IB 

Union Calendar No. 122 

111TH CONGRESS 

1ST SESSION H. R. 3155 

[Report No. 111–224] 

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

veterans with training, support, and medical care, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 9, 2009 

Mr. MICHAUD (for himself, Mr. RODRIGUEZ, Mrs. HALVORSON, Mr. TEAGUE, 

and Mr. DONNELLY of Indiana) introduced the following bill; which was 

referred to the Committee on Veterans’ Affairs 

JULY 23, 2009 

Additional sponsors: Ms. CORRINE BROWN of Florida, Mr. CRENSHAW, Mr. 

SMITH of New Jersey, Mr. KLEIN of Florida, and Mr. WOLF

JULY 23, 2009 

Reported with an amendment, committed to the Committee of the Whole 

House on the State of the Union, and ordered to be printed 

[Strike out all after the enacting clause and insert the part printed in italic] 

[For text of introduced bill, see copy of bill as introduced on July 9, 2009] 


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A BILL 

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

caregivers of veterans with training, support, and medical 

care, and for other purposes. 


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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 ‘‘Caregiver Assistance and 

5 Resource Enhancement Act’’. 

6 SEC. 2. SUPPORT SERVICES FOR CAREGIVERS. 

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

8 States Code, is amended by adding at the end the following 

9 new paragraphs: 

10 ‘‘(10) The term ‘caregiver services’ means non11 institutional extended care (as used in paragraph 

12 (6)). 

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

14 who— 

15 ‘‘(A) with respect to a disabled veteran who 

16 is enrolled in the health care system established 

17 under section 1705(a) of this title, provides care18 giver services to such veteran for such disability; 

19 and 

20 ‘‘(B) is not a member of the family (includ21 ing parents, spouses, children, siblings, step-fam22 ily members, and extended family members) of 

23 such veteran. 

24 ‘‘(12) The term ‘family caregiver’ means an in25 dividual who— 


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1 ‘‘(A) with respect to a disabled veteran who 

2 is enrolled in the health care system established 

3 under section 1705(a) of this title, provides care4 giver services to such veteran for such disability; 

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

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

7 members, and extended family members) of such 

8 veteran; and 

9 ‘‘(C) may or may not reside with such vet10 eran.’’. 

11 (b) SUPPORT SERVICES.— 

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

13 title 38, United States Code, is amended by adding 

14 at the end the following new section: 

15 ‘‘§ 1720G. Support services for caregivers and family 

16 caregivers 

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

18 shall develop and carry out a program for caregivers and 

19 family caregivers that includes the following: 

20 ‘‘(1) The educational sessions, stipends, and ac21 cess to support services provided under this section. 

22 ‘‘(2) Counseling and other services provided 

23 under section 1782 of this title. 

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

25 of this title. 


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

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

3 ‘‘(5) Travel expenses provided under section 

4 111(e) of this title. 

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

6 shall make available educational sessions for caregivers, 

7 family caregivers, and individuals described in paragraph 

8 (2). Such educational sessions shall— 

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

10 Internet website; 

11 ‘‘(B) incorporate available technology, including 

12 telehealth technology to the extent practicable; and 

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

14 caring for a disabled veteran, including, at a min15 imum, a veteran who— 

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

17 Enduring Freedom or Operation Iraqi Freedom; 

18 and 

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

20 traumatic brain injury, or other severe injury or 

21 illness. 

22 ‘‘(2) Individuals described in this paragraph are indi23 viduals who provide caregivers and family caregivers with 

24 support under this chapter or through an aging network 


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

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

3 ‘‘(A) respite care providers; 

4 ‘‘(B) nursing care providers; and 

5 ‘‘(C) counselors. 

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

7 monthly stipends to eligible family caregivers described in 

8 paragraph (2). 

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

10 paragraph is a family caregiver who— 

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

12 who— 

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

14 Enduring Freedom or Operation Iraqi Freedom; 

15 and 

16 ‘‘(ii) for purposes of this subsection, is de17 termined by the Secretary— 

18 ‘‘(I) to have a service-connected dis19 ability or illness that is severe; 

20 ‘‘(II) to be in need of caregiver services, 

21 such that without such services, the veteran 

22 would require hospitalization, nursing home 

23 care, or other residential institutional care; 

24 and 


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

2 physician employed by the Department (or, 

3 in areas where no such physician is avail4 able, by a physician carrying out such func5 tion under a contract or fee arrangement), 

6 to be unable to carry out the activities (in7 cluding instrumental activities) of daily liv8 ing; 

9 ‘‘(B) with respect to such veteran, meets the defi10 nition of the term ‘family caregiver’ under section 

11 1701(12) of this title; 

12 ‘‘(C) is designated by such veteran as the pri13 mary family caregiver for such veteran; and 

14 ‘‘(D) is not— 

15 ‘‘(i) employed by a home health care agency 

16 to provide such caregiver services; or 

17 ‘‘(ii) otherwise receiving payment for such 

18 services. 

19 ‘‘(3) The authority of the Secretary to provide a sti20 pend to an eligible family caregiver under this subsection 

21 shall expire on October 1, 2012. 

22 ‘‘(d) ACCESS TO SUPPORT SERVICES.—The Secretary 

23 shall provide caregivers and family caregivers with infor24 mation concerning public, private, and non-profit agencies 


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1 that offer support to caregivers. In providing such informa2 tion, the Secretary shall— 

3 ‘‘(1) collaborate with the Assistant Secretary for 

4 Aging of the Department of Health and Human Serv5 ices in order to provide caregivers and family care6 givers access to aging and disability resource centers 

7 under the Administration on Aging of the Depart8 ment of Health and Human Services; and 

9 ‘‘(2) include on an Internet website that is dedi10 cated to caregivers and family caregivers— 

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

12 caregivers and family caregivers at the county 

13 level; and 

14 ‘‘(B) tools that provide caregivers and fam15 ily caregivers with the ability to interact with 

16 each other for the purpose of fostering peer sup17 port and creating support networks. 

18 ‘‘(e) INFORMATION AND OUTREACH.—(1) The Sec19 retary shall conduct outreach to inform disabled veterans 

20 and the families of such veterans of the following: 

21 ‘‘(A) Medical care, educational sessions, stipends, 

22 and other services available for caregivers and family 

23 caregivers under this chapter. 

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

25 trained and certified by a home health care agency in 


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1 order to be paid by such agency for providing care2 giver services. 

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

4 a minimum, the following: 

5 ‘‘(A) Public service announcements. 

6 ‘‘(B) Brochures and pamphlets. 

7 ‘‘(C) Full use of Internet-based outreach methods, 

8 including such methods designed specifically for vet9 erans and the families of such veterans who reside in 

10 rural areas. 

11 ‘‘(3) With respect to a Department employee providing 

12 case management services (as defined in section 

13 1720C(b)(2) of this title) to a disabled veteran, the Sec14 retary shall ensure that such employee provides a caregiver 

15 or family caregiver of such veteran with information on the 

16 services described in subparagraphs (A) and (B) of para17 graph (1).’’. 

18 (2) CLERICAL AMENDMENT.—The table of sec19 tions at the beginning of chapter 17 of title 38, 

20 United States Code, is amended by inserting after the 

21 item related to section 1720F the following new item: 

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

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

23 the enactment of this Act, the Secretary shall submit to the 

24 Committee on Veterans’ Affairs of the House of Representa25 tives and the Committee on Veterans’ Affairs of the Senate 


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1 a plan for carrying out section 1720G of title 38, United 

2 States Code, as added by subsection (b) of this section. 

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

4 on which the plan is submitted under subsection (c), and 

5 annually thereafter for the following five years, the Sec6 retary shall submit to the Committee on Veterans’ Affairs 

7 of the House of Representatives and the Committee on Vet8 erans’ Affairs of the Senate a report describing the imple9 mentation of the plan. 

10 SEC. 3. COUNSELING AND MENTAL HEALTH SERVICES FOR 

11 CAREGIVERS AND FAMILY CAREGIVERS. 

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

13 States Code, is amended— 

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

15 the following: ‘‘, caregivers, and family care16 givers’’; and 

17 (2) in subsection (c)— 

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

19 and inserting a semicolon; 

20 (B) by redesignating paragraph (2) as 

21 paragraph (3); and 

22 (C) by inserting after paragraph (1) the fol23 lowing new paragraph (2): 

24 ‘‘(2) a caregiver or family caregiver of a veteran; 

25 or’’. 


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1 (b) CLERICAL AMENDMENT.—The table of sections at 

2 the beginning of chapter 17 of title 38, United States Code, 

3 is amended by striking the item relating to section 1782 

4 and inserting the following new item: 

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

members, caregivers, and family caregivers.’’. 

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

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

7 amended— 

8 (1) in subsection (a), by striking ‘‘title.’’ and in9 serting ‘‘title or who receives care from a family care10 giver.’’; and 

11 (2) by adding at the end the following new sub12 section: 

13 ‘‘(d) In furnishing respite care services under this sec14 tion, the Secretary shall ensure that such services— 

15 ‘‘(1) fulfill the needs of the veteran receiving care 

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

17 ‘‘(2) are appropriate for the veteran with respect 

18 to the age of the veteran.’’. 

19 SEC. 5. MEDICAL CARE FOR FAMILY CAREGIVERS. 

20 Section 1781 of title 38, United States Code, is amend21 ed— 

22 (1) in subsection (a)— 

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

24 the end; 


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

2 at the end; and 

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

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

6 caregiver,’’; 

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

8 striking ‘‘dependent or survivor’’ and inserting ‘‘de9 pendent, survivor, or family caregiver’’; and 

10 (3) by adding at the end the following new sub11 section: 

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

13 family caregiver under this section if the Secretary deter14 mines that the family caregiver is not entitled to care or 

15 services under a health-plan contract as defined under sec16 tion 1725(f)(2) of this title (determined, in the case of a 

17 health-plan contract as defined in subsection (f)(2)(B) or 

18 (f)(2)(C) of such section, without regard to any requirement 

19 or limitation relating to eligibility for care or services from 

20 any department or agency of the United States). 

21 ‘‘(2) In this subsection, a family caregiver is an indi22 vidual who— 

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

24 who— 


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

2 Enduring Freedom or Operation Iraqi Freedom; 

3 and 

4 ‘‘(ii) for purposes of this subsection, is de5 termined by the Secretary— 

6 ‘‘(I) to have a service-connected dis7 ability or illness that is severe; 

8 ‘‘(II) to be in need of caregiver services, 

9 such that without such services, the veteran 

10 would require hospitalization, nursing home 

11 care, or other residential institutional care; 

12 and 

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

14 physician employed by the Department (or, 

15 in areas where no such physician is avail16 able, by a physician carrying out such func17 tion under a contract or fee arrangement), 

18 to be unable to carry out the activities (in19 cluding instrumental activities) of daily liv20 ing; 

21 ‘‘(B) with respect to such veteran, meets the defi22 nition of the term ‘family caregiver’ under section 

23 1701(12) of this title; and 

24 ‘‘(C) is designated by such veteran as the pri25 mary family caregiver for such veteran. 


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1 ‘‘(3) The authority of the Secretary to provide medical 

2 care to a family caregiver under this section shall expire 

3 on October 1, 2012.’’. 

4 SEC. 6. LODGING AND SUBSISTENCE FOR FAMILY CARE5 GIVERS. 

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

7 amended— 

8 (1) by striking ‘‘When’’ and inserting the fol9 lowing: ‘‘(1) Except as provided in paragraph (2), 

10 when’’; and 

11 (2) by adding at the end the following new para12 graphs: 

13 ‘‘(2) Without regard to whether a covered veteran enti14 tled to mileage under this section requires an attendant in 

15 order to perform such travel, an attendant of such covered 

16 veteran may be allowed expenses of travel (including lodg17 ing and subsistence) upon the same basis as such veteran 

18 during— 

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

20 traveling to and from a treatment facility; and 

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

22 such veteran. 

23 ‘‘(3) The Secretary may prescribe regulations to carry 

24 out this subsection. Such regulations may include provi25 sions— 


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1 ‘‘(A) to limit the number of attendants that may 

2 receive expenses of travel under paragraph (2) for a 

3 single treatment episode of a covered veteran; and 

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

5 travel services. 

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

7 means a veteran who— 

8 ‘‘(A) was deployed in support of Operation En9 during Freedom or Operation Iraqi Freedom; and 

10 ‘‘(B) for purposes of this subsection, is deter11 mined by the Secretary— 

12 ‘‘(i) to have a service-connected disability or 

13 illness that is severe; 

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

15 that without such services, the veteran would re16 quire hospitalization, nursing home care, or 

17 other residential institutional care; and 

18 ‘‘(iii) based on an examination by a physi19 cian employed by the Department (or, in areas 

20 where no such physician is available, by a physi21 cian carrying out such function under a contract 

22 or fee arrangement), to be unable to carry out 

23 the activities (including instrumental activities) 

24 of daily living.’’. 


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1 SEC. 7. SURVEY ON CAREGIVERS AND FAMILY CAREGIVERS. 

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

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

4 in each three-year period thereafter, the Secretary of Vet5 erans Affairs shall design and conduct a survey of care6 givers and family caregivers. In carrying out the survey, 

7 the Secretary shall collect the following information: 

8 (1) The number of caregivers. 

9 (2) The number of family caregivers. 

10 (3) The number of veterans receiving caregiver 

11 services from caregivers and family caregivers, in12 cluding the era in which each veteran served in the 

13 Armed Forces. 

14 (4) The range of caregiver services provided by 

15 caregivers and family caregivers, including— 

16 (A) the average schedule of such services; 

17 and 

18 (B) the average amount of time a caregiver 

19 and family caregiver has spent providing such 

20 services. 

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

22 caregiver. 

23 (6) The health care coverage of caregivers and 

24 family caregivers, including the sources of such cov25 erage. 


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1 (7) The employment status of caregivers and 

2 family caregivers. 

3 (8) Incidents of significant life changes related to 

4 being a caregiver or family caregiver, including un5 employment and disenrollment from a course of edu6 cation. 

7 (9) The number of family caregivers trained and 

8 certified through a home health care agency. 

9 (10) Other information the Secretary considers 

10 appropriate. 

11 (b) SURVEY SAMPLE.—In carrying out the survey re12 quired by subsection (a), the Secretary shall ensure that— 

13 (1) a statistically representative sample of care14 givers and family caregivers is included in the sur15 vey; and 

16 (2) such sample covers veterans in each Veterans 

17 Integrated Service Network. 

18 (c) FINDINGS.—The Secretary shall consider the find19 ings of the survey when carrying out programs related to 

20 caregivers and family caregivers. 

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

22 on which each survey is completed, the Secretary shall sub23 mit to the Committee on Veterans’ Affairs of the House of 

24 Representatives and the Committee on Veterans’ Affairs of 


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1 the Senate a report on caregivers and family caregivers. 

2 Each such report shall include— 

3 (1) the findings of the survey required by sub4 section (a); 

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

6 caregivers and family caregivers by the Secretary; 

7 (3) the number of caregivers and family care8 givers who receive such services; 

9 (4) the cost to the Department of Veterans Af10 fairs of providing each such service; and 

11 (5) other information the Secretary considers ap12 propriate. 

13 (e) DEFINITIONS.—In this section: 

14 (1) The term ‘‘caregiver’’ has the meaning given 

15 such term in section 1701(11) of title 38, United 

16 States Code, as added by section 2(a) of this Act. 

17 (2) The term ‘‘family caregiver’’ has the meaning 

18 given such term in section 1701(12) of title 38, 

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

20 Act. 


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Union Calendar No. 122 

111TH CONGRESS 

1ST SESSION H. R. 3155 

[Report No. 111–224] 

A BILL 

To amend title 38, United States Code, to provide 

port, and medical care, and for other purposes. certain caregivers of veterans with training, supJULY 23, 2009 

Reported with an amendment, committed to the Comand ordered to be printed mittee of the Whole House on the State of the Union, 


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