RESPECT Act of 2023

II 118TH CONGRESS 1ST SESSION 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 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 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 VerDate Sep 11 2014 05:16 Feb 11, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S216.IS S216 pbinns on DSKJLVW7X2PROD with $$_JOB 2 •S 216 IS SEC. 2. MODIFICATION OF FAMILY CAREGIVER PROGRAM 1 OF DEPARTMENT OF VETERANS AFFAIRS TO 2 INCLUDE SERVICES RELATED TO MENTAL 3 HEALTH AND NEUROLOGICAL DISORDERS. 4 (a) IN GENERAL.—Section 1720G of title 38, United 5 States Code, is amended— 6 (1) in subsection (a)— 7 (A) in paragraph (2)(C)(ii), by striking 8 ‘‘neurological’’ and inserting ‘‘a neurological 9 disorder’’; 10 (B) in paragraph (3)— 11 (i) in subparagraph (A)(ii)(II), by in- 12 serting ‘‘, including through public or pri- 13 vate entities’’ before the semicolon; and 14 (ii) in subparagraph (C), by adding at 15 the end the following new clause: 16 ‘‘(v)(I) For purposes of determining the amount and 17 degree of personal care services provided under clause (i) 18 with respect to a veteran described in subclause (II), the 19 Secretary shall take into account relevant documentation 20 evidencing the provision of personal care services with re- 21 spect to the veteran during the preceding three-year pe- 22 riod. 23 ‘‘(II) A veteran described in this subclause is a vet- 24 eran whose need for personal care services as described 25 in paragraph (2)(C) is based in whole or in part on— 26 VerDate Sep 11 2014 05:16 Feb 11, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S216.IS S216 pbinns on DSKJLVW7X2PROD with $$_JOB 3 •S 216 IS ‘‘(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 VerDate Sep 11 2014 05:16 Feb 11, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S216.IS S216 pbinns on DSKJLVW7X2PROD with $$_JOB 4 •S 216 IS (B) by inserting after paragraph (3) the 1 following new paragraph (4): 2 ‘‘(4) the term ‘neurological disorder’ means a 3 disease of the brain, spinal cord, nerves, or neuro- 4 muscular system.’’; and 5 (C) in paragraph (5)(B), as redesignated 6 by subparagraph (A), by striking ‘‘neurological’’ 7 and inserting ‘‘a neurological disorder’’. 8 (b) TIMING FOR ESTABLISHMENT OF REQUIRE- 9 MENTS AND PROCESSES.— 10 (1) REPORT.—Not later than one year after the 11 date of the enactment of this Act, the Secretary of 12 Veterans Affairs shall— 13 (A) establish the process and requirements 14 required under paragraph (14) of section 15 1720G(a) of title 38, United States Code, as 16 added by subsection (a)(1)(B); and 17 (B) submit to the Committee on Veterans’ 18 Affairs of the Senate and the Committee on 19 Veterans’ Affairs of the House of Representa- 20 tives a description of such process and require- 21 ments. 22 (2) CERTIFICATION.— 23 (A) IN GENERAL.—Not later than one year 24 after the date of the enactment of this Act, the 25 VerDate Sep 11 2014 05:16 Feb 11, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S216.IS S216 pbinns on DSKJLVW7X2PROD with $$_JOB 5 •S 216 IS 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) FACILITIES 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) IN GENERAL.—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 VerDate Sep 11 2014 05:16 Feb 11, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S216.IS S216 pbinns on DSKJLVW7X2PROD with $$_JOB 6 •S 216 IS ‘‘(i) take into account relevant documenta- 1 tion and medical records generated by Depart- 2 ment and non-Department health care pro- 3 viders, including qualified mental health profes- 4 sionals and neurological specialists; 5 ‘‘(ii) if the caregiver of the veteran claims 6 that the serious injury or need for personal care 7 services of the veteran as described in para- 8 graph (2) is based in whole or in part on psy- 9 chological trauma or another mental disorder, 10 ensure— 11 ‘‘(I) a qualified mental health profes- 12 sional that treats the veteran participates 13 in the evaluation process; and 14 ‘‘(II) a qualified mental health profes- 15 sional participates in the assessment or re- 16 assessment process; and 17 ‘‘(iii) if the caregiver of the veteran claims 18 that the serious injury or need for personal care 19 services of the veteran as described in para- 20 graph (2) is based in whole or in part on a neu- 21 rological disorder, ensure— 22 ‘‘(I) a neurological specialist that 23 treats the veteran participates in the eval- 24 uation process; and 25 VerDate Sep 11 2014 05:16 Feb 11, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S216.IS S216 pbinns on DSKJLVW7X2PROD with $$_JOB 7 •S 216 IS ‘‘(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 VerDate Sep 11 2014 05:16 Feb 11, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S216.IS S216 pbinns on DSKJLVW7X2PROD with $$_JOB 8 •S 216 IS ‘‘(D)(i) The Secretary shall make reasonable ef- 1 forts to assist a caregiver and veteran in obtaining 2 evidence necessary to substantiate the claims of the 3 caregiver and veteran in the application process for 4 evaluation, assessment, or reassessment for the pro- 5 gram established under paragraph (1). 6 ‘‘(ii)(I) As part of the assistance provided to a 7 caregiver or veteran under clause (i), the Secretary 8 shall make reasonable efforts to obtain relevant pri- 9 vate records that the caregiver or veteran adequately 10 identifies to the Secretary. 11 ‘‘(II) Whenever the Secretary, after making 12 reasonable efforts under subclause (I), is unable to 13 obtain all of the relevant records sought, the Sec- 14 retary shall notify the caregiver and veteran that the 15 Secretary is unable to obtain records with respect to 16 the claim, which shall include— 17 ‘‘(aa) an identification of the records the 18 Secretary is unable to obtain; 19 ‘‘(bb) a brief explanation of the efforts 20 that the Secretary made to obtain such records; 21 and 22 ‘‘(cc) an explanation that the Secretary 23 will make a determination based on the evi- 24 dence of record and that this clause does not 25 VerDate Sep 11 2014 05:16 Feb 11, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S216.IS S216 pbinns on DSKJLVW7X2PROD with $$_JOB 9 •S 216 IS 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 VerDate Sep 11 2014 05:16 Feb 11, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S216.IS S216 pbinns on DSKJLVW7X2PROD with $$_JOB 10 •S 216 IS fied mental health professional that is treating a vet- 1 eran, shall waive the reassessment requirement for 2 the veteran for participation in the program estab- 3 lished under paragraph (1) if— 4 ‘‘(i) the serious injury of the veteran under 5 paragraph (2) is significantly caused by a de- 6 generative or chronic condition; and 7 ‘‘(ii) such condition is unlikely to improve 8 the dependency of the veteran for personal care 9 services. 10 ‘‘(B) The Secretary shall require a health care 11 provider, neurological specialist, or qualified mental 12 health professional that is treating a veteran to cer- 13 tify at appropriate intervals determined by the Sec- 14 retary the clinical decision of the provider, specialist, 15 or professional under subparagraph (A). 16 ‘‘(C) The Secretary may rescind a waiver under 17 subparagraph (A) with respect to a veteran and re- 18 quire a reassessment of the veteran if a health care 19 provider, neurological specialist, or qualified mental 20 health professional that is treating the veteran 21 makes a clinical determination that the level of de- 22 pendency of the veteran for personal care services 23 has diminished since the last certification of the clin- 24 VerDate Sep 11 2014 05:16 Feb 11, 2023 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S216.IS S216 pbinns on DSKJLVW7X2PROD with $$_JOB 11 •S 216 IS ical decision of the provider, specialist, or profes- 1 sional under subparagraph (B).’’. 2 (b) DEFINITIONS.—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 VerDate Sep 11 2014 05:16 Feb 11, 2023 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S216.IS S216 pbinns on DSKJLVW7X2PROD with $$_JOB 12 •S 216 IS 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) IN GENERAL.—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) PURPOSE.—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) AUTHORITY.—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) APPLICATION.—(1) To [Text truncated for display. 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