,,ii  #aaith ,,congress  #b;d ,session  
,s4 #cfdg  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,january #ae1  
#bjbf,mr4 ,moran introduced the         
following bill2 which was read twice and
 referred to the ,committee on          
,veterans' ,affairs  ,a ,,bill  ,to     
require the ,secretary of ,veterans     
,affairs to establish a program to      
address bowel and bladder care needs for
 veterans with spinal cord injuries and 
disorders1 and for other purposes4  #a4 
,short title ,this ,act may be cited as 
the ,disabled ,veterans ,dignity ,act of
 #bjbf4  #b4 ,findings2 sense of        
,congress  7a7 ,findings ,congress finds
 the following3 7#a7 ,bowel care and    
bladder care are supportive and         
necessary medical services for veterans 
with spinal cord injuries and disorders 
when they are unable to manage their    
bowel and bladder functions             
independently4  7#b7 ,inadequate care   
will lead to complications and problems 
such as autonomic dysreflexia that can  

be potentially life-threatening and     
result in illness and hospitalization4  
7#c7 ,bowel care and bladder care are   
essential to support veterans with      
spinal cord injuries and disorders in   
non-institutional settings1 improve     
quality of life1 optimize health1 and   
prevent complications from neurogenic   
bowel and bladder4  7#d7 ,family        
caregivers and individually employed    
caregivers provide life-sustaining care 
for the bowel and bladder care needs of 
veterans that allow them to live in     
their communities4  7b7 ,sense of       
,congress ,it is the sense of ,congress 
that-- 7#a7 family caregivers and       
individually employed caregivers should 
not be subjected to self-employment     
taxes and treated as vendors or         
contractors for the veterans to whom    
they provide care2  7#b7 veterans should
 not be forced to finish their bowel and
 bladder care needs in a set period of  
time that does not consider their       
individual needs2 and  7#c7 veterans    

should not be subjected to ongoing      
clinical determinations regarding their 
bowel and bladder care needs absent a   
decision by their medical care provider 
that such care is no longer needed4  #c4
 ,bowel and bladder care program of     
,department of ,veterans ,affairs  7a7  
,in general ,the ,secretary of ,veterans
 ,affairs shall establish a program to  
address the bowel and bladder care needs
 of covered veterans 7in this section   
referred to as the program74  7b7       
,provision of care  7#a7 ,clinical need 
,the ,secretary shall provide bowel and 
bladder care under the program to       
covered veterans based on clinical need1
 which may include covered veterans     
receiving aid and attendance benefits   
from the ,department of ,veterans       
,affairs4  7#b7 ,caregiver or agency ,a 
covered veteran may receive bowel and   
bladder care under the program through a
 qualified family member1 an            
individually employed caregiver1 or a   
contracted home health agency4  7#c7    

,individualized assessment ,the         
,secretary shall conduct an             
individualized assessment with respect  
to a covered veteran to determine the   
number of hours of bowel and bladder    
care needed by such veteran under the   
program4  7#d7 ,denial of care ,before  
denying bowel and bladder care for any  
covered veteran under the program1 the  
,secretary shall first obtain review of 
and concurrence with respect to such    
denial from a designated ,spinal ,cord  
,injuries and ,disorders ,center of the 
,department4  7c7 ,coordination of care 
and benefits ,the ,secretary shall      
ensure the program is coordinated with  
other programs and benefits of the      
,department for which the covered       
veteran is eligible to ensure that      
covered veterans and caregivers receive 
appropriate support without duplicating 
benefits or services4  7d7 ,supportive  
medical training and qualifications     
7#a7 ,in general ,the ,secretary shall  
provide to each family member or        

individually employed caregiver         
providing care to a covered veteran     
under the program necessary supportive  
medical training to participate in and  
receive payment by the ,secretary for   
the provision of such care4  7#b7       
,qualifications ,the ,secretary shall   
establish such requirements1 conditions1
 and qualifications for providers of    
care under the program as necessary to  
provide clinically appropriate bowel and
 bladder care to covered veterans and to
 ensure the financial and administrative
 integrity of the program4  7e7 ,payment
  7#a7 ,in general ,the ,secretary shall
 provide a monthly stipend to family    
members and individually employed       
caregivers and payment to contracted    
home health agencies for care provided  
to covered veterans under the program4  
7#b7 ,limitation  7,a7 ,family members  
and individually employed caregivers    
,the stipend for a family member or     
individually employed caregiver for care
 provided to a covered veteran under the

 program-- 7i7 shall be determined by   
the ,secretary2  7ii7 shall be based on 
the amount and degree of assistance     
provided2 and  7iii7 may not exceed the 
fifth step of the applicable grade of   
the ,general ,schedule hourly rate paid 
to nursing assistants who provide such  
care at the medical facility of the     
,department that is nearest to the      
residence of such veteran4  7,b7 ,home  
health agencies ,payment to a home      
health agency for care provided to a    
covered veteran under the program may   
not exceed the payment rates of the     
,department under section #ag4djce of   
title #ch1 ,code of ,federal            
,regulations 7relating to payment rates 
and methodologies71 or successor        
regulations4  7f7 ,submission of        
documentation ,family members and       
individually employed caregivers        
providing care to covered veterans under
 the program shall provide such         
documentation and information in such   
format and under such terms as the      

,secretary may require as a condition of
 receiving payment under the program4   
7g7 ,continued participation in program 
,if a covered veteran has been medically
 determined to require care under the   
program for a continuous period of three
 years or more1 the veteran is deemed to
 require such care for life or until    
such time as the medical provider for   
such veteran determines the service is  
no longer needed4  7h7 ,not vendors or  
contractors ,family members and         
individually employed caregivers        
providing care to covered veterans under
 the program shall not be considered    
vendors or contractors for purposes of  
the program4  7i7 ,limitation ,care may 
not be provided under the program to a  
veteran who can perform the bowel and   
bladder functions of the veteran without
 assistance4  7j7 ,covered veteran      
defined ,in this section1 the term      
covered veteran means a veteran who--   
7#a7 is enrolled in the system of annual
 patient enrollment of the ,department  

of ,veterans ,affairs established and   
operated under section #agje7;a7 of     
title #ch1 ,united ,states ,code2  7#b7 
has a spinal cord injury or disorder2   
and  7#c7 is dependent upon others for  
bowel and bladder care while residing in
 non-institutional settings4