59–008 

110TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 1st Session 110–78 

PROVIDING FOR CONSIDERATION OF THE BILL (H.R. 1538) TO AMEND 

TITLE 10, UNITED STATES CODE, TO IMPROVE THE MANAGEMENT OF 

MEDICAL CARE, PERSONNEL ACTIONS, AND QUALITY OF LIFE ISSUES 

FOR MEMBERS OF THE ARMED FORCES WHO ARE RECEIVING MEDICAL 

CARE IN AN OUTPATIENT STATUS, AND FOR OTHER PURPOSES 

MARCH 27, 2007.—Referred to the House Calendar and ordered to be printed 

Ms. CASTOR, from the Committee on Rules, 

submitted the following 

R E P O R T 

[To accompany H. Res. 274] 

The Committee on Rules, having had under consideration House 

Resolution 274, by a nonrecord vote, report the same to the House 

with the recommendation that the resolution be adopted. 

SUMMARY OF PROVISIONS OF THE RESOLUTION

The resolution provides for consideration of H.R. 1538 to improve 

the management of medical care, personnel actions, and quality of 

life issues for members of the Armed Forces who are receiving medical care in an outpatient status. The resolution provides for one 

hour and twenty minutes of general debate, with one hour equally 

divided and controlled by the Chairman and Ranking Minority 

Member of the Committee on Armed Services and twenty minutes 

equally divided and controlled by the Chairman and Ranking Minority Member of the Committee on Veterans’ Affairs. 

The resolution waives all points of order against consideration of 

the bill except those arising under clause 9 or 10 of rule XXI. The 

resolution makes in order the amendment in the nature of a substitute recommended by the Committee on Armed Services as the 

original bill for the purpose of further amendment. 

The resolution makes in order those amendments printed in this 

report. Finally, the resolution provides one motion to recommit 

with or without instructions. 

EXPLANATION OF WAIVERS

The resolution includes a waiver of all points of order against 

consideration of the bill except for those arising under clauses 9 

and 10 of rule XXI. The waiver includes a waiver of clause 3(c)(4) 


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of rule XIII (regarding statement of general performance goals and 

objectives in committee report). 

COMMITTEE VOTES

The results of each record vote on an amendment or motion to 

report, together with the names of those voting for and against, are 

printed below: 

Rules Committee record vote No. 105 

Date: March 27, 2007. 

Measure: H.R. 1538. 

Motion by: Mr. Dreier. 

Summary of motion: To report an open rule. 

Results: Defeated 3–9. 

Vote by Members: McGovern—Nay; Hastings (FL)—Nay; Matsui—Nay; Cardoza—Nay; Welch—Nay; Castor—Nay; Arcuri—Nay; 

Sutton—Nay; Dreier—Yea; Hastings (WA)—Yea; Sessions—Yea; 

Slaughter—Nay. 

Rules Committee record vote No. 106 

Date: March 27, 2007. 

Measure: H.R. 1538. 

Motion by: Mr. Dreier. 

Summary of motion: To make in order and provide appropriate 

waivers for an amendment by Rep. Shays (#6) requiring the establishment, publication, and monitoring of medical holdover (MHO) 

process performance standards and requiring holdover and inspection reports to be submitted to the Secretary of Defense and the 

Defense Department Inspector General. 

Results: Defeated 3–9. 

Vote by Members: McGovern—Nay; Hastings (FL)—Nay; Matsui—Nay; Cardoza—Nay; Welch—Nay; Castor—Nay; Arcuri—Nay; 

Sutton—Nay; Dreier—Yea; Hastings (WA)—Yea; Sessions—Yea; 

Slaughter—Nay. 

Rules Committee record vote No. 107 

Date: March 27, 2007. 

Measure: H.R. 1538. 

Motion by: Mr. Hastings of Washington. 

Summary of motion: To make in order and provide appropriate 

waivers for an amendment by Rep. Moran of Kansas (#21) establishing a pilot program to allow combat veterans residing in highly 

rural areas to receive covered Department of Veterans’ Affairs 

health care services through a non-VA provider. 

Results: Defeated 3–9. 

Vote by Members: McGovern—Nay; Hastings (FL)—Nay; Matsui—Nay; Cardoza—Nay; Welch—Nay; Castor—Nay; Arcuri—Nay; 

Sutton—Nay; Dreier—Yea; Hastings (WA)—Yea; Sessions—Yea; 

Slaughter—Nay. 

Rules Committee record vote No. 108 

Date: March 27, 2007. 

Measure: H.R. 1538. 

Motion by: Mr. Hastings of Washington. 


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Summary of motion: To make in order and provide appropriate 

waivers for an amendment by Rep. Pearce (#14) requiring the VA 

Secretary to contract with local doctors and hospitals on a case-bycase basis to provide medical services, including primary care, for 

those veterans who live far away from VA medical centers. 

Results: Defeated 3–9. 

Vote by Members: McGovern—Nay; Hastings (FL)—Nay; Matsui—Nay; Cardoza—Nay; Welch—Nay; Castor—Nay; Arcuri—Nay; 

Sutton—Nay; Dreier—Yea; Hastings (WA)—Yea; Sessions—Yea; 

Slaughter—Nay. 

Rules Committee record vote No. 109 

Date: March 27, 2007. 

Measure: H.R. 1538. 

Motion by: Mr. Sessions. 

Summary of motion: To make in order and provide appropriate 

waivers for an amendment by Rep. Shays (#7) establishing a patient advocate or ‘‘navigator’’ program for wounded service members. The Navigators will be representatives for patients and their 

families, independent of current military service. 

Results: Defeated 3–9. 

Vote by Members: McGovern—Nay; Hastings (FL)—Nay; Matsui—Nay; Cardoza—Nay; Welch—Nay; Castor—Nay; Arcuri—Nay; 

Sutton—Nay; Dreier—Yea; Hastings (WA)—Yea; Sessions—Yea; 

Slaughter—Nay. 

SUMMARY OF AMENDMENTS MADE IN ORDER

1. Barrow (GA): The amendment eliminates the deductible and 

changes the method of determining the mileage reimbursement 

rate under the beneficiary travel program administered by the Secretary of Veterans’ Affairs. The reimbursement rate will be increased to the level at which Government employees are reimbursed for the use of privately owned vehicles on official business. 

(10 minutes) 

2. Skelton (MO): The amendment would make technical changes 

in section 101 to clarify the qualification of military officers who 

may supervise medical care case managers and in section 107 to 

require that the tracking system for reports to medical authorities 

regarding wounded warrior symptoms of post-traumatic stress disorder or suicidal tendencies be developed not later than 180 days 

after the date of enactment and that the results be included in the 

Congressional reporting requirement. (10 minutes) 

3. Kline (MN): This amendment directs the Secretary of Defense 

to ensure that $10,000,000 is directed to support programs, activities, and facilities associated with the Marine Corps Wounded Warrior Regiment program from the Medical Support Fund created by 

this bill. (10 minutes) 

4. Sestak (PA)/Kennedy, Patrick (RI): The amendment adds a 

definition to Sec. 2 to clarify that ‘‘medical care’’ includes mental 

health care. (10 minutes) 

5. Brown, Corrine (FL): This amendment will ensure confidentiality for members of the military who call the hotline for help. (10 

minutes) 

6. Johnson, Eddie Bernice (TX): The amendment strengthens language that professionals’ training be ‘‘improved’’ rather than ‘‘modiVerDate Aug 31 2005 07:17 Mar 28, 2007 Jkt 059008 PO 00000 Frm 00003 Fmt 6659 Sfmt 6602 E:\HR\OC\HR078.XXX HR078

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fied,’’ and it also places greater emphasis on adequate training to 

detect mental health conditions among recovering service members. 

(10 minutes) 

7. Kennedy, Patrick (RI)/Sestak (PA): This amendment would require the Secretary of the Department of Defense to develop and 

implement a plan to help prevent Post-Traumatic Stress Disorder 

and other stress-related psychopathologies (including substance 

abuse conditions) trom developing in our military service members. 

In addition, this amendment would establish a new Peer-Reviewed 

research program within the Defense Health Program’s research 

and development function to research the prevention of Post-Traumatic Stress Disorder and how to best strengthen the psychological 

resiliency of our military service members. (10 minutes) 

8. Hooley (OR): Amendment would give members of the Reserve 

Component the option to use Military Medical Treatment Facilities 

closest to home for treatment on an outpatient basis of injuries sustained in theater. (10 minutes) 

9. Hensarling (TX): This amendment would direct the Secretary 

of Veterans Affairs to conduct a study to determine what the average length of time is between the date for which a veteran requests 

an appointment and the date he is able to receive care. This 

amendment also requires that the Secretary report back to Congress within 180 days with recommendations as to how this time 

could be decreased to 15 days. (10 minutes) 

10. Bilirakis (FL): The amendment creates an office of the ombudsman within the Office of the Secretary of Defense which would 

develop policies for the military departments on providing assistance to recovering service members and their families. (10 minutes) 

11. Buchanan (FL): The amendment would direct the Secretary 

of Defense to submit to Congress a report on the feasibility of a 

Soldier Patient Tracking System so any patient can be located in 

the medical holdover (MHO) process. (10 minutes) 

12. Welch (VT): The amendment requires that the Secretary concerned provide the medical care managers and service member advocates with all the resources they need to expeditiously carry out 

their work. The amendment would also require the Department of 

Defense to conduct outreach to inform all service members and 

their families about the existence of and services available to them 

by the medical care managers and service member advocates contained in the bill. (10 minutes) 

TEXT OF AMENDMENTS MADE IN ORDER UNDER THE RULE

1. AN AMENDMENT TO BE OFFERED BY REPRESENTATIVE BARROW

OF GEORGIA, OR HIS DESIGNEE, DEBATABLE FOR 10 MINUTES

Add at the end of the bill the following new section: 

SEC. 304. VETERANS BENEFICIARY TRAVEL PROGRAM. 

(a) ELIMINATION OF DEDUCTIBLE.—Subsection (c) of section 111 of 

title 38, United States Code, is repealed. 

(b) DETERMINATION OF MILEAGE REIMBURSEMENT RATE.—

(1) DETERMINATION.—Paragraph (1) of subsection (g) of such 

section is amended to read as follows: 

‘‘(1) In determining the amount of allowances or reimbursement 

to be paid under this section, the Secretary shall use the mileage 

reimbursement rates for the use of privately owned vehicles by 


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Government employees on official business, as prescribed by the 

Administrator of General Services under section 5707(b) of title 5, 

United States Code.’’. 

(2) CONFORMING AMENDMENT.—Subsection (g) of such section 

is further amended by striking paragraphs (3) and (4). 

(c) SOURCE OF FUNDS.—Such section is further amended by adding at the end the following new subsection: 

‘‘(i) Funds for payments made under this section shall be appropriated separately from other amounts appropriated for the Department.’’. 

(d) EFFECTIVE DATE.—The amendments made by this Act shall 

apply with respect to travel expenses incurred after the expiration 

of the 90-day period that begins on the date of the enactment of 

this Act. 

2. AN AMENDMENT TO BE OFFERED BY REPRESENTATIVE SKELTON

OF MISSOURI, OR HIS DESIGNEE, DEBATABLE FOR 10 MINUTES

At the end of section 1074l(a)(4)(B) of title 10, United States 

Code, as proposed to be added by section 101 of the bill, strike ‘‘or 

Air Force Medical Service.’’ and insert ‘‘Air Force Medical Service, 

or other corps comprised of health care professionals at the discretion of the Secretary of Defense.’’. 

In section 107(b), add at the end the following: 

(3) The progress made in developing the tracking system 

under subsection (c) and the results of the system. 

In section 107(c), strike ‘‘The’’ and insert ‘‘Not later than 180 

days after the date of the enactment of this Act, the’’. 

3. AN AMENDMENT TO BE OFFERED BY REPRESENTATIVE KLINE OF

MINNESOTA, OR HIS DESIGNEE, DEBATABLE FOR 10 MINUTES

Insert the following after subsection (d) of section 111 (and redesignate subsection (e) as subsection (f)): 

(e) WOUNDED WARRIOR REGIMENT PROGRAM.—The Secretary of Defense shall ensure that $10,000,000 for fiscal year 2007 is transferred from the Medical Support Fund to support programs, activities, and facilities associated with the Marine Corps Wounded Warrior Regiment program, to be used as follows: (1) $6,550,000 for Case Management and Patient Support. 

(2) $1,200,000 for Wounded Warrior Interim Regimental 

Headquarters Building conversion. (3) $1,300,000 for Case Management System Development. 

(4) $95,000 for Support Equipment. 

4. AN AMENDMENT TO BE OFFERED BY REPRESENTATIVE SESTAK OF

PENNSYLVANIA, OR HIS DESIGNEE, DEBATABLE FOR 10 MINUTES

At the end of section 2, add the following: 

(5) MEDICAL CARE.—The term ‘‘medical care’’ includes mental 

health care. 


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. AN AMENDMENT TO BE OFFERED BY REPRESENTATIVE CORRINE

BROWN OF FLORIDA, OR HER DESIGNEE, DEBATABLE FOR 10 MIN- UTES

In section 1567 of title 10, United States Code, as proposed to be 

added by section 102 of the bill—

(1) redesignate subsections (b), (c), and (d) as subsections (c), 

(d), and (e), respectively; and 

(2) insert after subsection (a) the following new subsection 

(b): 

‘‘(b) CONFIDENTIALITY.—(1) Individuals who seek to provide information through use of the toll-free telephone number under subsection (a) shall be notified, immediately before they provide such 

information, of their option to elect, at their discretion, to have 

their identity remain confidential. 

‘‘(2) In the case of information provided through use of the tollfree telephone number by an individual who elects to maintain the 

confidentiality of his or her identity, any individual who, by necessity, has had access to such information for purposes of conducting 

the investigation or executing the response plan required by subsection (c) may not disclose the identity of the individual who provided the information.’’. 

6. AN AMENDMENT TO BE OFFERED BY REPRESENTATIVE EDDIE

BERNICE JOHNSON OF TEXAS, OR HER DESIGNEE, DEBATABLE FOR

10 MINUTES

In section 107(a), in the first sentence, strike ‘‘modification of the 

training’’ and insert ‘‘improvement of the training’’. 

In section 107(a), strike the second sentence and insert the following: ‘‘The recommendations shall include, at a minimum, specific recommendations to ensure that such health care professionals, medical care case managers, and service member advocates 

are adequately trained and able to detect early warning signs of 

post-traumatic stress disorder (PTSD), suicidal tendencies, and 

other mental health conditions among recovering service members.’’. 

7. AN AMENDMENT TO BE OFFERED BY REPRESENTATIVE KENNEDY

OF RHODE ISLAND, OR HIS DESIGNEE, DEBATABLE FOR 10 MINUTES

At the end of title I, add the following new section (and conform 

the table of contents accordingly): 

SEC. 113. PLANS AND RESEARCH FOR REDUCING POST TRAUMATIC 

STRESS DISORDER. 

(a) PLANS FOR REDUCING POST TRAUMATIC STRESS DISORDER.—

(1) PLAN FOR PREVENTION.—

(A) IN GENERAL.—The Secretary of Defense shall develop 

a plan to incorporate evidence-based preventive and earlyintervention measures, practices, or procedures that reduce the likelihood that personnel in combat will develop 

post-traumatic stress disorder or other stress-related 

psychopathologies (including substance use conditions) 

into—


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(i) basic and pre-deployment training for enlisted 

members of the Armed Forces, noncommissioned officers, and officers; 

(ii) combat theater operations; and 

(iii) post-deployment service. 

(B) UPDATES.—The Secretary of Defense shall update 

the plan under subparagraph (A) periodically to incorporate, as the Secretary considers appropriate, the results 

of relevant research, including research conducted pursuant to subsection (b). 

(2) RESEARCH.—Subject to subsection (b), the Secretary of 

Defense shall develop a plan, in consultation with the Department of Veterans Affairs, the National Institutes of Health, 

and the National Academy of Sciences, to conduct such research as is necessary to develop the plan described in paragraph (1). 

(b) EVIDENCE-BASED RESEARCH AND TRAINING.— (1) WORKING GROUP.—The Secretary of Defense shall conduct 

a study, in coordination with the Department of Veterans Affairs, the National Institutes of Health, and the National Academy of Sciences’ Institute of Medicine, to determine the feasibility of establishing a working group tasked with researching 

and developing evidence-based measures, practices, or procedures that reduce the likelihood that personnel in combat will 

develop post-traumatic stress disorder or other stress-related 

psychological pathologies (including substance use conditions). 

The working group shall include personnel with experience in 

a combat theater, and behavioral health personnel who have 

experience providing treatment to individuals with experience 

in a combat theater. 

(2) PEER-REVIEWED RESEARCH PROGRAM.—Not later than 180 

days after the date of the enactment of this Act, the Secretary 

of Defense shall submit to Congress a plan for a peer-reviewed 

research program within the Defense Health Program’s research and development function to research and develop evidence-based preventive and early intervention measures, practices, or procedures that reduce the likelihood that personnel 

in combat will develop post-traumatic stress disorder or other 

stress-related psychopathologies (including substance use conditions). 

(c) REPORT.—The Secretary of Defense shall submit to Congress 

annually a report on the plans and studies required under this section. 

8. AN AMENDMENT TO BE OFFERED BY REPRESENTATIVE HOOLEY OF

OREGON, OR HER DESIGNEE, DEBATABLE FOR 10 MINUTES

At the end of title I, add the following new section (and conform 

the table of contents accordingly): 

SEC. 113. OPTION FOR MEMBERS OF RESERVE COMPONENTS TO USE 

MILITARY MEDICAL TREATMENT FACILITIES CLOSEST TO 

HOME FOR CERTAIN INJURIES. 

The Secretary of Defense shall provide that, in the case of members of the reserve components returning from a combat theater, if 

a member requires treatment on an outpatient basis for injuries or 


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wounds sustained in theater, the member may be provided treatment at the military medical treatment facility closest to the member’s home rather than closest to the base from which the member 

was deployed. 

9. AN AMENDMENT TO BE OFFERED BY REPRESENTATIVE

HENSARLING OF TEXAS, OR HIS DESIGNEE, DEBATABLE FOR 10 

MINUTES

At the end of title II, add the following new section (and conform 

the table of contents accordingly): 

SEC. 207. STUDY AND REPORT ON WAITING PERIODS FOR APPOINTMENTS AT DEPARTMENT OF VETERANS AFFAIRS MEDICAL FACILITIES. 

(a) STUDY REQUIRED.—The Secretary of Veterans Affairs shall 

conduct a study on the average length of time between the desired 

date for which a veteran seeks to schedule an appointment for 

health care at a Department of Veterans Affairs medical facility 

and the date on which such appointment is completed. 

(b) FOCUS OF STUDY.—In conducting the study under subsection 

(a), the Secretary shall focus on appointments scheduled and completed at Department medical facilities located in both rural and 

urban areas. 

(c) REPORT.—Not later than 180 days after the date of the enactment of this Act, the Secretary shall submit a report to Congress 

containing the findings of the study under subsection (a) and recommendations for decreasing the waiting time between the desired 

date of an appointment and the completion of the appointment to 

a maximum of 15 days. 

10. AN AMENDMENT TO BE OFFERED BY REPRESENTATIVE BILIRAKIS

OF FLORIDA, OR HIS DESIGNEE, DEBATABLE FOR 10 MINUTES

After section 101, insert the following new section (and conform 

the table of contents accordingly): 

SEC. 102. ESTABLISHMENT OF A DEPARTMENT OF DEFENSE-WIDE OMBUDSMAN OFFICE. 

(a) ESTABLISHMENT.—The Secretary of Defense shall establish a 

Department of Defense-wide Ombudsman Office (in this section referred to as the ‘‘Ombudsman Office’’) within the Office of the Secretary of Defense. 

(b) FUNCTIONS.—

(1) IN GENERAL.—The functions of the Ombudsman Office 

are to provide policy guidance to, and oversight of, the ombudsman offices in the military departments. 

(2) POLICY GUIDANCE.—The Ombudsman Office shall develop 

policy guidance with respect to the following: 

(A) Providing assistance to and answering questions 

from recovering service members and their families regarding—

(i) administrative processes, financial matters, and 

non-military related services available to the members 

and their families throughout the member’s evaluation, treatment, and recovery; 


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(ii) transfer to the care of the Veterans Administration; and 

(iii) support services available upon the member’s 

return home. 

(B) Accountability standards, including—

(i) creating and maintaining case files for individual 

specific questions received, and initiating inquiries 

and tracking responses for all such questions; 

(ii) setting standards for timeliness of responses; 

and 

(iii) setting standards for accountability to recovering service members and their families, including requirements for daily updates to the members and their 

families about steps being taken to alleviate problems 

and concerns until problems are addressed 

(c) STATUS REPORTS.—The ombudsman office in each military department shall submit status reports of actions taken to address individual concerns to the Ombudsman Office, at such times as the 

Ombudsman Office considers appropriate. 

(d) RESPONSES FROM OTHER OFFICES.—The Secretary of Defense 

shall ensure that all other offices within the Department of Defense and the military departments respond in a timely manner to 

resolve questions and requests from the Ombudsman Office on behalf of recovering service members and their families, including offices responsible for medical matters (including medical holdover 

processes), financial and accounting matters, legal matters, human 

resources matters, reserve component matters, installation and 

management matters, and physical disability matters. 

(e) STAFF OF THE OFFICE.—The staff of the Ombudsman Office 

shall include representatives from each military department, including persons with experience in medical holdover processes and 

other medical matters. 

11. AN AMENDMENT TO BE OFFERED BY REPRESENTATIVE BUCHANAN OF FLORIDA, OR HIS DESIGNEE, DEBATABLE FOR 10 MINUTES

At the end of title II, add the following new section: 

SEC. 207. STUDY AND REPORT ON STANDARD SOLDIER PATIENT 

TRACKING SYSTEM. 

(a) STUDY REQUIRED.—The Secretary of Defense shall conduct a 

study on the feasibility of developing a joint soldier tracking system 

for recovering service members. 

(b) MATTERS COVERED.—The study under subsection (a) shall include the following: 

(1) Review of the feasibility of allowing each recovering service member, each family member of such a member, each commander of a military installation retaining medical holdover 

patients, each patient navigator, and ombudsman office personnel, at all times, to be able to locate and understand exactly 

where a recovering service member is in the medical holdover 

process. 

(2) A determination of whether the tracking system can be 

designed to ensure that—


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(A) the commander of each military medical facility 

where recovering service members are located is able to 

track appointments of such members to ensure they are 

meeting timeliness and other standards that serve the 

member; and 

(B) each recovering service member is able to know 

when his appointments and other medical evaluation 

board or physical evaluation board deadlines will be and 

that they have been scheduled in a timely and accurate 

manner. 

(3) Any other information needed to conduct oversight of care 

of the member throughout the medical holdover process. 

(c) REPORT.—Not later than 180 days after the date of the enactment of this Act, the Secretary of Defense shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report on the results of the study, with such findings 

and recommendations as the Secretary considers appropriate. 

12. AN AMENDMENT TO BE OFFERED BY REPRESENTATIVE WELCH

OF VERMONT, OR HIS DESIGNEE, DEBATABLE FOR 10 MINUTES

Insert at the end of section 1074l(a) of title 10, United States 

Code, as proposed to be added by section 101 of the bill, the following new paragraph: 

‘‘(6) The Secretary concerned shall ensure that medical care case 

managers have the resources necessary to ensure that they expeditiously carry out the responsibilities and duties of their position. 

Insert at the end of section 1074l(b) of title 10, United States 

Code, as proposed to be added by section 101 of the bill, the following new paragraph: 

‘‘(7) The Secretary concerned shall ensure that service member 

advocates have the resources necessary to ensure that they expeditiously carry out the responsibilities and duties of their position. 

Insert after subsection (b) of section 1074l of title 10, United 

States Code, as proposed to be added by section 101 of the bill, the 

following new subsection (and redesignate subsections (c) and (d) of 

such section as subsections (d) and (e), respectively): ‘‘(c) OUTREACH.—The Secretary of Defense shall make available 

to each member in an outpatient status at a military medical treatment facility, and to the family members of all such members, information on the availability of services provided by the medical 

care case managers and service member advocates, including information on how to contact such managers and advocates and how 

to use their services. 

Æ 


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