IIB 

111TH CONGRESS 

1ST SESSION H. R. 3155 

IN THE SENATE OF THE UNITED STATES 

JULY 28, 2009 

Received; read twice and referred to the Committee on Veterans’ Affairs 

AN ACT 

To amend title 38, United States Code, to provide certain 

caregivers of veterans with training, support, and medical 

care, 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, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Caregiver Assistance 

3 and Resource Enhancement Act’’. 

4 SEC. 2. SUPPORT SERVICES FOR CAREGIVERS. 

5 (a) DEFINITIONS.—Section 1701 of title 38, United 

6 States Code, is amended by adding at the end the fol7 lowing new paragraphs: 

8 ‘‘(10) The term ‘caregiver services’ means non9 institutional extended care (as used in paragraph 

10 (6)). 

11 ‘‘(11) The term ‘caregiver’ means an individual 

12 who— 

13 ‘‘(A) with respect to a disabled veteran 

14 who is enrolled in the health care system estab15 lished under section 1705(a) of this title, pro16 vides caregiver services to such veteran for such 

17 disability; and 

18 ‘‘(B) is not a member of the family (in19 cluding parents, spouses, children, siblings, 

20 step-family members, and extended family 

21 members) of such veteran. 

22 ‘‘(12) The term ‘family caregiver’ means an in23 dividual who— 

24 ‘‘(A) with respect to a disabled veteran 

25 who is enrolled in the health care system estab26 lished under section 1705(a) of this title, proVerDate Nov 24 2008 00:43 Jul 29, 2009 Jkt 079200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3155.RFS H3155

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1 vides caregiver services to such veteran for such 

2 disability; 

3 ‘‘(B) is a member of the family (including 

4 parents, spouses, children, siblings, step-family 

5 members, and extended family members) of 

6 such veteran; and 

7 ‘‘(C) may or may not reside with such vet8 eran.’’. 

9 (b) SUPPORT SERVICES.— 

10 (1) IN GENERAL.—Subchapter II of chapter 17 

11 of title 38, United States Code, is amended by add12 ing at the end the following new section: 

13 ‘‘§ 1720G. Support services for caregivers and family 

14 caregivers 

15 ‘‘(a) ESTABLISHMENT OF PROGRAM.—The Secretary 

16 shall develop and carry out a program for caregivers and 

17 family caregivers that includes the following: 

18 ‘‘(1) The educational sessions, stipends, and ac19 cess to support services provided under this section. 

20 ‘‘(2) Counseling and other services provided 

21 under section 1782 of this title. 

22 ‘‘(3) Respite care provided under section 1720B 

23 of this title. 

24 ‘‘(4) With respect to family caregivers, medical 

25 care provided under section 1781(e) of this title. 


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1 ‘‘(5) Travel expenses provided under section 

2 111(e) of this title. 

3 ‘‘(b) EDUCATIONAL SESSIONS.—(1) The Secretary 

4 shall make available educational sessions for caregivers, 

5 family caregivers, and individuals described in paragraph 

6 (2). Such educational sessions shall— 

7 ‘‘(A) be made available both in person and on 

8 an Internet website; 

9 ‘‘(B) incorporate available technology, including 

10 telehealth technology to the extent practicable; and 

11 ‘‘(C) teach techniques, strategies, and skills for 

12 caring for a disabled veteran, including, at a min13 imum, a veteran who— 

14 ‘‘(i) was deployed in support of Operation 

15 Enduring Freedom or Operation Iraqi Free16 dom; and 

17 ‘‘(ii) has post-traumatic stress disorder, a 

18 traumatic brain injury, or other severe injury or 

19 illness. 

20 ‘‘(2) Individuals described in this paragraph are indi21 viduals who provide caregivers and family caregivers with 

22 support under this chapter or through an aging network 

23 (as defined in section 102(5) of the Older Americans Act 

24 of 1965 (42 U.S.C. 3002(5)), including— 

25 ‘‘(A) respite care providers; 


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1 ‘‘(B) nursing care providers; and 

2 ‘‘(C) counselors. 

3 ‘‘(c) STIPENDS.—(1) The Secretary shall provide 

4 monthly stipends to eligible family caregivers described in 

5 paragraph (2). 

6 ‘‘(2) An eligible family caregiver described in this 

7 paragraph is a family caregiver who— 

8 ‘‘(A) provides caregiver services to a veteran 

9 who— 

10 ‘‘(i) was deployed in support of Operation 

11 Enduring Freedom or Operation Iraqi Free12 dom; and 

13 ‘‘(ii) for purposes of this subsection, is de14 termined by the Secretary— 

15 ‘‘(I) to have a service-connected dis16 ability or illness that is severe; 

17 ‘‘(II) to be in need of caregiver serv18 ices, such that without such services, the 

19 veteran would require hospitalization, nurs20 ing home care, or other residential institu21 tional care; and 

22 ‘‘(III) based on an examination by a 

23 physician employed by the Department (or, 

24 in areas where no such physician is avail25 able, by a physician carrying out such 


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1 function under a contract or fee arrange2 ment), to be unable to carry out the activi3 ties (including instrumental activities) of 

4 daily living; 

5 ‘‘(B) with respect to such veteran, meets the 

6 definition of the term ‘family caregiver’ under sec7 tion 1701(12) of this title; 

8 ‘‘(C) is designated by such veteran as the pri9 mary family caregiver for such veteran; and 

10 ‘‘(D) is not— 

11 ‘‘(i) employed by a home health care agen12 cy to provide such caregiver services; or 

13 ‘‘(ii) otherwise receiving payment for such 

14 services. 

15 ‘‘(3) The authority of the Secretary to provide a sti16 pend to an eligible family caregiver under this subsection 

17 shall expire on October 1, 2012. 

18 ‘‘(d) ACCESS TO SUPPORT SERVICES.—The Sec19 retary shall provide caregivers and family caregivers with 

20 information concerning public, private, and non-profit 

21 agencies that offer support to caregivers. In providing 

22 such information, the Secretary shall— 

23 ‘‘(1) collaborate with the Assistant Secretary 

24 for Aging of the Department of Health and Human 

25 Services in order to provide caregivers and family 


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1 caregivers access to aging and disability resource 

2 centers under the Administration on Aging of the 

3 Department of Health and Human Services; and 

4 ‘‘(2) include on an Internet website that is dedi5 cated to caregivers and family caregivers— 

6 ‘‘(A) a directory of services available for 

7 caregivers and family caregivers at the county 

8 level; and 

9 ‘‘(B) tools that provide caregivers and fam10 ily caregivers with the ability to interact with 

11 each other for the purpose of fostering peer 

12 support and creating support networks. 

13 ‘‘(e) INFORMATION AND OUTREACH.—(1) The Sec14 retary shall conduct outreach to inform disabled veterans 

15 and the families of such veterans of the following: 

16 ‘‘(A) Medical care, educational sessions, sti17 pends, and other services available for caregivers 

18 and family caregivers under this chapter. 

19 ‘‘(B) The ability of a family caregiver to be 

20 trained and certified by a home health care agency 

21 in order to be paid by such agency for providing 

22 caregiver services. 

23 ‘‘(2) Outreach under this subsection shall include, at 

24 a minimum, the following: 

25 ‘‘(A) Public service announcements. 


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1 ‘‘(B) Brochures and pamphlets. 

2 ‘‘(C) Full use of Internet-based outreach meth3 ods, including such methods designed specifically for 

4 veterans and the families of such veterans who re5 side in rural areas. 

6 ‘‘(3) With respect to a Department employee pro7 viding case management services (as defined in section 

8 1720C(b)(2) of this title) to a disabled veteran, the Sec9 retary shall ensure that such employee provides a care10 giver or family caregiver of such veteran with information 

11 on the services described in subparagraphs (A) and (B) 

12 of paragraph (1).’’. 

13 (2) CLERICAL AMENDMENT.—The table of sec14 tions at the beginning of chapter 17 of title 38, 

15 United States Code, is amended by inserting after 

16 the item related to section 1720F the following new 

17 item: 

‘‘1720G. Support services for caregivers and family caregivers.’’. 

18 (c) PLAN.—Not later than 180 days after the date 

19 of the enactment of this Act, the Secretary shall submit 

20 to the Committee on Veterans’ Affairs of the House of 

21 Representatives and the Committee on Veterans’ Affairs 

22 of the Senate a plan for carrying out section 1720G of 

23 title 38, United States Code, as added by subsection (b) 

24 of this section. 


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1 (d) REPORTS.—Not later than 180 days after the 

2 date on which the plan is submitted under subsection (c), 

3 and annually thereafter for the following five years, the 

4 Secretary shall submit to the Committee on Veterans’ Af5 fairs of the House of Representatives and the Committee 

6 on Veterans’ Affairs of the Senate a report describing the 

7 implementation of the plan. 

8 SEC. 3. COUNSELING AND MENTAL HEALTH SERVICES FOR 

9 CAREGIVERS AND FAMILY CAREGIVERS. 

10 (a) IN GENERAL.—Section 1782 of title 38, United 

11 States Code, is amended— 

12 (1) in the section heading, by adding at the end 

13 the following: ‘‘, caregivers, and family care14 givers’’; and 

15 (2) in subsection (c)— 

16 (A) in paragraph (1), by striking ‘‘; or’’ 

17 and inserting a semicolon; 

18 (B) by redesignating paragraph (2) as 

19 paragraph (3); and 

20 (C) by inserting after paragraph (1) the 

21 following new paragraph (2): 

22 ‘‘(2) a caregiver or family caregiver of a vet23 eran; or’’. 

24 (b) CLERICAL AMENDMENT.—The table of sections 

25 at the beginning of chapter 17 of title 38, United States 


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1 Code, is amended by striking the item relating to section 

2 1782 and inserting the following new item: 

‘‘1782. Counseling, training, and mental health services for immediate family 

members, caregivers, and family caregivers.’’. 

3 SEC. 4. RESPITE CARE TO ASSIST FAMILY CAREGIVERS. 

4 Section 1720B of title 38, United States Code, is 

5 amended— 

6 (1) in subsection (a), by striking ‘‘title.’’ and in7 serting ‘‘title or who receives care from a family 

8 caregiver.’’; and 

9 (2) by adding at the end the following new sub10 section: 

11 ‘‘(d) In furnishing respite care services under this 

12 section, the Secretary shall ensure that such services— 

13 ‘‘(1) fulfill the needs of the veteran receiving 

14 care (including 24-hour in-home respite care); and 

15 ‘‘(2) are appropriate for the veteran with re16 spect to the age of the veteran.’’. 

17 SEC. 5. MEDICAL CARE FOR FAMILY CAREGIVERS. 

18 Section 1781 of title 38, United States Code, is 

19 amended— 

20 (1) in subsection (a)— 

21 (A) in paragraph (2), by striking ‘‘and’’ at 

22 the end; 

23 (B) in paragraph (3), by inserting ‘‘and’’ 

24 at the end; and 


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1 (C) by inserting after paragraph (3) the 

2 following new paragraph: 

3 ‘‘(4) in accordance with subsection (e), a family 

4 caregiver,’’; 

5 (2) in the third sentence of subsection (b), by 

6 striking ‘‘dependent or survivor’’ and inserting ‘‘de7 pendent, survivor, or family caregiver’’; and 

8 (3) by adding at the end the following new sub9 section: 

10 ‘‘(e)(1) The Secretary shall provide medical care to 

11 a family caregiver under this section if the Secretary de12 termines that the family caregiver is not entitled to care 

13 or services under a health-plan contract as defined under 

14 section 1725(f)(2) of this title (determined, in the case 

15 of a health-plan contract as defined in subsection (f)(2)(B) 

16 or (f)(2)(C) of such section, without regard to any require17 ment or limitation relating to eligibility for care or services 

18 from any department or agency of the United States). 

19 ‘‘(2) In this subsection, a family caregiver is an indi20 vidual who— 

21 ‘‘(A) provides caregiver services to a veteran 

22 who— 

23 ‘‘(i) was deployed in support of Operation 

24 Enduring Freedom or Operation Iraqi Free25 dom; and 


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1 ‘‘(ii) for purposes of this subsection, is de2 termined by the Secretary— 

3 ‘‘(I) to have a service-connected dis4 ability or illness that is severe; 

5 ‘‘(II) to be in need of caregiver serv6 ices, such that without such services, the 

7 veteran would require hospitalization, nurs8 ing home care, or other residential institu9 tional care; and 

10 ‘‘(III) based on an examination by a 

11 physician employed by the Department (or, 

12 in areas where no such physician is avail13 able, by a physician carrying out such 

14 function under a contract or fee arrange15 ment), to be unable to carry out the activi16 ties (including instrumental activities) of 

17 daily living; 

18 ‘‘(B) with respect to such veteran, meets the 

19 definition of the term ‘family caregiver’ under sec20 tion 1701(12) of this title; and 

21 ‘‘(C) is designated by such veteran as the pri22 mary family caregiver for such veteran. 

23 ‘‘(3) The authority of the Secretary to provide med24 ical care to a family caregiver under this section shall ex25 pire on October 1, 2012.’’. 


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1 SEC. 6. LODGING AND SUBSISTENCE FOR FAMILY CARE2 GIVERS. 

3 Section 111(e) of title 38, United States Code, is 

4 amended— 

5 (1) by striking ‘‘When’’ and inserting the fol6 lowing: ‘‘(1) Except as provided in paragraph (2), 

7 when’’; and 

8 (2) by adding at the end the following new 

9 paragraphs: 

10 ‘‘(2) Without regard to whether a covered veteran en11 titled to mileage under this section requires an attendant 

12 in order to perform such travel, an attendant of such cov13 ered veteran may be allowed expenses of travel (including 

14 lodging and subsistence) upon the same basis as such vet15 eran during— 

16 ‘‘(A) the period of time in which such veteran 

17 is traveling to and from a treatment facility; and 

18 ‘‘(B) the duration of the treatment episode for 

19 such veteran. 

20 ‘‘(3) The Secretary may prescribe regulations to 

21 carry out this subsection. Such regulations may include 

22 provisions— 

23 ‘‘(A) to limit the number of attendants that 

24 may receive expenses of travel under paragraph (2) 

25 for a single treatment episode of a covered veteran; 

26 and 


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1 ‘‘(B) to require such attendants to use certain 

2 travel services. 

3 ‘‘(4) In this subsection, the term ‘covered veteran’ 

4 means a veteran who— 

5 ‘‘(A) was deployed in support of Operation En6 during Freedom or Operation Iraqi Freedom; and 

7 ‘‘(B) for purposes of this subsection, is deter8 mined by the Secretary— 

9 ‘‘(i) to have a service-connected disability 

10 or illness that is severe; 

11 ‘‘(ii) to be in need of caregiver services, 

12 such that without such services, the veteran 

13 would require hospitalization, nursing home 

14 care, or other residential institutional care; and 

15 ‘‘(iii) based on an examination by a physi16 cian employed by the Department (or, in areas 

17 where no such physician is available, by a phy18 sician carrying out such function under a con19 tract or fee arrangement), to be unable to carry 

20 out the activities (including instrumental activi21 ties) of daily living.’’. 

22 SEC. 7. SURVEY ON CAREGIVERS AND FAMILY CARE23 GIVERS. 

24 (a) IN GENERAL.—Not later than 270 days after the 

25 date of the enactment of this Act, and not less than once 


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1 in each three-year period thereafter, the Secretary of Vet2 erans Affairs shall design and conduct a survey of care3 givers and family caregivers. In carrying out the survey, 

4 the Secretary shall collect the following information: 

5 (1) The number of caregivers. 

6 (2) The number of family caregivers. 

7 (3) The number of veterans receiving caregiver 

8 services from caregivers and family caregivers, in9 cluding the era in which each veteran served in the 

10 Armed Forces. 

11 (4) The range of caregiver services provided by 

12 caregivers and family caregivers, including— 

13 (A) the average schedule of such services; 

14 and 

15 (B) the average amount of time a caregiver 

16 and family caregiver has spent providing such 

17 services. 

18 (5) The average age of a caregiver and family 

19 caregiver. 

20 (6) The health care coverage of caregivers and 

21 family caregivers, including the sources of such cov22 erage. 

23 (7) The employment status of caregivers and 

24 family caregivers. 


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1 (8) Incidents of significant life changes related 

2 to being a caregiver or family caregiver, including 

3 unemployment and disenrollment from a course of 

4 education. 

5 (9) The number of family caregivers trained 

6 and certified through a home health care agency. 

7 (10) Other information the Secretary considers 

8 appropriate. 

9 (b) SURVEY SAMPLE.—In carrying out the survey re10 quired by subsection (a), the Secretary shall ensure that— 

11 (1) a statistically representative sample of care12 givers and family caregivers is included in the sur13 vey; and 

14 (2) such sample covers veterans in each Vet15 erans Integrated Service Network. 

16 (c) FINDINGS.—The Secretary shall consider the 

17 findings of the survey when carrying out programs related 

18 to caregivers and family caregivers. 

19 (d) REPORTS.—Not later than 180 days after the 

20 date on which each survey is completed, the Secretary 

21 shall submit to the Committee on Veterans’ Affairs of the 

22 House of Representatives and the Committee on Veterans’ 

23 Affairs of the Senate a report on caregivers and family 

24 caregivers. Each such report shall include— 


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1 (1) the findings of the survey required by sub2 section (a); 

3 (2) a summary of the services made available to 

4 caregivers and family caregivers by the Secretary; 

5 (3) the number of caregivers and family care6 givers who receive such services; 

7 (4) the cost to the Department of Veterans Af8 fairs of providing each such service; and 

9 (5) other information the Secretary considers 

10 appropriate. 

11 (e) DEFINITIONS.—In this section: 

12 (1) The term ‘‘caregiver’’ has the meaning 

13 given such term in section 1701(11) of title 38, 

14 United States Code, as added by section 2(a) of this 

15 Act. 

16 (2) The term ‘‘family caregiver’’ has the mean17 ing given such term in section 1701(12) of title 38, 

18 United States Code, as added by section 2(a) of this 

19 Act. 

Passed the House of Representatives July 27, 2009. 

Attest: LORRAINE C. MILLER, 

Clerk. 


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