USC Subchapter II

USC Subchapter II
in effect

38 U.S.C. § 1710 Eligibility for hospital, nursing home, and domiciliary care

(a)(1) The Secretary (subject to paragraph (4)) shall furnish hospital care and medical services which the Secretary determines to be needed—(A) to any veteran for a service-connected disability; and (B) to any veteran who has a service-connected disability rated at 50 percent or more. (2) The Secretary (subject to paragraph (4)) shall furnish hospital care and medical services, and may furnish nursing home care, which the Secretary determines to be needed to any veteran—(A) who has a compensable service-connected disability rated less than 50 percent or, with respect to nursing home care during any period during which the provisions of section 1710A(a) of this title are in effect, a compensable service-connected disability rated less than 70 percent; (B) whose discharge or release from active military, naval, air, or space service was for a disability that was incurred or aggravated in the line of duty; (C) who is in receipt of, or who, but for a suspension pursuant to section 1151 of this title (or both a suspension and the receipt of retired pay), would be entitled to disability compensation, but only to the extent that such veteran’s continuing eligibility for such care is provided for in the judgment or settlement provided for in such section; (D) who is a former prisoner of war, who was awarded the medal of honor under section 7271, 8291, or 9271 of title 10 or section 491 11 See References in Text note below. of title 14, or who was awarded the Purple Heart; (E) who is a veteran of—(i) the Mexican border period; (ii) World War I; or (iii) World War II; (F) who is a toxic-exposed veteran, in accordance with subsection (e); or (G) who is unable to defray the expenses of necessary care as determined under section 1722(a) of this title. (3) In the case of a veteran who is not described in paragraphs (1) and (2), the Secretary may, to the extent resources and facilities are available and subject to the provisions of subsections (f) and (g), furnish hospital care, medical services, and nursing home care which the Secretary determines to be needed. (4) The requirement in paragraphs (1) and (2) that the Secretary furnish hospital care and medical services, the requirement in section 1710A(a) of this title that the Secretary provide nursing home care, the requirement in section 1710B of this title that the Secretary provide a program of extended care services, and the requirement in section 1745 of this title to provide nursing home care and prescription medicines to veterans with service-connected disabilities in State homes shall be effective in any fiscal year only to the extent and in the amount provided in advance in appropriations Acts for such purposes. (5) During any period during which the provisions of section 1710A(a) of this title are not in effect, the Secretary may furnish nursing home care which the Secretary determines is needed to any veteran described in paragraph (1), with the priority for such care on the same basis as if provided under that paragraph. (b)(1) The Secretary may furnish to a veteran described in paragraph (2) of this subsection such domiciliary care as the Secretary determines is needed for the purpose of the furnishing of medical services to the veteran. (2) This subsection applies in the case of the following veterans:(A) Any veteran whose annual income (as determined under section 1503 of this title) does not exceed the maximum annual rate of pension that would be applicable to the veteran if the veteran were eligible for pension under section 1521(d) of this title. (B) Any veteran who the Secretary determines has no adequate means of support. (c) While any veteran is receiving hospital care or nursing home care in any Department facility, the Secretary may, within the limits of Department facilities, furnish medical services to correct or treat any non-service-connected disability of such veteran, in addition to treatment incident to the disability for which such veteran is hospitalized, if the veteran is willing, and the Secretary finds such services to be reasonably necessary to protect the health of such veteran. The Secretary may furnish dental services and treatment, and related dental appliances, under this subsection for a non-service-connected dental condition or disability of a veteran only (1) to the extent that the Secretary determines that the dental facilities of the Department to be used to furnish such services, treatment, or appliances are not needed to furnish services, treatment, or appliances for dental conditions or disabilities described in section 1712(a) of this title, or (2) if (A) such non-service-connected dental condition or disability is associated with or aggravating a disability for which such veteran is receiving hospital care, or (B) a compelling medical reason or a dental emergency requires furnishing dental services, treatment, or appliances (excluding the furnishing of such services, treatment, or appliances of a routine nature) to such veteran during the period of hospitalization under this section. (d) In no case may nursing home care be furnished in a hospital not under the direct jurisdiction of the Secretary except as provided in section 1720 of this title. (e)(1)(A) A Vietnam-era herbicide-exposed veteran is eligible (subject to paragraph (2)) for hospital care, medical services, and nursing home care under subsection (a)(2)(F) for any disability, notwithstanding that there is insufficient medical evidence to conclude that such disability may be associated with such exposure. (B) A radiation-exposed veteran is eligible for hospital care, medical services, and nursing home care under subsection (a)(2)(F) for any disease suffered by the veteran that is—(i) a disease listed in section 1112(c)(2) of this title; or (ii) any other disease for which the Secretary, based on the advice of the Advisory Committee on Environmental Hazards, determines that there is credible evidence of a positive association between occurrence of the disease in humans and exposure to ionizing radiation. (C) Subject to paragraph (2) of this subsection, a veteran who served on active duty between August 2, 1990, and November 11, 1998, in the Southwest Asia theater of operations during the Persian Gulf War is eligible for hospital care, medical services, and nursing home care under subsection (a)(2)(F) for any disability, notwithstanding that there is insufficient medical evidence to conclude that such disability may be associated with such service. (D) Subject to paragraphs (2) and (3), a veteran who served on active duty in a theater of combat operations (as determined by the Secretary in consultation with the Secretary of Defense) during a period of war after the Persian Gulf War (including any veteran who, in connection with service during such period, received the Armed Forces Expeditionary Medal, Service Specific Expeditionary Medal, Combat Era Specific Expeditionary Medal, Campaign Specific Medal, or any other combat theater award established by a Federal statute or an Executive order), or in combat against a hostile force during a period of hostilities after November 11, 1998, is eligible for hospital care, medical services, and nursing home care under subsection (a)(2)(F) for any illness, notwithstanding that there is insufficient medical evidence to conclude that such condition is attributable to such service. (E) Subject to paragraph (2), a veteran who participated in a test conducted by the Department of Defense Deseret Test Center as part of a program for chemical and biological warfare testing from 1962 through 1973 (including the program designated as “Project Shipboard Hazard and Defense (SHAD)” and related land-based tests) is eligible for hospital care, medical services, and nursing home care under subsection (a)(2)(F) for any illness, notwithstanding that there is insufficient medical evidence to conclude that such illness is attributable to such testing. (F) Subject to paragraph (2), a veteran who served on active duty in the Armed Forces at Camp Lejeune, North Carolina, for not fewer than 30 days during the period beginning on August 1, 1953, and ending on December 31, 1987, is eligible for hospital care and medical services under subsection (a)(2)(F) for any of the following illnesses or conditions, notwithstanding that there is insufficient medical evidence to conclude that such illnesses or conditions are attributable to such service:(i) Esophageal cancer. (ii) Lung cancer. (iii) Breast cancer. (iv) Bladder cancer. (v) Kidney cancer. (vi) Leukemia. (vii) Multiple myeloma. (viii) Myelodysplastic syndromes. (ix) Renal toxicity. (x) Hepatic steatosis. (xi) Female infertility. (xii) Miscarriage. (xiii) Scleroderma. (xiv) Neurobehavioral effects. (xv) Non-Hodgkin’s lymphoma. (G) Beginning not later than the applicable date specified in paragraph (6), and subject to paragraph (2), a veteran who participated in a toxic exposure risk activity while serving on active duty, active duty for training, or inactive duty training is eligible for hospital care (including mental health services and counseling), medical services, and nursing home care under subsection (a)(2)(F) for any illness. (H) Beginning not later than the applicable date specified in paragraph (6), and subject to paragraph (2), a covered veteran (as defined in section 1119(c) of this title) is eligible for hospital care (including mental health services and counseling), medical services, and nursing home care under subsection (a)(2)(F) for any illness. (I)(i) Beginning not later than the applicable date specified in paragraph (6), and subject to paragraph (2), a veteran who deployed in support of a contingency operation specified in clause (ii) is eligible for hospital care (including mental health services and counseling), medical services, and nursing home care under subsection (a)(2)(F) for any illness. (ii) A contingency operation specified in this clause is any of the following:(I) Operation Enduring Freedom. (II) Operation Freedom’s Sentinel. (III) Operation Iraqi Freedom. (IV) Operation New Dawn. (V) Operation Inherent Resolve. (VI) Resolute Support Mission. (2)(A) In the case of a veteran described in paragraph (1)(A), hospital care, medical services, and nursing home care may not be provided under subsection (a)(2)(F) with respect to—(i) a disability that is found, in accordance with guidelines issued by the Under Secretary for Health, to have resulted from a cause other than an exposure described in paragraph (4)(A)(ii); or (ii) a disease for which the National Academy of Sciences, in a report issued in accordance with section 3 of the Agent Orange Act of 1991, has determined that there is limited or suggestive evidence of the lack of a positive association between occurrence of the disease in humans and exposure to a herbicide agent. (B) In the case of a veteran described in subparagraph (C), (D), (E), (F), (G), (H), or (I) of paragraph (1), hospital care, medical services, and nursing home care may not be provided under subsection (a)(2)(F) with respect to a disability that is found, in accordance with guidelines issued by the Under Secretary for Health, to have resulted from a cause other than the service, testing, or activity described in such subparagraph. (3) In the case of care for a veteran described in paragraph (1)(D), hospital care, medical services, and nursing home care may be provided under or by virtue of subsection (a)(2)(F) only during the following periods:(A) Except as provided by subparagraph (B), with respect to a veteran described in paragraph (1)(D) who is discharged or released from the active military, naval, air, or space service after September 11, 2001, the 10-year period beginning on the date of such discharge or release. (B) With respect to a veteran described in paragraph (1)(D) who was discharged or released from the active military, naval, air, or space service after September 11, 2001, and before October 1, 2013, but did not enroll to receive such hospital care, medical services, or nursing home care under such paragraph pursuant to subparagraph (A) before October 1, 2022, the one-year period beginning on October 1, 2022. (4) For purposes of this subsection—(A) The term “Vietnam-era herbicide-exposed veteran” means a veteran who—(i) performed covered service, as defined in section 1116(d) of this title; or (ii) the Secretary finds may have been exposed during active military, naval, air, or space service to dioxin during the Vietnam era, regardless of the geographic area of such service, or was exposed during such service to a toxic substance found in a herbicide or defoliant used for military purposes during such era, regardless of the geographic area of such service. (B) The term “radiation-exposed veteran” has the meaning given that term in section 1112(c)(3) of this title. (C) The term “toxic exposure risk activity” means any activity—(i) that requires a corresponding entry in an exposure tracking record system (as defined in section 1119(c) of this title) for the veteran who carried out the activity; or (ii) that the Secretary determines qualifies for purposes of this subsection when taking into account what is reasonably prudent to protect the health of veterans. (5) When the Secretary first provides care for veterans using the authority provided in paragraph (1)(D), the Secretary shall establish a system for collection and analysis of information on the general health status and health care utilization patterns of veterans receiving care under that paragraph. Not later than 18 months after first providing care under such authority, the Secretary shall submit to Congress a report on the experience under that authority. The Secretary shall include in the report any recommendations of the Secretary for extension of that authority. (6)(A) The Secretary shall determine the dates in subparagraphs (G), (H), and (I) of paragraph (1) as follows:(i) October 1, 2024, with respect to a veteran described in such subparagraph (G) or (H) who was discharged or released from the active military, naval, air, or space service during the period beginning on August 2, 1990, and ending on September 11, 2001. (ii) October 1, 2026, with respect to a veteran described in such subparagraph (G) or (H) who was discharged or released from the active military, naval, air, or space service during the period beginning on September 12, 2001, and ending on December 31, 2006. (iii) October 1, 2028, with respect to a veteran described in such subparagraph (G) or (H) who was discharged or released from the active military, naval, air, or space service during the period beginning on January 1, 2007, and ending on December 31, 2012. (iv) October 1, 2030, with respect to a veteran described in such subparagraph (G) or (H) who was discharged or released from the active military, naval, air, or space service during the period beginning on January 1, 2013, and ending on December 31, 2018. (v) October 1, 2032, with respect to a veteran described in such subparagraph (I). (B)(i) The Secretary may modify a date specified in subparagraph (A) to an earlier date, as the Secretary determines appropriate based on the number of veterans receiving hospital care, medical services, and nursing home care under subparagraphs (G), (H), and (I) of paragraph (1) and the resources available to the Secretary. (ii) If the Secretary determines to modify a date under clause (i), the Secretary shall—(I) notify the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives of the proposed modification; and (II) publish such modified date in the Federal Register. (f)(1) The Secretary may not furnish hospital care or nursing home care (except if such care constitutes hospice care) under this section to a veteran who is eligible for such care under subsection (a)(3) of this section unless the veteran agrees to pay to the United States the applicable amount determined under paragraph (2) or (4) of this subsection. (2) A veteran who is furnished hospital care or nursing home care under this section and who is required under paragraph (1) of this subsection to agree to pay an amount to the United States in order to be furnished such care shall be liable to the United States for an amount equal to—(A) the lesser of—(i) the cost of furnishing such care, as determined by the Secretary; or (ii) the amount determined under paragraph (3) of this subsection; and (B) before September 30, 2026, an amount equal to $10 for every day the veteran receives hospital care and $5 for every day the veteran receives nursing home care. (3)(A) In the case of hospital care furnished during any 365-day period, the amount referred to in paragraph (2)(A)(ii) of this subsection is—(i) the amount of the inpatient Medicare deductible, plus (ii) one-half of such amount for each 90 days of care (or fraction thereof) after the first 90 days of such care during such 365-day period. (B) In the case of nursing home care furnished during any 365-day period, the amount referred to in paragraph (2)(A)(ii) of this subsection is the amount of the inpatient Medicare deductible for each 90 days of such care (or fraction thereof) during such 365-day period. (C)(i) Except as provided in clause (ii) of this subparagraph, in the case of a veteran who is admitted for nursing home care under this section after being furnished, during the preceding 365-day period, hospital care for which the veteran has paid the amount of the inpatient Medicare deductible under this subsection and who has not been furnished 90 days of hospital care in connection with such payment, the veteran shall not incur any liability under paragraph (2) of this subsection with respect to such nursing home care until—(I) the veteran has been furnished, beginning with the first day of such hospital care furnished in connection with such payment, a total of 90 days of hospital care and nursing home care; or (II) the end of the 365-day period applicable to the hospital care for which payment was made, whichever occurs first. (ii) In the case of a veteran who is admitted for nursing home care under this section after being furnished, during any 365-day period, hospital care for which the veteran has paid an amount under subparagraph (A)(ii) of this paragraph and who has not been furnished 90 days of hospital care in connection with such payment, the amount of the liability of the veteran under paragraph (2) of this subsection with respect to the number of days of such nursing home care which, when added to the number of days of such hospital care, is 90 or less, is the difference between the inpatient Medicare deductible and the amount paid under such subparagraph until—(I) the veteran has been furnished, beginning with the first day of such hospital care furnished in connection with such payment, a total of 90 days of hospital care and nursing home care; or (II) the end of the 365-day period applicable to the hospital care for which payment was made, whichever occurs first. (D) In the case of a veteran who is admitted for hospital care under this section after having been furnished, during the preceding 365-day period, nursing home care for which the veteran has paid the amount of the inpatient Medicare deductible under this subsection and who has not been furnished 90 days of nursing home care in connection with such payment, the veteran shall not incur any liability under paragraph (2) of this subsection with respect to such hospital care until—(i) the veteran has been furnished, beginning with the first day of such nursing home care furnished in connection with such payment, a total of 90 days of nursing home care and hospital care; or (ii) the end of the 365-day period applicable to the nursing home care for which payment was made, whichever occurs first. (E) A veteran may not be required to make a payment under this subsection for hospital care or nursing home care furnished under this section during any 90-day period in which the veteran is furnished medical services under paragraph (3) of subsection (a) to the extent that such payment would cause the total amount paid by the veteran under this subsection for hospital care and nursing home care furnished during that period and under subsection (g) for medical services furnished during that period to exceed the amount of the inpatient Medicare deductible in effect on the first day of such period. (F) A veteran may not be required to make a payment under this subsection or subsection (g) for any days of care in excess of 360 days of care during any 365-calendar-day period. (4) In the case of a veteran covered by this subsection who is also described by section 1705(a)(7) of this title, the amount for which the veteran shall be liable to the United States for hospital care under this subsection shall be an amount equal to 20 percent of the total amount for which the veteran would otherwise be liable for such care under subparagraphs (2)(B) and (3)(A) but for this paragraph. (5) For the purposes of this subsection, the term “inpatient Medicare deductible” means the amount of the inpatient hospital deductible in effect under section 1813(b) of the Social Security Act (42 U.S.C. 1395e(b)) on the first day of the 365-day period applicable under paragraph (3) of this subsection. (g)(1) The Secretary may not furnish medical services (except if such care constitutes hospice care) under subsection (a) of this section (including home health services under section 1717 of this title) to a veteran who is eligible for hospital care under this chapter by reason of subsection (a)(3) of this section unless the veteran agrees to pay to the United States in the case of each outpatient visit the applicable amount or amounts established by the Secretary by regulation. (2) A veteran who is furnished medical services under subsection (a) of this section and who is required under paragraph (1) of this subsection to agree to pay an amount to the United States in order to be furnished such services shall be liable to the United States, in the case of each visit in which such services are furnished to the veteran, for an amount which the Secretary shall establish by regulation. (3) This subsection does not apply with respect to the following:(A) Home health services under section 1717 of this title to the extent that such services are for improvements and structural alterations. (B) Education on the use of opioid antagonists to reverse the effects of overdoses of specific medications or substances. (h) Nothing in this section requires the Secretary to furnish care to a veteran to whom another agency of Federal, State, or local government has a duty under law to provide care in an institution of such government.

38 U.S.C. § 1710A Required nursing home care

(a) The Secretary (subject to section 1710(a)(4) of this title) shall provide nursing home care which the Secretary determines is needed (1) to any veteran in need of such care for a service-connected disability, and (2) to any veteran who is in need of such care and who has a service-connected disability rated at 70 percent or more. (b)(1) The Secretary shall ensure that a veteran described in subsection (a) who continues to need nursing home care is not, after placement in a Department nursing home, transferred from the facility without the consent of the veteran, or, in the event the veteran cannot provide informed consent, the representative of the veteran. (2) Nothing in subsection (a) may be construed as authorizing or requiring that a veteran who is receiving nursing home care in a Department nursing home on the date of the enactment of this section be displaced, transferred, or discharged from the facility. (c) The Secretary shall ensure that nursing home care provided under subsection (a) is provided in an age-appropriate manner. (d) The provisions of subsection (a) shall terminate on September 30, 2026.

38 U.S.C. § 1710B Extended care services

(a) The Secretary (subject to section 1710(a)(4) of this title and subsection (c) of this section) shall operate and maintain a program to provide extended care services to eligible veterans in accordance with this section. Such services shall include the following:(1) Geriatric evaluation. (2) Nursing home care (A) in facilities operated by the Secretary, and (B) in community-based facilities through contracts under section 1720 of this title. (3) Domiciliary services under section 1710(b) of this title. (4) Adult day health care under section 1720(f) of this title. (5) Such other noninstitutional alternatives to nursing home care as the Secretary may furnish as medical services under section 1701(10) 11 See References in Text note below. of this title. (6) Respite care under section 1720B of this title. (b) The Secretary shall ensure that the staffing and level of extended care services provided by the Secretary nationally in facilities of the Department during any fiscal year is not less than the staffing and level of such services provided nationally in facilities of the Department during fiscal year 1998. (c)(1) Except as provided in paragraph (2), the Secretary may not furnish extended care services for a non-service-connected disability other than in the case of a veteran who has a compensable service-connected disability unless the veteran agrees to pay to the United States a copayment (determined in accordance with subsection (d)) for any period of such services in a year after the first 21 days of such services provided that veteran in that year. (2) Paragraph (1) shall not apply—(A) to a veteran whose annual income (determined under section 1503 of this title) is less than the amount in effect under section 1521(b) of this title; (B) to a veteran being furnished hospice care under this section; (C) with respect to an episode of extended care services that a veteran is being furnished by the Department on November 30, 1999; or (D) to a veteran who was awarded the medal of honor under section 7271, 8291, or 9271 of title 10 or section 491 1 of title 14. (d)(1) A veteran who is furnished extended care services under this chapter and who is required under subsection (c) to pay an amount to the United States in order to be furnished such services shall be liable to the United States for that amount. (2) In implementing subsection (c), the Secretary shall develop a methodology for establishing the amount of the copayment for which a veteran described in subsection (c) is liable. That methodology shall provide for—(A) establishing a maximum monthly copayment (based on all income and assets of the veteran and the spouse of such veteran); (B) protecting the spouse of a veteran from financial hardship by not counting all of the income and assets of the veteran and spouse (in the case of a spouse who resides in the community) as available for determining the copayment obligation; and (C) allowing the veteran to retain a monthly personal allowance. (e)(1) There is established in the Treasury of the United States a revolving fund known as the Department of Veterans Affairs Extended Care Fund (hereinafter in this section referred to as the “fund”). Amounts in the fund shall be available, without fiscal year limitation and without further appropriation, exclusively for the purpose of providing extended care services under subsection (a). (2) All amounts received by the Department under this section shall be deposited in or credited to the fund.

38 U.S.C. § 1710C Traumatic brain injury: plans for rehabilitation and reintegration into the community

(a) Plan Required.—The Secretary shall, for each individual who is a veteran or member of the Armed Forces who receives inpatient or outpatient rehabilitative hospital care or medical services provided by the Department for a traumatic brain injury—(1) develop an individualized plan for the rehabilitation and reintegration of the individual into the community with the goal of maximizing the individual’s independence; and (2) provide such plan in writing to the individual—(A) in the case of an individual receiving inpatient care, before the individual is discharged from inpatient care or after the individual’s transition from serving on active duty as a member of the Armed Forces to receiving outpatient care provided by the Department; or (B) as soon as practicable following a diagnosis of traumatic brain injury by a Department health care provider. (b) Contents of Plan.—Each plan developed under subsection (a) shall include, for the individual covered by such plan, the following:(1) Rehabilitation objectives for improving (and sustaining improvement in) the physical, cognitive, behavioral, and vocational functioning of the individual with the goal of maximizing the independence and reintegration of such individual into the community. (2) Access, as warranted, to all appropriate rehabilitative services and rehabilitative components of the traumatic brain injury continuum of care, and where appropriate, to long-term care services. (3) A description of specific rehabilitative services and other services to achieve the objectives described in paragraph (1), which shall set forth the type, frequency, duration, and location of such services. (4) The name of the case manager designated in accordance with subsection (d) to be responsible for the implementation of such plan. (5) Dates on which the effectiveness of such plan will be reviewed in accordance with subsection (f). (c) Comprehensive Assessment.—(1) Each plan developed under subsection (a) shall be based on a comprehensive assessment, developed in accordance with paragraph (2), of—(A) the physical, cognitive, vocational, and neuropsychological and social impairments of the individual; and (B) the family education and family support needs of the individual after the individual is discharged from inpatient care or at the commencement of and during the receipt of outpatient care and services. (2) The comprehensive assessment required under paragraph (1) with respect to an individual is a comprehensive assessment of the matters set forth in that paragraph by a team, composed by the Secretary for purposes of the assessment, of individuals with expertise in traumatic brain injury, including any of the following:(A) A neurologist. (B) A rehabilitation physician. (C) A social worker. (D) A neuropsychologist. (E) A physical therapist. (F) A vocational rehabilitation specialist. (G) An occupational therapist. (H) A speech language pathologist. (I) A rehabilitation nurse. (J) An educational therapist. (K) An audiologist. (L) A blind rehabilitation specialist. (M) A recreational therapist. (N) A low vision optometrist. (O) An orthotist or prosthetist. (P) An assistive technologist or rehabilitation engineer. (Q) An otolaryngology physician. (R) A dietician. (S) An ophthalmologist. (T) A psychiatrist. (d) Case Manager.—(1) The Secretary shall designate a case manager for each individual described in subsection (a) to be responsible for the implementation of the plan developed for that individual under that subsection and the coordination of the individual’s medical care. (2) The Secretary shall ensure that each case manager has specific expertise in the care required by the individual for whom the case manager is designated, regardless of whether the case manager obtains such expertise through experience, education, or training. (e) Participation and Collaboration in Development of Plans.—(1) The Secretary shall involve each individual described in subsection (a), and the family or legal guardian of such individual, in the development of the plan for such individual under that subsection to the maximum extent practicable. (2) The Secretary shall collaborate in the development of a plan for an individual under subsection (a) with a State protection and advocacy system if—(A) the individual covered by the plan requests such collaboration; or (B) in the case of such an individual who is incapacitated, the family or guardian of the individual requests such collaboration. (3) In the case of a plan required by subsection (a) for a member of the Armed Forces who is serving on active duty, the Secretary shall collaborate with the Secretary of Defense in the development of such plan. (4) In developing vocational rehabilitation objectives required under subsection (b)(1) and in conducting the assessment required under subsection (c), the Secretary shall act through the Under Secretary for Health in coordination with the Vocational Rehabilitation and Employment Service of the Department of Veterans Affairs. (f) Evaluation.—(1) Periodic review by secretary.—The Secretary shall periodically review the effectiveness of each plan developed under subsection (a). The Secretary shall refine each such plan as the Secretary considers appropriate in light of such review. (2) Request for review by veterans.—In addition to the periodic review required by paragraph (1), the Secretary shall conduct a review of the plan for an individual under paragraph (1) at the request of the individual, or in the case of an individual who is incapacitated, at the request of the guardian or designee of the individual. (g) State Designated Protection and Advocacy System Defined.—In this section, the term “State protection and advocacy system” means a system established in a State under subtitle C of the Developmental Disabilities Assistance and Bill of Rights Act of 2000 (42 U.S.C. 15041 et seq.) to protect and advocate for the rights of persons with development disabilities. (h) Rehabilitative Services Defined.—For purposes of this section, and sections 1710D and 1710E of this title, the term “rehabilitative services” includes—(1) rehabilitative services, as defined in section 1701 of this title; (2) treatment and services (which may be of ongoing duration) to sustain, and prevent loss of, functional gains that have been achieved; and (3) any other rehabilitative services or supports that may contribute to maximizing an individual’s independence.

38 U.S.C. § 1710D Traumatic brain injury: comprehensive program for long-term rehabilitation

(a) Comprehensive Program.—In developing plans for the rehabilitation and reintegration of individuals with traumatic brain injury under section 1710C of this title, the Secretary shall develop and carry out a comprehensive program of long-term care and rehabilitative services (as defined in section 1710C of this title) for post-acute traumatic brain injury rehabilitation that includes residential, community, and home-based components utilizing interdisciplinary teams. (b) Location of Program.—The Secretary shall carry out the program developed under subsection (a) in each Department polytrauma rehabilitation center designated by the Secretary. (c) Eligibility.—A veteran is eligible for care under the program developed under subsection (a) if the veteran is otherwise eligible to receive hospital care and medical services under section 1710 of this title and—(1) served on active duty in a theater of combat operations (as determined by the Secretary in consultation with the Secretary of Defense) during a period of war after the Persian Gulf War, or in combat against a hostile force during a period of hostilities after November 11, 1998; (2) is diagnosed as suffering from moderate to severe traumatic brain injury; and (3) is unable to manage routine activities of daily living without supervision or assistance, as determined by the Secretary. (d) Report.—Not later than one year after the date of the enactment of this section, and annually thereafter, the Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and the House of Representatives a report containing the following information:(1) A description of the operation of the program. (2) The number of veterans provided care under the program during the year preceding such report. (3) The cost of operating the program during the year preceding such report.

38 U.S.C. § 1710E Traumatic brain injury: use of non-Department facilities for rehabilitation

(a) Cooperative Agreements.—The Secretary, in implementing and carrying out a plan developed under section 1710C of this title, may provide hospital care and medical services, including rehabilitative services (as defined in section 1710C of this title), through cooperative agreements with appropriate public or private entities that have established long-term neurobehavioral rehabilitation and recovery programs. (b) Covered Individuals.—The care and services provided under subsection (a) shall be made available to an individual—(1) who is described in section 1710C(a) of this title; and (2)(A) to whom the Secretary is unable to provide such treatment or services at the frequency or for the duration prescribed in such plan; or (B) for whom the Secretary determines that it is optimal with respect to the recovery and rehabilitation for such individual. (c) Authorities of State Protection and Advocacy Systems.—Nothing in subtitle C of the Developmental Disabilities Assistance and Bill of Rights Act of 2000 shall be construed as preventing a State protection and advocacy system (as defined in section 1710C(g) of this title) from exercising the authorities described in such subtitle with respect to individuals provided rehabilitative treatment or services under section 1710C of this title in a non-Department facility. (d) Standards.—The Secretary may not provide treatment or services as described in subsection (a) at a non-Department facility under such subsection unless such facility maintains standards for the provision of such treatment or services established by an independent, peer-reviewed organization that accredits specialized rehabilitation programs for adults with traumatic brain injury.

38 U.S.C. § 1711 Care during examinations and in emergencies

(a) The Secretary may furnish hospital care incident to physical examinations where such examinations are necessary in carrying out the provisions of other laws administered by the Secretary. [(b) Repealed. Pub. L. 107–135, title II, § 208(d), Jan. 23, 2002, 115 Stat. 2463.] (c)(1) The Secretary may contract with any organization named in, or approved by the Secretary under, section 5902 of this title to provide for the furnishing by the Secretary, on a reimbursable basis (as prescribed by the Secretary), of emergency medical services to individuals attending any national convention of such organization, except that reimbursement shall not be required for services furnished under this subsection to the extent that the individual receiving such services would otherwise be eligible under this chapter for medical services. (2) The authority of the Secretary to enter into contracts under this subsection shall be effective for any fiscal year only to such extent or in such amounts as are provided in appropriation Acts.

38 U.S.C. § 1712 Dental care; drugs and medicines for certain disabled veterans; vaccines

(a)(1) Outpatient dental services and treatment, and related dental appliances, shall be furnished under this section only for a dental condition or disability—(A) which is service-connected and compensable in degree; (B) which is service-connected, but not compensable in degree, but only if—(i) the dental condition or disability is shown to have been in existence at the time of the veteran’s discharge or release from active military, naval, air, or space service; (ii) the veteran had served on active duty for a period of not less than 180 days or, in the case of a veteran who served on active duty during the Persian Gulf War, 90 days immediately before such discharge or release; (iii) application for treatment is made within 180 days after such discharge or release, except that (I) in the case of a veteran who reentered active military, naval, air, or space service within 90 days after the date of such veteran’s prior discharge or release from such service, application may be made within 180 days from the date of such veteran’s subsequent discharge or release from such service, and (II) if a disqualifying discharge or release has been corrected by competent authority, application may be made within 180 days after the date of correction; and (iv) the veteran’s certificate of discharge or release from active duty does not bear a certification that the veteran was provided, within the 90-day period immediately before the date of such discharge or release, a complete dental examination (including dental X-rays) and all appropriate dental services and treatment indicated by the examination to be needed; (C) which is a service-connected dental condition or disability due to combat wounds or other service trauma, or of a former prisoner of war; (D) which is associated with and is aggravating a disability resulting from some other disease or injury which was incurred in or aggravated by active military, naval, air, or space service; (E) which is a non-service-connected condition or disability of a veteran for which treatment was begun while such veteran was receiving hospital care under this chapter and such services and treatment are reasonably necessary to complete such treatment; (F) from which a veteran who is a former prisoner of war is suffering; (G) from which a veteran who has a service-connected disability rated as total is suffering; or (H) the treatment of which is medically necessary (i) in preparation for hospital admission, or (ii) for a veteran otherwise receiving care or services under this chapter. (2) The Secretary concerned shall at the time a member of the Armed Forces is discharged or released from a period of active military, naval, air, or space service of not less than 180 days or, in the case of a veteran who served on active duty during the Persian Gulf War, 90 days provide to such member a written explanation of the provisions of clause (B) of paragraph (1) of this subsection and enter in the service records of the member a statement signed by the member acknowledging receipt of such explanation (or, if the member refuses to sign such statement, a certification from an officer designated for such purpose by the Secretary concerned that the member was provided such explanation). (3) The total amount which the Secretary may expend for furnishing, during any twelve-month period, outpatient dental services, treatment, or related dental appliances to a veteran under this section through private facilities for which the Secretary has contracted or entered an agreement may not exceed $1,000 unless the Secretary determines, prior to the furnishing of such services, treatment, or appliances and based on an examination of the veteran by a dentist employed by the Department (or, in an area where no such dentist is available, by a dentist conducting such examination under a contract or fee arrangement), that the furnishing of such services, treatment, or appliances at such cost is reasonably necessary. (4)(A) Except as provided in subparagraph (B) of this paragraph, in any year in which the President’s Budget for the fiscal year beginning October 1 of such year includes an amount for expenditures for contract dental care during such fiscal year in excess of the level of expenditures made for such purpose during fiscal year 1978, the Secretary shall, not later than February 15 of such year, submit a report to the appropriate committees of the Congress justifying the requested level of expenditures for contract dental care and explaining why the application of the criteria prescribed in section 1703 of this title for contracting with private facilities and in the second sentence of section 1710(c) of this title for furnishing incidental dental care to hospitalized veterans will not preclude the need for expenditures for contract dental care in excess of the fiscal year 1978 level of expenditures for such purpose. In any case in which the amount included in the President’s Budget for any fiscal year for expenditures for contract dental care under such provisions is not in excess of the level of expenditures made for such purpose during fiscal year 1978 and the Secretary determines after the date of submission of such budget and before the end of such fiscal year that the level of expenditures for such contract dental care during such fiscal year will exceed the fiscal year 1978 level of expenditures, the Secretary shall submit a report to the appropriate committees of the Congress containing both a justification (with respect to the projected level of expenditures for such fiscal year) and an explanation as required in the preceding sentence in the case of a report submitted pursuant to such sentence. Any report submitted pursuant to this paragraph shall include a comment by the Secretary on the effect of the application of the criteria prescribed in the second sentence of section 1710(c) of this title for furnishing incidental dental care to hospitalized veterans. (B) A report under subparagraph (A) of this paragraph with respect to a fiscal year is not required if, in the documents submitted by the Secretary to the Congress in justification for the amounts included for Department programs in the President’s Budget, the Secretary specifies with respect to contract dental care described in such subparagraph—(i) the actual level of expenditures for such care in the fiscal year preceding the fiscal year in which such Budget is submitted; (ii) a current estimate of the level of expenditures for such care in the fiscal year in which such Budget is submitted; and (iii) the amount included in such Budget for such care. (b) Dental services and related appliances for a dental condition or disability described in paragraph (1)(B) of subsection (a) shall be furnished on a one-time completion basis, unless the services rendered on a one-time completion basis are found unacceptable within the limitations of good professional standards, in which event such additional services may be afforded as are required to complete professionally acceptable treatment. (c) Dental appliances, wheelchairs, artificial limbs, trusses, special clothing, and similar appliances to be furnished by the Secretary under this section may be procured by the Secretary either by purchase or by manufacture, whichever the Secretary determines may be advantageous and reasonably necessary. (d) The Secretary shall furnish to each veteran who is receiving additional compensation or allowance under chapter 11 of this title, or increased pension as a veteran of a period of war, by reason of being permanently housebound or in need of regular aid and attendance, such drugs and medicines as may be ordered on prescription of a duly licensed physician as specific therapy in the treatment of any illness or injury suffered by such veteran. The Secretary shall continue to furnish such drugs and medicines so ordered to any such veteran in need of regular aid and attendance whose pension payments have been discontinued solely because such veteran’s annual income is greater than the applicable maximum annual income limitation, but only so long as such veteran’s annual income does not exceed such maximum annual income limitation by more than $1,000. (e) In order to assist the Secretary of Health and Human Services in carrying out national immunization programs under other provisions of law, the Secretary may authorize the administration of immunizations to eligible veterans who voluntarily request such immunizations in connection with the provision of care for a disability under this chapter in any Department health care facility. Any such immunization shall be made using vaccine furnished by the Secretary of Health and Human Services at no cost to the Department. For such purpose, notwithstanding any other provision of law, the Secretary of Health and Human Services may provide such vaccine to the Department at no cost. Section 7316 of this title shall apply to claims alleging negligence or malpractice on the part of Department personnel granted immunity under such section.

38 U.S.C. § 1712A Eligibility for readjustment counseling and related mental health services

(a)(1)(A) Upon the request of any individual referred to in subparagraph (C), the Secretary shall furnish counseling, including by furnishing counseling through a Vet Center, to the individual—(i) in the case of an individual referred to in clauses (i) through (vii) of subparagraph (C), to assist the individual in readjusting to civilian life; and (ii) in the case of an individual referred to in clause (viii) of such subparagraph who is a family member of a veteran or member described in such clause—(I) in the case of a member who is deployed in a theater of combat operations or an area at a time during which hostilities are occurring in that area, during such deployment to assist such individual in coping with such deployment; (II) in the case of a veteran or member who is readjusting to civilian life, to the degree that counseling furnished to such individual is found to aid in the readjustment of such veteran or member to civilian life; and (III) in the case of a veteran or member who died by suicide, to the degree that counseling furnished to such individual is found to aid in coping with the effects of such suicide. (B)(i) Counseling furnished to an individual under subparagraph (A) may include a comprehensive individual assessment of the individual’s psychological, social, and other characteristics to ascertain whether—(I) in the case of an individual referred to in clauses (i) through (vii) of subparagraph (C), such individual has difficulties associated with readjusting to civilian life; and (II) in the case of an individual referred to in clause (viii) of such subparagraph, such individual has difficulties associated with—(aa) coping with the deployment of a member described in subclause (I) of such clause; (bb) readjustment to civilian life of a veteran or member described in subclause (II) of such clause; or (cc) coping with the effects of a suicide described in subclause (III) of such clause. (ii)(I) Except as provided in subclauses (IV) and (V), counseling furnished to an individual under subparagraph (A) may include reintegration and readjustment services described in subclause (II) furnished in group retreat settings. (II) Reintegration and readjustment services described in this subclause are the following:(aa) Information on reintegration of the individual into family, employment, and community. (bb) Financial counseling. (cc) Occupational counseling. (dd) Information and counseling on stress reduction. (ee) Information and counseling on conflict resolution. (ff) Such other information and counseling as the Secretary considers appropriate to assist the individual in reintegration into family, employment, and community. (III) In furnishing reintegration and readjustment services under subclause (I), the Secretary shall offer women the opportunity to receive such services in group retreat settings in which the only participants are women. (IV) An individual described in subparagraph (C)(v) may receive reintegration and readjustment services under subclause (I) of this clause only if the individual receives such services with a family member described in subclause (I) or (II) of such subparagraph. (V) In each of fiscal years 2021 through 2025, the maximum number of individuals to whom integration and readjustment services may be furnished in group retreat settings under this subclause (I) shall not exceed 1,200 individuals. (C) Subparagraph (A) applies to the following individuals:(i) Any individual who is a veteran or member of the Armed Forces, including a member of a reserve component of the Armed Forces, who served on active duty in a theater of combat operations or an area at a time during which hostilities occurred in that area. (ii) Any individual who is a veteran or member of the Armed Forces, including a member of a reserve component of the Armed Forces, who provided direct emergency medical or mental health care, or mortuary services to the causalities of combat operations or hostilities, but who at the time was located outside the theater of combat operations or area of hostilities. (iii) Any individual who is a veteran or member of the Armed Forces, including a member of a reserve component of the Armed Forces, who engaged in combat with an enemy of the United States or against an opposing military force in a theater of combat operations or an area at a time during which hostilities occurred in that area by remotely controlling an unmanned aerial vehicle, notwithstanding whether the physical location of such veteran or member during such combat was within such theater of combat operations or area. (iv) Any individual who is a veteran or member of the Armed Forces, including a member of a reserve component of the Armed Forces, who served—(I) on active service in response to a national emergency or major disaster declared by the President; or (II) in the National Guard of a State under orders of the chief executive of that State in response to a disaster or civil disorder in such State. (v) Any individual who participated in a drug interdiction operation as a member of the Coast Guard, regardless of the location of that operation. (vi) Any individual who received counseling under this section before the date of the enactment of the National Defense Authorization Act for Fiscal Year 2013. (vii) Any veteran or member of the Armed Forces pursuing a course of education using covered educational assistance benefits. (viii) Any individual who is a family member of any—(I) member of the Armed Forces, including a member of a reserve component of the Armed Forces, who is serving on active duty in a theater of combat operations or in an area at a time during which hostilities are occurring in that area; (II) veteran or member of the Armed Forces described in this subparagraph; or (III) veteran or member of the Armed Forces who died by suicide. (D)(i) The Secretary, in consultation with the Secretary of Defense, may furnish to any member of the reserve components of the Armed Forces who has a behavioral health condition or psychological trauma, counseling under subparagraph (A)(i), which may include a comprehensive individual assessment under subparagraph (B)(i). (ii) A member of the reserve components of the Armed Forces described in clause (i) shall not be required to obtain a referral before being furnished counseling or an assessment under this subparagraph. (2)(A) Upon request of an individual described in paragraph (1)(C), the Secretary shall provide the individual a comprehensive individual assessment as described in paragraph (1)(B)(i) as soon as practicable after receiving the request, but not later than 30 days after receiving the request. (B) Upon the request of an individual described in paragraph (1)(C), the Secretary shall furnish the individual reintegration and readjustment services in group retreat settings under paragraph (1)(B)(ii) if the Secretary determines the experience will be therapeutically appropriate. (b)(1) If, on the basis of the assessment furnished to an individual under subsection (a) of this section, a licensed or certified mental health care provider employed by the Department (or, in areas where no such licensed or certified mental health care provider is available, a licensed or certified mental health care provider carrying out such function under a contract or fee arrangement with the Secretary) determines that the provision of mental health services to such individual is necessary to facilitate the successful readjustment of the individual to civilian life, such individual shall, within the limits of Department facilities, be furnished such services on an outpatient basis. For the purposes of furnishing such mental health services, the counseling furnished under subsection (a) of this section shall be considered to have been furnished by the Department as a part of hospital care. Any hospital care and other medical services considered necessary on the basis of the assessment furnished under subsection (a) of this section shall be furnished only in accordance with the eligibility criteria otherwise set forth in this chapter (including the eligibility criteria set forth in section 1784 of this title). (2) Mental health services furnished under paragraph (1) of this subsection may, if determined to be essential to the effective treatment and readjustment of the individual, include such consultation, counseling, training, services, and expenses as are described in sections 1782 and 1783 of this title. (c) Upon receipt of a request for counseling under this section from any individual who has been discharged or released from active military, naval, air, or space service but who is not otherwise eligible for such counseling, the Secretary shall—(1) provide referral services to assist such individual, to the maximum extent practicable, in obtaining mental health care and services from sources outside the Department; and (2) if pertinent, advise such individual of such individual’s rights to apply to the appropriate military, naval, air, or space service, and to the Department, for review of such individual’s discharge or release from such service. (d) The Under Secretary for Health may provide for such training of professional, paraprofessional, and lay personnel as is necessary to carry out this section effectively, and, in carrying out this section, may utilize the services of paraprofessionals, individuals who are volunteers working without compensation, and individuals who are veteran-students (as described in section 3485 of this title) in initial intake and screening activities. (e)(1) In furnishing counseling and related mental health services under subsections (a) and (b) of this section, the Secretary shall have available the same authority to enter into contracts or agreements with private facilities that is available to the Secretary in furnishing medical services to veterans suffering from total service-connected disabilities. (2) Before furnishing counseling or related mental health services described in subsections (a) and (b) of this section through a contract facility, as authorized by this subsection, the Secretary shall approve (in accordance with criteria which the Secretary shall prescribe by regulation) the quality and effectiveness of the program operated by such facility for the purpose for which the counseling or services are to be furnished. (3) The authority of the Secretary to enter into contracts under this subsection shall be effective for any fiscal year only to such extent or in such amounts as are provided in appropriation Acts. (f) The Secretary, in cooperation with the Secretary of Defense, shall take such action as the Secretary considers appropriate to notify veterans who may be eligible for assistance under this section of such potential eligibility. (g) In carrying out this section and in furtherance of the Secretary’s responsibility to carry out outreach activities under chapter 63 of this title, the Secretary may provide for and facilitate the participation of personnel employed by the Secretary to provide services under this section in recreational programs that are—(1) designed to encourage the readjustment of veterans described in subsection (a)(1)(C); and (2) operated by any organization named in or approved under section 5902 of this title. (h) For the purposes of this section:(1) The term “Vet Center” means a facility which is operated by the Department for the provision of services under this section and which is situated apart from Department general health care facilities. (2) The term “Department general health-care facility” means a health-care facility which is operated by the Department for the furnishing of health-care services under this chapter, not limited to services provided through the program established under this section. (3) The term “family member”, with respect to a veteran or member of the Armed Forces, means an individual who—(A) is a member of the family of the veteran or member, including—(i) a parent; (ii) a spouse; (iii) a child; (iv) a step-family member; and (v) an extended family member; or (B) lives with the veteran or member but is not a member of the family of the veteran or member. (4) The term “active service” has the meaning given that term in section 101 of title 10. (5) The term “civil disorder” has the meaning given that term in section 232 of title 18. (6) The term “covered educational assistance benefits” means educational assistance benefits provided pursuant to—(A) chapter 30, 31, 32, or 33 of this title; (B) chapter 1606 or 1607 of title 10; (C) section 116 of the Harry W. Colmery Veterans Educational Assistance Act of 2017 (Public Law 115–48; 38 U.S.C. 3001 note); or (D) section 8006 of the American Rescue Plan Act of 2021 (Public Law 117–2; 38 U.S.C. 3001 note prec.).

38 U.S.C. § 1712B Counseling for former prisoners of war

The Secretary may establish a program under which, upon the request of a veteran who is a former prisoner of war, the Secretary, within the limits of Department facilities, furnishes counseling to such veteran to assist such veteran in overcoming the psychological effects of the veteran’s detention or internment as a prisoner of war.

38 U.S.C. § 1712C Dental insurance plan for veterans and survivors and dependents of veterans

(a) In General.—The Secretary shall establish and administer a dental insurance plan for veterans and survivors and dependents of veterans described in subsection (b). (b) Covered Veterans and Survivors and Dependents.—The veterans and survivors and dependents of veterans described in this subsection are as follows:(1) Any veteran who is enrolled in the system of annual patient enrollment under section 1705 of this title. (2) Any survivor or dependent of a veteran who is eligible for medical care under section 1781 of this title. (c) Administration.—The Secretary shall contract with a dental insurer to administer the dental insurance plan under this section. (d) Benefits.—The dental insurance plan under this section shall provide such benefits for dental care and treatment as the Secretary considers appropriate for the dental insurance plan, including diagnostic services, preventative services, endodontics and other restorative services, surgical services, and emergency services. (e) Enrollment.—(1) Enrollment in the dental insurance plan under this section shall be voluntary. (2) Enrollment in the dental insurance plan shall be for such minimum period as the Secretary shall prescribe for purposes of this section. (f) Premiums.—(1) Premiums for coverage under the dental insurance plan under this section shall be in such amount or amounts as the Secretary shall prescribe to cover all costs associated with carrying out this section. (2) The Secretary shall adjust the premiums payable under this section for coverage under the dental insurance plan on an annual basis. Each individual covered by the dental insurance plan at the time of such an adjustment shall be notified of the amount and effective date of such adjustment. (3) Each individual covered by the dental insurance plan shall pay the entire premium for coverage under the dental insurance plan, in addition to the full cost of any copayments. (g) Voluntary Disenrollment.—(1) With respect to enrollment in the dental insurance plan under this section, the Secretary shall—(A) permit the voluntary disenrollment of an individual in the dental insurance plan if the disenrollment occurs during the 30-day period beginning on the date of the enrollment of the individual in the dental insurance plan; and (B) permit the voluntary disenrollment of an individual in the dental insurance plan for such circumstances as the Secretary shall prescribe for purposes of this subsection, but only to the extent such disenrollment does not jeopardize the fiscal integrity of the dental insurance plan. (2) The circumstances prescribed under paragraph (1)(B) shall include the following:(A) If an individual enrolled in the dental insurance plan relocates to a location outside the jurisdiction of the dental insurance plan that prevents use of the benefits under the dental insurance plan. (B) If an individual enrolled in the dental insurance plan is prevented by a serious medical condition from being able to obtain benefits under the dental insurance plan. (C) Such other circumstances as the Secretary shall prescribe for purposes of this subsection. (3) The Secretary shall establish procedures for determinations on the permissibility of voluntary disenrollments under paragraph (1)(B). Such procedures shall ensure timely determinations on the permissibility of such disenrollments. (h) Relationship to Dental Care Provided by Secretary.—Nothing in this section shall affect the responsibility of the Secretary to provide dental care under section 1712 of this title, and the participation of an individual in the dental insurance plan under this section shall not affect the entitlement of the individual to outpatient dental services and treatment, and related dental appliances, under such section 1712. (i) Regulations.—The dental insurance plan under this section shall be administered under such regulations as the Secretary shall prescribe.

38 U.S.C. § 1714 Fitting and training in use of prosthetic appliances; guide dogs; service dogs

(a)(1) Any veteran who is entitled to a prosthetic appliance shall be furnished such fitting and training, including institutional training, in the use of such appliance as may be necessary, whether in a Department facility or other training institution, or by outpatient treatment, including such service under contract, and including travel and incidental expenses (under the terms and conditions set forth in section 111 of this title) to and from such veteran’s home to such hospital or training institution. (2) In furnishing prosthetic appliances under paragraph (1), the Secretary shall ensure women veterans are able to access clinically appropriate prosthetic appliances through each medical facility of the Department. (b) The Secretary may provide guide dogs trained for the aid of the blind to veterans who are enrolled under section 1705 of this title. The Secretary may also provide such veterans with mechanical or electronic equipment for aiding them in overcoming the disability of blindness. (c) The Secretary may, in accordance with the priority specified in section 1705 of this title, provide—(1) service dogs trained for the aid of the hearing impaired to veterans who are hearing impaired and are enrolled under section 1705 of this title; (2) service dogs trained for the aid of persons with spinal cord injury or dysfunction or other chronic impairment that substantially limits mobility to veterans with such injury, dysfunction, or impairment who are enrolled under section 1705 of this title; and (3) service dogs trained for the aid of persons with mental illnesses, including post-traumatic stress disorder, to veterans with such illnesses who are enrolled under section 1705 of this title. (d) In the case of a veteran provided a dog under subsection (b) or (c), the Secretary may pay travel and incidental expenses for that veteran under the terms and conditions set forth in section 111 of this title to and from the veteran’s home for expenses incurred in becoming adjusted to the dog. (e) The Secretary may provide a service dog to a veteran under subsection (c)(3) regardless of whether the veteran has a mobility impairment. (f)(1) The Secretary shall provide to any veteran described in paragraph (2) a commercially available veterinary insurance policy for each dog provided to such veteran under subsection (b) or (c). (2) A veteran described in this paragraph is a veteran who—(A) is diagnosed with post-traumatic stress disorder or a visual, hearing, or substantial mobility impairment; (B) has received a dog under subsection (b) or (c) in connection with such disorder or impairment; and (C) meets such other requirements as the Secretary may prescribe.

38 U.S.C. § 1715 Tobacco for hospitalized veterans

The Secretary may furnish tobacco to veterans receiving hospital or domiciliary care.

38 U.S.C. § 1716 Hospital care by other agencies of the United States

When so specified in an appropriation or other Act, the Secretary may make allotments and transfers to the Departments of Health and Human Services (Public Health Service), the Army, Navy, Air Force, or Interior, for disbursement by them under the various headings of their appropriations, of such amounts as are necessary for the care and treatment of veterans entitled to hospitalization from the Department under this chapter. The amounts to be charged the Department for care and treatment of veterans in hospitals shall be calculated on the basis of a per diem rate approved by the Office of Management and Budget.

38 U.S.C. § 1717 Home health services; invalid lifts and other devices

(a)(1) As part of medical services furnished to a veteran under section 1710(a) of this title, the Secretary may furnish such home health services as the Secretary finds to be necessary or appropriate for the effective and economical treatment of the veteran. (2) Improvements and structural alterations may be furnished as part of such home health services only as necessary to assure the continuation of treatment for the veteran’s disability or to provide access to the home or to essential lavatory and sanitary facilities. The cost of such improvements and structural alterations (or the amount of reimbursement therefor) under this subsection may not exceed—(A) in the case of medical services furnished under section 1710(a)(1) of this title, or for a disability described in section 1710(a)(2)(C) of this title—(i) in the case of a veteran who first applies for benefits under this paragraph before May 5, 2010, $4,100; or (ii) in the case of a veteran who first applies for benefits under this paragraph on or after May 5, 2010, $6,800; and (B) in the case of medical services furnished under any other provision of section 1710(a) of this title—(i) in the case of a veteran who first applies for benefits under this paragraph before May 5, 2010, $1,200; or (ii) in the case of a veteran who first applies for benefits under this paragraph on or after May 5, 2010, $2,000. (3) The Secretary may furnish home health services to a veteran in any setting in which the veteran is residing. The Secretary may not furnish such services in such a manner as to relieve any other person or entity of a contractual obligation to furnish services to the veteran. When home health services are furnished in a setting other than the veteran’s home, such services may not include any structural improvement or alteration. (b) The Secretary may furnish an invalid lift, or any type of therapeutic or rehabilitative device, as well as other medical equipment and supplies (excluding medicines), if medically indicated, to any veteran who is receiving (1) compensation under section 1114(l)–(p) of this title (or the comparable rates provided pursuant to section 1134 of this title), or (2) pension under chapter 15 of this title by reason of being in need of regular aid and attendance. (c) The Secretary may furnish devices for assisting in overcoming the handicap of deafness (including telecaptioning television decoders) to any veteran who is profoundly deaf and is entitled to compensation on account of hearing impairment. (d)(1) In the case of a member of the Armed Forces who, as determined by the Secretary, has a disability permanent in nature incurred or aggravated in the line of duty in the active military, naval, air, or space service, the Secretary may furnish improvements and structural alterations for such member for such disability or as otherwise described in subsection (a)(2) while such member is hospitalized or receiving outpatient medical care, services, or treatment for such disability if the Secretary determines that such member is likely to be discharged or released from the Armed Forces for such disability. (2) The furnishing of improvements and alterations under paragraph (1) in connection with the furnishing of medical services described in subparagraph (A) or (B) of subsection (a)(2) shall be subject to the limitation specified in the applicable subparagraph.

38 U.S.C. § 1718 Therapeutic and rehabilitative activities

(a) In providing rehabilitative services under this chapter, the Secretary, upon the recommendation of the Under Secretary for Health, may use the services of patients and members in Department health care facilities for therapeutic and rehabilitative purposes. Such patients and members shall not under these circumstances be held or considered as employees of the United States for any purpose. The Secretary shall prescribe the conditions for the use of such services. (b)(1) In furnishing rehabilitative services under this chapter, the Secretary, upon the recommendation of the Under Secretary for Health, may enter into a contract or other arrangement with any appropriate source (whether or not an element of the Department of Veterans Affairs or of any other Federal entity) to provide for therapeutic work for patients and members in Department health care facilities. (2) Notwithstanding any other provision of law, the Secretary may also furnish rehabilitative services under this subsection through contractual arrangements with nonprofit entities to provide for such therapeutic work for such patients. The Secretary shall establish appropriate fiscal, accounting, management, recordkeeping, and reporting requirements with respect to the activities of any such nonprofit entity in connection with such contractual arrangements. (c)(1) There is hereby established in the Treasury of the United States a revolving fund known as the Department of Veterans Affairs Special Therapeutic and Rehabilitation Activities Fund (hereinafter in this section referred to as the “fund”) for the purpose of furnishing rehabilitative services authorized in subsection (b) or (d). Such amounts of the fund as the Secretary may determine to be necessary to establish and maintain operating accounts for the various rehabilitative services activities may be deposited in checking accounts in other depositaries selected or established by the Secretary. (2) All funds received by the Department under contractual arrangements made under subsection (b) or (d), or by nonprofit entities described in subsection (b)(2), shall be deposited in or credited to the fund, and the Secretary shall distribute out of the fund moneys to participants at rates not less than the wage rates specified in the Fair Labor Standards Act of 1938 (29 U.S.C. 201 et seq.) and regulations prescribed thereunder for work of similar character. (3) The Under Secretary for Health shall prepare, for inclusion in the annual report submitted to Congress under section 529 of this title, a description of the scope and achievements of activities carried out under this section (including pertinent data regarding productivity and rates of distribution) during the prior twelve months and an estimate of the needs of the program of therapeutic and rehabilitation activities to be carried out under this section for the ensuing fiscal year. (d) In providing to a veteran rehabilitative services under this chapter, the Secretary may furnish the veteran with the following:(1) Work skills training and development services. (2) Employment support services. (3) Job development and placement services. (e) In providing rehabilitative services under this chapter, the Secretary shall take appropriate action to make it possible for the patient to take maximum advantage of any benefits to which such patient is entitled under chapter 31, 34, or 35 of this title, and, if the patient is still receiving treatment of a prolonged nature under this chapter, the provision of rehabilitative services under this chapter shall be continued during, and coordinated with, the pursuit of education and training under such chapter 31, 34, or 35. (f) The Secretary shall prescribe regulations to ensure that the priorities set forth in section 1705 of this title shall be applied, insofar as practicable, to participation in therapeutic and rehabilitation activities carried out under this section. (g)(1) The Secretary may not consider any of the matters stated in paragraph (2) as a basis for the denial or discontinuance of a rating of total disability for purposes of compensation or pension based on the veteran’s inability to secure or follow a substantially gainful occupation as a result of disability. (2) Paragraph (1) applies to the following:(A) A veteran’s participation in an activity carried out under this section. (B) A veteran’s receipt of a distribution as a result of participation in an activity carried out under this section. (C) A veteran’s participation in a program of rehabilitative services that (i) is provided as part of the veteran’s care furnished by a State home and (ii) is approved by the Secretary as conforming appropriately to standards for activities carried out under this section. (D) A veteran’s receipt of payment as a result of participation in a program described in subparagraph (C). (3) A distribution of funds made under this section and a payment made to a veteran under a program of rehabilitative services described in paragraph (2)(C) shall be considered for the purposes of chapter 15 of this title to be a donation from a public or private relief or welfare organization.

38 U.S.C. § 1719 Repair or replacement of certain prosthetic and other appliances

The Secretary may repair or replace any artificial limb, truss, brace, hearing aid, spectacles, or similar appliance (not including dental appliances) reasonably necessary to a veteran and belonging to such veteran which was damaged or destroyed by a fall or other accident caused by a service-connected disability for which such veteran is in receipt of, or but for the receipt of retirement pay would be entitled to, disability compensation.

38 U.S.C. § 1720 Transfers for nursing home care; adult day health care

(a)(1) Subject to subsection (b) of this section, the Secretary may transfer to a non-Department nursing home, for care at the expense of the United States—(A) a veteran—(i) who has been furnished care by the Secretary in a facility under the direct jurisdiction of the Secretary; and (ii) who the Secretary determines—(I) requires a protracted period of nursing home care which can be furnished in the non-Department nursing home; and (II) in the case of a veteran who has been furnished hospital care in a facility under the direct jurisdiction of the Secretary, has received maximum benefits from such care; and (B) a member of the Armed Forces—(i) who has been furnished care in a hospital of the Armed Forces; (ii) who the Secretary concerned determines has received maximum benefits from such care but requires a protracted period of nursing home care; and (iii) who upon discharge from the Armed Forces will become a veteran. (2) The Secretary may transfer a person to a nursing home under this subsection only if the Secretary determines that the cost to the United States of the care of such person in the nursing home will not exceed—(A) the amount equal to 45 percent of the cost of care furnished by the Department in a general hospital under the direct jurisdiction of the Secretary (as such cost may be determined annually by the Secretary); or (B) the amount equal to 50 percent of such cost, if such higher amount is determined to be necessary by the Secretary (upon the recommendation of the Under Secretary for Health) to provide adequate care. (3) Nursing home care may not be furnished under this subsection at the expense of the United States for more than six months in the aggregate in connection with any one transfer except—(A) in the case of a veteran—(i) who is transferred to a non-Department nursing home from a hospital under the direct jurisdiction of the Secretary; and (ii) whose hospitalization was primarily for a service-connected disability; (B) in a case in which the nursing home care is required for a service-connected disability; or (C) in a case in which, in the judgment of the Secretary, a longer period of nursing home care is warranted. (4) A veteran who is furnished care by the Secretary in a hospital or domiciliary facility in Alaska or Hawaii may be furnished nursing home care at the expense of the United States under this subsection even if such hospital or domiciliary facility is not under the direct jurisdiction of the Secretary. (b) No veteran may be transferred or admitted to any institution for nursing home care under this section, unless such institution is determined by the Secretary to meet such standards as the Secretary may prescribe. The standards prescribed and any report of inspection of institutions furnishing care to veterans under this section made by or for the Secretary shall, to the extent possible, be made available to all Federal, State, and local agencies charged with the responsibility of licensing or otherwise regulating or inspecting such institutions. (c)(1)(A) In furnishing nursing home care, adult day health care, or other extended care services under this section, the Secretary may enter into agreements for furnishing such care or services with—(i) in the case of the medicare program, a provider of services that has entered into a provider agreement under section 1866(a) of the Social Security Act (42 U.S.C. 1395cc(a)); (ii) in the case of the medicaid program, a provider participating under a State plan under title XIX of such Act (42 U.S.C. 1396 et seq.); and (iii) a provider of services eligible to enter into a contract pursuant to section 1745(a) of this title that is not otherwise described in clause (i) or (ii). (B) In entering into an agreement under subparagraph (A) with a provider of services described in clause (i) of that subparagraph or a provider described in clause (ii) of that subparagraph, the Secretary may use the procedures available for entering into provider agreements under section 1866(a) of the Social Security Act. (2) In applying the provisions of section 6704(a) of title 41 with respect to any contract entered into under this section to provide nursing home care of veterans, the payment of wages not less than those specified in section 6(b) of the Fair Labor Standards Act of 1938 (29 U.S.C. 206(b)) shall be deemed to constitute compliance with such provisions. (d)(1) Subject to subsection (b) of this section, the Secretary may authorize for any veteran requiring nursing home care for a service-connected disability direct admission for such care at the expense of the United States to any non-Department nursing home. The Secretary may also authorize a direct admission to such a nursing home for nursing home care for any veteran who has been discharged from a hospital under the direct jurisdiction of the Secretary and who is currently receiving medical services as part of home health services from the Department. (2) Direct admission authorized by paragraph (1) of this subsection may be authorized upon determination of need therefor—(A) by a physician employed by the Department; or (B) in areas where no such physician is available, by a physician carrying out such function under contract or fee arrangement, based on an examination by such physician. (3) The amount which may be paid for such care and the length of care available under this subsection shall be the same as authorized under subsection (a) of this section. (e)(1) The cost of intermediate care for purposes of payment by the United States pursuant to subsection (a)(2)(B) of this section shall be determined by the Secretary except that the rate of reimbursement shall be commensurately less than that provided for nursing home care. (2) For the purposes of this section, the term “non-Department nursing home” means a public or private institution not under the direct jurisdiction of the Secretary which furnishes nursing home care. (f)(1)(A) The Secretary may furnish adult day health care services to a veteran enrolled under section 1705(a) of this title who would otherwise require nursing home care. (B) The Secretary may provide in-kind assistance (through the services of Department employees and the sharing of other Department resources) to a facility furnishing care to veterans under subparagraph (A) of this paragraph. Any such in-kind assistance shall be provided under a contract or agreement between the Secretary and the facility concerned. The Secretary may provide such assistance only for use solely in the furnishing of adult day health care and only if, under such contract or agreement, the Department receives reimbursement for the full cost of such assistance, including the cost of services and supplies and normal depreciation and amortization of equipment. Such reimbursement may be made by reduction in the charges to the United States or by payment to the United States. Any funds received through such reimbursement shall be credited to funds allotted to the Department facility that provided the assistance. (2) The Secretary may conduct, at facilities over which the Secretary has direct jurisdiction, programs for the furnishing of adult day health care to veterans who are eligible for such care under paragraph (1) of this subsection, except that necessary travel and incidental expenses (or transportation in lieu thereof) may be furnished under such a program only under the terms and conditions set forth in section 111 of this title. The furnishing of care under any such program shall be subject to the limitations that are applicable to the duration of adult day health care furnished under paragraph (1) of this subsection. (g) The Secretary may contract with appropriate entities to provide specialized residential care and rehabilitation services to a veteran of Operation Enduring Freedom or Operation Iraqi Freedom who the Secretary determines suffers from a traumatic brain injury, has an accumulation of deficits in activities of daily living and instrumental activities of daily living, and because of these deficits, would otherwise require admission to a nursing home even though such care would generally exceed the veteran’s nursing needs. (h)(1) During the five-year period beginning on the date of the enactment of the Joseph Maxwell Cleland and Robert Joseph Dole Memorial Veterans Benefits and Health Care Improvement Act of 2022, and subject to paragraph (3)—(A) at the request of a veteran for whom the Secretary is required to provide nursing home care under section 1710A of this title, the Secretary may place the veteran in a medical foster home that meets Department standards, at the expense of the United States, pursuant to a contract, agreement, or other arrangement entered into between the Secretary and the medical foster home for such purpose; and (B) the Secretary may pay for care of a veteran placed in a medical foster home before such date of enactment, if the home meets Department standards, pursuant to a contract, agreement, or other arrangement entered into between the Secretary and the medical foster home for such purpose. (2) A veteran on whose behalf the Secretary pays for care in a medical foster home under paragraph (1) shall agree, as a condition of such payment, to accept home health services furnished by the Secretary under section 1717 of this title. (3) In any year, not more than a daily average of 900 veterans receiving care in a medical foster home, whether placed before, on, or after the date of the enactment of the Joseph Maxwell Cleland and Robert Joseph Dole Memorial Veterans Benefits and Health Care Improvement Act of 2022, may have their care covered at the expense of the United States under paragraph (1). (4) The prohibition under section 1730(b)(3) of this title shall not apply to a veteran whose care is covered at the expense of the United States under paragraph (1). (5) In this subsection, the term “medical foster home” means a home designed to provide non-institutional, long-term, supportive care for veterans who are unable to live independently and prefer a family setting.

38 U.S.C. § 1720A Treatment and rehabilitative services for persons with drug or alcohol dependency

(a) The Secretary, in consultation with the Secretary of Labor and the Director of the Office of Personnel Management, may take appropriate steps to (1) urge all Federal agencies and appropriate private and public firms, organizations, agencies, and persons to provide appropriate employment and training opportunities for veterans who have been provided treatment and rehabilitative services under this title for alcohol or drug dependence or abuse disabilities and have been determined by competent medical authority to be sufficiently rehabilitated to be employable, and (2) provide all possible assistance to the Secretary of Labor in placing such veterans in such opportunities. (b) Upon receipt of an application for treatment and rehabilitative services under this title for an alcohol or drug dependence or abuse disability from any individual who has been discharged or released from active military, naval, air, or space service but who is not eligible for such treatment and services, the Secretary shall—(1) provide referral services to assist such individual, to the maximum extent practicable, in obtaining treatment and rehabilitative services from sources outside the Department; and (2) if pertinent, advise such individual of such individual’s rights to apply to the appropriate military, naval, air, or space service and the Department for review of such individual’s discharge or release from such service. (c)(1) Any person serving in the active military, naval, air, or space service who is determined by the Secretary concerned to have an alcohol or drug dependence or abuse disability may be transferred to any facility in order for the Secretary to furnish care or treatment and rehabilitative services for such disability. Care and services provided to a member so transferred shall be provided as if such member were a veteran. Any transfer of any such member for such care and services shall be made pursuant to such terms as may be agreed upon by the Secretary concerned and the Secretary, subject to the provisions of sections 1535 and 1536 of title 31. (2) No person serving in the active military, naval, air, or space service may be transferred pursuant to an agreement made under paragraph (1) of this subsection unless such person requests such transfer in writing for a specified period of time. No such person transferred pursuant to such a request may be furnished such care and services by the Secretary beyond the period of time specified in such request unless such person requests in writing an extension for a further specified period of time and such request is approved by the Secretary. (d)(1) The Secretary shall ensure that each medical center of the Department develops and carries out a plan to provide treatment for substance use disorders, either through referral or direct provision of services, to veterans who require such treatment. (2) Each plan under paragraph (1) shall make available clinically proven substance abuse treatment methods, including opioid substitution therapy, to veterans with respect to whom a qualified medical professional has determined such treatment methods to be appropriate.

38 U.S.C. § 1720B Respite care

(a) The Secretary may furnish respite care services to a veteran who is enrolled to receive care under section 1710 of this title. (b) For the purpose of this section, the term “respite care services” means care and services which—(1) are of limited duration; (2) are furnished on an intermittent basis to a veteran who is suffering from a chronic illness and who resides primarily at home; and (3) are furnished for the purpose of helping the veteran to continue residing primarily at home. (c) In furnishing respite care services, the Secretary may enter into contract arrangements.

38 U.S.C. § 1720C Noninstitutional alternatives to nursing home care

(a) The Secretary may furnish medical, rehabilitative, and health-related services in noninstitutional settings for veterans who are eligible under this chapter for, and are in need of, nursing home care. The Secretary shall give priority for participation in such program to veterans who—(1) are in receipt of, or are in need of, nursing home care primarily for the treatment of a service-connected disability; or (2) have a service-connected disability rated at 50 percent or more. (b)(1) Under the program conducted pursuant to subsection (a), the Secretary shall (A) furnish appropriate health-related services solely through contracts with appropriate public and private agencies that provide such services, and (B) designate Department health-care employees to furnish case management services to veteran furnished services under the program. (2) For the purposes of paragraph (1), the term “case management services” includes the coordination and facilitation of all services furnished to a veteran by the Department of Veterans Affairs, either directly or through contract, including assessment of needs, planning, referral (including referral for services to be furnished by the Department, either directly or through a contract, or by an entity other than the Department), monitoring, reassessment, and followup. (c) The Secretary may provide in-kind assistance (through the services of Department of Veterans Affairs employees and the sharing of other Department resources) to a facility furnishing services to veterans under subsection (b)(1)(A). Any such in-kind assistance shall be provided under a contract between the Department and the facility concerned. The Secretary may provide such assistance only for use solely in the furnishing of appropriate services under this section and only if, under such contract, the Department receives reimbursement for the full cost of such assistance (including the cost of services and supplies and normal depreciation and amortization of equipment). Such reimbursement may be made by reduction in the charges to the United States or by payment to the United States. Any funds received through such reimbursement shall be credited to funds allotted to the Department facility that provided the assistance. (d)(1) Except as provided in paragraph (2), the total cost of providing services or in-kind assistance in the case of any veteran for any fiscal year under the program may not exceed 100 percent of the cost that would have been incurred by the Department during that fiscal year if the veteran had been furnished, instead, nursing home care under section 1710 of this title during that fiscal year. (2)(A) The total cost of providing services or in-kind assistance in the case of any veteran described in subparagraph (B) for any fiscal year under the program may exceed 100 percent of the cost that would otherwise have been incurred as specified in paragraph (1) if the Secretary determines, based on a consideration of clinical need, geographic market factors, and such other matters as the Secretary may prescribe through regulation, that such higher total cost is in the best interest of the veteran. (B) A veteran described in this subparagraph is a veteran with amyotrophic lateral sclerosis, a spinal cord injury, or a condition the Secretary determines to be similar to such conditions. (e) The authority of the Secretary to enter into contracts under this section shall be effective for any fiscal year only to the extent that appropriations are available. (f) In furnishing services to a veteran under the program conducted pursuant to subsection (a), if a medical center of the Department through which such program is administered is located in a geographic area in which services are available to the veteran under a PACE program (as such term is defined in sections 1894(a)(2) and 1934(a)(2) of the Social Security Act (42 U.S.C. 1395eee(a)(2); 1396u–4(a)(2))), the Secretary shall seek to enter into an agreement with the PACE program operating in that area for the furnishing of such services.

38 U.S.C. § 1720D Counseling and treatment for sexual trauma

(a)(1) The Secretary shall operate a program under which the Secretary provides counseling and appropriate care and services, to include care for physical health conditions, as appropriate, to former members of the Armed Forces who the Secretary determines require such counseling and care and services to treat a condition, which in the judgment of a health care professional employed by the Department, resulted from a physical assault of a sexual nature, battery of a sexual nature, or sexual harassment which occurred while the former member of the Armed Forces was serving on duty, regardless of duty status or line of duty determination (as that term is used in section 12323 of title 10). (2)(A) In operating the program required by paragraph (1), the Secretary may, in consultation with the Secretary of Defense, provide counseling and care and services to members of the Armed Forces (including members of the National Guard and Reserves) to treat a condition described in that paragraph that was suffered by the member while serving on duty, regardless of duty status or line of duty determination (as that term is used in section 12323 of title 10). (B) A member described in subparagraph (A) shall not be required to obtain a referral before receiving counseling and care and services under this paragraph. (3) In furnishing counseling to an individual under this subsection, the Secretary may provide such counseling pursuant to a contract with a qualified mental health professional if (A) in the judgment of a mental health professional employed by the Department, the receipt of counseling by that individual in facilities of the Department would be clinically inadvisable, or (B) Department facilities are not capable of furnishing such counseling to that individual economically because of geographical inaccessibility. (b)(1) The Secretary shall give priority to the establishment and operation of the program to provide counseling and care and services under subsection (a). In the case of a former member of the Armed Forces eligible for counseling and care and services under subsection (a), the Secretary shall ensure that the former member of the Armed Forces is furnished counseling and care and services under this section in a way that is coordinated with the furnishing of such care and services under this chapter. (2) In establishing a program to provide counseling under subsection (a), the Secretary shall—(A) provide for appropriate training of mental health professionals and such other health care personnel as the Secretary determines necessary to carry out the program effectively; (B) seek to ensure that such counseling is furnished in a setting that is therapeutically appropriate, taking into account the circumstances that resulted in the need for such counseling; and (C) provide referral services to assist former members of the Armed Forces who are not eligible for services under this chapter to obtain those from sources outside the Department. (c) The Secretary shall provide information on the counseling and treatment available under this section. Efforts by the Secretary to provide such information—(1) shall include availability of a toll-free telephone number (commonly referred to as an 800 number); (2) shall ensure that information about the counseling and treatment available under this section—(A) is revised and updated as appropriate; (B) is made available and visibly posted at appropriate facilities of the Department; and (C) is made available through appropriate public information services; and (3) shall include coordination with the Secretary of Defense seeking to ensure that members of the Armed Forces and individuals who are being separated from active military, naval, air, or space service are provided appropriate information about programs, requirements, and procedures for applying for counseling and treatment under this section. (d)(1) The Secretary shall carry out a program to provide graduate medical education, training, certification, and continuing medical education for mental health professionals and other health care professionals who provide counseling, care, and services under subsection (a). (2) In carrying out the program required by paragraph (1), the Secretary shall ensure that—(A) all mental health professionals and other health care professionals described in such paragraph have been trained in a consistent manner; and (B) training described in such paragraph includes principles of evidence-based treatment and care for sexual trauma and post-traumatic stress disorder. (e) Each year, the Secretary shall submit to Congress an annual report on the counseling, care, and services provided pursuant to this section. Each report shall include data for the year covered by the report with respect to each of the following:(1) The number of mental health professionals, graduate medical education trainees, and primary care providers who have been certified under the program required by subsection (d) and the amount and nature of continuing medical education provided under such program to such professionals, trainees, and providers who are so certified. (2) The number of individuals who received counseling and care and services under subsection (a) from professionals and providers who received training under subsection (d), disaggregated by—(A) former members of the Armed Forces; (B) members of the Armed Forces (including members of the National Guard and Reserves) on active duty; and (C) for each of subparagraphs (A) and (B)—(i) men; and (ii) women. (3) The number of graduate medical education, training, certification, and continuing medical education courses provided by reason of subsection (d). (4) The number of trained full-time equivalent employees required in each facility of the Department to meet the needs of individuals requiring treatment and care for sexual trauma and post-traumatic stress disorder. (5) Such recommendations for improvements in the treatment of individuals with sexual trauma and post-traumatic stress disorder as the Secretary considers appropriate, including specific recommendations for individuals specified in subparagraphs (A), (B), and (C) of paragraph (2). (6) Such other information as the Secretary considers appropriate. (f) In this section, the term “sexual harassment” means unsolicited verbal or physical contact of a sexual nature which is threatening in character. (g) In this section, the term “former member of the Armed Forces” includes the following:(1) A veteran. (2) An individual described in section 1720I(b) of this title.

38 U.S.C. § 1720E Nasopharyngeal radium irradiation

(a) The Secretary may provide any veteran a medical examination, and hospital care, medical services, and nursing home care, which the Secretary determines is needed for the treatment of any cancer of the head or neck which the Secretary finds may be associated with the veteran’s receipt of nasopharyngeal radium irradiation treatments in active military, naval, air, or space service. (b) The Secretary shall provide care and services to a veteran under subsection (a) only on the basis of evidence in the service records of the veteran which document nasopharyngeal radium irradiation treatment in service, except that, notwithstanding the absence of such documentation, the Secretary may provide such care to a veteran who—(1) served as an aviator in the active military, naval, or air service before the end of the Korean conflict; or (2) underwent submarine training in active naval service before January 1, 1965.

38 U.S.C. § 1720F Comprehensive program for suicide prevention among veterans and members of the reserve components of the Armed Forces

(a) Establishment.—The Secretary shall develop and carry out a comprehensive program designed to reduce the incidence of suicide among covered individuals incorporating the components described in this section. (b) Staff Education.—In carrying out the comprehensive program under this section, the Secretary shall provide for mandatory training for appropriate staff and contractors (including all medical personnel) of the Department who interact with covered individuals. This training shall cover information appropriate to the duties being performed by such staff and contractors. The training shall include information on—(1) recognizing risk factors for suicide; (2) proper protocols for responding to crisis situations involving covered individuals who may be at high risk for suicide; and (3) best practices for suicide prevention. (c) Health Assessments.—In carrying out the comprehensive program, the Secretary shall direct that medical staff offer mental health in their overall health assessment when covered individuals seek medical care at a Department medical facility (including a center established under section 1712A of this title) and make referrals, at the request of the individual concerned, to appropriate counseling and treatment programs for covered individuals who show signs or symptoms of mental health problems. (d) Designation of Suicide Prevention Counselors.—In carrying out the comprehensive program, the Secretary shall designate a suicide prevention counselor at each Department medical facility other than centers established under section 1712A of this title. Each counselor shall work with local emergency rooms, police departments, mental health organizations, and veterans service organizations to engage in outreach to covered individuals and improve the coordination of mental health care to covered individuals. (e) Best Practices Research.—In carrying out the comprehensive program, the Secretary shall provide for research on best practices for suicide prevention among covered individuals. Research shall be conducted under this subsection in consultation with the heads of the following entities:(1) The Department of Health and Human Services. (2) The National Institute of Mental Health. (3) The Substance Abuse and Mental Health Services Administration. (4) The Centers for Disease Control and Prevention. (f) Sexual Trauma Research.—In carrying out the comprehensive program, the Secretary shall provide for research on mental health care for covered individuals who have experienced sexual trauma while in military service. The research design shall include consideration of veterans or members of a reserve component. (g) 24-Hour Mental Health Care.—In carrying out the comprehensive program, the Secretary shall provide for mental health care availability to covered individuals on a 24-hour basis. (h) Hotline.—In carrying out the comprehensive program, the Secretary may provide for a toll-free hotline for covered individuals to be staffed by appropriately trained mental health personnel and available at all times. (i) Outreach and Education.—In carrying out the comprehensive program, the Secretary shall provide for outreach to and education for covered individuals and the families of covered individuals, with special emphasis on providing information to veterans of Operation Iraqi Freedom and Operation Enduring Freedom and the families of such veterans. Education to promote mental health shall include information designed to—(1) remove the stigma associated with mental illness; (2) encourage covered individuals to seek treatment and assistance for mental illness; (3) promote skills for coping with mental illness; and (4) help families of covered individuals with—(A) understanding issues arising from the readjustment of covered individuals to civilian life; (B) identifying signs and symptoms of mental illness; and (C) encouraging covered individuals to seek assistance for mental illness. (j) Peer Support Counseling Program.—(1) In carrying out the comprehensive program, the Secretary shall establish and carry out a peer support counseling program, under which covered individuals shall be permitted to volunteer as peer counselors—(A) to assist other covered individuals with issues related to mental health and readjustment; and (B) to conduct outreach to covered individuals and the families of covered individuals. (2) In carrying out the peer support counseling program under this subsection, the Secretary shall provide adequate training for peer counselors, including training carried out under the national program of training required by section 304(c) of the Caregivers and Veterans Omnibus Health Services Act of 2010 (38 U.S.C. 1712A note). (3) In addition to other locations the Secretary considers appropriate, the Secretary shall carry out the peer support program under this subsection at each Department medical center. (4)(A) As part of the counseling program under this subsection, the Secretary shall emphasize appointing peer support counselors for covered individuals who are women. To the degree practicable, the Secretary shall seek to recruit women peer support counselors with expertise in—(i) female gender-specific issues and services; (ii) the provision of information about services and benefits provided under laws administered by the Secretary; or (iii) employment mentoring. (B) To the degree practicable, the Secretary shall emphasize facilitating peer support counseling for covered individuals who are women and are eligible for counseling and services under section 1720D of this title, have post-traumatic stress disorder or suffer from another mental health condition, are homeless or at risk of becoming homeless, or are otherwise at increased risk of suicide, as determined by the Secretary. (C) The Secretary shall conduct outreach to inform covered individuals who are women about the program and the assistance available under this paragraph. (D) In carrying out this paragraph, the Secretary shall coordinate with such community organizations, State and local governments, institutions of higher education, chambers of commerce, local business organizations, organizations that provide legal assistance, and other organizations as the Secretary considers appropriate. (E) In carrying out this paragraph, the Secretary shall provide adequate training for peer support counselors, including training carried out under the national program of training required by section 304(c) of the Caregivers and Veterans Omnibus Health Services Act of 2010 (38 U.S.C. 1712A note). (k) Other Components.—In carrying out the comprehensive program, the Secretary may provide for other actions to reduce the incidence of suicide among covered individuals that the Secretary considers appropriate. (l)(1) Covered Individual Defined.—In this section, the term “covered individual” means a veteran or a member of the reserve components of the Armed Forces. (2) In determining coverage of members of the reserve components of the Armed Forces under the comprehensive program, the Secretary shall consult with the Secretary of Defense.

38 U.S.C. § 1720G Assistance and support services for caregivers

(a) Program of Comprehensive Assistance for Family Caregivers.—(1)(A) The Secretary shall establish a program of comprehensive assistance for family caregivers of eligible veterans. (B) The Secretary shall only provide support under the program required by subparagraph (A) to a family caregiver of an eligible veteran if the Secretary determines it is in the best interest of the eligible veteran to do so. (2) For purposes of this subsection, an eligible veteran is any individual who—(A) is a veteran or member of the Armed Forces undergoing medical discharge from the Armed Forces; (B) for assistance provided under this subsection—(i) before the date on which the Secretary submits to Congress a certification that the Department has fully implemented the information technology system required by section 162(a) of the Caring for Our Veterans Act of 2018, has a serious injury (including traumatic brain injury, psychological trauma, or other mental disorder) incurred or aggravated in the line of duty in the active military, naval, air, or space service on or after September 11, 2001; (ii) during the 2-year period beginning on the date on which the Secretary submitted to Congress the certification described in clause (i), has a serious injury (including traumatic brain injury, psychological trauma, or other mental disorder) incurred or aggravated in the line of duty in the active military, naval, air, or space service—(I) on or before May 7, 1975; or (II) on or after September 11, 2001; or (iii) after the date that is 2 years after the date on which the Secretary submits to Congress the certification described in clause (i), has a serious injury (including traumatic brain injury, psychological trauma, or other mental disorder) incurred or aggravated in the line of duty in the active military, naval, air, or space service; and (C) is in need of personal care services because of—(i) an inability to perform one or more activities of daily living; (ii) a need for supervision or protection based on symptoms or residuals of neurological or other impairment or injury; (iii) a need for regular or extensive instruction or supervision without which the ability of the veteran to function in daily life would be seriously impaired; or (iv) such other matters as the Secretary considers appropriate. (3)(A) As part of the program required by paragraph (1), the Secretary shall provide to family caregivers of eligible veterans the following assistance:(i) To each family caregiver who is approved as a provider of personal care services for an eligible veteran under paragraph (6)—(I) such instruction, preparation, and training as the Secretary considers appropriate for the family caregiver to provide personal care services to the eligible veteran; (II) ongoing technical support consisting of information and assistance to address, in a timely manner, the routine, emergency, and specialized caregiving needs of the family caregiver in providing personal care services to the eligible veteran; (III) counseling; and (IV) lodging and subsistence under section 111(e) of this title. (ii) To each family caregiver who is designated as the primary provider of personal care services for an eligible veteran under paragraph (7)—(I) the assistance described in clause (i); (II) such mental health services as the Secretary determines appropriate; (III) covered respite care of not less than 30 days annually; (IV) medical care under section 1781 of this title; (V) a monthly personal caregiver stipend; and (VI) through the use of contracts with, or the provision of grants to, public or private entities—(aa) financial planning services relating to the needs of injured veterans and their caregivers; and (bb) legal services, including legal advice and consultation, relating to the needs of injured veterans and their caregivers. (B)(i) The amount of the monthly personal caregiver stipend provided under subparagraph (A)(ii)(V) shall be determined in accordance with a schedule established by the Secretary that specifies stipends based upon the amount and degree of personal care services provided. (ii) The Secretary shall ensure, to the extent practicable, that the schedule required by clause (i) specifies that the amount of the monthly personal caregiver stipend provided to a primary provider of personal care services for the provision of personal care services to an eligible veteran is not less than the monthly amount a commercial home health care entity would pay an individual in the geographic area of the eligible veteran to provide equivalent personal care services to the eligible veteran. (iii) In determining the amount and degree of personal care services provided under clause (i) with respect to an eligible veteran whose need for personal care services is based in whole or in part on a need for supervision or protection under paragraph (2)(C)(ii) or regular instruction or supervision under paragraph (2)(C)(iii), the Secretary shall take into account the following:(I) The assessment by the family caregiver of the needs and limitations of the veteran. (II) The extent to which the veteran can function safely and independently in the absence of such supervision, protection, or instruction. (III) The amount of time required for the family caregiver to provide such supervision, protection, or instruction to the veteran. (iv) If personal care services are not available from a commercial home health entity in the geographic area of an eligible veteran, the amount of the monthly personal caregiver stipend payable under the schedule required by clause (i) with respect to the eligible veteran shall be determined by taking into consideration the costs of commercial providers of personal care services in providing personal care services in geographic areas other than the geographic area of the eligible veteran with similar costs of living. (C) In providing instruction, preparation, and training under subparagraph (A)(i)(I) and technical support under subparagraph (A)(i)(II) to each family caregiver who is approved as a provider of personal care services for an eligible veteran under paragraph (6), the Secretary shall periodically evaluate the needs of the eligible veteran and the skills of the family caregiver of such veteran to determine if additional instruction, preparation, training, or technical support under those subparagraphs is necessary. (4) An eligible veteran and a family member of the eligible veteran seeking to participate in the program required by paragraph (1) shall jointly submit to the Secretary an application therefor in such form and in such manner as the Secretary considers appropriate. (5) For each application submitted jointly by an eligible veteran and family member, the Secretary shall evaluate (in collaboration with the primary care team for the eligible veteran to the maximum extent practicable)—(A) the eligible veteran—(i) to identify the personal care services required by the eligible veteran; and (ii) to determine whether such requirements could be significantly or substantially satisfied through the provision of personal care services from a family member; and (B) the family member to determine the amount of instruction, preparation, and training, if any, the family member requires to provide the personal care services required by the eligible veteran—(i) as a provider of personal care services for the eligible veteran; and (ii) as the primary provider of personal care services for the eligible veteran. (6)(A) The Secretary shall provide each family member of an eligible veteran who makes a joint application under paragraph (4) the instruction, preparation, and training determined to be required by such family member under paragraph (5)(B). (B) Upon the successful completion by a family member of an eligible veteran of instruction, preparation, and training under subparagraph (A), the Secretary shall approve the family member as a provider of personal care services for the eligible veteran. (C) The Secretary shall, subject to regulations the Secretary shall prescribe, provide for necessary travel, lodging, and per diem expenses incurred by a family member of an eligible veteran in undergoing instruction, preparation, and training under subparagraph (A). (D) If the participation of a family member of an eligible veteran in instruction, preparation, and training under subparagraph (A) would interfere with the provision of personal care services to the eligible veteran, the Secretary shall, subject to regulations as the Secretary shall prescribe and in consultation with the veteran, provide respite care to the eligible veteran during the provision of such instruction, preparation, and training to the family member so that the family member can participate in such instruction, preparation, and training without interfering with the provision of such services to the eligible veteran. (7)(A) For each eligible veteran with at least one family member who is described by subparagraph (B), the Secretary shall designate one family member of such eligible veteran as the primary provider of personal care services for such eligible veteran. (B) A primary provider of personal care services designated for an eligible veteran under subparagraph (A) shall be selected from among family members of the eligible veteran who—(i) are approved under paragraph (6) as a provider of personal care services for the eligible veteran; (ii) elect to provide the personal care services to the eligible veteran that the Secretary determines the eligible veteran requires under paragraph (5)(A)(i); (iii) have the consent of the eligible veteran to be the primary provider of personal care services for the eligible veteran; and (iv) are considered by the Secretary as competent to be the primary provider of personal care services for the eligible veteran. (C) An eligible veteran receiving personal care services from a family member designated as the primary provider of personal care services for the eligible veteran under subparagraph (A) may, in accordance with procedures the Secretary shall establish for such purposes, revoke consent with respect to such family member under subparagraph (B)(iii). (D) If a family member designated as the primary provider of personal care services for an eligible veteran under subparagraph (A) subsequently fails to meet any requirement set forth in subparagraph (B), the Secretary—(i) shall immediately revoke the family member’s designation under subparagraph (A); and (ii) may designate, in consultation with the eligible veteran, a new primary provider of personal care services for the eligible veteran under such subparagraph. (E) The Secretary shall take such actions as may be necessary to ensure that the revocation of a designation under subparagraph (A) with respect to an eligible veteran does not interfere with the provision of personal care services required by the eligible veteran. (8) If an eligible veteran lacks the capacity to make a decision under this subsection, the Secretary may, in accordance with regulations and policies of the Department regarding appointment of guardians or the use of powers of attorney, appoint a surrogate for the eligible veteran who may make decisions and take action under this subsection on behalf of the eligible veteran. (9)(A) The Secretary shall monitor the well-being of each eligible veteran receiving personal care services under the program required by paragraph (1). (B) The Secretary shall document each finding the Secretary considers pertinent to the appropriate delivery of personal care services to an eligible veteran under the program. (C) The Secretary shall establish procedures to ensure appropriate follow-up regarding findings described in subparagraph (B). Such procedures may include the following:(i) Visiting an eligible veteran in the eligible veteran’s home to review directly the quality of personal care services provided to the eligible veteran. (ii) Taking such corrective action with respect to the findings of any review of the quality of personal care services provided an eligible veteran as the Secretary considers appropriate, which may include—(I) providing additional training to a family caregiver; and (II) suspending or revoking the approval of a family caregiver under paragraph (6) or the designation of a family caregiver under paragraph (7). (10) The Secretary shall carry out outreach to inform eligible veterans and family members of eligible veterans of the program required by paragraph (1) and the benefits of participating in the program. (11)(A) In providing assistance under this subsection to family caregivers of eligible veterans, the Secretary may enter into contracts, provider agreements, and memoranda of understanding with Federal agencies, States, and private, nonprofit, and other entities to provide such assistance to such family caregivers. (B) The Secretary may provide assistance under this paragraph only if such assistance is reasonably accessible to the family caregiver and is substantially equivalent or better in quality to similar services provided by the Department. (C) The Secretary may provide fair compensation to Federal agencies, States, and other entities that provide assistance under this paragraph. (12)(A) The Secretary shall notify the individuals described in subparagraph (C) regarding decisions affecting the furnishing of assistance under this subsection using standardized letters, as the Secretary determines such notifications and letters to be appropriate, which shall include all criteria used to determine eligibility for such assistance and, in the case of a completed evaluation, how such criteria were used to evaluate information provided in assessments to determine such eligibility. (B) A notification provided under subparagraph (A) shall include the elements required for notices of decisions under section 5104(b) of this title to the extent that those elements apply to such notification, unless, not later than 60 days after the date of the enactment of the Transparency and Effective Accountability Measures for Veteran Caregivers Act, the Secretary determines that it would not be feasible to include such elements in such notifications and submits to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report setting forth the reasons for such determination. (C) The individuals described in this subparagraph shall include—(i) an individual who—(I) submits an application for the program established under paragraph (1); or (II) is being reassessed for eligibility to continue in such program. (ii) an individual determined by the Secretary to be an eligible veteran pursuant to such an application; and (iii) a family caregiver of an eligible veteran who is—(I) approved as a provider of personal care services under paragraph (6)(B); or (II) designated as a primary provider of personal care services under paragraph (7)(A). (13)(A) If the Secretary determines that a veteran receiving services under the program established under paragraph (1) is no longer eligible for such program solely because of improvement in the condition of the veteran—(i) the effective date of discharge of the veteran from the program shall be not earlier than the date that is 60 days after the date on which the Secretary provides notice of such lack of eligibility under paragraph (12)(A) to the relevant individuals described in paragraph (12)(C); and (ii) the Secretary shall extend benefits under the program established under paragraph (1) for a family caregiver of the veteran described in paragraph (12)(C)(iii), including stipends under paragraph (3)(A)(ii)(V), if such an extension is determined appropriate by the Secretary, for a 90-day period following discharge of the veteran from the program. (B) This paragraph shall not be construed to limit the authority of the Secretary—(i) to prescribe regulations addressing other bases for—(I) the discharge of a veteran from the program established under paragraph (1); or (II) the revocation of the designation of a family caregiver of a veteran as a primary provider of personal care services under paragraph (7)(A); or (ii) to provide advance notice and extended benefits under the program, as appropriate, if another basis for discharge of a veteran described in subclause (I) of clause (i) or revocation of a designation described in subclause (II) of such clause applies. (14)(A) In the case of a veteran or caregiver who seeks services under this subsection and is denied such services, or a veteran or the family caregiver of a veteran who is discharged from the program under this subsection, the Secretary shall—(i) if the veteran meets the requirements of a covered veteran under subsection (b), provide to such caregiver the option of enrolling in the program of general caregiver support services under such subsection; (ii) assess the veteran or caregiver for participation in any other available program of the Department for home- and community-based services (including the programs specified in section 1720L of this title) for which the veteran or caregiver may be eligible and, with respect to the veteran, store (and make accessible to the veteran) the results of such assessment in the electronic medical record of the veteran; and (iii) provide to the veteran or caregiver written information on any such program identified pursuant to the assessment under clause (ii), including information about facilities, eligibility requirements, and relevant contact information for each such program. (B) The Secretary shall, to the extent practicable, provide to a veteran or family caregiver the option of obtaining clinically appropriate services under any other available program of the Department for home- and community-based services (including the programs specified in section 1720L of this title) for which the veteran or family caregiver may be eligible prior to discharging the veteran or family caregiver from the program under this subsection. (C) For each veteran or family caregiver who is discharged from the program under this subsection, a caregiver support coordinator shall provide for a smooth and personalized transition from such program to an appropriate program of the Department for home- and community-based services (including the programs specified in section 1720L of this title), including by integrating caregiver support across programs. (15)(A) Not less frequently than annually, the Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and the House of Representatives a comprehensive report on the program required by paragraph (1) that includes, with respect to the one-year period preceding the date of the submission of such report, the following:(i) The number of applications received for such program. (ii) The number, disaggregated by race, sex, and era and branch of service in the Armed Forces of the applicant, of—(I) approvals of such applications; and (II) denials of such applications. (iii) The number of reassessments conducted for such program. (iv) An identification of each decision made with respect to a reassessment conducted for such program, disaggregated by decisions resulting in—(I) disenrollment, including removal, discharge, or voluntary withdrawal; (II) tier reduction; and (III) tier continuation. (v) The number of appeals of decisions made with respect to such program, disaggregated by type of appeal. (vi) With respect to each appeal described in clause (v), the decision rendered, if any. (vii) A description of all tools used in assessments conducted for such program, including an explanation of how and by whom such tools are administered. (viii) A description of procedures used under such program for reviewing and integrating clinical records from health care providers that includes an explanation of how such records are used in determinations of eligibility for such program. (ix) A description of procedures available under such program for health care providers to communicate medical opinions to the teams conducting assessments to determine eligibility for such program, including health care providers in the private sector and health care providers specified in subsection (c) of section 1703 of this title. (x) A description of information technology systems and processes used under such program to upload and integrate all clinical records from all non-Department providers, including providers in the private sector and providers under the Veterans Community Care Program established under such section. (B) The Secretary shall ensure that all data included in a report under subparagraph (A)—(i) relating to a decision made under the program required by paragraph (1), are disaggregated by the specific reason for the decision; (ii) relating to a veteran, include comprehensive demographic information of the veteran, including the time period of the injuries, if any, of the veteran and the Veterans Integrated Service Network in which the veteran is located; and (iii) with respect to eligibility determinations relating to a serious injury of a veteran, specify—(I) how many such determinations relate to the ability of the veteran to perform activities of daily living; and (II) how many such determinations relate to the need of a veteran for supervision and protection. (C) The Secretary shall provide the data under paragraph (B) pursuant to Federal laws and in a manner that is wholly consistent with applicable Federal privacy and confidentiality laws, including the Privacy Act (5 U.S.C. 552a), the Health Insurance Portability and Accountability Act (Public Law 104–191; 42 U.S.C. 201 note) and regulations (title 45, Code of Federal Regulations, parts 160 and 164, or successor regulations), and sections 5701, 5705, and 7332 of this title to ensure that the provided data, or some portion of the data, will not undermine the anonymity of a veteran. (b) Program of General Caregiver Support Services.—(1) The Secretary shall establish a program of support services for caregivers of covered veterans who are enrolled in the health care system established under section 1705(a) of this title (including caregivers who do not reside with such veterans). (2) For purposes of this subsection, a covered veteran is any individual who needs personal care services because of—(A) an inability to perform one or more activities of daily living; (B) a need for supervision or protection based on symptoms or residuals of neurological or other impairment or injury; or (C) such other matters as the Secretary shall specify. (3)(A) The support services furnished to caregivers of covered veterans under the program required by paragraph (1) shall include the following:(i) Services regarding the administering of personal care services, which, subject to subparagraph (B), shall include—(I) educational sessions made available both in person and on an Internet website; (II) use of telehealth and other available technologies; and (III) teaching techniques, strategies, and skills for caring for a disabled veteran; (ii) Counseling and other services under section 1782 of this title. (iii) Covered respite care of not less than 30 days annually. (iv) Information concerning the supportive services available to caregivers under this subsection and other public, private, and nonprofit agencies that offer support to caregivers. (B) If the Secretary certifies to the Committees on Veterans’ Affairs of the Senate and the House of Representatives that funding available for a fiscal year is insufficient to fund the provision of services specified in one or more subclauses of subparagraph (A)(i), the Secretary shall not be required under subparagraph (A) to provide the services so specified in the certification during the period beginning on the date that is 180 days after the date the certification is received by the Committees and ending on the last day of the fiscal year. (4) In providing information under paragraph (3)(A)(iv), the Secretary shall collaborate with the Assistant Secretary for Aging of the Department of Health and Human Services in order to provide caregivers access to aging and disability resource centers under the Administration on Aging of the Department of Health and Human Services. (5) In carrying out the program required by paragraph (1), the Secretary shall conduct outreach to inform covered veterans and caregivers of covered veterans about the program. The outreach shall include an emphasis on covered veterans and caregivers of covered veterans living in rural areas. (c) Construction.—(1) A decision by the Secretary under this section affecting the furnishing of assistance or support shall be considered a medical determination. (2) Nothing in this section shall be construed to create—(A) an employment relationship between the Secretary and an individual in receipt of assistance or support under this section; or (B) any entitlement to any assistance or support provided under this section. (d) Definitions.—In this section:(1) The term “caregiver”, with respect to an eligible veteran under subsection (a), a veteran denied or discharged as specified in paragraph (14) of such subsection, or a covered veteran under subsection (b), means an individual who provides personal care services to the veteran. (2) The term “covered respite care” means, with respect to a caregiver of a veteran, respite care under section 1720B of this title that—(A) is medically and age appropriate for the veteran (including 24-hour per day care of the veteran commensurate with the care provided by the caregiver); and (B) includes in-home care. (3) The term “family caregiver”, with respect to an eligible veteran under subsection (a) or a veteran denied or discharged as specified in paragraph (14) of such subsection, means a family member who is a caregiver of the veteran. (4) The term “family member”, with respect to an eligible veteran under subsection (a) or a veteran denied or discharged as specified in paragraph (14) of such subsection, means an individual who—(A) is a member of the family of the veteran, including—(i) a parent; (ii) a spouse; (iii) a child; (iv) a step-family member; and (v) an extended family member; or (B) lives with the veteran but is not a member of the family of the veteran. (5) The term “personal care services”, with respect to an eligible veteran under subsection (a), a veteran denied or discharged as specified in paragraph (14) of such subsection, or a covered veteran under subsection (b), means services that provide the veteran the following:(A) Assistance with one or more activities of daily living. (B) Supervision or protection based on symptoms or residuals of neurological or other impairment or injury. (C) Regular or extensive instruction or supervision without which the ability of the veteran to function in daily life would be seriously impaired. (D) Any other non-institutional extended care (as such term is used in section 1701(6)(E) of this title).

38 U.S.C. § 1720H Mental health treatment for veterans and members of the reserve components of the Armed Forces who served in classified missions

(a) Establishment of Standards.—(1) The Secretary shall establish standards and procedures to ensure that each eligible individual may access mental health care furnished by the Secretary in a manner that fully accommodates the obligation of the individual to not improperly disclose classified information. (2) In establishing standards and procedures under paragraph (1), the Secretary shall consult with the Secretary of Defense to ensure that such standards and procedures are consistent with the policies on classified information of the Department of Defense. (3) The Secretary shall disseminate guidance to employees of the Veterans Health Administration, including mental health professionals, on the standards and procedures established under paragraph (1) and how to best engage eligible individuals during the course of mental health treatment with respect to classified information. (b) Identification.—In carrying out this section, the Secretary shall ensure that an individual may elect to identify as an eligible individual on an appropriate form. (c) Definitions.—In this section:(1) The term “classified information” means any information or material that has been determined by an official of the United States pursuant to law to require protection against unauthorized disclosure for reasons of national security. (2) The term “eligible individual” means a veteran or a member of the reserve components of the Armed Forces who—(A) is eligible to receive health care furnished by the Department under this title; (B) is seeking mental health treatment; and (C) in the course of serving in the Armed Forces, participated in a sensitive mission or served in a sensitive unit. (3) The term “sensitive mission” means a mission of the Armed Forces that, at the time at which an eligible individual seeks treatment, is classified. (4) The term “sensitive unit” has the meaning given that term in section 130b(c)(4) of title 10.

38 U.S.C. § 1720I Mental and behavioral health care for certain former members of the Armed Forces

(a) In General.—The Secretary shall furnish to former members of the Armed Forces described in subsection (b)—(1) an initial mental health assessment; and (2) the mental healthcare or behavioral healthcare services authorized under this chapter that are required to treat the mental or behavioral health care needs of the former service members, including risk of suicide or harming others. (b) Eligible Individuals.—A former member of the Armed Forces described in this subsection is an individual who—(1) is a former member of the Armed Forces, including the reserve components; (2) while serving in the active military, naval, air, or space service, was discharged or released therefrom under a condition that is not honorable but not—(A) a dishonorable discharge; or (B) a discharge by court-martial; (3) is not enrolled in the health care system established by section 1705 of this title; and (4)(A)(i) served in the Armed Forces for a period of more than 100 cumulative days; and (ii) was deployed in a theater of combat operations, in support of a contingency operation, or in an area at a time during which hostilities are occurring in that area during such service, including by controlling an unmanned aerial vehicle from a location other than such theater or area; or (B) while serving in the Armed Forces, was the victim of a physical assault of a sexual nature, a battery of a sexual nature, or sexual harassment (as defined in section 1720D(f) of this title). (c) Non-Department Care.—(1) In furnishing mental or behavioral health care services to an individual under this section, the Secretary may provide such mental or behavioral health care services at a non-Department facility if—(A) in the judgment of a mental health professional employed by the Department, the receipt of mental or behavioral health care services by that individual in facilities of the Department would be clinically inadvisable; or (B) facilities of the Department are not capable of furnishing such mental or behavioral health care services to that individual economically because of geographical inaccessibility. (2) The Secretary shall carry out paragraph (1) pursuant to section 1703 of this title or any other provision of law authorizing the Secretary to enter into contracts or agreements to furnish hospital care and medical services to veterans at non-Department facilities. (d) Setting and Referrals.—In furnishing mental and behavioral health care services to individuals under this section, the Secretary shall—(1) seek to ensure that such services are furnished in settings that are therapeutically appropriate, taking into account the circumstances that resulted in the need for such services; and (2) provide referral services to assist former members who are not eligible for services under this chapter to obtain services from sources outside the Department. (e) Information.—The Secretary shall provide information on the mental and behavioral health care services available under this section. Efforts by the Secretary to provide such information—(1) shall include notification of each eligible individual described in subsection (b) about the eligibility of the individual for covered mental and behavioral health care under this section not later than the later of—(A) 180 days after the date of the enactment of the Military Construction, Veterans Affairs, and Related Agencies Appropriations Act, 2018; or (B) 180 days after the date on which the individual was discharged or released from the active military, naval, air, or space service; (2) shall include availability of a toll-free telephone number (commonly referred to as an 800 number); (3) shall ensure that information about the mental health care services available under this section—(A) is revised and updated as appropriate; (B) is made available and visibly posted at appropriate facilities of the Department; and (C) is made available to State veteran agencies and through appropriate public information services; and (4) shall include coordination with the Secretary of Defense seeking to ensure that members of the Armed Forces and individuals who are being separated from active military, naval, air, or space service are provided appropriate information about programs, requirements, and procedures for applying for mental health care services under this section. (f) Annual Reports.—(1) Not later than February 15 each year, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on the mental and behavioral health care services provided under this section. (2) Each report submitted under paragraph (1) shall include, with respect to the year preceding the submittal of the report, the following:(A) The number of eligible individuals who were furnished mental or behavioral health care services under this section, disaggregated by the number of men who received such services and the number of women who received such services. (B) The number of individuals who requested an initial mental health assessment under subsection (a)(1). (C) The types of mental or behavioral health care needs treated under this section. (D) The demographics of individuals being treated under this section, including—(i) age; (ii) era of service in the Armed Forces; (iii) branch of service in the Armed Forces; and (iv) geographic location. (E) The average number of visits for an individual for mental or behavioral health care under this section. (F) Such other information as the Secretary considers appropriate.

38 U.S.C. § 1720J Emergent suicide care

(a) Emergent Suicide Care.—Pursuant to this section, the Secretary shall—(1) furnish emergent suicide care to an eligible individual at a medical facility of the Department; (2) pay for emergent suicide care provided to an eligible individual at a non-Department facility; and (3) reimburse an eligible individual for emergent suicide care provided to the eligible individual at a non-Department facility. (b) Eligibility.—An individual is eligible for emergent suicide care under subsection (a) if the individual is in an acute suicidal crisis and is either of the following:(1) A veteran (as defined in section 101). (2) An individual described in section 1720I(b) of this title. (c) Period of Care.—(1) Emergent suicide care provided under subsection (a) shall be furnished to an eligible individual—(A) through inpatient or crisis residential care, for a period not to exceed 30 days; or (B) if care under subparagraph (A) is unavailable, or if such care is not clinically appropriate, as outpatient care for a period not to exceed 90 days. (2) If, upon the expiration of a period under paragraph (1), the Secretary determines that the eligible individual remains in an acute suicidal crisis, the Secretary may extend such period as the Secretary determines appropriate. (d) Notification.—An eligible individual who receives emergent suicide care under subsection (a) at a non-Department facility (or a person acting on behalf of the individual) shall notify the Secretary of such care within seven days of admission to such facility. (e) Outreach.—During any period when an eligible individual is receiving emergent suicide care under subsection (a), the Secretary shall—(1) ensure that—(A) in the case of an eligible individual whom the Veterans Crisis Line recommends to seek emergent suicide care at a medical facility of the Department, the Veterans Crisis Line notifies the Suicide Prevention Coordinator of such medical facility; (B) in the case of an eligible individual who presents at a medical facility of the Department in an acute suicidal crisis without a recommendation by the Veterans Crisis Line, the Secretary notifies the Suicide Prevention Coordinator; (C) in the case of an eligible individual whom the Veterans Crisis Line recommends to seek treatment at a non-Department facility, the Veterans Crisis Line notifies the Suicide Prevention Coordinator and the Office of Community Care at the medical facility of the Department located nearest to the eligible individual; and (D) in the case of an eligible individual who presents at a non-Department facility in an acute suicidal crisis without a recommendation by the Veterans Crisis Line and for whom the Secretary receives a notification under subsection (d), the Secretary notifies the Suicide Prevention Coordinator and the Office of Community Care at the medical facility of the Department located nearest to the eligible individual; (2) determine the eligibility of the eligible individual for other programs and benefits under the laws administered by the Secretary (or shall make such determination as soon as practicable following the period of such emergent suicide care); and (3) make referrals for care following the period of such emergent suicide care, as the Secretary determines appropriate. (f) Prohibition on Charge.—(1) If the Secretary provides emergent suicide care to an eligible individual under subsection (a), the Secretary—(A) may not charge the eligible individual for any cost of such emergent suicide care; and (B) shall pay for any costs of emergency transportation to a facility for such emergent suicide care (as such costs are determined pursuant to section 1725 of this title, to the extent practicable). (2)(A) In addition to the requirements of paragraph (1), if the Secretary pays for emergent suicide care provided under subsection (a) to an eligible individual at a non-Department facility, the Secretary shall reimburse the facility for the reasonable value of such emergent suicide care. (B)(i) In carrying out subparagraph (A), the Secretary may determine the amount to reimburse a non-Department facility in a similar manner to the manner in which the Secretary determines reimbursement amounts for that non-Department facility for medical care and services provided under another provision of this chapter. (ii) The requirements of section 1725(c)(3) of this title shall apply with respect to payments made under subparagraph (A) of this paragraph. (3) In the case of an eligible individual who receives emergent suicide care under this section and who is entitled to emergent suicide care (or payment for emergent suicide care) under a health-plan contract, the Secretary may recover the costs of such emergent suicide care provided under this section, other than for such care for a service-connected disability. (4) In carrying out subsection (d), the Secretary may not charge an eligible individual for any cost of emergent suicide care provided under subsection (a) solely by reason of the Secretary not having been notified of such care pursuant to such subsection. (g) Annual Report.—Not less than once each year, the Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and the House of Representatives a report on emergent suicide care provided under subsection (a). Each such report shall include, for the year covered by the report—(1) the number of eligible individuals who received emergent suicide care under subsection (a); (2) demographic information regarding eligible individuals described in paragraph (1); (3) the types of care furnished or paid for this section; 11 So in original. Probably should be “under this section;”. and (4) the total cost of providing care under subsection (a). (h) Definitions.—In this section:(1) The term “acute suicidal crisis” means that an individual was determined to be at imminent risk of self-harm by a trained crisis responder or health care provider. (2) The term “crisis residential care” means crisis stabilization care provided—(A) in a residential setting; and (B) in a facility other than a hospital. (3) The term “crisis stabilization care” includes, with respect to an individual in acute suicidal crisis, care that ensures, to the extent practicable, immediate safety and reduces—(A) the severity of distress; (B) the need for urgent care; or (C) the likelihood that the distress under subparagraph (A) or need under subparagraph (B) will increase during the transfer of that individual from a facility at which the individual has received care for that acute suicidal crisis. (4) The term “emergent suicide care” means crisis stabilization care provided to an eligible individual—(A) pursuant to a recommendation of the eligible individual from the Veterans Crisis Line; or (B) who presents at a medical facility in an acute suicidal crisis. (5) The term “health-plan contract” has the meaning given such term in section 1725 of this title. (6) The term “Veterans Crisis Line” means the hotline under section 1720F(h) of this title.

38 U.S.C. § 1720K Grants or contracts to provide mental health support to family caregivers of veterans

(a) Authority.—The Secretary may award grants or contracts to carry out, coordinate, improve, or otherwise enhance mental health counseling, treatment, or support to the family caregivers of veterans participating in the family caregiver program. (b) Application.—(1) To be eligible for a grant or contract under this section, an entity shall submit to the Secretary an application therefor at such time, in such manner, and containing such information as the Secretary may require. (2) Each application submitted under paragraph (1) shall include the following:(A) A detailed plan for the use of the grant or contract. (B) A description of the programs or efforts through which the entity will meet the outcome measures developed by the Secretary under subsection (f). (C) A description of how the entity will distribute grant or contract amounts equitably among areas with varying levels of urbanization. (D) A plan for how the grant or contract will be used to meet the unique needs of veterans residing in rural areas, Native American, Native Hawaiian, or Alaska Native veterans, elderly veterans, women veterans, and veterans from other underserved communities. (c) Distribution.—The Secretary shall seek to ensure that grants and contracts awarded under this section are equitably distributed among entities located in States with varying levels of urbanization. (d) Priority.—The Secretary shall prioritize awarding grants or contracts under this section that will serve the following areas:(1) Areas with high rates of veterans enrolled in the family caregiver program. (2) Areas with high rates of—(A) suicide among veterans; or (B) referrals to the Veterans Crisis Line. (e) Required Activities.—Any grant or contract awarded under this section shall be used—(1) to expand existing programs, activities, and services; (2) to establish new or additional programs, activities, and services; or (3) for travel and transportation to facilitate carrying out paragraph (1) or (2). (f) Outcome Measures.—(1) The Secretary shall develop and provide to each entity that receives a grant or contract under this section written guidance on the following:(A) Outcome measures. (B) Policies of the Department. (2) In developing outcome measures under paragraph (1), the Secretary shall consider the following goals:(A) Increasing the utilization of mental health services among family caregivers of veterans participating in the family caregiver program. (B) Reducing barriers to mental health services among family caregivers of veterans participating in such program. (g) Tracking Requirements.—(1) The Secretary shall establish appropriate tracking requirements with respect to the entities receiving a grant or contract under this section. (2) Not less frequently than annually, the Secretary shall submit to Congress a report on such tracking requirements. (h) Performance Review.—The Secretary shall—(1) review the performance of each entity that receives a grant or contract under this section; and (2) make information regarding such performance publicly available. (i) Remediation Plan.—(1) In the case of an entity that receives a grant or contract under this section and does not meet the outcome measures developed by the Secretary under subsection (f), the Secretary shall require the entity to submit to the Secretary a remediation plan under which the entity shall describe how and when it plans to meet such outcome measures. (2) The Secretary may not award a subsequent grant or contract under this section to an entity described in paragraph (1) unless the Secretary approves the remediation plan submitted by the entity under such paragraph. (j) Maximum Amount.—The amount of a grant or contract awarded under this section may not exceed 10 percent of amounts made available for grants or contracts under this section for the fiscal year in which the grant or contract is awarded. (k) Supplement, Not Supplant.—Any grant or contract awarded under this section shall be used to supplement and not supplant funding that is otherwise available through the Department to provide mental health support among family caregivers of veterans participating in the family caregiver program. (l) Outreach to Family Caregivers.—The Secretary shall include, in the outreach materials regularly provided to a family caregiver who participates in the family caregiver program, notice of mental health support provided by recipients of grants or contracts under this section that are located in the relevant Veterans Integrated Service Network. (m) Funding.—(1) Amounts for the activities of the Department under this section shall be budgeted and appropriated through a separate appropriation account. (2) In the budget justification materials submitted to Congress in support of the budget of the Department for any fiscal year (as submitted with the budget of the President under section 1105(a) of title 31), the Secretary shall include a separate statement of the amount requested to be appropriated for that fiscal year for the account specified in paragraph (1). (n) Authorization of Appropriations.—There is authorized to be appropriated to the Secretary, for each of fiscal years 2025 and 2026, $10,000,000 to carry out this section. (o) Definitions.—In this section:(1) The terms “caregiver” and “family caregiver” have the meanings given those terms in section 1720G of this title. (2) The term “family caregiver program” means the program of comprehensive assistance for family caregivers under section 1720G of this title. (3) The term “Veterans Crisis Line” means the toll-free hotline for veterans established under section 1720F of this title.

38 U.S.C. § 1720L Home- and community-based services: programs

(a) In General.—In furnishing noninstitutional alternatives to nursing home care pursuant to the authority of section 1720C of this title (or any other authority under this chapter or other provision of law administered by the Secretary of Veterans Affairs), the Secretary shall carry out each of the programs specified in this section in accordance with such relevant authorities except as otherwise provided in this section. (b) Veteran-Directed Care Program.—(1) The Secretary of Veterans Affairs, in collaboration with the Secretary of Health and Human Services, shall carry out a program to be known as the “Veteran-Directed Care program”. Under such program, the Secretary of Veterans Affairs may enter into agreements with the providers described in paragraph (2) to provide to eligible veterans funds, to the extent practicable, to obtain such in-home care services and related items that support clinical need and improve quality of life, as may be determined appropriate by the Secretary of Veterans Affairs and selected by the veteran, including through the veteran hiring individuals to provide such services and items or directly purchasing such services and items. (2) The providers described in this paragraph are the following:(A) An Aging and Disability Resource Center, an area agency on aging, or a State agency. (B) A center for independent living. (C) An Indian tribe or tribal organization receiving assistance under title VI of the Older Americans Act of 1965 (42 U.S.C. 3057 et seq.). (D) Any other entity that the Secretary, in consultation with the Secretary of Health and Human Services, determines appropriate. (3) In carrying out the Veteran-Directed Care program, the Secretary of Veterans Affairs shall—(A) administer such program through each medical center of the Department of Veterans Affairs; (B) seek to ensure the availability of such program in American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, the Commonwealth of Puerto Rico, the Virgin Islands of the United States, and any other territory or possession of the United States, to the extent practicable; and (C) seek to ensure the availability of such program for eligible veterans who are Native American veterans receiving care and services furnished by the Indian Health Service, a tribal health program, an Urban Indian organization, or (in the case of a Native Hawaiian veteran) a Native Hawaiian health care system, to the extent practicable. (4) If a veteran participating in the Veteran-Directed Care program is hospitalized, the veteran may continue to use funds under the program during a period of hospitalization in the same manner that the veteran would be authorized to use such funds under the program if the veteran were not hospitalized. (c) Homemaker and Home Health Aide Program.—(1) The Secretary shall carry out a program to be known as the “Homemaker and Home Health Aide program” under which the Secretary may enter into agreements with home health agencies to provide to eligible veterans such home health aide services as may be determined appropriate by the Secretary. (2) In carrying out the Homemaker and Home Health Aide program, the Secretary shall—(A) administer such program in the locations specified in subparagraph (A) of subsection (b)(3); (B) seek to ensure the availability of such program in the locations specified in subparagraph (B) of subsection (b)(3); and (C) seek to ensure the availability of such program for the veteran populations specified in subparagraph (C) of subsection (b)(3). (d) Home-Based Primary Care Program.—The Secretary shall carry out a program to be known as the “Home-Based Primary Care program” under which the Secretary may furnish to eligible veterans in-home health care, the provision of which is overseen by a provider of the Department. (e) Purchased Skilled Home Care Program.—The Secretary shall carry out a program to be known as the “Purchased Skilled Home Care program” under which the Secretary may furnish to eligible veterans such in-home care services as may be determined appropriate and selected by the Secretary for the veteran. (f) Caregiver Support.—(1) With respect to a resident eligible caregiver of a veteran participating in a program under this section, the Secretary shall—(A) if the veteran meets the requirements of a covered veteran under section 1720G(b) of this title, provide to such caregiver the option of enrolling in the program of general caregiver support services under such section; (B) provide to such caregiver covered respite care of not less than 30 days annually; and (C) conduct on an annual basis (and, to the extent practicable, in connection with in-person services provided under the program in which the veteran is participating), a wellness contact of such caregiver. (2) Covered respite care provided to a resident eligible caregiver of a veteran under paragraph (1) may exceed 30 days annually if such extension is requested by the resident eligible caregiver or veteran and determined medically appropriate by the Secretary. (g) Rule of Construction.—Nothing in this section shall be construed to limit the authority of the Secretary to carry out programs providing home- and community-based services under any other provision of law. (h) Definitions.—In this section:(1) The terms “Aging and Disability Resource Center”, “area agency on aging”, and “State agency” have the meanings given those terms in section 102 of the Older Americans Act of 1965 (42 U.S.C. 3002). (2) The terms “caregiver” and “family caregiver”, with respect to a veteran, have the meanings given those terms, respectively, under subsection (e) 11 So in original. Probably should be “subsection (d)”. of section 1720G of this title with respect to an eligible veteran under subsection (a) of such section or a covered veteran under subsection (b) of such section, as the case may be. (3) The term “center for independent living” has the meaning given that term in section 702 of the Rehabilitation Act of 1973 (29 U.S.C. 796a). (4) The term “covered respite care” has the meaning given such term in section 1720G(d) of this title. (5) The term “eligible veteran” means any veteran—(A) for whom the Secretary determines participation in a specific program under this section is medically necessary to promote, preserve, or restore the health of the veteran; and (B) who absent such participation would be at increased risk for hospitalization, placement in a nursing home, or emergency room care. (6) The term “home health aide” means an individual employed by a home health agency to provide in-home care services. (7) The term “in-home care service” means any service, including a personal care service, provided to enable the recipient of such service to live at home. (8) The terms “Indian tribe” and “tribal organization” have the meanings given those terms in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304). (9) The terms “Native American” and “Native American veteran” have the meanings given those terms in section 3765 of this title. (10) The terms “Native Hawaiian” and “Native Hawaiian health care system” have the meanings given those terms in section 12 of the Native Hawaiian Health Care Improvement Act (42 U.S.C. 11711). (11) The terms “tribal health programs” and “Urban Indian organizations” have the meanings given those terms in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603). (12) The term “resident eligible caregiver” means an individual who—(A) is a caregiver, or a family caregiver, of a veteran and resides with that veteran; and (B) has not entered into a contract, agreement, or other arrangement for such individual to act as a caregiver for that veteran unless such individual is a family member of the veteran or is furnishing caregiver services through a medical foster home.

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