Take Care of America’s Veterans Act

(a) Findings; Sense of Congress

(1) Findings. Congress finds the following:

(A) 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 independently.

(B) Inadequate care will lead to complications and problems such as autonomic dysreflexia that can be potentially life-threatening and result in illness and hospitalization.

(C) Bowel care and bladder care are essential to support veterans with spinal cord injuries and disorders in non-institutional settings, improve quality of life, optimize health, and prevent complications from neurogenic bowel and bladder.

(D) 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 communities.

(2) Sense of Congress. It is the sense of Congress that—

(A) 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 care;

(B) 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 needs; and

(C) 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 needed.

(b) In general. The Secretary of Veterans Affairs shall establish a program to address the bowel and bladder care needs of covered veterans (in this section referred to as the program).

(c) Provision of care

(1) Clinical need. The Secretary shall provide bowel and bladder care under the program to covered veterans based on clinical need, which may include covered veterans receiving aid and attendance benefits from the Department of Veterans Affairs.

(2) Caregiver or agency. A covered veteran may receive bowel and bladder care under the program through a qualified family member, an individually employed caregiver, or a contracted home health agency.

(3) 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 program.

(4) Denial of care. Before denying bowel and bladder care for any covered veteran under the program, 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 Department.

(d) 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 services.

(e) Supportive medical training and qualifications

(1) 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 care.

(2) Qualifications. The Secretary shall establish such requirements, conditions, 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 program.

(f) Payment

(1) 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 program.

(2) Limitation

(A) 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—

(i) shall be determined by the Secretary;

(ii) shall be based on the amount and degree of assistance provided; and

(iii) 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 veteran.

(B) 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 17.4035 of title 38, Code of Federal Regulations (relating to payment rates and methodologies), or successor regulations.

(g) 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 program.

(h) 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 more, 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 needed.

(i) 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 program.

(j) Limitation. Care may not be provided under the program to a veteran who can perform the bowel and bladder functions of the veteran without assistance.

(k) Covered veteran defined. In this section, the term covered veteran means a veteran who—

(1) is enrolled in the system of annual patient enrollment of the Department of Veterans Affairs established and operated under section 1705(a) of title 38, United States Code;

(2) has a spinal cord injury or disorder; and

(3) is dependent upon others for bowel and bladder care while residing in non-institutional settings.