,,ii  #aahth ,,congress  #ast ,session  
,s4 #baf  ,,in ,,the ,,senate ,,of ,,the
 ,,united ,,states  ,february #a1       
#bjbc,mr4 ,moran introduced the         
following bill2 which was read twice and
 referred to the ,committee on          
,veterans' ,affairs  ,a ,,bill  ,to     
amend title #ch1 ,united ,states ,code1 
to modify the family caregiver program  
of the ,department of ,veterans ,affairs
 to include services related to mental  
health and neurological disorders1 and  
for other purposes4  #a4 ,short title   
,this ,act may be cited as the          
,reinforcing ,enhanced ,support through 
,promoting ,equity for ,caregivers ,act 
of #bjbc or the ,,respect ,act of #bjbc4
  #b4 ,modification of family caregiver 
program of ,department of ,veterans     
,affairs to include services related to 
mental health and neurological disorders
  7a7 ,in general ,section #agbj;,g of  
title #ch1 ,united ,states ,code1 is    
amended-- 7#a7 in subsection 7a7-- 7,a7 
in paragraph 7#b77;,c77ii71 by striking 

neurological and inserting a            
neurological disorder2  7,b7 in         
paragraph 7#c7-- 7i7 in subparagraph    
7,a77ii77,,ii71 by inserting 1 including
 through public or private entities     
before the semicolon2 and  7ii7 in      
subparagraph 7,c71 by adding at the end 
the following new clause3  7v7 7,i7 ,for
 purposes of determining the amount and 
degree of personal care services        
provided under clause 7i7 with respect  
to a veteran described in subclause     
7,,ii71 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 
period4  7,,ii7 ,a veteran described in 
this subclause is a veteran whose need  
for personal care services as described 
in paragraph 7#b77;,c7 is based in whole
 or in part on-- 7aa7 a diagnosis of    
mental illness or history of suicidal   
ideation that puts the veteran at risk  
of self-harm2 or  7bb7 a neurological   

disorder4  2 and  7,c7 by adding at the 
end the following new paragraph3  7#ad7 
,the ,secretary shall establish a       
process and requirements for clinicians 
of facilities of the ,department-- 7,a7 
to document incidents in which an       
eligible veteran participating in the   
program established under paragraph     
7#a7-- 7i7 presents at such a facility  
for treatment for an emergent or urgent 
mental health crisis2 or  7ii7 is       
assessed by such a clinician to be at   
risk for suicide2 and  7,b7 to provide  
such documentation1 including any safety
 plans developed and referrals made to a
 suicide prevention coordinator of the  
,department1 to such program4  2  7#b7  
in subsection 7b77#b77;,b71 by striking 
neurological and inserting a            
neurological disorder2  7#c7 in         
subsection 7d7-- 7,a7 by redesignating  
paragraph 7#d7 as paragraph 7#e72  7,b7 
by inserting after paragraph 7#c7 the   
following new paragraph 7#d73  7#d7 the 
term neurological disorder means a      

disease of the brain1 spinal cord1      
nerves1 or neuromuscular system4  2 and 
7,c7 in paragraph 7#e77;,b71 as         
redesignated by subparagraph 7,a71 by   
striking neurological and inserting a   
neurological disorder4  7b7 ,timing for 
establishment of requirements and       
processes  7#a7 ,report ,not later than 
one year after the date of the enactment
 of this ,act1 the ,secretary of        
,veterans ,affairs shall-- 7,a7         
establish the process and requirements  
required under paragraph 7#ad7 of       
section #agbj;,g7a7 of title #ch1       
,united ,states ,code1 as added by      
subsection 7a77#a77;,b72 and  7,b7      
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         
requirements4  7#b7 ,certification  7,a7
 ,in general ,not later than one year   
after the date of the enactment of this 
,act1 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
 7#a77;,a74  7,b7 ,facilities of the    
,department defined ,in this paragraph1 
the term facilities of the ,department  
has the meaning given that term in      
section #agja of title #ch1 ,united     
,states ,code4  #c4 ,requirements       
relating to evaluations1 assessments1   
and reassessments relating to           
eligibility of veterans and caregivers  
for family caregiver program  7a7 ,in   
general ,subsection 7a7 of section      
#agbj;,g of title #ch1 ,united ,states  
,code1 as amended by section #b7;a77#a71
 is further amended by adding at the end
 the following new paragraphs3  7#ae7   
7,a7 ,for purposes of conducting        
evaluations and assessments to determine
 eligibility of a veteran and caregiver 
for the program established under       
paragraph 7#a7 or conducting            

reassessments to determine continued    
eligibility for such program1 the       
,secretary shall-- 7i7 take into account
 relevant documentation and medical     
records generated by ,department and    
non-,department health care providers1  
including qualified mental health       
professionals and neurological          
specialists2  7ii7 if the caregiver of  
the veteran claims that the serious     
injury or need for personal care        
services of the veteran as described in 
paragraph 7#b7 is based in whole or in  
part on psychological trauma or another 
mental disorder1 ensure-- 7,i7 a        
qualified mental health professional    
that treats the veteran participates in 
the evaluation process2 and  7,,ii7 a   
qualified mental health professional    
participates in the assessment or       
reassessment process2 and  7iii7 if the 
caregiver of the veteran claims that the
 serious injury or need for personal    
care services of the veteran as         
described in paragraph 7#b7 is based in 

whole or in part on a neurological      
disorder1 ensure-- 7,i7 a neurological  
specialist that treats the veteran      
participates in the evaluation process2 
and  7,,ii7 a neurological specialist   
participates in the assessment or       
reassessment process4  7,b7 7i7 ,the    
,secretary shall establish an           
appropriate time limit during a         
#bd-;hour period for the active         
participation of a veteran in an        
evaluation1 assessment1 or reassessment 
to determine eligibility of the veteran 
for the program established under       
paragraph 7#a74  7ii7 ,in determining an
 appropriate time limit for a veteran   
under clause 7i71 the ,secretary shall--
 7,i7 take into consideration necessary 
accommodations for the veteran stemming 
from the disability or medical condition
 of the veteran2 and  7,,ii7 consult    
with the primary care provider1         
neurological specialist1 or qualified   
mental health professional that is      
treating the veteran4  7,c7 ,the        

,secretary shall not require the        
presence of a veteran during portions of
 an evaluation1 assessment1 or          
reassessment to determine eligibility of
 the veteran for the program established
 under paragraph 7#a7 that only require 
the active participation of the         
caregiver4  7,d7 7i7 ,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 evaluation1 
assessment1 or reassessment for the     
program established under paragraph     
7#a74  7ii7 7,i7 ,as part of the        
assistance provided to a caregiver or   
veteran under clause 7i71 the ,secretary
 shall make reasonable efforts to obtain
 relevant private records that the      
caregiver or veteran adequately         
identifies to the ,secretary4  7,,ii7   
,whenever the ,secretary1 after making  
reasonable efforts under subclause 7,i71
 is unable to obtain all of the relevant

 records sought1 the ,secretary shall   
notify the caregiver and veteran that   
the ,secretary is unable to obtain      
records with respect to the claim1 which
 shall include-- 7aa7 an identification 
of the records the ,secretary is unable 
to obtain2  7bb7 a brief explanation of 
the efforts that the ,secretary made to 
obtain such records2 and  7cc7 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 allowed4        
7,,iii7 ,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   
7,i71 unless it is made evident by the  
first request that a second request     
would be futile in obtaining such       
record4  7iii7 ,under regulations       
prescribed by the ,secretary1 the       

,secretary-- 7,i7 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 evaluation1 
assessment1 or reassessment for the     
program established under paragraph 7#a7
 if such submission does not burden the 
caregiver or veteran2 and  7,,ii7 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 ,federal1 ,state1 or local law4    
7#af7 7,a7 ,the ,secretary1 in          
consultation with a health care         
provider1 neurological specialist1 or   
qualified mental health professional    
that is treating a veteran1 shall waive 
the reassessment requirement for the    
veteran for participation in the program
 established under paragraph 7#a7 if--  
7i7 the serious injury of the veteran   
under paragraph 7#b7 is significantly   

caused by a degenerative or chronic     
condition2 and  7ii7 such condition is  
unlikely to improve the dependency of   
the veteran for personal care services4 
7,b7 ,the ,secretary shall require a    
health care provider1 neurological      
specialist1 or qualified mental health  
professional that is treating a veteran 
to certify at appropriate intervals     
determined by the ,secretary the        
clinical decision of the provider1      
specialist1 or professional under       
subparagraph 7,a74  7,c7 ,the ,secretary
 may rescind a waiver under subparagraph
 7,a7 with respect to a veteran and     
require a reassessment of the veteran if
 a health care provider1 neurological   
specialist1 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         
provider1 specialist1 or professional   

under subparagraph 7,b74  4  7b7        
,definitions ,subsection 7d7 of such    
section1 as amended by section          
#b7;a77#b71 is further amended-- 7#a7 by
 redesignating paragraph 7#e7 as        
paragraph 7#f72  7#b7 by inserting after
 paragraph 7#d7 the following new       
paragraph 7#e73  7#e7 ,the term         
neurological specialist means a         
neurologist1 neuropsychiatrist1         
physiatrist1 geriatrician1 certified    
brain injury specialist1 neurology      
nurse1 neurology nurse practitioner1    
neurology physician assistant1 or such  
other licensed medical professional as  
the ,secretary considers appropriate4  2
 and  7#c7 by adding at the end the     
following new paragraph3  7#g7 ,the term
 qualified mental health professional   
means a psychiatrist1 psychologist1     
licensed clinical social worker1        
psychiatric nurse1 licensed professional
 mental health counselor1 or other      
licensed mental health professional as  
the ,secretary considers appropriate4  4

  #d4 ,authority for ,secretary of      
,veterans ,affairs to award grants to   
entities to improve provision of mental 
health support to family caregivers of  
veterans  7a7 ,in general ,subchapter   
,,ii of chapter #ag of title #ch1       
,united ,states ,code1 is amended by    
adding at the end the following new     
section3  #agbj,k4 ,grants to provide   
mental health support to family         
caregivers of veterans  7a7 ,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 program4  7b7 ,authority ,the 
,secretary may award grants to carry    
out1 coordinate1 improve1 or otherwise  
enhance mental health counseling1       
treatment1 or support to the family     
caregivers of veterans participating in 
the family caregiver program4  7c7      
,application  7#a7 ,to be eligible for a

 grant under this section1 an entity    
shall submit to the ,secretary an       
application therefor at such time1 in   
such manner1 and containing such        
information as the ,secretary may       
require4  7#b7 ,each application        
submitted under paragraph 7#a7 shall    
include the following3 7,a7 ,a detailed 
plan for the use of the grant4  7,b7 ,a 
description of the programs or efforts  
through which the entity will meet the  
outcome measures developed by the       
,secretary under subsection 7g74  7,c7  
,a description of how the entity will   
distribute grant amounts equitably among
 areas with varying levels of           
urbanization4  7,d7 ,a plan for how the 
grant will be used to meet the unique   
needs of veterans residing in rural     
areas1 ,american ,indian or ,alaska     
,native veterans1 elderly veterans1     
women veterans1 and veterans from other 
underserved communities4  7d7           
,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 urbanization4  7e7    
,priority ,the ,secretary shall         
prioritize awarding grants under this   
section that will serve the following   
areas3 7#a7 ,areas with high rates of   
veterans enrolled in the family         
caregiver program4  7#b7 ,areas with    
high rates of-- 7,a7 suicide among      
veterans2 or  7,b7 referrals to the     
,veterans ,crisis ,line4  7f7 ,required 
activities ,any grant awarded under this
 section shall be used-- 7#a7 to expand 
existing programs1 activities1 and      
services2  7#b7 to establish new or     
additional programs1 activities1 and    
services2 or  7#c7 for travel and       
transportation to facilitate carrying   
out paragraph 7#a7 or 7#b74  7g7        
,outcome measures  7#a7 ,the ,secretary 
shall develop and provide to each entity
 that receives a grant under this       
section written guidance on the         
following3 7,a7 ,outcome measures4  7,b7

 ,policies of the ,department4  7#b7 ,in
 developing outcome measures under      
paragraph 7#a71 the ,secretary shall    
consider the following goals3 7,a7      
,increasing the utilization of mental   
health services among family caregivers 
of veterans participating in the family 
caregiver program4  7,b7 ,reducing      
barriers to mental health services among
 family caregivers of veterans          
participating in such program4  7h7     
,tracking requirements  7#a7 ,the       
,secretary shall establish appropriate  
tracking requirements with respect to   
the entities receiving a grant under    
this section4  7#b7 ,not less frequently
 than annually1 the ,secretary shall    
submit to ,congress a report on such    
tracking requirements4  7i7 ,performance
 review ,the ,secretary shall-- 7#a7    
review the performance of each entity   
that receives a grant under this        
section2 and  7#b7 make information     
regarding such performance publicly     
available4  7j7 ,remediation plan  7#a7 

,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 7g71 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 measures4  7#b7 ,the       
,secretary may not award a subsequent   
grant under this section to an entity   
described in paragraph 7#a7 unless the  
,secretary approves the remediation plan
 submitted by the entity under such     
paragraph4  7k7 ,maximum amount ,the    
amount of a grant awarded under this    
section may not exceed #aj percent of   
amounts made available for grants under 
this section for the fiscal year in     
which the grant is awarded4  7l7        
,supplement1 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 program4  7m7 ,funding  7#a7  
,amounts for the activities of the      
,department under this section shall be 
budgeted and appropriated through a     
separate appropriation account4  7#b7   
,in the budget justification materials  
submitted to ,congress in support of the
 budget of the ,department for any      
fiscal year 7as submitted with the      
budget of the ,president under section  
#aaje7;a7 of title #ca71 the ,secretary 
shall include a separate statement of   
the amount requested to be appropriated 
for that fiscal year for the account    
specified in paragraph 7#a74  7n7       
,authorization of appropriations ,there 
is authorized to be appropriated to the 
,secretary for each of fiscal years     
#bjbc through #bjbe #ej1jjj1jjj to carry
 out this section4  7o7 ,definitions ,in
 this section3 7#a7 ,the terms caregiver
 and family caregiver have the meanings 
given those terms in section #agbj;,g7d7

 of this title4  7#b7 ,the term family  
caregiver program means the program of  
comprehensive assistance for family     
caregivers under section #agbj;,g7a7 of 
this title4  7#c7 ,the term ,veterans   
,crisis ,line means the toll-free       
hotline for veterans established under  
section #agbj;,f7h7 of this title4  4   
7b7 ,clerical amendment ,the table of   
sections at the beginning of such       
subchapter is amended by adding at the  
end the following new item3  #agbj,k4   
,grants to provide mental health support
 to family caregivers of veterans4  4   
#e4 ,comptroller ,general report on     
mental health support for caregivers    
7a7 ,report required ,not later than one
 year after the date of the enactment of
 this ,act1 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 veterans4  7b7 ,contents  
,the report submitted under subsection  
7a7 shall include the following3 7#a7   
,an assessment of the need for mental   
health support among caregivers         
participating in the caregiver programs4
  7#b7 ,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 programs4
  7#c7 ,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 programs4  7#d7 ,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 programs4
  7#e7 ,an assessment of barriers to    
mental health support in facilities of  
the ,department and in the community for

 caregivers participating in the        
caregiver programs4  7c7 ,definitions   
,in this section3 7#a7 ,caregiver ,the  
term caregiver has the meaning given    
that term in section #agbj;,g7d7 of     
title #ch1 ,united ,states ,code4  7#b7 
,caregiver programs ,the term caregiver 
programs means-- 7,a7 the program of    
comprehensive assistance for family     
caregivers under subsection 7a7 of      
section #agbj;,g of title #ch1 ,united  
,states ,code2 and  7,b7 the program of 
support services for caregivers under   
subsection 7b7 of such section4