**S. 2162, as amended**

**Veterans' Mental Health and Other Care Improvements Act of 2008**

**Title:** To improve the treatment and services provided by the
Department of Veterans Affairs to veterans with post-traumatic stress
disorder and substance use disorders, and for other purposes.

**Mr. Akaka** of Hawaii introduced S. 2162 on October 15, 2007.

**S. 2162, as amended, would:**

[Title I -- Substance Use Disorders and Mental Health Care]{.underline}

-   Sec 101 -- This title is enacted in tribute to Justin Bailey, who,
    after redeploying from OIF, died in a VA domiciliary facility while
    receiving care for PTSD and substance use disorder.

-   Sec 102 -- Lists findings of Congress on Substance Use Disorders and
    Mental Health.

-   Sec 103 -- Defines "full continuum of care" with respect to
    substance use disorders and requires that all VA medical centers
    provide ready access to a full continuum of care for substance use
    disorders.

-   Sec 104 -- Requires the Secretary to ensure that treatment for
    substance use disorders and a co-morbid mental health disorder is
    provided concurrently through a health professional with training
    and expertise in the treatment of both disorders, by separate
    services for each disorder, or by a team of experienced clinicians.

-   Sec 105 -- Requires the Secretary to carry out a 2-year pilot
    program to test the feasibility and advisability of providing
    assessment, education and treatment via the Internet to veterans
    with substance use disorders at VA medical centers that have
    established "Centers for Excellence for Substance Abuse Treatment
    and Education" or "Substance Abuse Program Evaluation and Research
    Centers." A report is required to Congress no later than six months
    upon completing the pilot program and \$1,500,000 is authorized to
    be appropriated for each year of the pilot.

-   Sec 106 -- Requires the Secretary through the Inspector General at
    the VA to conduct a review of all residential mental health care
    facilities, including domiciliary facilities not later than six
    months after the enactment of this Act and another review not later
    than two years after completing the first review. A report is
    required to Congress no later than 90 days after completing the
    first review.

-   Sec 107 -- Requires the Secretary to implement a 3-year pilot
    program in at least 3 VISNs providing peer outreach, peer support,
    readjustment and mental health services to OEF/OIF veterans through
    contracts with community mental health centers and the Indian Health
    Services. Training is required for veterans conducting peer outreach
    and support, as well as clinicians providing readjustment and mental
    health services. There is an annual reporting requirement, a
    mandated program evaluation, and funding is authorized for
    appropriations as needed.

[Title II -- Mental Health Research]{.underline}

-   Sec 201 -- Directs the Secretary to carry out a program of research
    into co-morbid PTSD and substance use disorder through the National
    Center for Post-traumatic Stress Disorder. Authorizes annual
    appropriations of \$2,000,000 for 2009 through 2012.

-   Sec 202 -- Extends authorization for the Special Committee on
    Post-Traumatic Stress Disorder through 2012.

[Title III -- Assistance for Families of Veterans]{.underline}

-   Sec 301 -- Includes marriage and family counseling within authorized
    mental health services and removes the requirement that counseling
    must be initiated during the veterans' hospitalization and is
    essential to permit the discharge of the veteran from the hospital.

-   Sec 302 -- Directs the Secretary to carry out, through a non-VA
    entity, a three-year pilot program (with an authorized one-year
    extension) to assess the feasibility and advisability of providing
    readjustment and transition assistance to veterans and their
    families in cooperation with ten VA Vet Centers. A report is
    required to Congress no later than six months upon the conclusion of
    the pilot program and \$1,000,000 is authorized to be appropriated
    each year from 2009 to 2011.

[Title IV -- Health Care Matters]{.underline}

-   Sec 401 -- Amends the federal veterans\' benefits provisions to
    repeal a requirement that the Secretary of Veterans Affairs adjust
    the amounts deducted from payments or allowances made by the VA for
    beneficiary travel expenses in connection with health care whenever
    the payment or allowance is adjusted. Requires the Secretary to use
    the mileage reimbursement rate for the use of privately owned
    vehicles by government employees on official business. A report is
    required no later than 14 months upon enactment of the Act.

-   Sec 402 -- Requires the Secretary to reimburse a veteran for the
    costs of emergency treatment received in a non-VA facility prior to
    transfer to a VA facility.

-   Sec 403 -- Requires the Secretary to establish a pilot program that
    allows a highly rural veteran, residing in five VISNs and is
    enrolled in the system of patient enrollment at the start date of
    the pilot, to receive health care in facilities other than VA.

-   Sec 404 -- Directs the Secretary to designate at least four but not
    more than six VA health care facilities as locations for epilepsy
    centers of excellence. Requires the Under Secretary for Health to
    establish a peer review panel to assess the scientific and clinical
    merit of proposals submitted for designation as such a center.
    Directs the Secretary to designate an individual in the Veterans
    Health Administration (VHA) as a national coordinator for VHA
    epilepsy programs. Authorizes \$6,000,000 to be appropriated for
    each of fiscal years 2009 to 2013.

-   Sec 405 -- Establishes the qualifications for peer specialist
    appointees as follows: (1) A veteran who has recovered or is
    recovering from a mental health condition; and, (2) Certified as
    having met the criteria for such position. Authorizes the Secretary
    to enter into contracts with nonprofit entities to provide peer
    specialist training and certification for veterans.

-   Sec 406 -- Requires the VA to establish up to seven consolidated
    patient

> accounting centers (CPACs) within the next five years. CPACs are
> required to apply commercial industry standards to coordinate and
> standardize billing and collections related to health care.

-   Sec 407 -- Eliminates a rule prohibiting VA from conducting
    widespread testing for HIV infection in the population of veterans
    who use VA health care facilities. It also would eliminate current
    requirements for separate written consent for HIV tests and pre- and
    post-test counseling.

-   Sec 408 -- Authorizes the Department of Veterans Affairs (VA) to
    expand the health care benefits provided to the children, born with
    spina bifida, of certain veterans. Under current law, the children
    of Vietnam and Korean war veterans who were born with spina bifida
    are eligible for VA health care related to that condition. This
    provision expands the benefit and allows the children to receive
    comprehensive health care through the VA.

-   Sec 409 -- Prohibits the VA from collecting copayments for hospice
    care.

[Title V -- Pain Care]{.underline}

-   Sec 501 -- Directs the VA to develop and implement a comprehensive
    policy on the management of pain experienced by veterans enrolled
    for health care services provided by the VA. The Secretary is to:

    -   Revise the policy on a periodic basis in accordance with
        experience and evolving best practice guidelines.

    -   Develop and revise the policy in consultation with veterans'
        service organizations and organizations with expertise in the
        assessment, diagnosis, treatment, and management of pain.

    -   Submit a report on the implementation of the policy no later
        than 180 days after the date of the completion and initial
        implementation of the policy and on October 1 of every fiscal
        year thereafter through fiscal year 2018.

[Title VI -- Homeless Veterans Matters]{.underline}

-   Sec 601 -- Increases authorization of appropriations for
    comprehensive service programs from \$130 million to \$150 million.

-   Sec 602 -- Revises provisions establishing a demonstration program
    of referral and counseling services for at-risk veterans
    transitioning from institutional living to: (1) remove the
    \"demonstration\" designation; (2) require the program to be carried
    out in at least 12 (currently, six) locations; and, (3) extend the
    program through fiscal year 2012.

-   Sec 603 -- Requires the Secretary to ensure that VA domiciliary care
    programs are adequate, with respect to capacity and safety, to meet
    the needs of women veterans.

-   Sec 604 -- Directs the Secretary to provide financial assistance to
    private nonprofit organizations or consumer cooperatives to provide
    and coordinate supportive services for very low-income (less than
    50% of the median income for the area) veteran families residing in
    permanent housing. Provides a preference for families who are
    transitioning from homelessness to permanent housing. There is a
    required study of the effectiveness of permanent housing program for
    2009 and 2010 and a report must be submitted to Congress no later
    than 3/31/2011. Funding is authorized to be appropriated in the
    amount of \$15,000,000 for 2009, \$20,000,000 for 2010, and
    \$25,000,000 for 2011. Funding is also provided for technical
    assistance.

[Title VII -- Authorization of Medical Facility Projects and Major
Medical Facility Leases]{.underline}

-   Sec. 701 -- Authorizes medical facility projects for fiscal year
    2009 major medical facility projects as follows:

    -   \$54,000,000 to construct a facility to replace a seismically
        unsafe acute psychiatric inpatient building in Palo Alto,
        California.

    -   \$66,000,000 to construct a state-of-the-art polytrauma
        healthcare and rehabilitation center in San Antonio, Texas.

    -   \$225,900,000 to make seismic corrections at a VA medical center
        in San Juan, Puerto Rico.

-   Sec. 702 -- Modifies authorization for major medical facility
    construction projects previously authorized as follows:

    -   \$625,000,000 for restoration, new construction, or replacement
        of the medical care facility for the VA medical center at New
        Orleans, Louisiana.

    -   \$568,400,000 for the replacement of the VA medical center at
        Denver, Colorado.

    -   \$131,800,000 for an outpatient clinic in Lee County, Florida.

    -   \$136,700,000 to correct patient privacy deficiencies at the VA
        medical center in Gainesville, Florida.

    -   \$600,400,000 to construct a new VA medical center in Las Vegas,
        Nevada.

    -   \$656,800,000 to construct a new VA medical center in Orlando,
        Florida.

    -   \$295,600,000 to consolidate campuses at the University Drive
        and H. John Heinz III Divisions in Pittsburgh, Pennsylvania.

-   Sec. 703 -- Authorizes fiscal year 2009 major medical facility
    leases as follows:

    -   \$4,326,000 for an outpatient clinic in Brandon, Florida.

    -   \$10,300,000 for a community-based outpatient clinic in Colorado
        Springs, Colorado.

    -   \$5,826,000 for an outpatient clinic in Eugene, Oregon.

    -   \$5,891,000 to expand an outpatient clinic Green Bay, Wisconsin.

    -   \$3,731,000 for an outpatient clinic in Greenville, South
        Carolina.

    -   \$2,212,000 for a community-based outpatient clinic in
        Mansfield, Ohio.

    -   \$6,276,000 for a satellite outpatient clinic in Mayaguez,
        Puerto Rico.

    -   \$5,106,000 for a community-based outpatient clinic in Southeast
        Phoenix, Mesa, Arizona.

    -   \$8,636,000 for interim research space in Palo Alto, California

    -   \$3,168,000 to expand a community-based outpatient clinic in
        Savannah, Georgia.

    -   \$2,295,000 for a community-based outpatient clinic in Northwest
        Phoenix, Sun City, Arizona.

    -   \$8,652,000 for a primary care annex in Tampa, Florida.

    -   \$3,600,000 for an outpatient clinic in Peoria, Illinois.

-   Sec. 704 -- Authorizes for appropriations:

    -   \$345,900,000 for the aforementioned list of major medical
        facility projects authorized for fiscal year 2009.

    -   \$1,493,495,000 for the aforementioned list of major medical
        facility construction projects previously authorized.

    -   \$70,019,000 for the aforementioned list of major facility
        leases authorized for fiscal year 2009.

-   Sec. 705-- Increases the threshold for major medical facility leases
    requiring Congressional approval from \$600,000 to \$1,000,000.

-   Sec. 706 -- Authorizes the city of Aurora to donate non-Federal land
    on the Fitzsimons campus for use by the Secretary of Veterans
    Affairs to construct a veterans' medical facility no later than 60
    days after the enactment of this section.

-   Sec. 707 -- Requires the Secretary of Veterans Affairs to submit a
    report on facilities administration no later than 60 days after the
    date of the enactment of this section.

-   Sec. 708 -- Requires an annual report on outpatient clinics no later
    than the date on which the budget for the next fiscal year is
    submitted to the Congress under section 1105 of title 31.

-   Sec. 709 -- Names the VA spinal cord injury center in Tampa Florida,
    "Michael Bilirakis Department of Veterans Affairs Spinal Cord Injury
    Center."

[Title VIII -- Extension of Certain Authorities]{.underline}

-   Sec. 801 -- Repeals the December 31, 2008, sunset on the inclusion
    of non-institutional extended care services in the definition of
    medical services.

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-   Sec. 802 -- Extends the recovery audit authority for fee basis
    contracts and other medical services contracts in non-VA facilities
    from September 30, 2008, under current law to September 30, 2013.

-   Sec. 803 -- Provides permanent authority for the provision of
    hospital care, medical services, and nursing home care to veterans
    who participated in certain chemical and biological testing
    conducted by the Department of Defense.

-   Sec. 804 -- Extends the expiring collections authorities for the
    following:

    -   Health care copayments, which expire on September 30, 2008,
        under current law, to September 30, 2010; and,

    -   Medical care cost recovery, which expires on October 1, 2008,
        under current law, to October 1, 2010.

-   Sec. 805 -- Extends the authority to provide nursing home care to
    veterans with service-connected disability, which expires on
    December 31, 2008, under current law, to December 31, 2013.

-   Sec. 806 -- Provides permanent authority to establish research
    corporations.

-   Sec. 807 -- Extends the requirement to submit an annual report on
    the committee on care of severely chronically mentally ill veterans
    through 2012.

-   Sec. 808 -- Provides for a permanent requirement for a biannual
    report by the women's advisory committee on the needs of women
    veterans including compensation, health care, rehabilitation,
    outreach, and other benefits and programs administered by the VA.

-   Sec. 809 -- Extends the pilot program on improvement of caregiver
    assistance services for a three-year period through fiscal year
    2009.

[Title IX -- Other Matters]{.underline}

-   Sec. 901 -- Provides for a number of amendments, technical in
    nature, to title 38.

**Cost:** The Congressional Budget Office estimates that the bill will
have no direct spending.

**Legislative History:**

Nov. 14, 2007: Ordered reported, as amended, by the Senate Committee on
Veterans' Affairs.

Apr. 8, 2008: Reported, as amended, S. Rept. 110-281.

Jun. 3, 2008: Passed the Senate, as amended, by Unanimous Consent.

Jun. 4, 2008: Referred to House Committee on Veterans' Affairs.

Sept. 24, 2008: Passed the House, as amended, by voice vote.

Sept. 27, 2008: Senate agreed to the House amendment and passed the bill
by Unanimous Consent.

Provisions of H.R. 1527, H.R. 2623, H.R. 2818, H.R. 2874, H.R. 3819,
H.R. 4053, H.R. 4264, H.R. 5554, H.R. 5729, H.R. 5856, and H.R. 6445,
H.R. 6802, and H.R. 6832 are included in this legislation