```

[House Report 115-390]
[From the U.S. Government Publishing Office]

115th Congress    }                                     {       Report
                        HOUSE OF REPRESENTATIVES
 1st Session      }                                     {      115-390

======================================================================

 
             VETERAN URGENT ACCESS TO MENTAL HEALTHCARE ACT

                                _______
                                

November 6, 2017.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

    Mr. Roe of Tennessee, from the Committee on Veterans' Affairs, 
                        submitted the following

                              R E P O R T

                        [To accompany H.R. 918]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 918) to amend title 38, United States Code, to 
direct the Secretary of Veterans Affairs to furnish mental 
health care to certain former members of the Armed Forces who 
are not otherwise eligible to receive such care, and for other 
purposes, having considered the same, report favorably thereon 
with an amendment and recommend that the bill as amended do 
pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     4
Background and Need for Legislation..............................     4
Hearings.........................................................     6
Subcommittee Consideration.......................................     6
Committee Consideration..........................................     6
Committee Votes..................................................     6
Committee Oversight Findings.....................................     7
Statement of General Performance Goals and Objectives............     7
New Budget Authority, Entitlement Authority, and Tax Expenditures     7
Earmarks and Tax and Tariff Benefits.............................     7
Committee Cost Estimate..........................................     7
Congressional Budget Office Cost Estimate........................     7
Federal Mandates Statement.......................................    11
Advisory Committee Statement.....................................    11
Statement of Constitutional Authority............................    11
Applicability to Legislative Branch..............................    11
Statement on Duplication of Federal Programs.....................    11
Disclosure of Directed Rulemaking................................    11
Section-by-Section Analysis of the Legislation...................    11
Changes in Existing Law Made by the Bill as Reported.............    13

    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Veteran Urgent Access to Mental 
Healthcare Act''.

SEC. 2. EXPANSION OF MENTAL HEALTH CARE FOR CERTAIN FORMER MEMBERS OF 
                    THE ARMED FORCES.

  (a) In General.--Chapter 17 of title 38, United States Code, is 
amended by inserting after section 1720H the following new section:

``Sec. 1720I. Expansion of mental 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 health care services authorized under this 
        chapter that the Secretary determines are required to treat the 
        mental health care needs of the former member, including risk 
        of suicide or harming others.
  ``(b) Former Members of the Armed Forces Described.--A former member 
of the Armed Forces described in this subsection is an individual who 
meets the following criteria:
          ``(1) The individual is a former member of the Armed Forces, 
        including the reserve components, who--
                  ``(A) served in the active military, naval, or air 
                service, and was discharged or released therefrom under 
                a condition that is not honorable except--
                          ``(i) dishonorable; or
                          ``(ii) bad conduct discharge;
                  ``(B) has applied for a character of service 
                determination and such determination has not been made; 
                and
                  ``(C) is not otherwise eligible to enroll in the 
                health care system established by section 1705 of this 
                title by reason of such discharge or release not 
                meeting the requirements of section 101(2) of this 
                title.
          ``(2) While serving in the Armed Forces--
                  ``(A) the former member was deployed in a theater of 
                combat operations or an area at a time during which 
                hostilities occurred in that area;
                  ``(B) participated in or experienced such combat 
                operations or hostilities, including by controlling an 
                unmanned aerial vehicle from a location other than such 
                theater or area; or
                  ``(C) was the victim of a physical assault of a 
                sexual nature, 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 health care 
services to an individual under this section, the Secretary may provide 
such mental 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 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 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 health care 
services to an individual under this section, the Secretary shall--
          ``(1) seek to ensure that such mental health care services 
        are furnished in a setting that is therapeutically appropriate, 
        taking into account the circumstances that resulted in the need 
        for such mental health care 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 health care services 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 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
          ``(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, or air service are provided appropriate information 
        about programs, requirements, and procedures for applying for 
        mental health care services under this section.
  ``(f) Annual Reports.--Each year, the Secretary shall submit to 
Congress an annual report on the mental health care 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 individuals who received mental health 
        care services under subsection (a), disaggregated by the number 
        of men who received such services and the number of women who 
        received such services.
          ``(2) Such other information as the Secretary considers 
        appropriate.''.
  (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 17 of title 38, United States Code, is amended by inserting 
after the item relating to section 1720H the following new item:

``1720I. Expansion of mental health care for certain former members of 
the Armed Forces.''.

SEC. 3. EXTENSION OF REQUIREMENT FOR COLLECTION OF FEES FOR HOUSING 
                    LOANS GUARANTEED BY SECRETARY OFVETERANS AFFAIRS.

  Section 3729(b)(2) of title 38, United States Code, is amended--
          (1) in subparagraph (A)--
                  (A) in clause (iii), by striking ``September 30, 
                2024'' and inserting ``September 30, 2025''; and
                  (B) in clause (iv), by striking ``September 30, 
                2024'' and inserting ``September 30, 2025'';
          (2) in subparagraph (B)--
                  (A) in clause (i), by striking ``September 30, 2024'' 
                and inserting ``September 30, 2025''; and
                  (B) in clause (ii), by striking ``September 30, 
                2024'' and inserting ``September 30, 2025'';
          (3) in subparagraph (C)--
                  (A) in clause (i), by striking ``September 30, 2024'' 
                and inserting ``September 30, 2025''; and
                  (B) in clause (ii), by striking ``September 30, 
                2024'' and inserting ``September 30, 2025''; and
          (4) in subparagraph (D)--
                  (A) in clause (i), by striking ``September 30, 2024'' 
                and inserting ``September 30, 2025''; and
                  (B) in clause (ii), by striking ``September 30, 
                2024'' and inserting ``September 30, 2025''.

SEC. 4. CHARACTER OF SERVICE DETERMINATIONS.

  (a) In General.--Chapter 53 of title 38, United States Code, is 
amended by inserting after section 5303A the following new section:

``Sec. 5303B. Character of service determinations

  ``(a) Determination.--The Secretary shall establish a process by 
which an individual who served in the Armed Forces and was discharged 
or dismissed therefrom may seek a determination from the Secretary with 
respect to whether such discharge or release was under a condition that 
bars the right of such individual to a benefit under the laws 
administered by the Secretary based upon the period of service from 
which discharged or dismissed.
  ``(b) Provision of Information.--If the Secretary determines under 
subsection (a) that an individual is barred to a benefit under the laws 
administered by the Secretary, the Secretary shall provide to such 
individual information regarding the ability of the individual to 
address such condition, including pursuant to section 5303 of this 
title and chapter 79 of title 10.''.
  (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item relating to section 
5303A the following new item:

``5303B. Character of service determinations.''.

                          Purpose and Summary

    Representative Mike Coffman of Colorado introduced H.R. 
918, the Veteran Urgent Access to Mental Healthcare Act, on 
February 7, 2017.
    H.R. 918, as amended, would: (1) require the Department of 
Veterans Affairs (VA) to provide mental health care to certain 
former servicemembers who would otherwise be ineligible for 
such care because they were discharged from military service 
under conditions that were other than honorable (OTH); (2) 
extend the requirement to collect fees for certain housing 
loans made, insured, or guaranteed by VA; and, (3) require VA 
to establish a character of service determination process.

                  Background and Need for Legislation

Section 2. Expansion of mental health care for certain former members 
        of the Armed Forces

    Veteran status and eligibility for VA benefits and services 
generally require an individual to be discharged or released 
under conditions other than dishonorable.\1\ Individuals with 
OTH discharges may or may not be eligible to enroll in the VA 
healthcare system and/or to receive care through the Veterans 
Health Administration for conditions other than those incurred 
in or aggravated in service in the Armed Forces depending on 
the outcome of a character of service review by the Veterans 
Benefits Administration.\2\
---------------------------------------------------------------------------
    \1\Other Than Honorable Discharges--Impact on Eligibility for VA 
Health Care Benefits. Health Benefits Resources. https://www.va.gov/
healthbenefits/resources/publications/IB10-
448_other_than_honorable_discharges5_17.pdf Accessed July 20, 2017.
    \2\United States Cong. House Committee on Veterans' Affairs 
Subcommittee on Health. Legislative Hearing. March 29, 2017. 115th 
Cong. 1st sess. Washington: GPO, 2017 (statement from Jennifer S. Lee, 
Deputy Under Secretary for Health for Policy and Services, Veterans 
Health Administration, U.S. Department of Veterans Affairs).
---------------------------------------------------------------------------
    According to the Vietnam Veterans of America, ``the use of 
less-than-honorable administrative discharges has grown 
significantly for recent generations of veterans.''\3\ VA 
currently estimates that there are approximately 505,000 former 
servicemembers with OTH discharges.\4\ Recently, stakeholders--
including many veterans service organizations--began noting a 
connection between combat stress and conditions prevalent among 
servicemembers and OTH discharges. For example, the Wounded 
Warrior Project testified that, ``in our experience, many 
veterans suffering from post-traumatic stress disorder, 
traumatic brain injury, or military sexual trauma have received 
[OTH] discharges for behavioral problems rooted in the same 
circumstances that led to those [discharges].''\5\ The Wounded 
Warrior Project also noted that veterans with OTH discharges 
are at a greater risk for homelessness, substance use disorder, 
incarceration, untreated physical and mental conditions.\6\ 
Furthermore, VA data has shown that the rate of death by 
suicide among those who do not use VA care--like those with OTH 
discharges who may be barred from such care--is increasing at a 
significantly greater rate than that among veterans who use VA 
care.\7\
---------------------------------------------------------------------------
    \3\United States Cong. House Committee on Veterans' Affairs 
Subcommittee on Health. Legislative Hearing. March 29, 2017. 115th 
Cong. 1st sess. Washington: GPO, 2017 (statement from Kristofer 
Goldsmith, Assistant Director for Policy and Government Affairs, 
Vietnam Veterans of America).
    \4\Emergent Mental Health Care for Former Service Members. VA Fact 
Sheet. June 2017.
    \5\United States Cong. House Committee on Veterans' Affairs 
Subcommittee on Health. Legislative Hearing. March 29, 2017. 115th 
Cong. 1st sess. Washington: GPO, 2017 (statement from Michael S. 
Linnington, LTG (ret), U.S. Army, Chief Executive Officer, Wounded 
Warrior Project).
    \6\Ibid.
    \7\Emergent Mental Health Care for Former Service Members. VA Fact 
Sheet. June 2017.
---------------------------------------------------------------------------
    Section 2 of the bill would require VA to provide an 
initial mental health assessment and subsequent mental health 
services that are required to meet the mental healthcare needs 
of former servicemembers who would otherwise be ineligible for 
such services because they were discharged from military 
service under OTH conditions. Individuals would be eligible for 
such care if they have applied for a character of service 
determination, deployed or participated in a theater of combat 
operations, or were the victim of military sexual assault. 
These services could be provided at either VA medical 
facilities or at community facilities at VA's expense. Section 
2 of the bill would further require VA to submit an annual 
report to Congress on the mental healthcare services provided 
pursuant to this authority.

Section 3. Extension of requirement for collection of fees for housing 
        loans guaranteed by Secretary of Veterans Affairs

    Under VA's home loan guaranty program, VA may guarantee a 
loan made to eligible servicemembers, veterans, reservists, and 
certain un-remarried surviving spouses for the purchase or 
refinancing of a house, condominium, or manufactured home. 
Section 3729(b)(2) of title 38, U.S.C., sets forth a loan fee 
table that lists funding fees associated with such loans. These 
funding fees are expressed as a percentage of the loan amount 
for different types of loans. Under current law, the higher 
rates will expire on September 30, 2024.
    Section 3 of the bill would extend through September 30, 
2025, VA's authority to collect certain funding fees by 
amending the fee schedule set forth in section 3729(b)(2) of 
title 38, U.S.C.

Section 4. Character of service determinations

    Under current procedures, an individual's character of 
service is only adjudicated if he/she applies for a specific VA 
benefit, like disability compensation.\8\ Therefore, the 
majority of those with OTH discharges do not know whether or 
not they are eligible to receive VA healthcare services because 
their eligibility for such services has never been adjudicated 
by VA.\9\
---------------------------------------------------------------------------
    \8\Ibid.
    \9\United States Cong. House Committee on Veterans' Affairs 
Subcommittee on Health. Legislative Hearing. March 29, 2017. 115th 
Cong. 1st sess. Washington: GPO, 2017 (statement from Swords to 
Plowshares, a Veteran Rights Organization, with the assistance of the 
Veterans Legal Clinic at Harvard Law School).
---------------------------------------------------------------------------
    Section 4 of the bill would require VA to establish a 
character of service determination process to determine whether 
or not an individual's discharge or release from military 
service was under a condition that bars such an individual from 
accessing VA benefits and services.

                                Hearings

    There were no full Committee hearings held on H.R. 918, as 
amended.
    On March 29, 2017, the Subcommittee on Health conducted a 
legislative hearing on a number of bills, including H.R. 918.
    The following witnesses testified:

          The Honorable David P. Roe M.D. of Tennessee; The 
        Honorable Jackie Walorski of Indiana; The Honorable 
        Doug Collins of Georgia; The Honorable Mike Coffman of 
        Colorado; The Honorable Stephen Knight of California; 
        The Honorable Ann M. Kuster of New Hampshire; Jennifer 
        S. Lee, M.D., the Deputy Under Secretary for Health for 
        Policy and Services for the Veterans Health 
        Administration of the U.S. Department of Veterans 
        Affairs who was accompanied by Susan Blauert, the Chief 
        Counsel for the Health Care Law Group of the Office of 
        the General Counsel for the U.S. Department of Veterans 
        Affairs; Kayda Keleher, Legislative Associate for the 
        National Legislative Service of the Veterans of Foreign 
        Wars of the United States; Shurhonda Y. Love, the 
        Assistant National Legislative Director for the 
        Disabled American Veterans; and, Sarah S. Dean, the 
        Associate Legislative Director for the Paralyzed 
        Veterans of America.

    Statements for the record were submitted by:

          The Honorable Lee Zeldin of New York; The American 
        Legion; the National Association of State Veteran 
        Homes; Swords to Plowshares; and, the Wounded Warrior 
        Project.

                       Subcommittee Consideration

    On April 6, 2017, the Subcommittee on Health met in an open 
markup session, a quorum being present, and ordered H.R. 918 to 
be reported favorably to the Full Committee by voice vote.

                        Committee Consideration

    On July 19, 2017, the Full Committee met in open markup 
session, a quorum being present, and ordered H.R. 918, as 
amended, to be reported favorably to the House of 
Representatives by voice vote. During consideration of the 
bill, the following amendments were considered and agreed to by 
voice vote:

          An Amendment in the Nature of a Substitute to H.R. 
        918 offered by Representative Mike Coffman of Colorado.
          An Amendment to the Amendment in the Nature of a 
        Substitute to H.R. 918 offered by Representative Beto 
        O'Rourke of Texas.
          An Amendment to the Amendment in the Nature of a 
        Substitute to H.R. 918 offered by Representative 
        Jenniffer Gonzalez-Colon of Puerto Rico.

                            Committee Votes

    In compliance with clause 3(b) of rule XIII of the Rules of 
the House of Representatives, there were no recorded votes 
taken on amendments or in connection with ordering H.R. 918, as 
amended, reported to the House. A motion by Representative Tim 
Walz of Minnesota--the Ranking Member of the Committee on 
Veterans' Affairs--to report H.R. 918, as amended, favorably to 
the House of Representatives was agreed to by voice vote.

                      Committee Oversight Findings

    In compliance with clause 3(c)(1) of rule XIII and clause 
(2)(b)(1) of rule X of the Rules of the House of 
Representatives, the Committee's oversight findings and 
recommendations are reflected in the descriptive portions of 
this report.

         Statement of General Performance Goals and Objectives

    In accordance with clause 3(c)(4) of rule XIII of the Rules 
of the House of Representatives, the Committee's performance 
goals and objectives are to provide mental health care to 
certain former servicemembers who would otherwise be ineligible 
for such care because they were discharged from military 
service under conditions that were OTH.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee adopts as its 
own the estimate of new budget authority, entitlement 
authority, or tax expenditures or revenues contained in the 
cost estimate prepared by the Director of the Congressional 
Budget Office pursuant to section 402 of the Congressional 
Budget Act of 1974.

                  Earmarks and Tax and Tariff Benefits

    H.R. 918, as amended, does not contain any Congressional 
earmarks, limited tax benefits, or limited tariff benefits as 
defined in clause 9 of rule XXI of the Rules of the House of 
Representatives.

                        Committee Cost Estimate

    The Committee adopts as its own the cost estimate on H.R. 
918, as amended, prepared by the Director of the Congressional 
Budget Office pursuant to section 402 of the Congressional 
Budget Act of 1974.

               Congressional Budget Office Cost Estimate

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
for H.R. 918, as amended, provided by the Congressional Budget 
Office pursuant to section 402 of the Congressional Budget Act 
of 1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                Washington, DC, September 28, 2017.
Hon. Phil Roe, M.D.,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 918, the Veteran 
Urgent Access to Mental Healthcare Act.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Ann E. 
Futrell.
            Sincerely,
                                                Keith Hall,
                                                          Director.
    Enclosure.

H.R. 918--Veteran Urgent Access to Mental Healthcare Act

    Summary: H.R. 918 would change the fees charged to veterans 
who obtain loans guaranteed by the Department of Veterans 
Affairs (VA). CBO estimates that enacting the bill would 
increase direct spending by $688 million over the 2026-2027 
period. Because enacting the bill would affect direct spending, 
pay-as-you-go procedures apply. Enacting the bill would not 
affect revenues.
    The bill also would require VA to provide an initial mental 
health assessment and subsequent mental health care to certain 
former service members who are currently not eligible for such 
care. CBO estimates that implementing that provision would cost 
$15 million over the 2017-2022 period, assuming appropriation 
of the necessary amounts.
    CBO estimates that enacting H.R. 918 would not increase net 
direct spending or on-budget deficits in any of the four 
consecutive 10-year periods beginning in 2028.
    H.R. 918 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA) 
and would impose no costs on state, local, or tribal 
governments.
    Estimated cost to the Federal Government: The estimated 
budgetary effects of H.R. 918 are shown in the following table. 
The costs of this legislation fall within budget function 700 
(veterans benefits and services).

--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                           By fiscal year, in millions of dollars--
                                     -------------------------------------------------------------------------------------------------------------------
                                        2017     2018     2019     2020     2021     2022    2023    2024    2025    2026    2027   2017-2022  2017-2027
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                              INCREASES IN DIRECT SPENDING
 
Estimated Budget Authority..........        0        0        0        0        0        0       0       0       0     340     348         0        688
Estimated Outlays...................        0        0        0        0        0        0       0       0       0     340     348         0        688
 
                                                     INCREASES IN SPENDING SUBJECT TO APPROPRIATION
 
Estimated Authorization Level.......        0        4        3        3        3        3    n.a.    n.a.    n.a.    n.a.    n.a.        16       n.a.
Estimated Outlays...................        0        3        3        3        3        3    n.a.    n.a.    n.a.    n.a.    n.a.        15       n.a.
 
--------------------------------------------------------------------------------------------------------------------------------------------------------
Note: n.a. = not applicable.

    Basis of estimate: For this estimate, CBO assumes that H.R. 
918 will be enacted near the beginning of fiscal year 2018 and 
that the estimated amounts will be appropriated each year. 
Estimated outlays are based on historical spending patterns for 
the affected programs.

Direct spending

    Under its Home Loan program, VA guarantees mortgages made 
to veterans. Those guarantees enable veterans to get better 
loan terms, such as lower interest rates or smaller down 
payments. The loan guarantee provides lenders a payment of up 
to 25 percent of the outstanding balances (subject to some 
limitations on the original loan amounts) in the event that a 
veteran defaults on a guaranteed loan. Section 3 would decrease 
some of the fees that VA charges veterans for providing those 
guarantees. Those fees lower the subsidy cost of the guarantees 
by partially offsetting the costs of subsequent defaults.\1\ 
The subsidy cost of VA loan guarantees are paid from mandatory 
appropriations. Hence, by increasing the subsidy cost, lowering 
those fees would increase direct spending.
---------------------------------------------------------------------------
    \1\Under the Federal Credit Reform Act of 1990, the subsidy cost of 
a loan guarantee is the net present value of estimated payments by the 
government to cover defaults and delinquencies, interest subsidies, or 
other expenses, offset by any payments to the government, including 
origination fees, other fees, penalties, and recoveries on defaulted 
loans. Such subsidy costs are calculated by discounting those expected 
cash flows using the rate on Treasury securities of comparable 
maturity. The resulting estimated subsidy costs are recorded in the 
budget when the loans are disbursed.
---------------------------------------------------------------------------
    Under current law, the up-front fee varies on the basis of 
the size of the down payment and whether the veteran has 
previously used the loan-guarantee benefit. Borrowers who are 
members of the reserve component pay an additional fee of 0.25 
percent of the loan amount. Veterans who receive compensation 
for service-connected disabilities areexempt from paying the 
fee. The fees that would be affected by section 3 are currently set as 
follows:
           2.15 percent of the loan amount for loans 
        with no down payment on the first use of the guarantee 
        benefit,
           3.30 percent of the loan amount for loans 
        with no down payment on subsequent uses of the 
        guarantee benefit,
           1.50 percent of the loan amount for loans 
        with a 5 percent down payment, and
           0.75 percent of the loan amount for loans 
        with a 10 percent down payment.
    Those fees are scheduled to decline on October 1, 2027, to 
1.40 percent, 1.25 percent, 0.75 percent, and 0.50 percent, 
respectively.
    Under section 3, that scheduled fee reduction would occur 
two years earlier, on September 30, 2025. Reducing the fees 
from their current level would decrease collections by VA, 
thereby increasing the subsidy cost of the loan guarantees. 
Based on data from VA regarding the number and initial 
principal value of the loans it guarantees each year, CBO 
estimates that enacting section 3 would increase direct 
spending by $688 million over the 2026-2027 period.

Spending subject to appropriation

    Under current law, former service members are eligible for 
VA health care benefits if they separated from military service 
with an honorable discharge or a discharge characterized as 
``General, Under Honorable Conditions.'' Individuals whose 
discharges are characterized as ``Under Other Than Honorable 
Conditions (OTH),'' Bad Conduct, or Dishonorable are generally 
not eligible for those benefits. Section 2 would require VA to 
provide an initial health assessment and any necessary mental 
health services to former service members who received an OTH 
discharge and have requested an upgrade of that status, if they 
were deployed to a theater of combat operations, participated 
in combat operations or hostilities, or experienced sexual 
trauma. That period of special eligibility would end once the 
Department of Defense (DoD) has made a determination on the 
veteran's request to have the character of their discharge 
changed.
    On the basis of data from DoD and VA, CBO estimates that 
roughly 340 additional former service members would use medical 
services through VA each year under this provision. On average, 
costs at VA for the first year of treatment for mental health 
conditions is about $10,000 (including costs for the initial 
mental health assessments). In total, CBO estimates that 
implementing this section would cost $15 million over the 2017-
2022 period.
    Pay-As-You-Go considerations: The Statutory Pay-As-You-Go 
Act of 2010 establishes budget-reporting and enforcement 
procedures for legislation affecting direct spending or 
revenues. The net changes in outlays that are subject to those 
pay-as-you-go procedures are shown in the following table.

  CBO ESTIMATE OF PAY-AS-YOU-GO EFFECTS FOR H.R. 918, THE VETERAN URGENT ACCESS TO MENTAL HEALTHCARE ACT, AS ORDERED REPORTED BY THE HOUSE COMMITTEE ON
                                                           VETERANS' AFFAIRS ON JULY 19, 2017
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                              By fiscal year, in millions of dollars--
                                           -------------------------------------------------------------------------------------------------------------
                                             2017    2018    2019    2020    2021    2022    2023    2024    2025    2026    2027   2017-2022  2017-2027
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                       NET INCREASE OR DECREASE (-) IN THE DEFICIT
 
Statutory Pay-As-You-Go Impact............       0       0       0       0       0       0       0       0       0     340     348         0        688
--------------------------------------------------------------------------------------------------------------------------------------------------------

    Increase in long-term direct spending and deficits: CBO 
estimates that enacting the legislation would not increase net 
direct spending or on-budget deficits in any of the four 
consecutive 10-year periods beginning in 2028.
    Intergovernmental and private-sector impact: H.R. 918 
contains no intergovernmental or private-sector mandates as 
defined in UMRA and would impose no costs on state, local, or 
tribal governments.
    Previous CBO estimates: The language in H.R. 918, the 
Veteran Urgent Access to Mental Healthcare Act that affects 
loan guarantee fees is similar to language in the following 
bills that were ordered reported by the House Committee on 
Veterans' Affairs on July 19, 2017:
           H.R. 95, the Veterans' Access to Child Care 
        Act, and
           H.R. 3262, the Grow Our Own Directive: 
        Physician Assistant Employment and Education Act of 
        2017.
    However, CBO's estimate of the loan guarantee fees in H.R. 
918 differs from those in the above mentioned bills because of 
different proposed extension periods and the enactment of S. 
114, the VA Choice and Quality Employment Act of 2017, on 
August 12, 2017.
    When H.R. 918 was ordered reported on July 19, 2017, the 
loan fees were scheduled to decline on September 30, 2024. S. 
114, the VA Choice and Quality Employment Act of 2017 (Public 
Law 115-46), which was enacted on August 12, 2017, postponed 
the date on which those fees would decline to September 30, 
2027. Compared with the law prior to enactment of that act, 
section 3 would have postponed the date on which the fees would 
have declined by one year. Thus, absent the enactment of S. 
114, section 3 would have reduced direct spending by $332 
million in 2025, CBO estimates.
    Estimate prepared by: Federal Costs: Ann E. Futrell and 
David Newman; Impact on State, Local, and Tribal Governments: 
Jon Sperl; Impact on the Private Sector: Paige Piper/Bach.
    Estimate approved by: H. Samuel Papenfuss, Deputy Assistant 
Director for Budget Analysis.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates regarding H.R. 918, as amended, prepared by the 
Director of the Congressional Budget Office pursuant to section 
423 of the Unfunded Mandates Reform Act.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act would be created by H.R. 
918, as amended.

                 Statement of Constitutional Authority

    Pursuant to Article I, section 8 of the United States 
Constitution, H.R. 918, as amended, is authorized by Congress' 
power to ``provide for the common Defense and general Welfare 
of the United States.''

                  Applicability to Legislative Branch

    The Committee finds that H.R. 918, as amended, does not 
relate to the terms and conditions of employment or access to 
public services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

              Statement on Duplication of Federal Programs

    Pursuant to section 3(g) of H. Res. 5, 114th Cong. (2015), 
the Committee finds that no provision of H.R. 918, as amended, 
establishes or reauthorizes a program of the Federal Government 
known to be duplicative of another Federal program, a program 
that was included in any report from the Government 
Accountability Office to Congress pursuant to section 21 of 
Public Law 111-139, or a program related to a program 
identified in the most recent Catalog of Federal Domestic 
Assistance.

                   Disclosure of Directed Rulemaking

    Pursuant to section 3(i) of H. Res. 5, 114th Cong. (2015), 
the Committee estimates that H.R. 918, as amended, contains no 
directed rulemaking that would require the Secretary to 
prescribe regulations.

             Section-by-Section Analysis of the Legislation

Section 1. Short title

    Section 1 of the bill would provide a short title of H.R. 
918, as amended, as the ``Veteran Urgent Access to Mental 
Healthcare Act.''

Section 2. Expansion of mental health care for certain former members 
        of the Armed Forces

    Section 2(a) of the bill would amend subchapter II of 
chapter 17 of title 38 to of title 38 U.S.C. to add at the end 
the new section, Sec. 1720I. Expansion of mental health care 
for certain former members of the Armed Forces.''
    The new subsection 1720I(a) would require that the 
Secretary furnish to former members of the Armed Forces 
described in subsection (b): (1) an initial mental health 
assessment; and, (2) any subsequent mental health services that 
are required to meet their mental health care needs, including 
services that address risk of suicide or harming others.
    The new subsection 1720I(b) would define former members of 
the Armed Services to mean individuals who: (1) served in the 
active duty military, naval, or air service, as well as the 
reserve component, and were discharged or released under a 
less-than-honorable condition, but not dishonorable or a bad 
conduct discharge, who have applied for a character of service 
determination that has not yet been made, and, are not 
otherwise eligible to enroll in the VHA health care system; (2) 
were deployed or participated in a theater of combat 
operations; or, (3) were the victims of military sexual 
assault.
    The new subsection 1720I(c) would allow the Secretary to 
furnish such care at a non-VA facility if the VA provider 
determines that furnishing the care within VA would be 
clinically inadvisable or a VA facility is not capable of 
providing the services. This subsection would also require the 
Secretary to enter into any necessary contracts or agreements 
to furnish this care at non-VA facilities.
    The new subsection 1720I (d) would require the Secretary 
to: (1) seek to ensure that such mental health care services 
are furnished in a setting that is 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 VA.
    The new subsection 1720I (e) would require that the 
Secretary provide information on the mental health care 
services available under this section, to include ensuring: (1) 
the availability of a toll-free phone number; (2) that the 
information available is revised and updated as needed, visible 
at VA facilities, and is made available to State veteran 
agencies; and, (3) produced in coordination with DOD to ensure 
that separating servicemembers receive it.
    The new subsection 1720I (f) would require that the 
Secretary submit to Congress an annual report on the mental 
health care services provided pursuit to this section, to 
include: (1) the number of men and the number of women, 
respectively, who received services; and, (2) any other 
information the Secretary considers appropriate.
    Section 2(b) of the bill would amend the table of sections 
at the beginning of chapter 17 of title 38 by inserting 
``1720I. Expansion of mental health care for certain former 
members of the Armed Forces'' following the item relating to 
section 1720H.

Section 3. Extension of requirement for collection of fees for housing 
        loans guaranteed by Secretary of Veterans Affairs

    Section 3 of the bill would amend section 3729(b)(2) of 
title 38, U.S.C. clause (iii) in subparagraph (A) by striking 
``September 30, 2024'' and inserting ``September 30, 2025;'' 
clause (iv) in subparagraph (A) by striking ``September 30, 
2024'' and inserting ``September 30, 2025;'' clause (i) in 
subparagraph (B) by striking ``September 30, 2024'' and 
inserting ``September 30, 2025;'' clause (ii) in subparagraph 
(B) by striking ``September 30, 2024'' and inserting 
``September 30, 2025;'' clause (i) in subparagraph (C) by 
striking ``September 30, 2024'' and inserting ``September 30, 
2025;'' clause (ii) in subparagraph (C) by striking ``September 
30, 2024'' and inserting ``September 30, 2025;'' clause (i) in 
subparagraph (D) by striking ``September 30, 2024'' and 
inserting ``September 30, 2025;'' and, clause (ii) in 
subparagraph (D) by striking ``September 30, 2024'' and 
inserting ``September 30, 2025.''

Section 4. Character of service determination

    Section 4(a) of the bill would amend chapter 53 of title 
38, U.S.C., by inserting after section 5303A the new section, 
``Sec. 5303B. Character of service determinations.''
    The new subsection 5303B(a) would require that the 
Secretary establish a process by which an individual who was 
discharged from the Armed Services can seek a determination 
from the Secretary with respect to whether that discharge was 
under a condition that bars him or her from receiving a benefit 
under the laws administered by the Secretary.
    The new section 5303B(a) would require that if the 
Secretary determines under subsection 5303B(a) that an 
individual is barred from receiving a benefit, the Secretary 
shall provide to such individual information regarding the 
ability of the individual to address such condition, including 
pursuant to section 5303 of this title and chapter 79 of title 
10.
    Section 4(b) of the bill would amend the table of sections 
at the beginning of chapter 53 of title 38 by inserting 
``5303B. Character of service determinations.''

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italics, and existing law in which no 
change is proposed is shown in roman):

TITLE 38, UNITED STATES CODE

           *       *       *       *       *       *       *

PART II--GENERAL BENEFITS

           *       *       *       *       *       *       *

   CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE

                          SUBCHAPTER I--GENERAL

Sec.
1701. Definitions.
     * * * * * * *

 SUBCHAPTER II--HOSPITAL, NURSING HOME, OR DOMICILIARY CARE AND MEDICAL 
                                TREATMENT

     * * * * * * *
1720I. Expansion of mental health care for certain former members of the 
          Armed Forces.

           *       *       *       *       *       *       *

SUBCHAPTER II--HOSPITAL, NURSING HOME, OR DOMICILIARY CARE AND MEDICAL 
TREATMENT

           *       *       *       *       *       *       *

Sec. 1720I. Expansion of mental 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 health care services authorized under 
        this chapter that the Secretary determines are required 
        to treat the mental health care needs of the former 
        member, including risk of suicide or harming others.
  (b) Former Members of the Armed Forces Described.--A former 
member of the Armed Forces described in this subsection is an 
individual who meets the following criteria:
          (1) The individual is a former member of the Armed 
        Forces, including the reserve components, who--
                  (A) served in the active military, naval, or 
                air service, and was discharged or released 
                therefrom under a condition that is not 
                honorable except--
                          (i) dishonorable; or
                          (ii) bad conduct discharge;
                  (B) has applied for a character of service 
                determination and such determination has not 
                been made; and
                  (C) is not otherwise eligible to enroll in 
                the health care system established by section 
                1705 of this title by reason of such discharge 
                or release not meeting the requirements of 
                section 101(2) of this title.
          (2) While serving in the Armed Forces--
                  (A) the former member was deployed in a 
                theater of combat operations or an area at a 
                time during which hostilities occurred in that 
                area;
                  (B) participated in or experienced such 
                combat operations or hostilities, including by 
                controlling an unmanned aerial vehicle from a 
                location other than such theater or area; or
                  (C) was the victim of a physical assault of a 
                sexual nature, 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 health 
care services to an individual under this section, the 
Secretary may provide such mental 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 
        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 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 health care 
services to an individual under this section, the Secretary 
shall--
          (1) seek to ensure that such mental health care 
        services are furnished in a setting that is 
        therapeutically appropriate, taking into account the 
        circumstances that resulted in the need for such mental 
        health care 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 health care services 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 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
          (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, or air service are provided 
        appropriate information about programs, requirements, 
        and procedures for applying for mental health care 
        services under this section.
  (f) Annual Reports.--Each year, the Secretary shall submit to 
Congress an annual report on the mental health care 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 individuals who received mental 
        health care services under subsection (a), 
        disaggregated by the number of men who received such 
        services and the number of women who received such 
        services.
          (2) Such other information as the Secretary considers 
        appropriate.

           *       *       *       *       *       *       *

PART III--READJUSTMENT AND RELATED BENEFITS

           *       *       *       *       *       *       *

CHAPTER 37--HOUSING AND SMALL BUSINESS LOANS

           *       *       *       *       *       *       *

Sec. 3729. Loan fee

  (a) Requirement of Fee.--(1) Except as provided in subsection 
(c), a fee shall be collected from each person obtaining a 
housing loan guaranteed, insured, or made under this chapter, 
and each person assuming a loan to which section 3714 of this 
title applies. No such loan may be guaranteed, insured, made, 
or assumed until the fee payable under this section has been 
remitted to the Secretary.
  (2) The fee may be included in the loan and paid from the 
proceeds thereof.
  (b) Determination of Fee.--(1) The amount of the fee shall be 
determined from the loan fee table in paragraph (2). The fee is 
expressed as a percentage of the total amount of the loan 
guaranteed, insured, or made, or, in the case of a loan 
assumption, the unpaid principal balance of the loan on the 
date of the transfer of the property.
  (2) The loan fee table referred to in paragraph (1) is as 
follows:

                             LOAN FEE TABLE
------------------------------------------------------------------------
                   Active duty
 Type of loan        veteran            Reservist         Other obligor
------------------------------------------------------------------------
(A)(i) Initial  2.00               2.75                 NA
 loan
 described in
 section
 3710(a) to
 purchase or
 construct a
 dwelling with
 0-down, or
 any other
 initial loan
 described in
 section
 3710(a) other
 than with 5-
 down or 10-
 down (closed
 before
 January 1,
 2004)
(A)(ii)         2.20               2.40                 NA
 Initial loan
 described in
 section
 3710(a) to
 purchase or
 construct a
 dwelling with
 0-down, or
 any other
 initial loan
 described in
 section
 3710(a) other
 than with 5-
 down or 10-
 down (closed
 on or after
 January 1,
 2004, and
 before
 October 1,
 2004)
(A)(iii)        2.15               2.40                 NA
 Initial loan
 described in
 section
 3710(a) to
 purchase or
 construct a
 dwelling with
 0-down, or
 any other
 initial loan
 described in
 section
 3710(a) other
 than with 5-
 down or 10-
 down (closed
 on or after
 October 1,
 2004, and
 before
 September 30,
 [2024] 2025 )
(A)(iv)         1.40               1.65                 NA
 Initial loan
 described in
 section
 3710(a) to
 purchase or
 construct a
 dwelling with
 0-down, or
 any other
 initial loan
 described in
 section
 3710(a) other
 than with 5-
 down or 10-
 down (closed
 on or after
 September 30,
 [2024] 2025 )
(B)(i)          3.30               3.30                 NA
 Subsequent
 loan
 described in
 section
 3710(a) to
 purchase or
 construct a
 dwelling with
 0-down, or
 any other
 subsequent
 loan
 described in
 section
 3710(a)
 (closed
 before
 September 30,
 [2024] 2025 )
(B)(ii)         1.25               1.25                 NA
 Subsequent
 loan
 described in
 section
 3710(a) to
 purchase or
 construct a
 dwelling with
 0-down, or
 any other
 subsequent
 loan
 described in
 section
 3710(a)
 (closed on or
 after
 September 30,
 [2024] 2025 )
(C)(i) Loan     1.50               1.75                 NA
 described in
 section
 3710(a) to
 purchase or
 construct a
 dwelling with
 5-down
 (closed
 before
 September 30,
 [2024] 2025 )
(C)(ii) Loan    0.75               1.00                 NA
 described in
 section
 3710(a) to
 purchase or
 construct a
 dwelling with
 5-down
 (closed on or
 after
 September 30,
 [2024] 2025 )
(D)(i) Initial  1.25               1.50                 NA
 loan
 described in
 section
 3710(a) to
 purchase or
 construct a
 dwelling with
 10-down
 (closed
 before
 September 30,
 [2024] 2025 )
(D)(ii)         0.50               0.75                 NA
 Initial loan
 described in
 section
 3710(a) to
 purchase or
 construct a
 dwelling with
 10-down
 (closed on or
 after
 September 30,
 [2024] 2025 )
(E) Interest    0.50               0.50                 NA
 rate
 reduction
 refinancing
 loan
(F) Direct      1.00               1.00                 NA
 loan under
 section 3711
(G)             1.00               1.00                 NA
 Manufactured
 home loan
 under section
 3712 (other
 than an
 interest rate
 reduction
 refinancing
 loan)
(H) Loan to     1.25               1.25                 NA
 Native
 American
 veteran under
 section 3762
 (other than
 an interest
 rate
 reduction
 refinancing
 loan)
(I) Loan        0.50               0.50                 0.50
 assumption
 under section
 3714
(J) Loan under  2.25               2.25                 2.25
 section
 3733(a)
------------------------------------------------------------------------

  (3) Any reference to a section in the ``Type of loan'' column 
in the loan fee table in paragraph (2) refers to a section of 
this title.
  (4) For the purposes of paragraph (2):
          (A) The term ``active duty veteran'' means any 
        veteran eligible for the benefits of this chapter other 
        than a Reservist.
          (B) The term ``Reservist'' means a veteran described 
        in section 3701 (b)(5)(A) of this title who is eligible 
        under section 3702(a)(2)(E) of this title.
          (C) The term ``other obligor'' means a person who is 
        not a veteran, as defined in section 101 of this title 
        or other provision of this chapter.
          (D) The term ``initial loan'' means a loan to a 
        veteran guaranteed under section 3710 or made under 
        section 3711 of this title if the veteran has never 
        obtained a loan guaranteed under section 3710 or made 
        under section 3711 of this title.
          (E) The term ``subsequent loan'' means a loan to a 
        veteran, other than an interest rate reduction 
        refinancing loan, guaranteed under section 3710 or made 
        under section 3711 of this title if the veteran has 
        previously obtained a loan guaranteed under section 
        3710 or made under section 3711 of this title.
          (F) The term ``interest rate reduction refinancing 
        loan'' means a loan described in section 3710(a)(8), 
        3710(a)(9)(B)(i), 3710(a)(11), 3712(a)(1)(F), or 
        3762(h) of this title.
          (G) The term ``0-down'' means a downpayment, if any, 
        of less than 5 percent of the total purchase price or 
        construction cost of the dwelling.
          (H) The term ``5-down'' means a downpayment of at 
        least 5 percent or more, but less than 10 percent, of 
        the total purchase price or construction cost of the 
        dwelling.
          (I) The term ``10-down'' means a downpayment of 10 
        percent or more of the total purchase price or 
        construction cost of the dwelling.
  (c) Waiver of Fee.--(1) A fee may not be collected under this 
section from a veteran who is receiving compensation (or who, 
but for the receipt of retirement pay or active service pay, 
would be entitled to receive compensation) or from a surviving 
spouse of any veteran (including a person who died in the 
active military, naval, or air service) who died from a 
service-connected disability.
  (2)(A) A veteran described in subparagraph (B) shall be 
treated as receiving compensation for purposes of this 
subsection as of the date of the rating described in such 
subparagraph without regard to whether an effective date of the 
award of compensation is established as of that date.
  (B) A veteran described in this subparagraph is a veteran who 
is rated eligible to receive compensation--
          (i) as the result of a pre-discharge disability 
        examination and rating; or
          (ii) based on a pre-discharge review of existing 
        medical evidence (including service medical and 
        treatment records) that results in the issuance of a 
        memorandum rating.

           *       *       *       *       *       *       *

PART IV--GENERAL ADMINISTRATIVE PROVISIONS

           *       *       *       *       *       *       *

          CHAPTER 53--SPECIAL PROVISIONS RELATING TO BENEFITS

Sec.
5301. Nonassignability and exempt status of benefits.
     * * * * * * *
5303B. Character of service determinations.

           *       *       *       *       *       *       *

Sec. 5303B. Character of service determinations

  (a) Determination.--The Secretary shall establish a process 
by which an individual who served in the Armed Forces and was 
discharged or dismissed therefrom may seek a determination from 
the Secretary with respect to whether such discharge or release 
was under a condition that bars the right of such individual to 
a benefit under the laws administered by the Secretary based 
upon the period of service from which discharged or dismissed.
  (b) Provision of Information.--If the Secretary determines 
under subsection (a) that an individual is barred to a benefit 
under the laws administered by the Secretary, the Secretary 
shall provide to such individual information regarding the 
ability of the individual to address such condition, including 
pursuant to section 5303 of this title and chapter 79 of title 
10.

           *       *       *       *       *       *       *

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