```

[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[S. 1233 Introduced in Senate (IS)]

110th CONGRESS
  1st Session
                                S. 1233

  To provide and enhance intervention, rehabilitative treatment, and 
    services to veterans with traumatic brain injury, and for other 
                               purposes.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                             April 26, 2007

 Mr. Akaka (for himself and Mr. Craig) introduced the following bill; 
which was read twice and referred to the Committee on Veterans' Affairs

_______________________________________________________________________

                                 A BILL

 
  To provide and enhance intervention, rehabilitative treatment, and 
    services to veterans with traumatic brain injury, and for other 
                               purposes.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Veterans Traumatic 
Brain Injury Rehabilitation Act of 2007''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Sense of Congress on Department of Veterans Affairs efforts in 
                            the rehabilitation and reintegration of 
                            veterans with traumatic brain injury.
Sec. 3. Individual rehabilitation and community reintegration plans for 
                            veterans and others with traumatic brain 
                            injury.
Sec. 4. Use of non-Department of Veterans Affairs facilities for 
                            implementation of rehabilitation and 
                            community reintegration plans for traumatic 
                            brain injury.
Sec. 5. Research, education, and clinical care program on severe 
                            traumatic brain injury.
Sec. 6. Pilot program on assisted living services for veterans with 
                            traumatic brain injury.
Sec. 7. Age-appropriate nursing home care.
Sec. 8. Research on traumatic brain injury.

SEC. 2. SENSE OF CONGRESS ON DEPARTMENT OF VETERANS AFFAIRS EFFORTS IN 
              THE REHABILITATION AND REINTEGRATION OF VETERANS WITH 
              TRAUMATIC BRAIN INJURY.

    It is the sense of Congress that--
            (1) the Department of Veterans Affairs should have the 
        capacity and expertise to provide veterans who have a traumatic 
        brain injury with patient-centered health care, rehabilitation, 
        and community integration services that are comparable to or 
        exceed similar care and services available to persons with such 
        injuries in the academic and private sector;
            (2) rehabilitation for veterans who have a traumatic brain 
        injury should be individualized, comprehensive, and 
        multidisciplinary with the goals of optimizing the independence 
        of such veterans and reintegrating them into their communities;
            (3) family support is integral to the rehabilitation and 
        community reintegration of veterans who have sustained a 
        traumatic brain injury, and the Department should provide the 
        families of such veterans with education and support;
            (4) the Department of Defense and Department of Veterans 
        Affairs have made efforts to provide a smooth transition of 
        medical care and rehabilitative services to individuals as they 
        transition from the health care system of the Department of 
        Defense to that of the Department of Veterans Affairs, but more 
        can be done to assist veterans and their families in the 
        continuum of the rehabilitation, recovery, and reintegration of 
        wounded or injured veterans into their communities; and
            (5) in planning for rehabilitation and community 
        reintegration of veterans who have a traumatic brain injury, it 
        is necessary for the Department of Veterans Affairs to provide 
        a system for life-long case management for such veterans.

SEC. 3. INDIVIDUAL REHABILITATION AND COMMUNITY REINTEGRATION PLANS FOR 
              VETERANS AND OTHERS WITH TRAUMATIC BRAIN INJURY.

    (a) In General.--Subchapter II of chapter 17 of title 38, United 
States Code, is amended by inserting after section 1710B the following 
new section:
``Sec. 1710C. Traumatic brain injury: plans for rehabilitation and 
              reintegration into the community
    ``(a) Plan Required.--The Secretary shall, for each veteran or 
member of the Armed Forces who receives inpatient rehabilitation care 
from the Department for a traumatic brain injury--
            ``(1) develop an individualized plan for the rehabilitation 
        and reintegration of such individual into the community; and
            ``(2) provide such plan to such individual before such 
        individual is discharged from inpatient care.
    ``(b) Contents of Plan.--Each plan developed under subsection (a) 
shall include, for the individual covered by such plan, the following:
            ``(1) Rehabilitation objectives for improving the physical, 
        cognitive, vocational, and psychosocial functioning of such 
        individual with the goal of maximizing the independence and 
        reintegration of such individual into the community.
            ``(2) A description of specific interventions, 
        rehabilitative treatments, and other services to achieve the 
        objectives described in paragraph (2), which description shall 
        set forth the type, frequency, duration, and location of such 
        interventions, treatments, and services.
            ``(3) The name of the case manager designated in accordance 
        with subsection (d) to be responsible for the implementation of 
        such plan.
            ``(4) Dates on which the effectiveness of the plan will be 
        reviewed in accordance with subsection (f).
    ``(c) Comprehensive Assessment.--
            ``(1) In general.--Each plan developed under subsection (a) 
        shall be based upon a comprehensive assessment, developed in 
        accordance with paragraph (2), of--
                    ``(A) the physical, cognitive, vocational, and 
                psychosocial impairments of such individual; and
                    ``(B) the family education and family support needs 
                of such individual after discharge from inpatient care.
            ``(2) Formation.--The comprehensive assessment required 
        under paragraph (1) with respect to an individual is a 
        comprehensive assessment of the matters set forth in that 
        paragraph by a team, composed by the Secretary for purposes of 
        the assessment, from among individuals with expertise in 
        traumatic brain injury as follows:
                    ``(A) A neurologist.
                    ``(B) A rehabilitation physician.
                    ``(C) A social worker.
                    ``(D) A neuropsychologist or neuropsychiatrist.
                    ``(E) A physical therapist.
                    ``(F) A vocational rehabilitation specialist.
                    ``(G) An occupational therapist.
                    ``(H) A rehabilitation nurse.
                    ``(I) Such other health care professionals as the 
                Secretary considers appropriate, including--
                            ``(i) an audiologist;
                            ``(ii) a blind rehabilitation specialist;
                            ``(iii) a recreational therapist;
                            ``(iv) a speech language pathologist; and
                            ``(v) a low vision optometrist.
    ``(d) Case Manager.--The Secretary shall designate a case manager 
for each individual described in subsection (a) to be responsible for 
the implementation of the plan required by such subsection for such 
individual.
    ``(e) Participation and Collaboration in Development of Plans.--(1) 
The Secretary shall involve each individual described in subsection 
(a), and the family of such individual, in the development of the plan 
for such individual under that subsection to the maximum extent 
practicable.
    ``(2) The Secretary shall collaborate in the development of a plan 
for an individual under subsection (a) with an individual with 
expertise in the protection of, and advocacy for, individuals with 
traumatic brain injury if--
            ``(A) the individual covered by such plan requests such 
        collaboration; or
            ``(B) if such individual is incapacitated, the family or 
        guardian of such individual requests such collaboration.
    ``(3) In the case of a plan required by subsection (a) for a member 
of the Armed Forces who is on active duty, the Secretary shall 
collaborate with the Secretary of Defense in the development of such 
plan.
    ``(4) In developing vocational rehabilitation objectives required 
under subsection (b)(2) and in conducting the assessment required under 
subsection (c), the Secretary shall act through the Under Secretary for 
Health in coordination with the Vocational Rehabilitation and 
Employment Service of the Department of Veterans Affairs.
    ``(f) Evaluation.--
            ``(1) Periodic review by secretary.--The Secretary shall 
        periodically review the effectiveness of each plan developed 
        under subsection (a). The Secretary shall refine each such plan 
        as the Secretary considers appropriate in light of such review.
            ``(2) Request for review by veterans.--In addition to the 
        periodic review required by paragraph (1), the Secretary shall 
        conduct a review of the plan of a veteran under paragraph (1) 
        at the request of such veteran, or in the case that such 
        veteran is incapacitated, at the request of the guardian or the 
        designee of such veteran.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 17 of such title is amended by inserting after the item 
relating to section 1710B the following new item:

``1710C. Traumatic brain injury: plans for rehabilitation and 
                            reintegration into the community.''.

SEC. 4. USE OF NON-DEPARTMENT OF VETERANS AFFAIRS FACILITIES FOR 
              IMPLEMENTATION OF REHABILITATION AND COMMUNITY 
              REINTEGRATION PLANS FOR TRAUMATIC BRAIN INJURY.

    (a) In General.--Subchapter II of chapter 17 of title 38, United 
States Code, is amended by inserting after section 1710C, as added by 
section 3 of this Act, the following new section:
``Sec. 1710D. Traumatic brain injury: use of non-Department facilities 
              for rehabilitation
    ``(a) In General.--Subject to section 1710(a)(4) of this title and 
subsection (b) of this section, the Secretary shall provide 
intervention, rehabilitative treatment, or services to implement a plan 
developed under section 1710C of this title at a non-Department 
facility with which the Secretary has entered into an agreement for 
such purpose, to an individual--
            ``(1) who is described in subsection (a) of such section; 
        and
            ``(2)(A) to whom the Secretary is unable to provide such 
        intervention, treatment, or services at the frequency or for 
        the duration prescribed in such plan; or
            ``(B) who resides at such distance, as determined by the 
        Secretary, from a Department medical facility as to make the 
        implementation of such plan through a Department facility 
        infeasible or impracticable.
    ``(b) Standards.--The Secretary may not provide intervention, 
treatment, or services as described in subsection (a) at a non-
Department facility under such subsection unless such facility 
maintains standards for the provision of such intervention, treatment, 
or services established by an independent, peer-reviewed organization 
that accredits specialized rehabilitation programs for adults with 
traumatic brain injury.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 17 of such title is amended by inserting after the item 
relating to section 1710C, as added by section 3 of this Act, the 
following new item:

``1710D. Traumatic brain injury: use of non-Department facilities for 
                            rehabilitation.''.

SEC. 5. RESEARCH, EDUCATION, AND CLINICAL CARE PROGRAM ON SEVERE 
              TRAUMATIC BRAIN INJURY.

    (a) Program Required.--Subchapter II of chapter 73 of title 38, 
United States Code, is amended by inserting after section 7330 the 
following new section:
``Sec. 7330A. Severe traumatic brain injury research, education, and 
              clinical care program
    ``(a) Program Required.--The Secretary shall establish a program on 
research, education, and clinical care to provide intensive neuro-
rehabilitation to veterans with a severe traumatic brain injury, 
including veterans in a minimally conscious state who would otherwise 
receive nursing home care.
    ``(b) Collaboration Required.--The Secretary shall establish the 
program required by subsection (a) in collaboration with the Defense 
and Veterans Brain Injury Center of the Department of Defense and 
academic institutions selected by the Secretary from among institutions 
having an expertise in research in neuro-rehabilitation.
    ``(c) Education Required.--As part of the program required by 
subsection (a), the Secretary shall conduct educational programs on 
recognizing and diagnosing mild and moderate cases of traumatic brain 
injury.
    ``(d) Authorization of Appropriations.--There is authorized to be 
appropriated to the Secretary for each of fiscal years 2008 through 
2012, $3,000,000 to carry out the program required by subsection 
(a).''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 73 of such title is amended by inserting after the item 
relating to section 7330 the following new item:

``7330A. Severe traumatic brain injury research, education, and 
                            clinical care program.''.
    (c) Report.--Not later than 120 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall submit 
to Congress a report on the research to be conducted under the program 
required by section 7330A of title 38, United States Code, as added by 
subsection (a).

SEC. 6. PILOT PROGRAM ON ASSISTED LIVING SERVICES FOR VETERANS WITH 
              TRAUMATIC BRAIN INJURY.

    (a) Pilot Program.--Not later than 90 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall carry 
out a pilot program to assess the effectiveness of providing assisted 
living services to eligible veterans to enhance the rehabilitation, 
quality of life, and community integration of such veterans.
    (b) Duration of Program.--The pilot program shall be carried out 
during the five-year period beginning on the date of the commencement 
of the pilot program.
    (c) Program Locations.--
            (1) In general.--The pilot program shall be carried out at 
        locations selected by the Secretary for purposes of the pilot 
        program. Of the locations so selected--
                    (A) at least one shall be in each health care 
                region of the Veterans Health Administration that 
                contains a polytrauma center of the Department of 
                Veterans Affairs; and
                    (B) any other locations shall be in areas that 
                contain high concentrations of veterans with traumatic 
                brain injury, as determined by the Secretary.
            (2) Special consideration for veterans in rural areas.--
        Special consideration shall be given to provide veterans in 
        rural areas with an opportunity to participate in the pilot 
        program.
    (d) Provision of Assisted Living Services.--
            (1) Agreements.--In carrying out the pilot program, the 
        Secretary may enter into agreements for the provision of 
        assisted living services on behalf of eligible veterans with 
        either of the following:
                    (A) A provider of services that has entered into a 
                provider agreement under section 1866(a) of the Social 
                Security Act (42 U.S.C. 1395cc(a)).
                    (B) A provider participating under a State plan 
                under title XIX of such Act (42 U.S.C. 1396 et seq.).
            (2) Standards.--The Secretary may not place, transfer, or 
        admit a veteran to any facility for assisted living services 
        under this program unless the Secretary determines that the 
        facility meets such standards as the Secretary may prescribe 
        for purposes of the pilot program. Such standards shall, to the 
        extent practicable, be consistent with the standards of 
        Federal, State, and local agencies charged with the 
        responsibility of licensing or otherwise regulating or 
        inspecting such facilities.
    (e) Continuation of Case Management and Rehabilitation Services.--
In carrying the pilot program under subsection (a), the Secretary shall 
continue to provide each veteran who is receiving assisted living 
services under the pilot program with rehabilitative services and shall 
designate Department health-care employees to furnish case management 
services for veterans participating in the pilot program.
    (f) Report.--
            (1) In general.--Not later than 60 days after the 
        completion of the pilot program, the Secretary shall submit to 
        the congressional veterans affairs committees a report on the 
        pilot program.
            (2) Contents.--The report required by paragraph (1) shall 
        include the following:
                    (A) A description of the pilot program.
                    (B) An assessment of the utility of the activities 
                under the pilot program in enhancing the 
                rehabilitation, quality of life, and community 
                reintegration of veterans with traumatic brain injury.
                    (C) Such recommendations as the Secretary considers 
                appropriate regarding the extension or expansion of the 
                pilot program.
    (g) Definitions.--In this section:
            (1) The term ``assisted living services'' means services of 
        a facility in providing room, board, and personal care for and 
        supervision of residents for their health, safety, and welfare.
            (2) The term ``case management services'' includes the 
        coordination and facilitation of all services furnished to a 
        veteran by the Department of Veterans Affairs, either directly 
        or through contract, including assessment of needs, planning, 
        referral (including referral for services to be furnished by 
        the Department, either directly or through a contract, or by an 
        entity other than the Department), monitoring, reassessment, 
        and followup.
            (3) The term ``congressional veterans affairs committees'' 
        means--
                    (A) the Committee on Veterans' Affairs of the 
                Senate; and
                    (B) the Committee on Veterans' Affairs of the House 
                of Representatives.
            (4) The term ``eligible veteran'' means a veteran who--
                    (A) is enrolled in the Department of Veterans 
                Affairs health care system;
                    (B) has received treatment for traumatic brain 
                injury from the Department of Veterans Affairs;
                    (C) is unable to manage routine activities of daily 
                living without supervision and assistance; and
                    (D) could reasonably be expected to receive ongoing 
                services after the end of the pilot program under this 
                section under another government program or through 
                other means.
    (h) Authorization of Appropriations.--There is authorized to be 
appropriated to the Secretary of Veterans Affairs to carry out this 
section, $8,000,000 for each of fiscal years 2008 through 2013.

SEC. 7. AGE-APPROPRIATE NURSING HOME CARE.

    (a) Finding.--Congress finds that young veterans who are injured or 
disabled through military service and require long-term care should 
have access to age-appropriate nursing home care.
    (b) Requirement To Provide Age-Appropriate Nursing Home Care.--
Section 1710A of title 38, United States Code, is amended--
            (1) by redesignating subsection (c) as subsection (d); and
            (2) by inserting after subsection (b) the following new 
        subsection (c):
    ``(c) The Secretary shall ensure that nursing home care provided 
under subsection (a) is provided in an age-appropriate manner.''.

SEC. 8. RESEARCH ON TRAUMATIC BRAIN INJURY.

    (a) Inclusion of Research on Traumatic Brain Injury Under Ongoing 
Research Programs.--The Secretary of Veterans Affairs shall, in 
carrying out research programs and activities under the provisions of 
law referred to in subsection (b), ensure that such programs and 
activities include research on the sequelae of traumatic brain injury, 
including--
            (1) research on visually-related neurological conditions;
            (2) research on seizure disorders; and
            (3) research on means of improving the diagnosis, 
        treatment, and prevention of such sequelae.
    (b) Research Authorities.--The provisions of law referred to in 
this subsection are the following:
            (1) Section 3119 of title 38, United States Code, relating 
        to rehabilitation research and special projects.
            (2) Section 7303 of title 38, United States Code, relating 
        to research programs of the Veterans Health Administration.
            (3) Section 7327 of title 38, United States Code, relating 
        to research, education, and clinical activities on complex 
        multi-trauma associated with combat injuries.
    (c) Collaboration.--In carrying out the research required by 
subsection (a), the Secretary shall collaborate with facilities that--
            (1) conduct research on rehabilitation for individuals with 
        traumatic brain injury; and
            (2) receive grants for such research from the National 
        Institute on Disability and Rehabilitation Research of the 
        Department of Education.
    (d) Report.--Not later than 90 days after the date of the enactment 
of this Act, the Secretary shall submit to the Committees on Veterans' 
Affairs of the Senate and the House of Representatives a report 
describing in comprehensive detail the research to be carried out in 
order to fulfill the requirement in subsection (a).
                                 <all>
```