II 118th CONGRESS 1st Session S. 216 IN THE SENATE OF THE UNITED STATES February 1, 2023 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 2023 or the RESPECT Act of 2023 . 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)(ii), by striking neurological and inserting a neurological disorder ; (B) in paragraph (3)— (i) in subparagraph (A)(ii)(II), by inserting , including through public or private entities before the semicolon; and (ii) in subparagraph (C), by adding at the end the following new clause: (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; 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 participating in the program established under paragraph (1)— (i) presents at such a facility for treatment for an emergent or urgent mental health crisis; or (ii) is assessed by such a clinician to be at risk for suicide; and (B) to provide such documentation, including any safety plans developed and referrals made to a suicide prevention coordinator of the Department, to such program. ; (2) in subsection (b)(2)(B), by striking neurological and inserting a neurological disorder ; (3) in subsection (d)— (A) by redesignating paragraph (4) as paragraph (5); (B) by inserting after paragraph (3) the following new paragraph (4): (4) the term neurological disorder means a disease of the brain, spinal cord, nerves, or neuromuscular system. ; and (C) in paragraph (5)(B), as redesignated by subparagraph (A), by striking neurological and inserting a neurological disorder . (b) Timing for establishment of requirements and processes (1) Report Not later than one year 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)(B); 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 Department and 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 certify at appropriate intervals determined by the Secretary 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) Definitions Subsection (d) of such section, as amended by section 2(a)(2), is further amended— (1) by redesignating paragraph (5) as paragraph (6); (2) by inserting after paragraph (4) the following new paragraph (5): (5) 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. ; and (3) by adding at the end the following new paragraph: (7) The term qualified mental health professional means a psychiatrist, psychologist, licensed clinical social worker, psychiatric nurse, licensed professional mental health counselor, or other licensed mental health professional as the Secretary considers appropriate. . 4. Authority for Secretary of Veterans Affairs to award grants to entities to improve provision of mental health support to family caregivers of veterans (a) In general Subchapter II of chapter 17 of title 38, United States Code, is amended by adding at the end the following new section: 1720K. Grants to provide mental health support to family caregivers of veterans (a) Purpose It is the purpose of this section to provide for assistance by the Secretary to entities to carry out programs that improve the provision of mental health support to the family caregivers of veterans participating in the family caregiver program. (b) Authority The Secretary may award grants to carry out, coordinate, improve, or otherwise enhance mental health counseling, treatment, or support to the family caregivers of veterans participating in the family caregiver program. (c) Application (1) To be eligible for a grant under this section, an entity shall submit to the Secretary an application therefor at such time, in such manner, and containing such information as the Secretary may require. (2) Each application submitted under paragraph (1) shall include the following: (A) A detailed plan for the use of the grant. (B) A description of the programs or efforts through which the entity will meet the outcome measures developed by the Secretary under subsection (g). (C) A description of how the entity will distribute grant amounts equitably among areas with varying levels of urbanization. (D) A plan for how the grant will be used to meet the unique needs of veterans residing in rural areas, American Indian or Alaska Native veterans, elderly veterans, women veterans, and veterans from other underserved communities. (d) Distribution The Secretary shall seek to ensure that grants awarded under this section are equitably distributed among entities located in States with varying levels of urbanization. (e) Priority The Secretary shall prioritize awarding grants under this section that will serve the following areas: (1) Areas with high rates of veterans enrolled in the family caregiver program. (2) Areas with high rates of— (A) suicide among veterans; or (B) referrals to the Veterans Crisis Line. (f) Required activities Any grant awarded under this section shall be used— (1) to expand existing programs, activities, and services; (2) to establish new or additional programs, activities, and services; or (3) for travel and transportation to facilitate carrying out paragraph (1) or (2). (g) Outcome measures (1) The Secretary shall develop and provide to each entity that receives a grant under this section written guidance on the following: (A) Outcome measures. (B) Policies of the Department. (2) In developing outcome measures under paragraph (1), the Secretary shall consider the following goals: (A) Increasing the utilization of mental health services among family caregivers of veterans participating in the family caregiver program. (B) Reducing barriers to mental health services among family caregivers of veterans participating in such program. (h) Tracking requirements (1) The Secretary shall establish appropriate tracking requirements with respect to the entities receiving a grant under this section. (2) Not less frequently than annually, the Secretary shall submit to Congress a report on such tracking requirements. (i) Performance review The Secretary shall— (1) review the performance of each entity that receives a grant under this section; and (2) make information regarding such performance publicly available. (j) Remediation plan (1) In the case of an entity that receives a grant under this section and does not meet the outcome measures developed by the Secretary under subsection (g), the Secretary shall require the entity to submit to the Secretary a remediation plan under which the entity shall describe how and when it plans to meet such outcome measures. (2) The Secretary may not award a subsequent grant under this section to an entity described in paragraph (1) unless the Secretary approves the remediation plan submitted by the entity under such paragraph. (k) Maximum amount The amount of a grant awarded under this section may not exceed 10 percent of amounts made available for grants under this section for the fiscal year in which the grant is awarded. (l) Supplement, not supplant Any grant awarded under this section shall be used to supplement and not supplant funding that is otherwise available through the Department to provide mental health support among family caregivers of veterans participating in the family caregiver program. (m) Funding (1) Amounts for the activities of the Department under this section shall be budgeted and appropriated through a separate appropriation account. (2) In the budget justification materials submitted to Congress in support of the budget of the Department for any fiscal year (as submitted with the budget of the President under section 1105(a) of title 31), the Secretary shall include a separate statement of the amount requested to be appropriated for that fiscal year for the account specified in paragraph (1). (n) Authorization of appropriations There is authorized to be appropriated to the Secretary for each of fiscal years 2023 through 2025 $50,000,000 to carry out this section. (o) Definitions In this section: (1) The terms caregiver and family caregiver have the meanings given those terms in section 1720G(d) of this title. (2) The term family caregiver program means the program of comprehensive assistance for family caregivers under section 1720G(a) of this title. (3) The term Veterans Crisis Line means the toll-free hotline for veterans established under section 1720F(h) of this title. . (b) Clerical amendment The table of sections at the beginning of such subchapter is amended by adding at the end the following new item: 1720K. Grants to provide mental health support to family caregivers of veterans. . 5. Comptroller General report on mental health support for caregivers (a) Report required Not later than one year after the date of the enactment of this Act, the Comptroller General of the United States shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on the provision of mental health support to caregivers of veterans. (b) Contents The report submitted under subsection (a) shall include the following: (1) An assessment of the need for mental health support among caregivers participating in the caregiver programs. (2) An assessment of options for mental health support in facilities of the Department of Veterans Affairs and in the community for caregivers participating in the caregiver programs. (3) An assessment of the availability and accessibility of mental health support in facilities of the Department and in the community for caregivers participating in the caregiver programs. (4) An assessment of the awareness among caregivers of the availability of mental health support in facilities of the Department and in the community for caregivers participating in the caregiver programs. (5) An assessment of barriers to mental health support in facilities of the Department and in the community for caregivers participating in the caregiver programs. (c) Definitions In this section: (1) Caregiver The term caregiver has the meaning given that term in section 1720G(d) of title 38, United States Code. (2) Caregiver programs The term caregiver programs means— (A) the program of comprehensive assistance for family caregivers under subsection (a) of section 1720G of title 38, United States Code; and (B) the program of support services for caregivers under subsection (b) of such section.