II 117th CONGRESS 2d Session S. 3964 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. Short title This Act may be cited as the Reinforcing Enhanced Support through Promoting Equity for Caregivers Act of 2022 or the RESPECT Act of 2022 . 2. Modification of family caregiver program of Department of Veterans Affairs to include services related to mental health and neurological disorders (a) In general Section 1720G of title 38, United States Code, is amended— (1) in subsection (a)— (A) in paragraph (2)(C)— (i) in clause (iii), by striking ; or and inserting a semicolon; (ii) by redesignating clause (iv) as clause (v); and (iii) by inserting after clause (iii) the following new clause (iv): (iv) a diagnosed mental illness or history of suicidal ideation within the past three years that puts the veteran at risk of self-harm; or ; (B) in paragraph (3)— (i) in subparagraph (A)(ii)(VI)— (I) in item (aa), by striking ; and and inserting a semicolon; (II) in item (bb), by striking the period at the end and inserting ; and ; and (III) by adding at the end the following new item: (cc) mental health treatment and counseling services. ; and (ii) in subparagraph (C)— (I) in clause (iii)— (aa) in the matter preceding subclause (I)— (AA) by striking or regular instruction and inserting , regular instruction ; and (BB) by inserting or a diagnosis of mental illness or history of suicidal ideation that puts the veteran at risk of self-harm under paragraph (2)(C)(iv), before the Secretary shall ; (bb) in subclause (II), by inserting before the period at the end the following: , or assistance relating to the risk of self-harm of the veteran, as the case may be ; and (cc) in subclause (III), by striking such supervision, protection, or instruction to the veteran and inserting to the veteran such supervision, protection, or instruction, or assistance relating to the risk of self-harm of the veteran, as the case may be ; and (II) by adding at the end the following new clauses: (v) (I) For purposes of determining the amount and degree of personal care services provided under clause (i) with respect to a veteran described in subclause (II), the Secretary shall take into account relevant documentation evidencing the provision of personal care services with respect to the veteran during the preceding three-year period. (II) A veteran described in this subclause is a veteran whose need for personal care services as described in paragraph (2)(C) is based in whole or in part on— (aa) a diagnosis of mental illness or history of suicidal ideation that puts the veteran at risk of self-harm under clause (iv) of such paragraph; or (bb) a neurological disorder. ; and (C) by adding at the end the following new paragraph: (14) The Secretary shall establish a process and requirements for clinicians of facilities of the Department— (A) to document incidents in which an eligible veteran presents at such a facility for treatment for an emergent or urgent mental health crisis or an eligible veteran is assessed by such a clinician to be at risk for suicide; and (B) provide such documentation to the program established under paragraph (1). ; and (2) in subsection (d), by adding at the end the following new paragraph: (5) The term qualified mental health professional means a psychiatrist, psychologist, licensed clinical social worker, psychiatric nurse, or other licensed mental health professional as the Secretary considers appropriate. . (b) Timing for establishment of requirements and processes (1) Report Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall— (A) establish the process and requirements required under paragraph (14) of section 1720G(a) of title 38, United States Code, as added by subsection (a)(1)(C); and (B) submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a description of such process and requirements. (2) Certification (A) In general Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall require all clinicians of facilities of the Department to certify to the Secretary that the clinician understands the process and requirements established under paragraph (1)(A). (B) Facilities of the Department defined In this paragraph, the term facilities of the Department has the meaning given that term in section 1701 of title 38, United States Code. 3. Requirements relating to evaluations, assessments, and reassessments relating to eligibility of veterans and caregivers for family caregiver program (a) In general Subsection (a) of section 1720G of title 38, United States Code, as amended by section 2(a)(1), is further amended by adding at the end the following new paragraphs: (15) (A) For purposes of conducting evaluations and assessments to determine eligibility of a veteran and caregiver for the program established under paragraph (1) or conducting reassessments to determine continued eligibility for such program, the Secretary shall— (i) take into account relevant documentation and medical records generated by non-Department health care providers, including qualified mental health professionals and neurological specialists; (ii) if the caregiver of the veteran claims that the serious injury or need for personal care services of the veteran as described in paragraph (2) is based in whole or in part on psychological trauma or another mental disorder, ensure— (I) a qualified mental health professional that treats the veteran participates in the evaluation process; and (II) a qualified mental health professional participates in the assessment or reassessment process; and (iii) if the caregiver of the veteran claims that the serious injury or need for personal care services of the veteran as described in paragraph (2) is based in whole or in part on a neurological disorder, ensure— (I) a neurological specialist that treats the veteran participates in the evaluation process; and (II) a neurological specialist participates in the assessment or reassessment process. (B) (i) The Secretary shall establish an appropriate time limit during a 24-hour period for the active participation of a veteran in an evaluation, assessment, or reassessment to determine eligibility of the veteran for the program established under paragraph (1). (ii) In determining an appropriate time limit for a veteran under clause (i), the Secretary shall— (I) take into consideration necessary accommodations for the veteran stemming from the disability or medical condition of the veteran; and (II) consult with the primary care provider, neurological specialist, or qualified mental health professional that is treating the veteran. (C) The Secretary shall not require the presence of a veteran during portions of an evaluation, assessment, or reassessment to determine eligibility of the veteran for the program established under paragraph (1) that only require the active participation of the caregiver. (D) (i) The Secretary shall make reasonable efforts to assist a caregiver and veteran in obtaining evidence necessary to substantiate the claims of the caregiver and veteran in the application process for evaluation, assessment, or reassessment for the program established under paragraph (1). (ii) (I) As part of the assistance provided to a caregiver or veteran under clause (i), the Secretary shall make reasonable efforts to obtain relevant private records that the caregiver or veteran adequately identifies to the Secretary. (II) Whenever the Secretary, after making reasonable efforts under subclause (I), is unable to obtain all of the relevant records sought, the Secretary shall notify the caregiver and veteran that the Secretary is unable to obtain records with respect to the claim, which shall include— (aa) an identification of the records the Secretary is unable to obtain; (bb) a brief explanation of the efforts that the Secretary made to obtain such records; and (cc) an explanation that the Secretary will make a determination based on the evidence of record and that this clause does not prohibit the submission of records at a later date if such submission is otherwise allowed. (III) The Secretary shall make not fewer than two requests to a custodian of a private record in order for an effort to obtain such record to be treated as reasonable under subclause (I), unless it is made evident by the first request that a second request would be futile in obtaining such record. (iii) Under regulations prescribed by the Secretary, the Secretary— (I) shall encourage a caregiver and veteran to submit relevant private medical records of the veteran to the Secretary to substantiate the claims of the caregiver and veteran in the application process for evaluation, assessment, or reassessment for the program established under paragraph (1) if such submission does not burden the caregiver or veteran; and (II) may require the caregiver or veteran to authorize the Secretary to obtain such relevant private medical records if such authorization is required to comply with Federal, State, or local law. (16) (A) The Secretary, in consultation with a health care provider, neurological specialist, or qualified mental health professional that is treating a veteran, shall waive the reassessment requirement for the veteran for participation in the program established under paragraph (1) if— (i) the serious injury of the veteran under paragraph (2) is significantly caused by a degenerative or chronic condition; and (ii) such condition is unlikely to improve the dependency of the veteran for personal care services. (B) The Secretary shall require a health care provider, neurological specialist, or qualified mental health professional that is treating a veteran to annually certify the clinical decision of the provider, specialist, or professional under subparagraph (A). (C) The Secretary may rescind a waiver under subparagraph (A) with respect to a veteran and require a reassessment of the veteran if a health care provider, neurological specialist, or qualified mental health professional that is treating the veteran makes a clinical determination that the level of dependency of the veteran for personal care services has diminished since the last certification of the clinical decision of the provider, specialist, or professional under subparagraph (B). . (b) Definition Subsection (d) of such section, as amended by section 2(a)(2), is further amended— (1) by redesignating paragraphs (4) and (5) as paragraphs (5) and (6), respectively; and (2) by inserting after paragraph (3) the following new paragraph (4): (4) The term neurological specialist means a neurologist, neuropsychiatrist, physiatrist, geriatrician, certified brain injury specialist, neurology nurse, neurology nurse practitioner, neurology physician assistant, or such other licensed medical professional as the Secretary considers appropriate. . 4. Requirements relating to provision of grants for assistance to family caregivers of veterans (a) Distribution of grants Section 1720G(a)(3) of title 38, United States Code, is amended by adding at the end the following new subparagraph: (E) (i) The Secretary shall distribute grants provided under subparagraph (A)(ii)(VI) to entities eligible for the provision of such a grant in geographically dispersed areas. (ii) In providing grants to entities under subparagraph (A)(ii)(VI), the Secretary shall provide equal consideration to national, regional, and local organizations, in an effort to adequately serve individuals in need of services provided pursuant to such a grant. . (b) Grant program requirements (1) Rulemaking Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall begin the rulemaking process to establish a grant program under each of items (aa), (bb), and (cc) of section 1720G(a)(3)(A)(ii)(VI) of title 38, United States Code, as amended by section 2(a)(1)(B)(i), to provide grants under such items. (2) Report (A) In general Not later than one year after the date on which the first grant is provided after the date of the enactment of this Act under a grant program established under paragraph (1), the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and Committee on Veterans’ Affairs of the House of Representatives a report on the provision of grants under each such program. (B) Elements The report required by subparagraph (A) shall include the following: (i) An assessment of the effectiveness of the grant programs established under paragraph (1), including— (I) the number of individuals who benefitted from each grant program in each Veterans Integrated Service Network of the Department of Veterans Affairs; and (II) an assessment of the effectiveness of increasing engagement by individuals eligible for such programs in mental health care treatment and services, financial planning services, and legal services in each Veterans Integrated Service Network. (ii) A list of recipients of grants under each such program and their partner organizations, if applicable, that delivered services funded by the grant and the amount of such grant received by each recipient and partner organization.