H. R. 3989
IN THE HOUSE OF REPRESENTATIVES
November 5, 2015
Ms. Stefanik introduced the following bill; which was referred to the Committee on Veterans’ Affairs
To amend title 38, United States Code, to improve the process for determining the eligibility of caregivers of veterans to certain benefits administered by the Secretary of Veterans Affairs.
This Act may be cited as the
Support Our Military Caregivers Act.
External clinical review of denied applications by caregivers of veterans
Section 1720G of title 38, United States Code, is amended—
by redesignating subsections (d) and (e) as subsections (e) and (f), respectively; and
by inserting after subsection (c) the following new subsection (d):
External clinical review of applications
Using amounts otherwise appropriated to carry out this section, an individual may elect to have an independent contractor described in paragraph (2) perform an external clinical review of any of the following:
The denial by the Secretary of an application by an individual to be a caregiver or family caregiver eligible for benefits administered by the Secretary pursuant to this section.
With respect to such an application that the Secretary has granted, a determination by the Secretary of the level or amount of personal care services that a veteran requires.
A request by a caregiver or family caregiver for a reconsideration of the level or amount of personal care services that a veteran requires based on changes to the health or abilities of the veteran occurring since the Secretary granted such an application.
The revocation by the Secretary of benefits administered by the Secretary pursuant to this section.
An independent contractor described in this paragraph is an independent contractor that—
is awarded a contract by the Secretary to carry out this section pursuant to full and open competition under the Federal Acquisition Regulation;
has no direct or indirect financial relationship with any non-Department provider of services to caregivers and family caregivers pursuant to this title;
has not otherwise conducted an external clinical review of benefits administered by the Secretary pursuant to this title other than this section;
has sufficient training and expertise in medical science and other appropriate health, educational, and vocational training and legal matters to perform the reviews described in paragraph (1); and
employs a panel of physicians or other appropriate health care professionals who do not provide health care to the individual who makes an election under paragraph (1).
Each external clinical review conducted pursuant to paragraph (1) shall—
be based on applicable information included in the application for benefits described in such paragraph, including clinical expertise, medical, technical, and scientific evidence;
include an opportunity for the individual who elects for such review to provide the opinions of the individual and the veteran for whom care is provided; and
include a review of the initial clinical review of such veteran and any other review made by the Secretary.
In carrying out the external clinical reviews pursuant to paragraph (1), the independent contractor shall, as determined appropriate by the Secretary—
collect and maintain information required; and
share such information with the Secretary.
The determination made by the independent contractor pursuant to paragraph (1) shall be final.
The Secretary shall ensure that each external clinical review conducted by the independent contractor pursuant to paragraph (1) is completed and the individual is notified in writing of the results of the review by not later than 120 days after the date on which the individual makes the election under such paragraph. Such notification shall include an explanation of the decision, a discussion of the facts and applicable regulations, and an explanation of the clinical rationale for the decision.
The Secretary shall notify individuals who submit an application to be a caregiver or family caregiver eligible for benefits administered by the Secretary pursuant to this section of the ability of the individual to make an election under paragraph (1).
Nothing in this subsection may be construed to affect claims made by veterans for disability compensation under chapter 11 of this title.
Except as provided by paragraph (2), the amendments made by subsection (a) shall apply with respect to elections under subsection (d) of section 1720G of title 38, United States Code, as added by subsection (a)(2), that are for applications or revocations for benefits by caregivers and family caregivers pursuant to such section for which the Secretary of Veterans Affairs has not made a final decision as of the date of the enactment of this Act.
A caregiver or family caregiver may make an election for an external clinical review under subsection (d)(1)(C) of section 1720G of title 38, United States Code, as added by subsection (a)(2), regardless of whether the Secretary of Veterans Affairs made the final decision with respect to the application for benefits by the caregiver or family caregiver before the date of the enactment of this Act.