I 

111TH CONGRESS 

1ST SESSION 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. 

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 

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. 

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 

5 and 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 fol9 lowing new paragraphs: 


tjames on DSKG8SOYB1PROD with BILLS
2 

•HR 3155 IH

1 ‘‘(10) The term ‘caregiver services’ means non2 institutional extended care (as used in paragraph 

3 (6)). 

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

5 who— 

6 ‘‘(A) provides caregiver services to a dis7 abled veteran for such disability; and 

8 ‘‘(B) is not a member of the family (in9 cluding parents, spouses, children, siblings, 

10 step-family members, and extended family 

11 members) of such veteran. 

12 ‘‘(12) The term ‘family caregiver’ means an in13 dividual who— 

14 ‘‘(A) provides caregiver services to a dis15 abled veteran for such disability; 

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

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

18 members, and extended family members) of 

19 such veteran; and 

20 ‘‘(C) may or may not reside with such vet21 eran.’’. 

22 (b) SUPPORT SERVICES.— 

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

24 of title 38, United States Code, is amended by add25 ing at the end the following new section: 


tjames on DSKG8SOYB1PROD with BILLS
3 

•HR 3155 IH

1 ‘‘§ 1720G. Support services for caregivers and family 

2 caregivers 

3 ‘‘(a) 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 

8 on an Internet website; 

9 ‘‘(B) incorporate available technology, in10 cluding telehealth technology to the extent prac11 ticable; and 

12 ‘‘(C) teach techniques, strategies, and 

13 skills for caring for a disabled veteran, includ14 ing, at a minimum, a veteran who— 

15 ‘‘(i) was deployed in support of Oper16 ation Enduring Freedom or Operation 

17 Iraqi Freedom; and 

18 ‘‘(ii) has post-traumatic stress dis19 order, a traumatic brain injury, or other 

20 severe injury or illness. 

21 ‘‘(2) Individuals described in this paragraph are indi22 viduals who provide caregivers and family caregivers with 

23 support under this chapter or through an aging network 

24 (as that term is defined in section 102(5) of the Older 

25 Americans Act of 1965 (42 U.S.C. 3002(5)), including— 

26 ‘‘(A) respite care providers; 


tjames on DSKG8SOYB1PROD with BILLS
4 

•HR 3155 IH

1 ‘‘(B) nursing care providers; and 

2 ‘‘(C) counselors. 

3 ‘‘(b) ACCESS TO SUPPORT SERVICES.—The Secretary 

4 shall provide caregivers and family caregivers with infor5 mation concerning public, private, and non-profit agencies 

6 that offer support to caregivers. In providing such infor7 mation, the Secretary shall— 

8 ‘‘(1) collaborate with the Assistant Secretary 

9 for Aging of the Department of Health and Human 

10 Services in order to provide caregivers and family 

11 caregivers access to aging and disability resource 

12 centers under the Administration on Aging of the 

13 Department of Health and Human Services; and 

14 ‘‘(2) include on an Internet website that is dedi15 cated to caregivers and family caregivers— 

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

17 caregivers and family caregivers at the county 

18 level; and 

19 ‘‘(B) tools that provide caregivers and fam20 ily caregivers with the ability to interact with 

21 each other for the purpose of fostering peer 

22 support and creating support networks. 

23 ‘‘(c) INFORMATION AND OUTREACH.—The Secretary 

24 shall conduct outreach to inform disabled veterans and the 

25 families of such veterans of the medical care, educational 


tjames on DSKG8SOYB1PROD with BILLS
5 

•HR 3155 IH

1 sessions, and services available under this chapter for 

2 caregivers and family caregivers. Such outreach shall in3 clude, at a minimum, the following: 

4 ‘‘(1) Public service announcements. 

5 ‘‘(2) Brochures and pamphlets. 

6 ‘‘(3) Full use of Internet-based outreach meth7 ods, including such methods designed specifically for 

8 veterans and the families of such veterans who re9 side in rural areas.’’. 

10 (2) CLERICAL AMENDMENT.—The table of sec11 tions at the beginning of chapter 17 of title 38, 

12 United States Code, is amended by inserting after 

13 the item related to section 1720F the following new 

14 item: 

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

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

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

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

18 Representatives and the Committee on Veterans’ Affairs 

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

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

21 of this section. 

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

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

24 and annually thereafter for the following five years, the 

25 Secretary shall submit to the Committee on Veterans’ AfVerDate Nov 24 2008 06:36 Jul 10, 2009 Jkt 079200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3155.IH H3155

tjames on DSKG8SOYB1PROD with BILLS
6 

•HR 3155 IH

1 fairs of the House of Representatives and the Committee 

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

3 implementation of the plan. 

4 SEC. 3. COUNSELING AND MENTAL HEALTH SERVICES FOR 

5 CAREGIVERS AND FAMILY CAREGIVERS. 

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

7 States Code, is amended— 

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

9 the following: ‘‘, caregivers, and family care10 givers’’; and 

11 (2) in subsection (c)— 

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

13 and inserting a semicolon; 

14 (B) by redesignating paragraph (2) as 

15 paragraph (3); and 

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

17 following new paragraph (2): 

18 ‘‘(2) a caregiver or family caregiver of a vet19 eran; or’’. 

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

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

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

23 1782 and inserting the following new item: 

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

members, caregivers, and family caregivers.’’. 


tjames on DSKG8SOYB1PROD with BILLS
7 

•HR 3155 IH

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

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

3 amended— 

4 (1) in subsection (a), by striking ‘‘title.’’ and in5 serting ‘‘title or who receives care from a family 

6 caregiver.’’; and 

7 (2) by adding at the end the following new sub8 section: 

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

10 section, the Secretary shall ensure that such services— 

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

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

13 ‘‘(2) are appropriate for the veteran with re14 spect to the age of the veteran.’’. 

15 SEC. 5. MEDICAL CARE FOR FAMILY CAREGIVERS. 

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

17 amended— 

18 (1) in subsection (a)— 

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

20 the end; 

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

22 at the end; and 

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

24 following new paragraph: 

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

26 caregiver,’’; 


tjames on DSKG8SOYB1PROD with BILLS
8 

•HR 3155 IH

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

2 striking ‘‘dependent or survivor’’ and inserting ‘‘de3 pendent, survivor, or family caregiver’’; and 

4 (3) by adding at the end the following new sub5 section: 

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

7 a family caregiver under this section if the Secretary de8 termines that the family caregiver is not entitled to care 

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

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

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

12 or (f)(2)(C) of such section, without regard to any require13 ment or limitation relating to eligibility for care or services 

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

15 ‘‘(2) In this subsection, a family caregiver is an indi16 vidual who— 

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

18 who— 

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

20 Enduring Freedom or Operation Iraqi Free21 dom; and 

22 ‘‘(ii) for purposes of this subsection, is de23 termined by the Secretary— 

24 ‘‘(I) to have a service-connected dis25 ability or illness that is severe; 


tjames on DSKG8SOYB1PROD with BILLS
9 

•HR 3155 IH

1 ‘‘(II) to be in need of caregiver serv2 ices, such that without such services, the 

3 veteran would require hospitalization, nurs4 ing home care, or other residential institu5 tional care; and 

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

7 physician employed by the Department (or, 

8 in areas where no such physician is avail9 able, by a physician carrying out such 

10 function under a contract or fee arrange11 ment), to be unable to carry out the activi12 ties (including instrumental activities) of 

13 daily living; 

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

15 definition of the term ‘family caregiver’ under sec16 tion 1701(12) of this title; and 

17 ‘‘(C) is designated by such veteran as the pri18 mary family caregiver for such veteran. 

19 ‘‘(3) The authority of the Secretary to provide med20 ical care to a family caregiver under this section shall ex21 pire on October 1, 2012.’’. 

22 SEC. 6. LODGING AND SUBSISTENCE FOR FAMILY CARE23 GIVERS. 

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

25 amended— 


tjames on DSKG8SOYB1PROD with BILLS
10 

•HR 3155 IH

1 (1) by striking ‘‘When’’ and inserting the fol2 lowing: ‘‘(1) Except as provided in paragraph (2), 

3 when’’; and 

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

5 paragraphs: 

6 ‘‘(2) Without regard to whether a covered veteran en7 titled to mileage under this section requires an attendant 

8 in order to perform such travel, an attendant of such cov9 ered veteran may be allowed expenses of travel (including 

10 lodging and subsistence) upon the same basis as such vet11 eran during— 

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

13 is traveling to and from a treatment facility; and 

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

15 such veteran. 

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

17 carry out this subsection. Such regulations may include 

18 provisions— 

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

20 may receive expenses of travel under paragraph (2) 

21 for a single treatment episode of a covered veteran; 

22 and 

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

24 travel services. 


tjames on DSKG8SOYB1PROD with BILLS
11 

•HR 3155 IH

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

2 means a veteran who— 

3 ‘‘(A) was deployed in support of Operation En4 during Freedom or Operation Iraqi Freedom; and 

5 ‘‘(B) for purposes of this subsection, is deter6 mined by the Secretary— 

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

8 or illness that is severe; 

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

10 such that without such services, the veteran 

11 would require hospitalization, nursing home 

12 care, or other residential institutional care; and 

13 ‘‘(iii) based on an examination by a physi14 cian employed by the Department (or, in areas 

15 where no such physician is available, by a phy16 sician carrying out such function under a con17 tract or fee arrangement), to be unable to carry 

18 out the activities (including instrumental activi19 ties) of daily living.’’. 

20 SEC. 7. SURVEY ON CAREGIVERS AND FAMILY CARE21 GIVERS. 

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

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

24 in each three-year period thereafter, the Secretary of Vet25 erans Affairs shall design and conduct a survey of careVerDate Nov 24 2008 06:36 Jul 10, 2009 Jkt 079200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H3155.IH H3155

tjames on DSKG8SOYB1PROD with BILLS
12 

•HR 3155 IH

1 givers and family caregivers. In carrying out the survey, 

2 the Secretary shall collect the following information: 

3 (1) The number of caregivers. 

4 (2) The number of family caregivers. 

5 (3) The number of veterans receiving caregiver 

6 services from caregivers and family caregivers, in7 cluding the era in which each veteran served in the 

8 Armed Forces. 

9 (4) The range of caregiver services provided by 

10 caregivers and family caregivers, including— 

11 (A) the average schedule of such services; 

12 and 

13 (B) the average amount of time a caregiver 

14 and family caregiver has spent providing such 

15 services. 

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

17 caregiver. 

18 (6) The health care coverage of caregivers and 

19 family caregivers, including the sources of such cov20 erage. 

21 (7) The employment status of caregivers and 

22 family caregivers. 

23 (8) Incidents of significant life changes related 

24 to being a caregiver or family caregiver, including 


tjames on DSKG8SOYB1PROD with BILLS
13 

•HR 3155 IH

1 unemployment and disenrollment from a course of 

2 education. 

3 (9) Other information the Secretary considers 

4 appropriate. 

5 (b) SURVEY SAMPLE.—In carrying out the survey re6 quired by subsection (a), the Secretary shall ensure that— 

7 (1) a statistically representative sample of care8 givers and family caregivers is included in the sur9 vey; and 

10 (2) such sample covers veterans in each Vet11 erans Integrated Service Network. 

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

13 findings of the survey when carrying out programs related 

14 to caregivers and family caregivers. 

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

16 date on which each survey is completed, the Secretary 

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

18 House of Representatives and the Committee on Veterans’ 

19 Affairs of the Senate a report on caregivers and family 

20 caregivers. Each such report shall include— 

21 (1) the findings of the survey required by sub22 section (a); 

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

24 caregivers and family caregivers by the Secretary; 


tjames on DSKG8SOYB1PROD with BILLS
14 

•HR 3155 IH

1 (3) the number of caregivers and family care2 givers who receive such services; 

3 (4) the cost to the Department of Veterans Af4 fairs of providing each such service; and 

5 (5) other information the Secretary considers 

6 appropriate. 

7 (e) DEFINITIONS.—In this section: 

8 (1) The term ‘‘caregiver’’ means an individual 

9 who— 

10 (A) provides caregiver services to a veteran 

11 who is enrolled in the health care system estab12 lished under section 1705(a) of title 38, United 

13 States Code; and 

14 (B) with respect to such veteran, meets the 

15 definition of the term ‘‘caregiver’’ under section 

16 1701(11) of such title, as added by section 2(a) 

17 of this Act. 

18 (2) The term ‘‘family caregiver’’ means an indi19 vidual who— 

20 (A) provides caregiver services to a veteran 

21 who is enrolled in the health care system estab22 lished under section 1705(a) of title 38, United 

23 States Code; and 

24 (B) with respect to such veteran, meets the 

25 definition of the term ‘‘family caregiver’’ under 


tjames on DSKG8SOYB1PROD with BILLS
15 

•HR 3155 IH

1 section 1701(12) of such title, as added by sec2 tion 2(a) of this Act. 

Æ 


tjames on DSKG8SOYB1PROD with BILLS