79–006 

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 

2 

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: 

‘‘§ 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); 

3 

‘‘(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: 

‘‘§ 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.’’. 

4 

1Other 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). 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. 

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

According to the Vietnam Veterans of America, ‘‘the use of lessthan-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 disVerDate Sep 11 2014 04:38 Nov 07, 2017 Jkt 079006 PO 00000 Frm 00004 Fmt 6659 Sfmt 6602 E:\HR\OC\HR390.XXX HR390
5 

7 Emergent Mental Health Care for Former Service Members. VA Fact Sheet. June 2017. 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). 

charges who may be barred from such care—is increasing at a significantly greater rate than that among veterans who use VA care.7

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

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. 

6 

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 

Gonza ́lez-Colo ́n 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. 

7 

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. 

8 

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. 

9 

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. 

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. 

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 are exempt 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 

10 

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-AsYou-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 

11 

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.’’ 

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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, 

§ 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 tollfree 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. 

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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, ‘‘§ 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 

* * * * * * * 

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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 

* * * * * * * 

§ 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). 

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(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. 

* * * * * * * 

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PART III—READJUSTMENT AND RELATED 

BENEFITS 

* * * * * * * 

CHAPTER 37—HOUSING AND SMALL BUSINESS LOANS 

* * * * * * * 

§ 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 

Type of loan Active duty veteran Reservist Other obligor 

(A)(i) 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 before January 1, 

2004) 

2.00 2.75 NA 

(A)(ii) 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) 

2.20 2.40 NA 

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LOAN FEE TABLE—Continued 

Type of loan Active duty veteran Reservist Other obligor 

(A)(iii) 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, ø2024¿ 

2025 ) 

2.15 2.40 NA 

(A)(iv) 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, ø2024¿ 

2025 ) 

1.40 1.65 NA 

(B)(i) 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, ø2024¿ 

2025 ) 

3.30 3.30 NA 

(B)(ii) 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, 

ø2024¿ 2025 ) 

1.25 1.25 NA 

(C)(i) Loan described in 

section 3710(a) to purchase or construct a 

dwelling with 5-down 

(closed before September 

30, ø2024¿ 2025 ) 

1.50 1.75 NA 

(C)(ii) Loan described in 

section 3710(a) to purchase or construct a 

dwelling with 5-down 

(closed on or after September 30, ø2024¿ 

2025 ) 

0.75 1.00 NA 

(D)(i) Initial loan described 

in section 3710(a) to 

purchase or construct a 

dwelling with 10-down 

(closed before September 

30, ø2024¿ 2025 ) 

1.25 1.50 NA 

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LOAN FEE TABLE—Continued 

Type of loan Active duty veteran Reservist Other obligor 

(D)(ii) Initial loan described 

in section 3710(a) to 

purchase or construct a 

dwelling with 10-down 

(closed on or after September 30, ø2024¿ 

2025 ) 

0.50 0.75 NA 

(E) Interest rate reduction 

refinancing loan 

0.50 0.50 NA 

(F) Direct loan under section 3711 1.00 1.00 NA 

(G) Manufactured home 

loan under section 3712 

(other than an interest 

rate reduction refinancing loan) 

1.00 1.00 NA 

(H) Loan to Native American veteran under section 3762 (other than an 

interest rate reduction 

refinancing loan) 

1.25 1.25 NA 

(I) Loan assumption under 

section 3714 

0.50 0.50 0.50 

(J) Loan under section 

3733(a) 

2.25 2.25 2.25 

(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. 

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(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. 

* * * * * * * 

§ 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 indiVerDate Sep 11 2014 04:38 Nov 07, 2017 Jkt 079006 PO 00000 Frm 00019 Fmt 6659 Sfmt 6603 E:\HR\OC\HR390.XXX HR390
20 

vidual to address such condition, including pursuant to section 

5303 of this title and chapter 79 of title 10. 

* * * * * * * 

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