli6 gible veteran is assessed by such a clinician to be at 

7 risk for suicide; and 

8 ‘‘(B) provide such documentation to the pro9 gram established under paragraph (1).’’; and 

10 (2) in subsection (d), by adding at the end the 

11 following new paragraph: 

12 ‘‘(5) The term ‘qualified mental health profes13 sional’ means a psychiatrist, psychologist, licensed 

14 clinical social worker, psychiatric nurse, or other li15 censed mental health professional as the Secretary 

16 considers appropriate.’’. 

17 (b) TIMING FOR ESTABLISHMENT OF REQUIRE18 MENTS AND PROCESSES.— 

19 (1) REPORT.—Not later than 180 days after 

20 the date of the enactment of this Act, the Secretary 

21 of Veterans Affairs shall— 

22 (A) establish the process and requirements 

23 required under paragraph (14) of section 

24 1720G(a) of title 38, United States Code, as 

25 added by subsection (a)(1)(C); and 


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1 (B) submit to the Committee on Veterans’ 

2 Affairs of the Senate and the Committee on 

3 Veterans’ Affairs of the House of Representa4 tives a description of such process and require5 ments. 

6 (2) CERTIFICATION.— 

7 (A) IN GENERAL.—Not later than one year 

8 after the date of the enactment of this Act, the 

9 Secretary of Veterans Affairs shall require all 

10 clinicians of facilities of the Department to cer11 tify to the Secretary that the clinician under12 stands the process and requirements established 

13 under paragraph (1)(A). 

14 (B) FACILITIES OF THE DEPARTMENT DE15 FINED.—In this paragraph, the term ‘‘facilities 

16 of the Department’’ has the meaning given that 

17 term in section 1701 of title 38, United States 

18 Code. 

19 SEC. 3. REQUIREMENTS RELATING TO EVALUATIONS, AS20 SESSMENTS, AND REASSESSMENTS RELAT21 ING TO ELIGIBILITY OF VETERANS AND 

22 CAREGIVERS FOR FAMILY CAREGIVER PRO23 GRAM. 

24 (a) IN GENERAL.—Subsection (a) of section 1720G 

25 of title 38, United States Code, as amended by section 


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1 2(a)(1), is further amended by adding at the end the fol2 lowing new paragraphs: 

3 ‘‘(15)(A) For purposes of conducting evaluations and 

4 assessments to determine eligibility of a veteran and care5 giver for the program established under paragraph (1) or 

6 conducting reassessments to determine continued eligi7 bility for such program, the Secretary shall— 

8 ‘‘(i) take into account relevant documentation 

9 and medical records generated by non-Department 

10 health care providers, including qualified mental 

11 health professionals and neurological specialists; 

12 ‘‘(ii) if the caregiver of the veteran claims that 

13 the serious injury or need for personal care services 

14 of the veteran as described in paragraph (2) is based 

15 in whole or in part on psychological trauma or an16 other mental disorder, ensure— 

17 ‘‘(I) a qualified mental health professional 

18 that treats the veteran participates in the eval19 uation process; and 

20 ‘‘(II) a qualified mental health professional 

21 participates in the assessment or reassessment 

22 process; and 

23 ‘‘(iii) if the caregiver of the veteran claims that 

24 the serious injury or need for personal care services 

25 of the veteran as described in paragraph (2) is based 


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1 in whole or in part on a neurological disorder, en2 sure— 

3 ‘‘(I) a neurological specialist that treats 

4 the veteran participates in the evaluation proc5 ess; and 

6 ‘‘(II) a neurological specialist participates 

7 in the assessment or reassessment process. 

8 ‘‘(B)(i) The Secretary shall establish an appropriate 

9 time limit during a 24-hour period for the active participa10 tion of a veteran in an evaluation, assessment, or reassess11 ment to determine eligibility of the veteran for the pro12 gram established under paragraph (1). 

13 ‘‘(ii) In determining an appropriate time limit for a 

14 veteran under clause (i), the Secretary shall— 

15 ‘‘(I) take into consideration necessary accom16 modations for the veteran stemming from the dis17 ability or medical condition of the veteran; and 

18 ‘‘(II) consult with the primary care provider, 

19 neurological specialist, or qualified mental health 

20 professional that is treating the veteran. 

21 ‘‘(C) The Secretary shall not require the presence of 

22 a veteran during portions of an evaluation, assessment, 

23 or reassessment to determine eligibility of the veteran for 

24 the program established under paragraph (1) that only re25 quire the active participation of the caregiver. 


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1 ‘‘(D)(i) The Secretary shall make reasonable efforts 

2 to assist a caregiver and veteran in obtaining evidence nec3 essary to substantiate the claims of the caregiver and vet4 eran in the application process for evaluation, assessment, 

5 or reassessment for the program established under para6 graph (1). 

7 ‘‘(ii)(I) As part of the assistance provided to a care8 giver or veteran under clause (i), the Secretary shall make 

9 reasonable efforts to obtain relevant private records that 

10 the caregiver or veteran adequately identifies to the Sec11 retary. 

12 ‘‘(II) Whenever the Secretary, after making reason13 able efforts under subclause (I), is unable to obtain all 

14 of the relevant records sought, the Secretary shall notify 

15 the caregiver and veteran that the Secretary is unable to 

16 obtain records with respect to the claim, which shall in17 clude— 

18 ‘‘(aa) an identification of the records the Sec19 retary is unable to obtain; 

20 ‘‘(bb) a brief explanation of the efforts that the 

21 Secretary made to obtain such records; and 

22 ‘‘(cc) an explanation that the Secretary will 

23 make a determination based on the evidence of 

24 record and that this clause does not prohibit the 


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1 submission of records at a later date if such submis2 sion is otherwise allowed. 

3 ‘‘(III) The Secretary shall make not fewer than two 

4 requests to a custodian of a private record in order for 

5 an effort to obtain such record to be treated as reasonable 

6 under subclause (I), unless it is made evident by the first 

7 request that a second request would be futile in obtaining 

8 such record. 

9 ‘‘(iii) Under regulations prescribed by the Secretary, 

10 the Secretary— 

11 ‘‘(I) shall encourage a caregiver and veteran to 

12 submit relevant private medical records of the vet13 eran to the Secretary to substantiate the claims of 

14 the caregiver and veteran in the application process 

15 for evaluation, assessment, or reassessment for the 

16 program established under paragraph (1) if such 

17 submission does not burden the caregiver or veteran; 

18 and 

19 ‘‘(II) may require the caregiver or veteran to 

20 authorize the Secretary to obtain such relevant pri21 vate medical records if such authorization is re22 quired to comply with Federal, State, or local law. 

23 ‘‘(16)(A) The Secretary, in consultation with a health 

24 care provider, neurological specialist, or qualified mental 

25 health professional that is treating a veteran, shall waive 


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1 the reassessment requirement for the veteran for partici2 pation in the program established under paragraph (1) 

3 if— 

4 ‘‘(i) the serious injury of the veteran under 

5 paragraph (2) is significantly caused by a degenera6 tive or chronic condition; and 

7 ‘‘(ii) such condition is unlikely to improve the 

8 dependency of the veteran for personal care services. 

9 ‘‘(B) The Secretary shall require a health care pro10 vider, neurological specialist, or qualified mental health 

11 professional that is treating a veteran to annually certify 

12 the clinical decision of the provider, specialist, or profes13 sional under subparagraph (A). 

14 ‘‘(C) The Secretary may rescind a waiver under sub15 paragraph (A) with respect to a veteran and require a re16 assessment of the veteran if a health care provider, neuro17 logical specialist, or qualified mental health professional 

18 that is treating the veteran makes a clinical determination 

19 that the level of dependency of the veteran for personal 

20 care services has diminished since the last certification of 

21 the clinical decision of the provider, specialist, or profes22 sional under subparagraph (B).’’. 

23 (b) DEFINITION.—Subsection (d) of such section, as 

24 amended by section 2(a)(2), is further amended— 


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1 (1) by redesignating paragraphs (4) and (5) as 

2 paragraphs (5) and (6), respectively; and 

3 (2) by inserting after paragraph (3) the fol4 lowing new paragraph (4): 

5 ‘‘(4) The term ‘neurological specialist’ means a 

6 neurologist, neuropsychiatrist, physiatrist, geriatri7 cian, certified brain injury specialist, neurology 

8 nurse, neurology nurse practitioner, neurology physi9 cian assistant, or such other licensed medical profes10 sional as the Secretary considers appropriate.’’. 

11 SEC. 4. REQUIREMENTS RELATING TO PROVISION OF 

12 GRANTS FOR ASSISTANCE TO FAMILY CARE13 GIVERS OF VETERANS. 

14 (a) DISTRIBUTION OF GRANTS.—Section 

15 1720G(a)(3) of title 38, United States Code, is amended 

16 by adding at the end the following new subparagraph: 

17 ‘‘(E)(i) The Secretary shall distribute grants provided 

18 under subparagraph (A)(ii)(VI) to entities eligible for the 

19 provision of such a grant in geographically dispersed 

20 areas. 

21 ‘‘(ii) In providing grants to entities under subpara22 graph (A)(ii)(VI), the Secretary shall provide equal con23 sideration to national, regional, and local organizations, 

24 in an effort to adequately serve individuals in need of serv25 ices provided pursuant to such a grant.’’. 


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1 (b) GRANT PROGRAM REQUIREMENTS.— 

2 (1) RULEMAKING.—Not later than 180 days 

3 after the date of the enactment of this Act, the Sec4 retary of Veterans Affairs shall begin the rule5 making process to establish a grant program under 

6 each of items (aa), (bb), and (cc) of section 

7 1720G(a)(3)(A)(ii)(VI) of title 38, United States 

8 Code, as amended by section 2(a)(1)(B)(i), to pro9 vide grants under such items. 

10 (2) REPORT.— 

11 (A) IN GENERAL.—Not later than one year 

12 after the date on which the first grant is pro13 vided after the date of the enactment of this 

14 Act under a grant program established under 

15 paragraph (1), the Secretary shall submit to the 

16 Committee on Veterans’ Affairs of the Senate 

17 and Committee on Veterans’ Affairs of the 

18 House of Representatives a report on the provi19 sion of grants under each such program. 

20 (B) ELEMENTS.—The report required by 

21 subparagraph (A) shall include the following: 

22 (i) An assessment of the effectiveness 

23 of the grant programs established under 

24 paragraph (1), including— 


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1 (I) the number of individuals who 

2 benefitted from each grant program in 

3 each Veterans Integrated Service Net4 work of the Department of Veterans 

5 Affairs; and 

6 (II) an assessment of the effec7 tiveness of increasing engagement by 

8 individuals eligible for such programs 

9 in mental health care treatment and 

10 services, financial planning services, 

11 and legal services in each Veterans In12 tegrated Service Network. 

13 (ii) A list of recipients of grants under 

14 each such program and their partner orga15 nizations, if applicable, that delivered serv16 ices funded by the grant and the amount 

17 of such grant received by each recipient 

18 and partner organization. 

Æ 


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