II
118THCONGRESS
1
STSESSION S. 216
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.
IN THE SENATE OF THE UNITED STATES
FEBRUARY1, 2023
Mr. M
ORANintroduced 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 neuro-
logical disorders, and for other purposes.
Be it enacted by the Senate and House of Representa-1
tives of the United States of America in Congress assembled, 2
SECTION 1. SHORT TITLE. 3
This Act may be cited as the ‘‘Reinforcing Enhanced 4
Support through Promoting Equity for Caregivers Act of 5
2023’’ or the ‘‘RESPECT Act of 2023’’. 6
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SEC. 2. MODIFICATION OF FAMILY CAREGIVER PROGRAM 1
OF DEPARTMENT OF VETERANS AFFAIRS TO 2
INCLUDE SERVICES RELATED TO MENTAL 3
HEALTH AND NEUROLOGICAL DISORDERS. 4
(a) I
NGENERAL.—Section 1720G of title 38, United 5
States Code, is amended— 6
(1) in subsection (a)— 7
(A) in paragraph (2)(C)(ii), by striking 8
‘‘neurological’’ and inserting ‘‘a neurological 9
disorder’’; 10
(B) in paragraph (3)— 11
(i) in subparagraph (A)(ii)(II), by in-12
serting ‘‘, including through public or pri-13
vate entities’’ before the semicolon; and 14
(ii) in subparagraph (C), by adding at 15
the end the following new clause: 16
‘‘(v)(I) For purposes of determining the amount and 17
degree of personal care services provided under clause (i) 18
with respect to a veteran described in subclause (II), the 19
Secretary shall take into account relevant documentation 20
evidencing the provision of personal care services with re-21
spect to the veteran during the preceding three-year pe-22
riod. 23
‘‘(II) A veteran described in this subclause is a vet-24
eran whose need for personal care services as described 25
in paragraph (2)(C) is based in whole or in part on— 26
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‘‘(aa) a diagnosis of mental illness or history of 1
suicidal ideation that puts the veteran at risk of self- 2
harm; or 3
‘‘(bb) a neurological disorder.’’; and 4
(C) by adding at the end the following new 5
paragraph: 6
‘‘(14) The Secretary shall establish a process and re-7
quirements for clinicians of facilities of the Department— 8
‘‘(A) to document incidents in which an eligible 9
veteran participating in the program established 10
under paragraph (1)— 11
‘‘(i) presents at such a facility for treat-12
ment for an emergent or urgent mental health 13
crisis; or 14
‘‘(ii) is assessed by such a clinician to be 15
at risk for suicide; and 16
‘‘(B) to provide such documentation, including 17
any safety plans developed and referrals made to a 18
suicide prevention coordinator of the Department, to 19
such program.’’; 20
(2) in subsection (b)(2)(B), by striking ‘‘neuro-21
logical’’ and inserting ‘‘a neurological disorder’’; 22
(3) in subsection (d)— 23
(A) by redesignating paragraph (4) as 24
paragraph (5); 25
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(B) by inserting after paragraph (3) the 1
following new paragraph (4): 2
‘‘(4) the term ‘neurological disorder’ means a 3
disease of the brain, spinal cord, nerves, or neuro-4
muscular system.’’; and 5
(C) in paragraph (5)(B), as redesignated 6
by subparagraph (A), by striking ‘‘neurological’’ 7
and inserting ‘‘a neurological disorder’’. 8
(b) T
IMING FORESTABLISHMENT OF REQUIRE-9
MENTS ANDPROCESSES.— 10
(1) R
EPORT.—Not later than one year after the 11
date of the enactment of this Act, the Secretary of 12
Veterans Affairs shall— 13
(A) establish the process and requirements 14
required under paragraph (14) of section 15
1720G(a) of title 38, United States Code, as 16
added by subsection (a)(1)(B); and 17
(B) submit to the Committee on Veterans’ 18
Affairs of the Senate and the Committee on 19
Veterans’ Affairs of the House of Representa-20
tives a description of such process and require-21
ments. 22
(2) C
ERTIFICATION.— 23
(A) I
N GENERAL.—Not later than one year 24
after the date of the enactment of this Act, the 25
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Secretary of Veterans Affairs shall require all 1
clinicians of facilities of the Department to cer-2
tify to the Secretary that the clinician under-3
stands the process and requirements established 4
under paragraph (1)(A). 5
(B) F
ACILITIES OF THE DEPARTMENT DE -6
FINED.—In this paragraph, the term ‘‘facilities 7
of the Department’’ has the meaning given that 8
term in section 1701 of title 38, United States 9
Code. 10
SEC. 3. REQUIREMENTS RELATING TO EVALUATIONS, AS-11
SESSMENTS, AND REASSESSMENTS RELAT-12
ING TO ELIGIBILITY OF VETERANS AND 13
CAREGIVERS FOR FAMILY CAREGIVER PRO-14
GRAM. 15
(a) I
NGENERAL.—Subsection (a) of section 1720G 16
of title 38, United States Code, as amended by section 17
2(a)(1), is further amended by adding at the end the fol-18
lowing new paragraphs: 19
‘‘(15)(A) For purposes of conducting evalua-20
tions and assessments to determine eligibility of a 21
veteran and caregiver for the program established 22
under paragraph (1) or conducting reassessments to 23
determine continued eligibility for such program, the 24
Secretary shall— 25
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‘‘(i) take into account relevant documenta-1
tion and medical records generated by Depart-2
ment and non-Department health care pro-3
viders, including qualified mental health profes-4
sionals and neurological specialists; 5
‘‘(ii) if the caregiver of the veteran claims 6
that the serious injury or need for personal care 7
services of the veteran as described in para-8
graph (2) is based in whole or in part on psy-9
chological trauma or another mental disorder, 10
ensure— 11
‘‘(I) a qualified mental health profes-12
sional that treats the veteran participates 13
in the evaluation process; and 14
‘‘(II) a qualified mental health profes-15
sional participates in the assessment or re-16
assessment process; and 17
‘‘(iii) if the caregiver of the veteran claims 18
that the serious injury or need for personal care 19
services of the veteran as described in para-20
graph (2) is based in whole or in part on a neu-21
rological disorder, ensure— 22
‘‘(I) a neurological specialist that 23
treats the veteran participates in the eval-24
uation process; and 25
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‘‘(II) a neurological specialist partici-1
pates in the assessment or reassessment 2
process. 3
‘‘(B)(i) The Secretary shall establish an appro-4
priate time limit during a 24-hour period for the ac-5
tive participation of a veteran in an evaluation, as-6
sessment, or reassessment to determine eligibility of 7
the veteran for the program established under para-8
graph (1). 9
‘‘(ii) In determining an appropriate time limit 10
for a veteran under clause (i), the Secretary shall— 11
‘‘(I) take into consideration necessary ac-12
commodations for the veteran stemming from 13
the disability or medical condition of the vet-14
eran; and 15
‘‘(II) consult with the primary care pro-16
vider, neurological specialist, or qualified mental 17
health professional that is treating the veteran. 18
‘‘(C) The Secretary shall not require the pres-19
ence of a veteran during portions of an evaluation, 20
assessment, or reassessment to determine eligibility 21
of the veteran for the program established under 22
paragraph (1) that only require the active participa-23
tion of the caregiver. 24
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‘‘(D)(i) The Secretary shall make reasonable ef-1
forts to assist a caregiver and veteran in obtaining 2
evidence necessary to substantiate the claims of the 3
caregiver and veteran in the application process for 4
evaluation, assessment, or reassessment for the pro-5
gram established under paragraph (1). 6
‘‘(ii)(I) As part of the assistance provided to a 7
caregiver or veteran under clause (i), the Secretary 8
shall make reasonable efforts to obtain relevant pri-9
vate records that the caregiver or veteran adequately 10
identifies to the Secretary. 11
‘‘(II) Whenever the Secretary, after making 12
reasonable efforts under subclause (I), is unable to 13
obtain all of the relevant records sought, the Sec-14
retary shall notify the caregiver and veteran that the 15
Secretary is unable to obtain records with respect to 16
the claim, which shall include— 17
‘‘(aa) an identification of the records the 18
Secretary is unable to obtain; 19
‘‘(bb) a brief explanation of the efforts 20
that the Secretary made to obtain such records; 21
and 22
‘‘(cc) an explanation that the Secretary 23
will make a determination based on the evi-24
dence of record and that this clause does not 25
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prohibit the submission of records at a later 1
date if such submission is otherwise allowed. 2
‘‘(III) The Secretary shall make not fewer than 3
two requests to a custodian of a private record in 4
order for an effort to obtain such record to be treat-5
ed as reasonable under subclause (I), unless it is 6
made evident by the first request that a second re-7
quest would be futile in obtaining such record. 8
‘‘(iii) Under regulations prescribed by the Sec-9
retary, the Secretary— 10
‘‘(I) shall encourage a caregiver and vet-11
eran to submit relevant private medical records 12
of the veteran to the Secretary to substantiate 13
the claims of the caregiver and veteran in the 14
application process for evaluation, assessment, 15
or reassessment for the program established 16
under paragraph (1) if such submission does 17
not burden the caregiver or veteran; and 18
‘‘(II) may require the caregiver or veteran 19
to authorize the Secretary to obtain such rel-20
evant private medical records if such authoriza-21
tion is required to comply with Federal, State, 22
or local law. 23
‘‘(16)(A) The Secretary, in consultation with a 24
health care provider, neurological specialist, or quali-25
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fied mental health professional that is treating a vet-1
eran, shall waive the reassessment requirement for 2
the veteran for participation in the program estab-3
lished under paragraph (1) if— 4
‘‘(i) the serious injury of the veteran under 5
paragraph (2) is significantly caused by a de-6
generative or chronic condition; and 7
‘‘(ii) such condition is unlikely to improve 8
the dependency of the veteran for personal care 9
services. 10
‘‘(B) The Secretary shall require a health care 11
provider, neurological specialist, or qualified mental 12
health professional that is treating a veteran to cer-13
tify at appropriate intervals determined by the Sec-14
retary the clinical decision of the provider, specialist, 15
or professional under subparagraph (A). 16
‘‘(C) The Secretary may rescind a waiver under 17
subparagraph (A) with respect to a veteran and re-18
quire a reassessment of the veteran if a health care 19
provider, neurological specialist, or qualified mental 20
health professional that is treating the veteran 21
makes a clinical determination that the level of de-22
pendency of the veteran for personal care services 23
has diminished since the last certification of the clin-24
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ical decision of the provider, specialist, or profes-1
sional under subparagraph (B).’’. 2
(b) D
EFINITIONS.—Subsection (d) of such section, as 3
amended by section 2(a)(2), is further amended— 4
(1) by redesignating paragraph (5) as para-5
graph (6); 6
(2) by inserting after paragraph (4) the fol-7
lowing new paragraph (5): 8
‘‘(5) The term ‘neurological specialist’ means a 9
neurologist, neuropsychiatrist, physiatrist, geriatri-10
cian, certified brain injury specialist, neurology 11
nurse, neurology nurse practitioner, neurology physi-12
cian assistant, or such other licensed medical profes-13
sional as the Secretary considers appropriate.’’; and 14
(3) by adding at the end the following new 15
paragraph: 16
‘‘(7) The term ‘qualified mental health profes-17
sional’ means a psychiatrist, psychologist, licensed 18
clinical social worker, psychiatric nurse, licensed pro-19
fessional mental health counselor, or other licensed 20
mental health professional as the Secretary considers 21
appropriate.’’. 22
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SEC. 4. AUTHORITY FOR SECRETARY OF VETERANS AF-1
FAIRS TO AWARD GRANTS TO ENTITIES TO 2
IMPROVE PROVISION OF MENTAL HEALTH 3
SUPPORT TO FAMILY CAREGIVERS OF VET-4
ERANS. 5
(a) I
NGENERAL.—Subchapter II of chapter 17 of 6
title 38, United States Code, is amended by adding at the 7
end the following new section: 8
‘‘§ 1720K. Grants to provide mental health support to 9
family caregivers of veterans 10
‘‘(a) P
URPOSE.—It is the purpose of this section to 11
provide for assistance by the Secretary to entities to carry 12
out programs that improve the provision of mental health 13
support to the family caregivers of veterans participating 14
in the family caregiver program. 15
‘‘(b) A
UTHORITY.—The Secretary may award grants 16
to carry out, coordinate, improve, or otherwise enhance 17
mental health counseling, treatment, or support to the 18
family caregivers of veterans participating in the family 19
caregiver program. 20
‘‘(c) A
PPLICATION.—(1) To be eligible for a grant 21
under this section, an entity shall submit to the Secretary 22
an application therefor at such time, in such manner, and 23
containing such information as the Secretary may require. 24
‘‘(2) Each application submitted under paragraph (1) 25
shall include the following: 26
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‘‘(A) A detailed plan for the use of the grant. 1
‘‘(B) A description of the programs or efforts 2
through which the entity will meet the outcome 3
measures developed by the Secretary under sub-4
section (g). 5
‘‘(C) A description of how the entity will dis-6
tribute grant amounts equitably among areas with 7
varying levels of urbanization. 8
‘‘(D) A plan for how the grant will be used to 9
meet the unique needs of veterans residing in rural 10
areas, American Indian or Alaska Native veterans, 11
elderly veterans, women veterans, and veterans from 12
other underserved communities. 13
‘‘(d) D
ISTRIBUTION.—The Secretary shall seek to en-14
sure that grants awarded under this section are equitably 15
distributed among entities located in States with varying 16
levels of urbanization. 17
‘‘(e) P
RIORITY.—The Secretary shall prioritize 18
awarding grants under this section that will serve the fol-19
lowing areas: 20
‘‘(1) Areas with high rates of veterans enrolled 21
in the family caregiver program. 22
‘‘(2) Areas with high rates of— 23
‘‘(A) suicide among veterans; or 24
‘‘(B) referrals to the Veterans Crisis Line. 25
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‘‘(f) REQUIREDACTIVITIES.—Any grant awarded 1
under this section shall be used— 2
‘‘(1) to expand existing programs, activities, 3
and services; 4
‘‘(2) to establish new or additional programs, 5
activities, and services; or 6
‘‘(3) for travel and transportation to facilitate 7
carrying out paragraph (1) or (2). 8
‘‘(g) O
UTCOMEMEASURES.—(1) The Secretary shall 9
develop and provide to each entity that receives a grant 10
under this section written guidance on the following: 11
‘‘(A) Outcome measures. 12
‘‘(B) Policies of the Department. 13
‘‘(2) In developing outcome measures under para-14
graph (1), the Secretary shall consider the following goals: 15
‘‘(A) Increasing the utilization of mental health 16
services among family caregivers of veterans partici-17
pating in the family caregiver program. 18
‘‘(B) Reducing barriers to mental health serv-19
ices among family caregivers of veterans partici-20
pating in such program. 21
‘‘(h) T
RACKINGREQUIREMENTS.—(1) The Secretary 22
shall establish appropriate tracking requirements with re-23
spect to the entities receiving a grant under this section. 24
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‘‘(2) Not less frequently than annually, the Secretary 1
shall submit to Congress a report on such tracking re-2
quirements. 3
‘‘(i) P
ERFORMANCEREVIEW.—The Secretary shall— 4
‘‘(1) review the performance of each entity that 5
receives a grant under this section; and 6
‘‘(2) make information regarding such perform-7
ance publicly available. 8
‘‘(j) R
EMEDIATIONPLAN.—(1) In the case of an enti-9
ty that receives a grant under this section and does not 10
meet the outcome measures developed by the Secretary 11
under subsection (g), the Secretary shall require the entity 12
to submit to the Secretary a remediation plan under which 13
the entity shall describe how and when it plans to meet 14
such outcome measures. 15
‘‘(2) The Secretary may not award a subsequent 16
grant under this section to an entity described in para-17
graph (1) unless the Secretary approves the remediation 18
plan submitted by the entity under such paragraph. 19
‘‘(k) M
AXIMUMAMOUNT.—The amount of a grant 20
awarded under this section may not exceed 10 percent of 21
amounts made available for grants under this section for 22
the fiscal year in which the grant is awarded. 23
‘‘(l) S
UPPLEMENT, NOTSUPPLANT.—Any grant 24
awarded under this section shall be used to supplement 25
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and not supplant funding that is otherwise available 1
through the Department to provide mental health support 2
among family caregivers of veterans participating in the 3
family caregiver program. 4
‘‘(m) F
UNDING.—(1) Amounts for the activities of 5
the Department under this section shall be budgeted and 6
appropriated through a separate appropriation account. 7
‘‘(2) In the budget justification materials submitted 8
to Congress in support of the budget of the Department 9
for any fiscal year (as submitted with the budget of the 10
President under section 1105(a) of title 31), the Secretary 11
shall include a separate statement of the amount re-12
quested to be appropriated for that fiscal year for the ac-13
count specified in paragraph (1). 14
‘‘(n) A
UTHORIZATION OF APPROPRIATIONS.—There 15
is authorized to be appropriated to the Secretary for each 16
of fiscal years 2023 through 2025 $50,000,000 to carry 17
out this section. 18
‘‘(o) D
EFINITIONS.—In this section: 19
‘‘(1) The terms ‘caregiver’ and ‘family care-20
giver’ have the meanings given those terms in sec-21
tion 1720G(d) of this title. 22
‘‘(2) The term ‘family caregiver program’ 23
means the program of comprehensive assistance for 24
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family caregivers under section 1720G(a) of this 1
title. 2
‘‘(3) The term ‘Veterans Crisis Line’ means the 3
toll-free hotline for veterans established under sec-4
tion 1720F(h) of this title.’’. 5
(b) C
LERICALAMENDMENT.—The table of sections 6
at the beginning of such subchapter is amended by adding 7
at the end the following new item: 8
‘‘1720K. Grants to provide mental health support to family caregivers of vet-
erans.’’.
SEC. 5. COMPTROLLER GENERAL REPORT ON MENTAL
9
HEALTH SUPPORT FOR CAREGIVERS. 10
(a) R
EPORTREQUIRED.—Not later than one year 11
after the date of the enactment of this Act, the Comp-12
troller General of the United States shall submit to the 13
Committee on Veterans’ Affairs of the Senate and the 14
Committee on Veterans’ Affairs of the House of Rep-15
resentatives a report on the provision of mental health 16
support to caregivers of veterans. 17
(b) C
ONTENTS.—The report submitted under sub-18
section (a) shall include the following: 19
(1) An assessment of the need for mental 20
health support among caregivers participating in the 21
caregiver programs. 22
(2) An assessment of options for mental health 23
support in facilities of the Department of Veterans 24
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Affairs and in the community for caregivers partici-1
pating in the caregiver programs. 2
(3) An assessment of the availability and acces-3
sibility of mental health support in facilities of the 4
Department and in the community for caregivers 5
participating in the caregiver programs. 6
(4) An assessment of the awareness among 7
caregivers of the availability of mental health sup-8
port in facilities of the Department and in the com-9
munity for caregivers participating in the caregiver 10
programs. 11
(5) An assessment of barriers to mental health 12
support in facilities of the Department and in the 13
community for caregivers participating in the care-14
giver programs. 15
(c) D
EFINITIONS.—In this section: 16
(1) C
AREGIVER.—The term ‘‘caregiver’’ has the 17
meaning given that term in section 1720G(d) of title 18
38, United States Code. 19
(2) C
AREGIVER PROGRAMS .—The term ‘‘care-20
giver programs’’ means— 21
(A) the program of comprehensive assist-22
ance for family caregivers under subsection (a) 23
of section 1720G of title 38, United States 24
Code; and 25
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(B) the program of support services for 1
caregivers under subsection (b) of such section. 2
Æ
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