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[Senate Report 107-82]
[From the U.S. Government Publishing Office]

                                                       Calendar No. 191
107th Congress                                                   Report
                                 SENATE
 1st Session                                                     107-82

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

 
     HEATHER FRENCH HENRY HOMELESS VETERANS ASSISTANCE ACT OF 2001

                                _______
                                

                October 11, 2001.--Ordered to be printed

                                _______
                                

Mr. Rockefeller, from the Committee on Veterans' Affairs, submitted the 
                               following

                              R E P O R T

                         [To accompany S. 739]

    The Committee on Veterans' Affairs, to which was referred 
the bill (S. 739) to amend title 38, United States Code, to 
improve programs for homeless veterans and for other purposes, 
having considered the same, reports favorably and recommends 
that the bill, as amended, do pass.

                              Introduction

    On April 6, 2001, Committee member Paul D. Wellstone 
introduced S. 739, the proposed ``Heather French Henry Homeless 
Veterans Assistance Act of 2001,'' with the cosponsorship of 
Committee member Patty Murray, and Senators Jeff Bingaman, 
Harry Reid, John F. Kerry, Thomas A. Daschle, Jon Corzine, 
Byron L. Dorgan, Deborah Ann Stabenow, Tim Johnson, Mark 
Dayton, Richard J. Durbin, Edward M. Kennedy, and Mary L. 
Landrieu. S. 739, as introduced, would have reauthorized, 
modified, and enhanced certain programs that the Department of 
Veterans Affairs (VA) and a program that the Department of 
Labor administers to homeless veterans.

                           Committee Hearing

    On July 19, 2001, the Committee held a hearing on a number 
of bills pending before the Committee, including S. 739. The 
Committee received testimony from representatives of VA and 
organizations which assist homeless veterans, including 
representatives of the National Coalition for Homeless 
Veterans, the Minnesota Assistance Council for Veterans, the 
Non-Commissioned Officers Association of the United States of 
America, and the American Federation of Government Employees.

                           Committee Meeting

    On July 31, 2001, the Committee met in open session to 
consider S. 739, as amended, and other legislation pending 
before the Committee. The Committee voted by unanimous voice 
vote to report the Committee bill favorably to the Senate.

                     Summary of S. 739 As Reported

    S. 739, as reported (herein referred to as the ``Committee 
bill''), contains amendments to title 38, United States Code, 
and freestanding provisions that:

          (a) state the national goal of ending homelessness 
        within the next decade and encourage interagency and 
        multilevel cooperation in order to achieve this goal;
          (b) establish an Advisory Committee on Homeless 
        Veterans within VA that will examine and report to the 
        Secretary of Veterans Affairs on various services 
        provided to homeless veterans, and require annual 
        meetings of the Interagency Council on the Homeless;
          (c) mandate the continued support of at least one 
        evaluation center to monitor the effectiveness of VA's 
        various homeless programs;
          (d) require VA to report on the activities of both 
        the Veterans Benefits and Health Administrations in 
        assisting homeless veterans;
          (e) link the per diem rate for domiciliary care 
        allotted to State Veterans Homes to the amount given to 
        community-based organizations for homeless veterans 
        through the Grant and Per Diem Program, thereby raising 
        the amount from $19 to $24 per day for FY 2002;
          (f) clarify the eligibility for dental care services 
        to homeless veterans who are currently receiving care 
        or services through the VA;
          (g) authorize VA to spend up to $55 million per year 
        on the transitional housing Grant and Per Diem Program;
          (h) require VA to establish at least five new 
        comprehensive service centers for homeless veterans in 
        those metropolitan areas found to have the greatest 
        need;
          (i) extend the Homeless Chronically Mentally Ill and 
        Comprehensive Homeless Programs until December 31, 
        2006;
          (j) authorize the Secretary to allow homeless 
        veterans receiving care through the vocational 
        rehabilitation programs to participate in the 
        Compensated Work Therapy (CWT) program, authorize the 
        Secretary to allow homeless veterans in the CWT program 
        to receive housing through the therapeutic residence 
        program, require VA to report on Homeless Coordinators 
        assigned to VBA Regional Offices, and require each 
        disabled veterans outreach program specialist to 
        coordinate employment services and training assistance 
        provided to veterans by entities receiving grants under 
        the McKinney Act;
          (k) require that real property of grantees under VA's 
        homeless Grant and Per Diem Program meet fire and 
        safety requirements applicable under the Life Safety 
        Code of the National Fire Protection Association;
          (l) require the Secretary to conduct a technical 
        assistance grants program to assist nonprofit groups in 
        applying for grants for programs that address problems 
        of homeless veterans and authorize $750,000 for each of 
        FY's 2002 through 2006 for this purpose; and
          (m) extend the Homeless Veterans Reintegration 
        Program and authorize $50 million a year for each of 
        FY's 2002 through 2006.

                               Discussion

Background

    The VA currently administers a number of programs which 
furnish services aimed at addressing the needs of homeless 
veterans, including mental health and substance abuse 
treatment; social services such as case management, employment 
assistance, and transitional housing; and primary health care. 
In assisting homeless veterans to receive benefits, VA employs 
Homeless Coordinators at over 50 VBA Regional Offices who 
provide outreach to homeless veterans. Additionally, claims for 
VA benefits are expedited for homeless veterans in order to 
assist in the establishment of a steady income and return to 
stable housing. The two main health care programs that VA 
administers for homeless veterans are Health Care for Homeless 
Veterans (HCHV) and Domiciliary Care for Homeless Veterans 
(DCHV). In the area of social services, VA partners with 
community-based providers through the Transitional Housing 
Grant and Per Diem Program to be able to ensure that homeless 
veterans receive care across the continuum. Since 1987, VA has 
spent upward of $640 million on combating veterans' 
homelessness.
    The VA is certainly not alone in its quest to reduce 
homelessness. Today, eight different Federal departments and 
agencies administer about 50 low income and homeless assistance 
programs. These programs enable the provision of services such 
as primary and mental health care, substance abuse treatment, 
transitional and long-term housing, education, job training, 
and transportation. The total annual funding for all of these 
efforts now exceeds $1.2 billion.
    Still, homelessness remains a large and difficult problem 
for veterans and for the general population. It is estimated 
that roughly one-third of our Nation's total homeless 
population are veterans. As the homeless population is 
difficult to track, estimates of the total number of homeless 
veterans range from 250,000 to 500,000 on any given night. This 
Committee, VA, and the veterans service organizations all 
acknowledge that this is a national disgrace that must continue 
to be addressed. It is imperative that VA develop new programs 
to attempt to address unmet needs, while maintaining the 
current specialized programs they have specifically tailored to 
serve homeless veterans.
    Several of the provisions in the Committee bill seek to 
enhance VA's existing health care programs by extending current 
programs and by authorizing an increase in the appropriation 
level. The Grant and Per Diem Program, for example, is one VA 
program that has met with great success, and the Committee 
believes that an increase in funding is warranted. The 
Committee bill also places added emphasis on the benefits-
related programs for homeless veterans, by requiring annual 
reports on Veterans Benefits Administration programs and on the 
assignments of Homeless Coordinators at VBA Regional Offices.
    Another facet of the Committee bill would create new 
programs that will contribute to the overall quality of care VA 
delivers to homeless veterans. An example of this is the 
Advisory Committee on Homeless Veterans that would be 
established within VA.
    The title of this bill is also quite significant. By naming 
the bill for Heather French Henry, Miss America 2000, the 
Committee acknowledges her tenacity and dedication on behalf of 
homeless veterans. Mrs. Henry brought the issue of homeless 
veterans to national attention by committing herself to it 
during her reign and subsequent to the end of her tenure as 
Miss America. On March 9, 2000, she testified before the House 
Committee on Veterans' Affairs Subcommittee on Benefits and 
Health, expressing the harsh reality of the problem:

          On any given night there are the equivalent of 17 
        infantry divisions on the streets of this great nation 
        with no place to call home. These are men and women who 
        served our nation during its greatest times of need and 
        now live without shelter or food or medical care. They 
        are the once young men and women now aging who we sent 
        abroad to defend our country but cast aside upon their 
        return. They are our country's forgotten heroes, those 
        who at one time may have been awarded a Medal of Honor 
        or Purple Heart.

                             Committee Bill

Sections 1-3.

    Sections 1 through 3 include the following: findings as to 
the problem of homelessness in this country and the number of 
homeless veterans; a definition of ``homeless veteran''; and 
the declaration of a national goal to end homelessness among 
veterans in the coming decade.

Section 4. Advisory Committee on Homeless Veterans

    While the current Secretary of Veterans Affairs has 
declared his commitment to homeless veterans, there is 
currently no formal advisory committee mandated by legislation. 
The Secretary has already taken steps to form such a committee 
internally. On July 31, 2001, VA issued a press release 
announcing a plan to establish such an advisory group to ``make 
recommendations to the VA secretary and other senior VA 
leaders.'' Despite this recent action, this Committee seeks to 
formalize, via public law, such an advisory committee--ensuring 
that those who are closest to the problem will always have a 
voice. To that end, the advisory committee envisioned in the 
legislation would be made up of 12-15 members, and would 
consist of representatives from the veterans service 
organizations, community-based providers, homeless advocates, 
VA's homeless program employees, mental health and substance 
abuse treatment experts, state veterans affairs officials, 
experts in the development of permanent housing alternatives 
for lower income populations, vocational rehabilitation 
experts, and formerly homeless veterans. The following ex-
officio members will be included on the advisory committee: the 
Secretaries (or their representatives) of the Departments of 
Labor, Defense, Health and Human Services, and Housing and 
Urban Development.
    The primary role of this advisory committee will be to 
review current programs and make recommendations to the VA 
Secretary. The advisory committee will also conduct a 
comprehensive review of current outreach efforts to homeless 
veterans carried out by VA, and provide placement options for 
homeless veterans ineligible for vocational rehabilitation or 
independent living. At this time, there is no comparable body 
within VA to make recommendations to the Secretary on any of 
these issues as they relate to homeless veterans.
    While this Committee acknowledges and applauds the current 
Secretary's efforts to establish an advisory group, this 
Committee also recognizes that administrations change and wants 
to ensure that this initiative will be carried out through any 
changes in personnel.

Section 5. Annual Meetings of the Interagency Council on the Homeless

    In 1987, the Interagency Council on the Homeless was 
created by Public Law 100-77, with the intent of coordinating 
the homeless programs of the various Federal agencies that 
administer them. The council is chaired on a rotating basis by 
the Secretaries of Housing and Urban Development, Health and 
Human Services, Labor, and VA. However, the council has not met 
in over 5 years, as it lacks funding, organization, and 
leadership. Section 5 of the Committee bill seeks to rejuvenate 
the council by requiring that it meet at the call of its 
chairperson or a majority of its members, but not less often 
than annually. This Committee recognizes that the VA-HUD 
Appropriations Subcommittee and the Executive Branch have taken 
steps to do this by staffing and funding the council, and the 
Committee fully supports these efforts. The Committee bill, as 
in section 4, seeks to ensure that the council's support 
transcends changes in administrations by requiring annual 
meetings.

Section 6. Evaluation of Homeless Programs

    Performance measures are the primary method Congress 
employs to evaluate the effectiveness of any given program. 
With regard to homeless programs, these measures have been 
seriously lacking, and consequently it is difficult to 
determine which programs are successful and which are not. At 
the Committee's hearing on S. 739, the Veterans Organization 
Homeless Council (VOHC) endorsed this principle in the 
testimony of the Non-Commissioned Officers Association, a 
member of VOHC. Specifically, Richard Snyder of NCOA stated 
that:

          There is a need for evaluation of homeless programs 
        to ensure the effective use of resources. . . . A 
        greater emphasis on program outcomes is necessary to 
        assure that veterans' grant programs operated by the 
        Departments of Veterans Affairs, Labor, and Housing and 
        Urban Development are efficient and effective.

    VA already does a great deal of evaluation, primarily of 
its health care services for homeless veterans, through the 
Northeast Program Evaluation Center (NEPEC). Section 6 of the 
Committee bill would encourage the continued support of NEPEC. 
It also calls for two annual reports to Congress: one on VA's 
health care programs for homeless veterans, and one on VA's 
benefits-related programs for homeless veterans. As the bulk of 
evaluation up until now has been focused on health care, this 
bill seeks to include the benefits-related services provided by 
VA to homeless veterans in its regular evaluation processes.

Section 7. Per Diem Payments for Furnishing Services to Homeless 
        Veterans

    The VA Grant and Per Diem Program, authorized in 1992 by 
Public Law 102-590, has proven to be highly successful. As a 
result of the program, about 5,000 new beds will be available 
to homeless veterans.
    Under the program, community-based providers may apply for 
grants from VA to provide direct services to homeless veterans. 
In addition to providing grants, VA also subsidizes eligible 
facilities with a daily per diem rate, currently $19 per day, 
for expenses of care. Section 7 of the Committee bill would 
link this daily rate to the amount given for domiciliary care 
allotted to State Veterans Homes, thereby raising the rate from 
$19 to $24 per day. Homeless service providers in the community 
have expressed the need for this increase, as the National 
Coalition for Homeless Veterans (NCHV) estimates that the cost 
of providing beds alone is expected to increase next year. 
According to NCHV, if the increase in the daily rate is not 
implemented, we can expect the elimination of up to 1,000 beds 
for homeless veterans.

Section 8. Dental Care for Homeless Veterans

    Dental care is considered by many homeless advocates, such 
as the National Coalition for Homeless Veterans, to be 
essential in assisting homeless veterans obtain employment. It 
is understandably difficult to apply for a job with serious 
dental problems. S. 739, as introduced, contained a requirement 
that substantial new dental benefits for homeless veterans be 
provided. VA strongly opposed this proposal for a number of 
reasons, most notably the relative inadequacy of the current 
dental care eligibility for all veterans. VA expressed this in 
their testimony at the Committee hearing on S. 739:

          Although we recognize that these veterans need dental 
        care and services, we do not support this provision 
        because it would result in a disparity in access to 
        needed outpatient dental care and services among 
        equally deserving veterans. As an alternative, we will 
        heighten and expand our current efforts to obtain 
        dental care and services for homeless veterans through 
        pro bono providers, dental schools and related teaching 
        programs, and service providers receiving grants under 
        VA's Homeless Providers Grant and Per Diem Program.

    In response to these concerns, section 8 of the Committee 
bill would amend section 1712(a) of title 38 U.S.C. to clarify 
eligibility for dental care services under the law. The 
Committee encourages VA to do what is necessary to facilitate 
dental care for homeless veterans through available sources.

Section 9. Programmatic Expansions

    To complement the increase in the daily per diem rate under 
the Grant and Per Diem program, section 9 of the Committee bill 
would provide an overall funding cap for the grants portion of 
the program. It would authorize VA to spend up to $55 million a 
year on grants to community-based service providers. Since the 
inception of the program, 243 grants have been approved and the 
numbers are expected to increase.
    Section 9 also requires the establishment of at least five 
new comprehensive service centers for homeless veterans. These 
centers are to be located in those metropolitan areas found to 
have the greatest need. The Committee intends to give VA 
discretion in determining where the need for homeless services 
is highest, as well as flexibility in the number of new centers 
to be created in accordance with the demand found in the 
various metropolitan areas that do not currently have such 
services.
    The Committee bill also extends the Homeless Chronically 
Mentally Ill (HCMI) and Comprehensive Homeless Programs until 
December 31, 2006. As these programs offer services targeted 
specifically to meet the needs of homeless veterans, extending 
them is necessary for maintaining the continuum of care 
essential to ending homelessness. The Homeless Chronically 
Mentally Ill program, in particular, provides extensive 
outreach, physical and psychiatric health exams, treatment, 
referrals, and ongoing case management to homeless veterans 
with mental health and substance abuse problems. The HCMI 
program will also place homeless veterans needing longer-term 
care into community-based facilities as deemed appropriate. 
Over 20,000 homeless veterans have received treatment under the 
HCMI program, with over 3,000 veterans receiving residential 
treatment.
    The Comprehensive Homeless Program encompasses all of the 
services that compose the ``continuum of care'' often referred 
to with regard to the treatment of the homeless. This section 
of the bill is directly related to section 9, which requires VA 
to establish at least five new comprehensive service centers in 
the metropolitan areas determined to need those services the 
most. The services offered at these centers through the 
Comprehensive Homeless Program include the full range from 
mental health/substance abuse treatment to transitional 
housing. The program enables these centers to offer such a wide 
array of services through partnerships with community-based 
providers.

Section 10. Various Authorities

    In an effort to make some of VA's existing homeless 
veterans employment training programs better complement each 
other, the Committee bill would allow homeless veterans already 
receiving care through vocational rehabilitation programs to 
participate in the Compensated Work Therapy (CWT) program. 
Additionally, the bill would permit homeless veterans in the 
CWT program to receive housing through the therapeutic 
residence program or through grantees of VA's homeless 
providers Grant and Per Diem Program. At the Committee's 
hearing, VA testified in support of both of these provisions.
    Section 10 would also require a report from VA on the 
current assignments of Homeless Coordinators at each of the 
Veterans Benefits Administration's Regional Offices. This is 
based on Section 14(c) of S. 739, as introduced, which would 
have required the Secretary to ensure that a Homeless 
Coordinator is assigned to every regional office. The need to 
make sure that there is substantial oversight and coordination 
of homeless programs is recognized by this Committee. 
Therefore, the Committee amended the original provision to 
instead require a report on the current assignments of Homeless 
Coordinators. Specifically, the report would be required to 
include a list of those regional offices that already have 
Homeless Coordinators; a description of the caseload and how 
the duties of the coordinator are assigned, such as whether 
they are collateral or full-time; and evaluations of the need 
for such services at the various regional offices and how that 
need is currently being met, if not by an assigned Homeless 
Coordinator.
    Rather than mandating the assignment of a Homeless 
Coordinator to every regional office--included in S. 739 as 
originally introduced--the Committee has chosen to give VA 
discretion in assigning this position so as to avoid 
duplication or lack of necessity in assigning such a 
Coordinator to a given regional office.

Section 11. Life Safety Code for Grant and Per Diem Providers

    Under current law, Grant and Per Diem providers are not 
required to meet Federal fire safety standards, even if they 
are receiving Federal monies. Section 11 would change this by 
requiring that real property of grantees under VA's Homeless 
Grant and Per Diem Program meet fire and safety requirements 
applicable under the Life Safety Code of the National Fire 
Protection Association. All the witnesses at the Committee's 
hearing supported this change.

Section 12. Assistance for Grant Applications

    While VA has provided more than 200 grants through the 
Grant and Per Diem Program since its inception in 1994, over 
400 applicants have been denied funding, according to the 
National Coalition for Homeless Veterans. This is due to a 
number of factors, including potential grantees' inability to 
master the complex application processes of the multiple 
federal agencies that offer grants. As many of these providers 
are nonprofit organizations, grant money is often their primary 
source of funding.
    Section 12 would require the Secretary of Veterans Affairs 
to conduct a technical grants assistance program to help these 
nonprofit groups in applying for grants for programs that 
address the problems of homeless veterans. The bill authorizes 
$750,000 for this purpose for each of fiscal years 2002 through 
2006. It is the Committee's goal that this will lead to an 
increase in the number of successful applicants, as it will 
allow more service providers to correctly apply for grants 
through the Grant and Per Diem Program.

Section 13. Extension of Homeless Veterans Reintegration Program

    The Homeless Veterans Reintegration Program is administered 
through the Department of Labor's Veterans' Employment and 
Training Service. It is one of the few programs that focuses 
specifically on assisting homeless veterans in obtaining 
employment. This program is critical in combating homelessness, 
as it provides the job training and placement necessary to 
reintegrate veterans into the workforce. It is also a 
relatively low cost program. The National Coalition for 
Homeless Veterans emphasized these points at the Committee's 
July 19, 2001, hearing, stating that:

          HVRP is an extraordinarily cost efficient program, 
        with a cost per placement of about $1,500 per veteran 
        entering employment. Based on years of experience of 
        our member organizations, NCHV strongly believes that 
        helping homeless veterans to get and keep a job is the 
        key to reducing homelessness among veterans.

    Section 13 of the reported bill would extend this program 
and authorize $50 million per year for each of fiscal years 
2002 through 2006.

                             Cost Estimate

    In compliance with paragraph 11(a) of rule XXVI of the 
Standing Rules of the Senate, the Committee, based on 
information supplied by the Congressional Budget Office (CBO), 
estimates that, compared to the CBO baseline, there would be 
costs resulting from enactment of the Committee bill.
    The cost estimate provided by CBO follows:

                                     U.S. Congress,
                               Congressional Budget Office,
                                   Washington, DC, August 17, 2001.
Hon. John D. Rockefeller IV,
Chairman, Committee on Veterans' Affairs,
U.S. Senate, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for S. 739, the Heather 
French Henry Homeless Veterans Assistance Act.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Sam 
Papenfuss.
            Sincerely,
                                          Dan L. Crippen, Director.
    Enclosure.

S. 739, Heather French Henry Homeless Assistance Act of 2001 (As 
        ordered reported by the Senate Committee on Veterans' Affairs 
        on August 2, 2001)

                                SUMMARY

    S. 739 contains several provisions that would change how 
the Department of Veterans Affairs (VA) provides assistance to 
homeless veterans. The bill would extend the authority for VA 
to provide health care to homeless veterans outside of VA 
facilities. S. 739 also would require VA to establish at least 
five new comprehensive homeless services centers and increase 
funding for programs that provide shelter to homeless veterans. 
In addition, the bill would authorize more money for the 
homeless veterans reintegration program operated by the 
Department of Labor.
    S. 739 would authorize funding or modify provisions 
governing discretionary spending for veterans' programs, which 
CBO estimates would result in additional outlays of $37 million 
in 2002 and $342 million over the 2002-2006 period, assuming 
appropriation of the necessary amounts. Because the bill would 
not affect direct spending or receipts, pay-as-you-go 
procedures would not apply.
    S. 739 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 impact of S. 739 is shown in the 
following table. This estimate assumes that S. 739 will be 
enacted by October 1, 2001, and that the necessary amounts will 
be appropriated for each year. The costs of this legislation 
fall within budget functions 500 (education, employment, and 
social services) and 700 (veterans benefits and services).

                                    [By Fiscal Year, in Millions of Dollars]
----------------------------------------------------------------------------------------------------------------
                                                              2001     2002     2003     2004     2005     2006
----------------------------------------------------------------------------------------------------------------

VETERANS' MEDICAL CARE

Baseline Spending Under Current Law:
  Estimated Authorization Level a.........................   20,863   21,866   22,110   22,839   23,547   24,285
  Estimated Outlays.......................................   20,418   21,501   22,020   22,613   23,298   24,028
Proposed Changes:
  Estimated Authorization Level...........................        0       36       37       39       40       40
  Estimated Outlays.......................................        0       33       37       38       39       40
Spending Under S. 739:
  Estimated Authorization Level...........................   20,863   21,902   22,147   22,878   23,587   24,325
  Estimated Outlays.......................................   20,418   21,534   22,057   22,651   23,337   24,068

ASSISTANCE FOR GRANT APPLICATIONS

Spending Under Current Law:
  Estimated Authorization Level...........................        0        0        0        0        0        0
  Estimated Outlays.......................................        0        0        0        0        0        0
Proposed Changes:
  Estimated Authorization Level...........................        0        1        1        1        1        1
  Estimated Outlays.......................................        0        1        1        1        1        1
Spending Under S. 739:
  Estimated Authorization Level...........................        0        1        1        1        1        1
  Estimated Outlays.......................................        0        1        1        1        1        1

HOMELESS VETERANS REINTEGRATION PROGRAM

Spending Under Current Law b:
  Authorization Level.....................................       15       20       20        0        0        0
  Estimated Outlays.......................................        0        2       14       18        6        0
Proposed Changes:
  Authorization Level.....................................        0       30       30       50       50       50
  Estimated Outlays.......................................        0        3       21       32       44       50
Spending Under S. 739:
  Authorization Level.....................................       15       50       50       50       50       50
  Estimated Outlays.......................................        0        5       35       50       50       50

SUMMARY OF CHANGES IN SPENDING SUBJECT TO APPROPRIATION

Estimated Authorization Level.............................        0       67       68       90       91       91
Estimated Outlays.........................................        0       37       59       71       84       91
----------------------------------------------------------------------------------------------------------------
a The 2001 level is the estimated amount appropriated for that year. The current-law amounts for the 2002-2006
  period assume that appropriations remain at the 2001 level, with adjustments for inflation.
b This program was authorized by Public Law 106-117, but the Congress has not appropriated any money for it yet.
  ``Spending Under Current Law'' reflects the prior authorization and CBO's estimate of outlays if funds were
  appropriated for 2002 and 2003.

                         BASIS OF THE ESTIMATE

    Veterans Medical Care. CBO estimates that implementing S. 
739 would increase discretionary spending for veterans' medical 
care by $33 million in 2002 and by $187 million over the 2002-
2006 period.
    Comprehensive homeless services program. Under current law, 
VA provides at least 15 different programs to assist homeless 
veterans. These services are provided in over 140 cities across 
the country but no one location offers all of the programs. 
Within this framework, VA operates eight centers that offer 
comprehensive homeless services. Under section 9, VA would be 
required to establish at least five new similar centers.
    Since none of the existing centers provide exactly the same 
services, CBO assumes that these new centers would offer those 
services that are provided by a majority of the existing 
centers. Seven programs are provided by at least four of the 
eight centers including domiciliary care for homeless veterans, 
compensated work therapy, and the grant and per diem programs. 
Of the seven programs, six are not available in most major 
metropolitan areas where these new centers would likely be 
established. For those programs that do not already exist in 
these metropolitan areas, CBO used data from VA to calculate 
the average cost to establish and administer each program. CBO 
estimates that creating these comprehensive homeless services 
centers and operating these programs would cost $11 million in 
2002 and $59 million over the 2002-2006 period, assuming 
appropriation of the estimated amounts.
    Grant and per diem programs. Under current law, VA may 
provide grants to nonprofit organizations that serve the 
homeless. These grants partially subsidize the construction, 
acquisition, and outreach costs of providing shelter and beds 
to homeless veterans but not the daily costs of the operation. 
VA may also provide a per diem payment that covers not more 
than 50 percent of the daily costs of providing shelter to 
homeless veterans. These rates are calculated annually to 
ensure that VA does not pay more than half of the daily costs 
of providing shelter. In 2001, VA estimated that it would spend 
about $33 million on the two programs. Funding for these 
programs comes from VA's annual appropriation for medical care.
    Section 9 of S. 739 would allow VA to spend not less than 
$55 million of its annual medical care appropriation on the 
grant and per diem program with that amount increasing at the 
same rate that the annual medical care appropriation increases. 
CBO assumes that in the absence of this bill, VA would continue 
to spend what it has in the past on the grant and per diem 
program, with adjustments for inflation. Accordingly, CBO 
estimates that this provision would increase spending by $19 
million in 2002 and by $107 million over 2002-2006 period, 
assuming appropriation of the authorized amounts.
    Section 7 would affect the grant and per diem programs by 
changing the way per diem rates are calculated. Under the bill, 
VA would use the same rate that is authorized for veterans 
receiving domiciliary care at VA State Homes. That rate is 
about $3 per day higher than the average rate paid for homeless 
shelter. According to VA, the number of beds in use will double 
from 2,500 in 2001 to about 5,000 in 2003. Thus, CBO estimates 
that this provision would cost $3 million in 2002 and $21 
million over the 2002-2006 period, assuming appropriation of 
the estimated amounts.
    Medical care for homeless veterans. Section 9 would extend 
for five years a provision of current law that allows VA to 
provide outreach services to homeless veterans and medical care 
in non-VA facilities including community-based treatment 
facilities and halfway houses. This provision is due to expire 
on December 31, 2001. VA currently plans to spend about $60 
million in 2001 to provide medical care to homeless veterans 
both in and out of VA facilities. Based on data from VA, CBO 
estimates that about 20 percent of that care is provided under 
the expiring provision. Consequently, CBO estimates that 
allowing VA to continue these services would cost $8 million in 
2002 and $60 million over the 2002-2006 period, assuming 
appropriation of the estimated amounts. Because VA is currently 
funding this program, the costs associated with this provision 
are assumed in the baseline levels shown for medical care.
    Assistance for Grant Applications. Section 12 would 
authorize $750,000 in each of fiscal years 2002 through 2006 
for technical assistance grants to not-for-profit groups with 
experience in providing assistance to homeless veterans. These 
funds would help the groups in applying for grants relating to 
addressing problems of homeless veterans. CBO estimates that 
implementing this section would cost about $4 million over the 
2002-2006 period, assuming appropriation of the authorized 
amounts.
    Homeless Veterans Reintegration Program. Section 13 would 
increase the authorization of appropriations to be used by the 
Department of Labor to integrate homeless veterans into the 
labor force from $20 million to $50 million for 2002 and 2003. 
It would also authorize $50 million a year for 2004, 2005, and 
2006. Although the program was authorized by Public Law 106-
117, the Congress has not yet appropriated any money for it. 
CBO estimates that the increased authorization would cost $3 
million in 2002 and $150 million over the 2002-2006 period, 
assuming appropriation of the authorized amounts.

                      PAY-AS-YOU-GO CONSIDERATIONS

    None.

              INTERGOVERNMENTAL AND PRIVATE-SECTOR IMPACT

    S. 739 contains no intergovernmental or private-sector 
mandates as defined in UMRA and would impose no costs on state, 
local, or tribal governments.

                         PREVIOUS CBO ESTIMATE

    On April 12, 2001, CBO prepared a cost estimate of H.R. 
936, also called the Heather French Henry Homeless Veterans 
Assistance Act. Sections 7, 12, and 13 in S. 739 are identical 
to sections 8, 17, and 19 in H.R. 936. Unlike section 12 of 
H.R. 936, section 8 of S. 739 would not change the benefit for 
dental care for homeless veterans. In addition, section 9 of S. 
739 is similar to section 13 of H.R. 936, but S. 739 does not 
contain any provisions regarding mental health, or opioid 
substitution therapy and authorizes at least five additional 
comprehensive homeless services programs as opposed to 14 
additional programs under H.R. 936.
    Estimate prepared by: Federal Costs: Sam Papenfuss and 
Christi Hawley Sadoti. Impact on State, Local, and Tribal 
Governments: Elyse Goldman. Impact on the Private Sector: Sally 
Sagraves Maxwell.
    Estimate approved by: Peter H. Fontaine, Deputy Assistant 
Director for Budget Analysis, Congressional Budget Office.

                      Regulatory Impact Statement

    In compliance with paragraph 11(b) of rule XXVI of the 
Standing Rules of the Senate, the Committee on Veterans' 
Affairs has made an evaluation of the regulatory impact that 
would be incurred in carrying out the Committee bill. The 
Committee finds that the Committee bill would not entail any 
regulation of individuals or businesses or result in any impact 
on the personal privacy of any individuals and that the 
paperwork resulting from enactment would be minimal.

                 Tabulation of Votes Cast in Committee

    In compliance with paragraph 7 of rule XXVI of the Standing 
Rules of the Senate, the following is a tabulation of votes 
cast in person or by proxy by members of the Committee on 
Veterans' Affairs at its August 2, 2001, meeting. On that date, 
the Committee, by unanimous voice vote, ordered S. 739, as 
amended, reported favorably to the Senate.

                             Agency Report

    On July 19, 2001, the Honorable Thomas L. Garthwaite, Under 
Secretary for Health at the Department of Veterans Affairs, 
appeared before the Committee and submitted testimony on, among 
other things, S. 739 as originally introduced, the Heather 
French Henry Homeless Veterans Assistance Act of 2001. Excerpts 
from this statement are reprinted below:

  STATEMENT OF THOMAS L. GARTHWAITE, M.D, UNDER SECRETARY FOR 
HEALTH, DEPARTMENT OF VETERANS AFFAIRS

           *       *       *       *       *       *       *

    Mr. Chairman, I will begin by offering comments on S. 739, 
a bill entitled the Heather French Henry Homeless Veterans 
Assistance Act. The bill is an ambitious and comprehensive 
piece of legislation that seeks to improve the services and 
benefits furnished to homeless veterans. We strongly support 
the objectives of the bill and generally support many of its 
provisions. However, we are unable to support some of the 
provisions largely because they duplicate long-standing 
activities and programs conducted by the Department for 
homeless veterans or more recent initiatives begun in Fiscal 
Year 2000. Today I will briefly comment on each of the sections 
of the bill.
    Section 2 articulates Congress' findings regarding the 
magnitude and scope of homelessness among veterans, the 
inadequacy of current programs to provide them needed services, 
the levels of funding needed to provide beds to homeless 
veterans, and the commitment of the Congress to end 
homelessness among the Nation's veterans. Other findings 
articulate statistical information obtained from VA's report on 
activities conducted under the Community Homelessness 
Assessment, Local Education and Networking Groups (CHALENG) 
program for veterans. Section 2 also defines various terms used 
in the bill.
    It is important to note that in light of more recent 
information from our CHALENG program the number of homeless 
veterans, as well as the number of additional beds needed for 
homeless veterans, are likely to be somewhat lower than the 
numbers cited in section 2.
    Section 3 would declare a national goal of ending 
homelessness among veterans within a decade and encourage all 
governmental components, quasi-governmental departments, 
agencies, and private and public sector entities to work 
cooperatively in reaching this goal. We strongly support 
section 3.
    Section 4 would establish a 15-member Advisory Committee on 
Homeless Veterans within the Department of Veterans Affairs, 
articulate the functions and responsibility of the committee, 
and establish the pay, allowances and terms for members. It 
would also establish various reporting requirements. We share 
the view that an advisory committee would be beneficial, but a 
statutorily-created Committee is not needed. The Secretary has 
already announced his intention to establish an Advisory 
Committee on Homeless Veterans with many of the same functions 
and objectives.
    Section 5 would amend the McKinney-Vento Homeless 
Assistance Act to require that the Interagency Council on 
Homeless (ICH) meet at the call of its Chairperson or a 
majority of its members and that the ICH meet at least 
annually. We support this provision.
    Section 6 is concerned with evaluation of our programs for 
homeless veterans and calls for reporting to Congress on those 
programs. It would require the Secretary to support the 
continuation of at least one Department center for evaluation 
to monitor the structure, process, and outcome of VA's programs 
for homeless veterans. It would further require the Secretary 
to annually provide Congress with a detailed report on the 
health care needs of homeless veterans including information on 
our Health Care for Homeless Veterans Program (HCHV) and 
Homeless Providers Grant and Per Diem Program. Section 6 would 
also require that we carry out our CHALENG assessment program 
on an annual basis and report to Congress on the findings and 
conclusions of the CHALENG report.
    We support the objective of the requirement for maintenance 
of an evaluation center, as called for in section 6, but we 
believe the objective can be achieved without legislation by 
expanding the mission of our Northeast Program Evaluation 
Center (NEPEC). We currently rely on NEPEC to monitor and 
evaluate the services provided to homeless veterans. Its 
current efforts are comprehensive with respect to the health 
care related services that are available and furnished to 
homeless veterans. However, we capture limited information on 
outreach activities and monetary benefits administered by the 
Veterans Benefits Administration (VBA) in connection with 
homeless veterans. Recognizing that our current efforts in this 
area are fragmented and incomplete, we plan to take steps to 
improve and strengthen the reporting of all programs and 
benefits to fully and effectively monitor and evaluate all of 
the Department's programs for homeless veterans.
    We do not support the requirements of section 6 that would 
statutorily require additional reporting and assessment 
activities. We are essentially already performing these 
assessment activities and reporting on them. Through the NEPEC, 
we provide ongoing monitoring and evaluation of our health care 
programs for homeless veterans. NEPEC provides detailed reports 
on structure, process, and outcomes for all specially funded 
homeless veterans programs as well as evaluation support for a 
wide range of other mental health programs that are not 
exclusively targeted to homeless veterans but are utilized by 
homeless veterans such as the Compensated Work Therapy (CWT) 
Program, and the Compensated Work Therapy/Transitional 
Residence (CWT/TR) Program. In addition, the CHALENG program 
achieves the objectives of the proposed requirements.
    Section 7 would require the Secretary to designate care and 
services provided to certain specified veterans as ``complex 
care'' for purposes of the Veterans Equitable Resource 
Allocation system (VERA). Veterans receiving the following 
types of care would be covered: (1) veterans enrolled in the 
Mental Health Intensive Community Case Management program; (2) 
continuous care in homeless chronically mentally ill veterans 
programs; (3) continuous care within specialized programs 
provided to veterans who have been diagnosed with both serious 
chronic mental illness and substance abuse disorders; (4) 
continuous therapy combined with sheltered housing provided to 
veterans in specialized treatment for substance use disorders; 
and (5) specialized therapies provided to veterans with post-
traumatic stress disorders (PTSD), including specialized 
outpatient PTSD programs; PTSD clinical teams; women veterans 
stress disorder treatment teams; and substance abuse disorder 
PTSD teams. Finally, section 7 would require that we ensure 
that funds for any new program for homeless veterans carried 
out through a Department health care facility are designated as 
special purpose program funds (not VERA funds) for the first 
three years of the program's operation.
    We do not support section 7 of the bill. The complex 
reimbursement rate under the VERA system is currently reserved 
for reimbursing VISNs for providing the most complex and 
expensive care, and should not be based on diagnosis or type of 
disorder being treated. Section 7 directs complex reimbursement 
based on broad and general diagnosis and does not consider 
whether the care is costly. For example, VA now treats some 
2,800 veterans in its Mental Health Intensive Community Case 
management (MHICM) Program. If a veteran in that program 
receives at least 41 visits per year, the VERA model will 
reimburse at the complex rate because that veteran is receiving 
costly care. Many others in the program have far fewer visits 
and are far less costly to treat. Section 7 of this bill would 
require complex reimbursement for all of 2,800 veterans in the 
program regardless of how many visits they have.
    The proposal could add more than 200,000 additional 
veterans into the category of patients for whom Veterans 
Integrated Service Networks (VISNs) receive complex 
reimbursement. This would require VHA to either set aside a 
greater percentage of the medical care appropriation for the 
care of veterans identified in this section, or significantly 
reduce the complex reimbursement rate per veteran treated. 
Neither option is acceptable. The first reduces funding for the 
standard care of veterans, and the second dilutes the 
reimbursement for complex care so that there is little 
incentive to provide services to these veterans. In addition, 
this approach provides a perverse incentive for clinicians to 
provide more treatment than is needed in order to qualify for 
the complex reimbursement rate. The effect of this provision 
would be to reduce the availability to veterans, including many 
who are homeless, of care not identified in the complex 
reimbursement category.
    Section 8 would require that per diem payments paid to 
grantees of our Homeless Providers Grant and Per Diem Program 
be calculated at the same rate that currently applies to VA per 
diem payments to State homes providing domiciliary care to 
veterans. Under current law, the homeless provider per diem 
rates are based on each grant recipient's costs. In short, we 
pay per diem that amounts to not more than 50% of the 
recipient's total costs up to a cap. To calculate the per diem 
rate for each grantee, we must document each recipient's costs. 
This is an extremely labor intensive and complex process.
    We support simplification of program management in the 
manner proposed. However, since domiciliary care and care under 
the Homeless Providers Grant and Per Diem Program vary in types 
of services and intensity, we support a per diem rate of 85 
percent of the domiciliary care per diem rate. That would 
equate more closely with the actual cost of services provided 
under the Homeless Providers Grant and Per Diem Program.
    Section 9 would require that we carry out a new grant 
program for VA health care facilities and grantees of VA's 
Homeless Grant and Per Diem Payment Program. The new program 
would encourage the development of programs targeted at meeting 
special needs of homeless veterans, including those who are 
women, who are age 50 or older, who are substance abusers, who 
suffer from PTSD, a terminal illness, or a chronic mental 
illness; or who have care of minor dependents or other family 
members. The measure would also require a report that includes 
a detailed comparison of the results of the new grant program 
with those obtained for similar veterans in VA programs or in 
programs operated by grantees of VA's Homeless Providers Grant 
and Per Diem Program.
    We appreciate the intent of this provision, but we do not 
support the section because it appears to be unnecessary. We 
currently operate and/or support successful programs that are 
specifically targeted at meeting the special needs of these 
particularly vulnerable groups of homeless veterans. We 
undertook several special program initiatives in 2000 that were 
specifically targeted at the special needs of homeless 
veterans, including women veterans. A study of the 
effectiveness of the initiative related to homeless programs 
for women veterans is underway. Finally, we have been 
successful in establishing and cultivating relations with non-
profits in the community to ensure a continuum of services for 
homeless veterans. We are concerned that this proposal may have 
a disruptive effect on those relationships by requiring our 
community partners to compete with VA facilities for these 
limited grant funds.
    Section 10 would require that appropriate officials of our 
Mental Health Service and Readjustment Counseling Service 
initiate a coordinated plan for joint outreach on behalf of 
veterans at risk of homelessness, expressly including those who 
are being discharged from institutions such as inpatient 
psychiatric care units, substance abuse treatment programs, and 
penal institutions. The section sets out a detailed list of 
items and factors to be included or provided for in the plan.
    We support this provision in concept but suggest that it 
may be duplicative of our current outreach authority and 
statutory requirement to coordinate with other governmental and 
non-governmental agencies and organizations. However, we 
recognize the need for continuing to expand and improve our 
coordination efforts on behalf of homeless veterans and those 
at risk for homelessness and the concomitant need to report 
adequately on these efforts. We will work towards these ends.
    As to the issue of coordination between VHA and Vet 
Centers, our Health Care for Homeless Veterans (HCHV) Programs 
staff, who primarily serve under mental health service lines at 
VA medical centers, currently collaborate with Vet Centers 
staff regarding the needs of homeless veterans. (Vet Centers 
estimate that approximately 10% of veterans served in Vet 
Centers are homeless.) Referrals are regularly made between 
VA's specialized homeless programs and Vet Centers for 
appropriate services for veterans who are homeless or at risk 
for homelessness. In addition, Vet Centers staff are invited to 
attend and participate in CHALENG meetings. Further, HCHV staff 
and Vet Centers staff already collaborate with non-VA 
community-based service providers and with other government 
sponsored programs.
    Section 11 would require that we conduct two treatment 
trials in integrated mental health services delivery. The bill 
defines ``integrated mental health services delivery'' as ``a 
coordinated and standardized approach to evaluation for 
enrollment, treatment, and follow-up with patients who have 
both mental health disorders (to include substance use 
disorders) and medical conditions between mental health and 
primary health care professionals.'' One of the treatment 
trials would have to use a model incorporating mental health 
primary care teams and the other would have to use a model 
using patient assignment to a mental health primary care team 
that is linked with the patient's medical primary care team. We 
would also have to compare treatment outcomes obtained from the 
two treatment trials with those for similar chronically 
mentally ill veterans who receive treatment through 
traditionally consultative relationships. The VA Inspector 
General would have to review the medical records of 
participants and controls for both trials to ensure that the 
results are accurate.
    We share an interest in this area of clinical research and 
have decided to carry out the project contemplated by section 
11 using mechanisms and special programs already in place, i.e. 
VA's Health Services Research and Development Service and the 
Department's MIRECCs program. In pursuing this endeavor, we 
welcome the opportunity to work with Committee staff to ensure 
the language of the request for research proposals satisfies 
the objectives of section 11. However, this particular research 
study (including the final analysis and report to Congress) 
would likely require more than the amount of time permitted 
under section 11. Additionally, VA program officials and 
evaluators will be expected to manage and report on the results 
of a project of this size without immediate and direct 
oversight from the Office of the Inspector General (OIG). If 
there is a need for human subject protection review, the Office 
of Research and Compliance Assurance (ORCA) should conduct it 
and OIG involvement should consist only of their current 
oversight of the activities of ORCA.
    Section 12 would effectively extend eligibility for 
outpatient dental services, treatment, and appliances to 
certain veterans when such services, treatment, and appliances 
are needed to successfully gain or regain employment, to 
alleviate pain, or to treat moderate, severe, or severe and 
complicated gingival and periodontal pathology. The new 
authority would extend benefits to enrolled veterans who are 
receiving care in an array of VA settings, and community 
programs supported by VA.
    Although we recognize that these veterans need dental care 
and services, we do not support this provision because it would 
result in a disparity in access to needed outpatient dental 
care and services among equally deserving veterans. As an 
alternative, we will heighten and expand our current efforts to 
obtain dental care and services for homeless veterans through 
pro bono providers, dental schools and related teaching 
programs, and service providers receiving grants under VA's 
Homeless Providers Grant and Per Diem Program.
    Section 13 contains several varied provisions. The first 
would require the Secretary to develop standards to ensure that 
mental health services are available to veterans in a manner 
similar to that in which primary care is made available to 
veterans by requiring every VA primary care health care 
facility to have mental health treatment capacity. We certainly 
believe in equitable availability of mental health services and 
we have included such services in our basic benefits package. 
We are also already working to assure that all sites of care 
can either directly provide, contract for, or refer patients to 
other VA facilities for mental health care.
    Another provision in section 13 would require that we 
expend not less than $55 million from Medical Care funds for 
our Homeless Providers Grant and Per Diem Program. The amounts 
to be expended would also have to be increased for any fiscal 
year by the overall percentage increase in the Medical Care 
account for that fiscal year from the preceding fiscal year. We 
don't concur with this provision. We have offered grant funds 
each year for the past seven years. Grant fund availability has 
ranged from a low of $3.3 million in FY 1996 to a high of $15.3 
million in FY 1998. Of the $32.4 million identified for the 
Grant and Per Diem Program in FY 2001, approximately $22 
million is expected to be spent on per diem payments, leaving 
$10 million available for the eighth round of grants. We 
believe that making $10 million available for grants is a 
reasonable funding level for any given year. Grant awards of 
$10 million assist with the development of approximately 1,000 
community-based beds. It often takes grant recipients two years 
or longer to complete construction or renovation and to bring 
the program to full operation. During the development phase, VA 
staff at the national, VISN and VAMC level are available to 
assist grant recipients with any problems they might encounter. 
We believe this personal attention and assistance are partially 
responsible for the relatively high success rate of grant 
program implementation. Steady and reasonable growth in the 
Homeless Providers Grant and Per Diem Program appears to be one 
of the keys to the success of this program. It is likely that 
the Grant and Per Diem Program will reach a spending level of 
$55 million in the next five years.
    Moreover, a requirement to spend not less than $55 million 
next year and in future years may actually be counter-
productive to achieving the goals of this program because it 
would require VA to fund programs that would otherwise not 
merit grant assistance based on competitive scoring criteria. 
Past experience has shown VA that not all grant applicants are 
able to propose viable projects. Indeed, less than 50 
applications received in any given year satisfy scoring 
criteria. This is not indicative of a program weakness; rather, 
it reflects the requirement that we award grants under the 
program only to those providers that demonstrate their 
viability and ability to succeed in meeting their grant 
applications' stated purpose(s).
    A third part of section 13 would require that we establish 
centers to provide comprehensive services to homeless veterans 
in at least each of the 20 largest metropolitan statistical 
areas. Currently, we must have eight such centers.
    We support this provision, but defining what services would 
constitute a comprehensive homeless services program for each 
of the 20 largest metropolitan statistical areas is a 
particularly complex task, which depends on the specific 
demographics of, and the services available in, each particular 
area. We would like to work with the Congress in defining what 
specific programs and services are envisioned by this 
provision.
    A fourth aspect of Section 13 would require us to ensure 
that opioid substitution therapy is available at each VA 
medical center. We don't support this provision on the basis 
that a determination to provide opioid substitution therapy is 
medical in nature (not legislative) and, as such, is dependent 
on the individual clinical facts of each case. The size and 
location of medical programs should be determined by veterans' 
medical needs. However, we recognize the clinical value of this 
particular treatment. Indeed, we have established 36 opioid 
substitution programs in VA medical centers across the country 
and we are evaluating our substance abuse treatment needs to 
determine whether additional programs may be needed. If deemed 
to be medically necessary and appropriate, we will not hesitate 
to establish more programs where needed.
    Finally, the last part of section 13 would extend, through 
December 31, 2006, both our authority to treat veterans who are 
suffering from serious mental illness, including veterans who 
are homeless and VA's authority to provide benefits and 
services to homeless veterans through VA's Comprehensive 
Homeless Centers. The authority for each of those programs will 
expire on December 31, 2001 and we support both extensions.
    Section 14 would permit homeless veterans receiving care 
through vocational rehabilitation programs to participate in 
the Compensated Work Therapy program. It would also allow 
homeless veterans in VHA's Compensated Work Therapy program to 
receive housing through the therapeutic residence program or 
through grantees of VA's Homeless Providers Grant and Per Diem 
Program. We support both of those provisions.
    Section 14 would also require that we ensure that each 
Regional Office assign at least one employee to oversee and 
coordinate homeless veterans programs in that region, and that 
any regional office with at least 140 employees have at least 
one full-time employee assigned to the above-stated functions.
    We support the need for continued effective outreach to 
homeless veterans, but we have concerns about the proposed 
staffing requirements. Homeless Veterans Outreach Coordinators 
are already assigned at each VBA regional office. In most 
instances, this assignment is a collateral duty and not a full-
time assignment. There are, however, some regional offices at 
which a full-time coordinator is assigned as necessitated by 
the size of the homeless veteran population and homeless 
support programs within its jurisdictional area. In addition, 
we have eight full-time homeless outreach coordinators assigned 
as members of our Health Care for Homeless Veterans Program and 
DCHV programs. We also have two offices that have a part-time 
employee on the homeless program. These positions are 
reimbursed by VHA. The staffing requirement in this measure 
would therefore be an unfunded mandate for which employees 
would have to be re-assigned from other key duties such as 
claims processing, rating functions, etc. In addition, we 
believe the veteran population and its particular needs, not 
the organizational structure of an office, should determine the 
number and type of outreach coordinators assigned.
    Finally, the last part of section 14 would require disabled 
veterans' outreach program specialists and local veterans' 
employment representatives where available to also coordinate 
training assistance benefits provided to veterans by entities 
receiving financial assistance under section 738 of the 
McKinney-Vento Homeless Assistance Act. We support this 
provision.
    Section 15 would require that, with a limited exception, 
real property of grantees under our Homeless Providers Grant 
and Per Diem Program meet fire and safety requirements 
applicable under the Life Safety Code of the NFPA.
    We strongly support this requirement. The fire and safety 
requirements under the Life Safety Code of the National Fire 
Protection Association (NFPA) have been developed through 
consensus of experts across the country. They assure a 
consistent level of safety for homeless veterans living in 
transitional housing or receiving services in supportive 
service centers developed under the Grant and Per Diem Program. 
Entities that have received grants in recent years have been 
aware of VA's preference for structures to meet the fire and 
safety requirements under the Life Safety Code of NFPA and have 
developed their grant applications to cover the costs 
associated with meeting those requirements. There are, however, 
some organizations that received grant awards and their 
buildings do not meet the fire and safety requirements under 
the Life Safety Code of NFPA. It is therefore particularly 
valuable that this measure would permit VA to award grant 
assistance to these entities to enable them to upgrade their 
facilities to meet the Life Safety Code of NFPA.
    Section 16 would establish a three-year pilot program to 
provide transitional assistance grants to up to 600 eligible 
homeless veterans at not less than three but not more than six 
regional offices. The sites for the pilot must include at least 
one regional office located in a large urban area and at least 
one serving primarily rural veterans. To be eligible, a veteran 
would have to live in the area of the regional office, be a war 
veteran or meet minimum service requirements, be recently 
released, or in the process of being released from an 
institution, be homeless and have less then marginal income.
    Grants under the program would be limited to three months 
with an exception for any veteran who, while receiving such 
transitional assistance, has a claim pending for service-
connected disability compensation or non-service-connected 
pension. Such veterans could continue to receive transitional 
assistance under this section until the earlier of (A) the date 
on which a decision on the claim is made by the regional 
office, or (B) the end of the six-month period beginning on the 
date of expiration of eligibility under subsection (c). The 
measure would also require the Department to expedite its 
consideration of pending claims of veterans. VA would have to 
pay the grants monthly and in the same amount as that which VA 
would be obligated to pay under chapter 15 of title 38, United 
States Code, if the veteran had a permanent and total non-
service-connected disability. VA would have to determine the 
amount of the grant without regard to the income of the 
veteran, once it is determined the veteran meets the 
eligibility criteria. Finally it would require the Department 
to offset the amount of retroactive disability or pension 
benefits paid to a veteran by the amount of transitional 
assistance provided to the veteran for the same monthly period.
    We cannot support section 16, as it appears to be at odds 
with the inherent interest of our attempts at rehabilitation. 
The provision lacks safeguards or limitations on the receipt 
and use of the grant funds, notwithstanding the strong 
likelihood that many of the grant recipients would be veterans 
suffering from mental illnesses and/or substance abuse 
disorders. Awarding funds to these veterans without also 
requiring them to participate in simultaneous clinical 
intervention or oversight would result in many of them not 
seeking the care and treatment necessary to overcome their 
disorders. This, in turn, could keep those veterans in a 
condition of homelessness. Simply awarding grant funds, as 
proposed, is not, in our view, an appropriate means for making 
these vulnerable veterans self-sufficient.
    Section 17 would require that we conduct a technical 
assistance grants program to assist non-profit groups, which 
are experienced in providing services to homeless veterans, to 
apply for grants related to addressing problems of homeless 
veterans. The measure would authorize $750,000 to be 
appropriated for each of fiscal years 2001 through 2005 to 
carry out the program. We do not support this section as we 
already provide extensive information about the Homeless 
Providers Grant and Per Diem Program through the Internet, 
participation in national, state and some local conferences and 
one-on-one discussions between interested applicants and VA 
program managers.
    Section 18 would authorize the Secretary to waive any 
requirement that a veteran purchasing a manufactured home with 
the assistance of a VA guaranteed loan own or purchase a lot to 
which the manufactured home is permanently affixed.
    We do not favor this provision. Rather than address the 
specifics of this section of the bill, we have concluded the 
manufactured home loan program no longer provides a viable 
benefit to veterans, homeless or otherwise. Accordingly, VA 
recommends that the manufactured home loan program, which for 
all intents and purposes is dormant, be terminated.
    The number of veterans obtaining manufactured housing loans 
has significantly declined over the years since Fiscal Year 
1983 when VA guaranteed 15,725 such loans. No manufactured 
housing loans have been guaranteed since Fiscal Year 1996.
    The cumulative foreclosure rate on VA manufactured home 
loans is 39.2 percent, which is significantly higher than the 
5.6 percent rate for loans for conventionally-built homes. This 
foreclosure rate has greatly increased the cost to the 
taxpayers of the VA housing loan program and resulted in 
substantial debts being established against veterans.
    Therefore, VA does not believe the manufactured home loan 
program has any role in the effort to assist homeless veterans.
    Section 19 would increase from $20 million to $50 million 
the amount authorized to be appropriated for the Homeless 
Veterans' Reintegration Programs for Fiscal Year 2002 and 
Fiscal Year 2003. It would also authorize that same amount to 
be appropriated for purposes of this program for Fiscal Years 
2004, 2005, and 2006. VA defers to the Secretary of Labor, who 
administers the Homeless Veterans' Reintegration Programs.
    Section 20 would require the Secretary, before disposing of 
real property as excess, to determine that the property is not 
suitable for use for the provision of services to homeless 
veterans by the Department or by another entity under an 
enhanced-use lease. Although we agree with the purpose of 
section 20, this provision appears to be redundant with 
existing authorities. Under the Department's enhanced-use 
leasing authority, we now have the ability to lease available 
lands and facilities for compatible uses including those that 
provide services to homeless veterans. We have, in fact, 
recently used this authority to obtain a 120-unit ``Single Room 
Occupancy'' (SRO) housing complex in Vancouver, Washington, and 
a 63-unit SRO in Roseburg, Oregon. We are examining similar 
initiatives nationwide. In addition, pursuant to the Stewart B. 
McKinney Act, the Department surveys its property holdings and 
provides quarterly reports to the Department of Housing and 
Urban Development on the availability of excess or 
underutilized properties for housing for the homeless. In 
general terms, the provisions of the McKinney Act related to 
surplus federal property require each Department, in deeming 
property under its jurisdiction to be unutilized, under-
utilized, or excess, to state that the property cannot be made 
available for use to assist the homeless. Before ultimately 
disposing of such property, the McKinney Act requires the 
Government to again give priority of consideration to uses to 
assist the homeless. Given that VA has active programs in place 
that strive to achieve the objective reflected in section 20, 
establishing a duplicate requirement would only lend confusion 
to the process.

           *       *       *       *       *       *       *

    Changes in Existing Law Made by the Committee bill, As Reported

    In compliance with rule XXVI paragraph 12 of the Standing 
Rules of the Senate, the following provides a print of the 
statute or the part or section thereof to be amended or 
replaced (existing law proposed to be omitted is enclosed in 
black brackets, new matter is printed in italic, existing law 
in which no change is proposed is shown in roman):

                      TITLE 38, UNITED STATES CODE

            CHAPTER 5--AUTHORITY AND DUTIES OF THE SECRETARY

                   subchapter i--general authorities

Sec.

501.  * * *

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                   subchapter ii--specified functions

546. ADVISORY COMMITTEE ON HOMELESS VETERANS.

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Sec. 546. Advisory Committee on Homeless Veterans

  (a)(1) There is established in the Department the Advisory 
Committee on Homeless Veterans (hereinafter in this section 
referred to as the ``Committee'').
  (2) The Committee shall consist of not more than 15 members 
appointed by the Secretary from among the following:
          (A) Veterans service organizationsvocational 
        rehabilitation.
          (J) Such other organizations or groups as the 
        Secretary considers appropriate.
  (3) The Committee shall include, as ex officio members--
          (A) the Secretary of Labor (or a representative of 
        the Secretary selected after consultation with the 
        Assistant Secretary of Labor for Veterans' Employment 
        and Training);
          (B) the Secretary of Defense (or a representative of 
        the Secretary);
          (C) the Secretary of Health and Human Services (or a 
        representative of the Secretary); and
          (D) the Secretary of Housing and Urban Development 
        (or a representative of the Secretary).
  (4) The Secretary shall determine the terms of service and 
pay and allowances of the members of the Committee, except that 
a term of service may not exceed three years. The Secretary may 
reappoint any member for additional terms of service.
  (b)(1) The Secretary shall, on a regular basis, consult with 
and seek the advice of the Committee with respect to the 
provision by the Department of benefits and services to 
homeless veterans.
  (2)(A) In providing advice to the Secretary under this 
subsection, the Committee shall--
          (i) assemble and review information relating to the 
        needs of homeless veterans;
          (ii) provide an on-going assessment of the 
        effectiveness of the policies, organizational 
        structures, and services of the Department in assisting 
        homeless veterans; and
          (iii) provide on-going advice on the most appropriate 
        means of providing assistance to homeless veterans.
  (3) The Committee shall--
          (A) review the continuum of services provided by the 
        Department, whether directly or by contract, in order 
        to define cross-cutting issues and to improve 
        coordination of all services in the Department that 
        address the special needs of homeless veterans;
          (B) identify (through annual assessments under 
        section 1774 of this title and other available 
        resources) gaps in programs of the Department in 
        serving homeless veterans, including identification of 
        geographic areas with unmet needs, and provide 
        recommendations to address those gaps;
          (C) identify gaps in existing information systems on 
        homeless veterans, both within and outside the 
        Department, and provide recommendations about 
        redressing problems in data collection;
          (D) identify barriers under existing laws and 
        policies to effective coordination by the Department 
        with other Federal agencies and with State and local 
        agencies addressing homeless populations;
          (E) identify opportunities for enhanced liaison by 
        the Department with nongovernmental organizations and 
        individual groups addressing homeless populations;
          (F) with appropriate officials of the Department 
        designated by the Secretary, participate with the 
        Interagency Council on the Homeless under title II of 
        the McKinney-Vento Homeless Assistance Act (42 U.S.C. 
        11311 et seq.);
          (G) recommend appropriate funding levels for 
        specialized programs for homeless veterans provided or 
        funded by the Department;
          (H) recommend appropriate placement options for 
        veterans who, because of advanced age, frailty, or 
        severe mental illness, may not be appropriate 
        candidates for vocational rehabilitation or independent 
        living; and
          (I) perform such other functions as the Secretary may 
        direct.
  (c)(1) Not later than March 31 of each year, the Committee 
shall submit to the Secretary a report on the programs and 
activities of the Department that relate to homeless veterans 
during the preceding year. Each such report shall include--
          (A) an assessment of the needs of homeless veterans;
          (B) a review of the programs and activities of the 
        Department designed to meet such needs, including the 
        evaluation of outreach activities required under 
        paragraph (2);
          (C) a review of the activities of the Committee; and
          (D) such recommendations (including recommendations 
        for administrative and legislative action) as the 
        Committee considers appropriate.
  (2)(A) The Committee shall include in each report under 
paragraph (1) an evaluation of the outreach activities of the 
Department with respect to homeless veterans, including 
outreach regarding clinical issues and outreach regarding other 
benefits.
  (B) The Committee shall conduct each evaluation under this 
paragraph in consultation with the Under Secretary for 
Benefits, the Under Secretary for Health, the Readjustment 
Counseling Service, the Director of Homeless Veterans Programs, 
and the Mental Health Strategic Health Care Group.
  (C) In including an evaluation under this paragraph in a 
report under paragraph (1), the Committee shall set forth in 
the report the following:
          (i) The results of the evaluation.
          (ii) Any recommendations that the Committee considers 
        appropriate to improve the outreach activities of the 
        Department with respect to homeless veterans, including 
        recommendations for enhanced interagency cooperation 
        and enhanced cooperation between the Department and 
        appropriate community organizations and recommendations 
        for additional activities to complement, supplement, or 
        otherwise eliminate deficiencies in the outreach 
        activities.
  (3) Not later than 90 days after the receipt of a report 
under paragraph (1), the Secretary shall transmit to the 
Committees on Veterans' Affairs of the Senate and House of 
Representatives a copy of the report, together with any 
comments and recommendations concerning the report that the 
Secretary considers appropriate.
  (4) The Committee may also submit to the Secretary such other 
reports and recommendations as the Committee considers 
appropriate.
  (5) The Secretary shall include with each annual report 
submitted to Congress pursuant to section 529 of this title a 
summary of all reports and recommendations of the Committee 
submitted to the Secretary since the previous annual report of 
the Secretary submitted pursuant to that section.
  (d)(1) Except as provided in paragraph (2), the provisions of 
the Federal Advisory Committee Act (5 U.S.C. App.) shall apply 
to the activities of the Committee under this section.
  (2) Section 14 of such Act shall not apply to the Committee.

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Sec. 1712. Dental care; drugs and medicines for certain 
                    disabled veterans; vaccines

  (a)(1) Outpatient dental services and treatment, and related 
dental appliances, shall be furnished under this section only 
for a dental condition or disability--

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          (H) the treatment of which is medically necessary (i) 
        in preparation for hospital admission, or (ii) for a 
        veteran (including a homeless veteran) otherwise 
        receiving care or services under this chapter.

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SUBCHAPTER VII--TREATMENT AND REHABILITATION FOR SERIOUSLY MENTALLY ILL 
                         AND HOMELESS VETERANS

Sec. 1771. General treatment

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  (b) The authority of the Secretary under subsection (a) 
expires on [December 31, 2001] December 31, 2006.

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Sec. 1773. Additional services at certain locations

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  (b) The program shall include the establishment of [not fewer 
than eight] programs (in addition to any existing programs 
providing similar services) at sites under the jurisdiction of 
the Secretary to be centers for the provision of comprehensive 
services to homeless veterans. The services to be provided at 
each site shall include a comprehensive and coordinated array 
of those specialized services which may be provided under 
existing law.

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  (d) The program under this section shall terminate on 
[December 31, 2001] December 31, 2006.

Sec. 1774. Coordination with other agencies and organizations

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  (b)(1) The Secretary shall require the director of each 
medical center or the director of each regional benefits office 
to make an annual assessment of the needs of homeless veterans 
living within the area served by the medical center or regional 
office, as the case may be.

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  (6) The Secretary shall review each annual assessment under 
this subsection, and shall consolidate the findings and 
conclusions of such assessments into an annual report which the 
Secretary shall submit to Congress.

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Sec. 4103A. Disabled veterans' outreach program

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  (c) Each disabled veterans' outreach program specialist shall 
carry out the following functions for the purpose of providing 
services to eligible veterans in accordance with the priorities 
set forth in subsection (b) of this section:

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          (11) Coordination of services provided to veterans 
        with training assistance provided to veterans by 
        entities receiving financial assistance under section 
        738 of the McKinney-Vento Homeless Assistance Act (42 
        U.S.C. 11448).

Sec. 4104. Local veterans' employment representatives

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  (b) Local veterans' employment representatives shall--

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          (11) when requested by a Federal or State agency, a 
        private employer, or a service-connected disabled 
        veteran, assist such agency, employer, or veteran in 
        identifying and acquiring prosthetic and sensory aids 
        and devices needed to enhance the employability of 
        disabled veterans; [and]
          (12) facilitate the provision of guidance or 
        counseling services, or both, to veterans who, pursuant 
        to section 5(b)(3) of the Veterans' Job Training Act 
        (29 U.S.C. 1721 note), are certified as eligible for 
        participation under such Act[.] ; and
          (13) coordinate services provided to veterans with 
        training assistance for veterans provided by entities 
        receiving financial assistance under section 738 of the 
        McKinney-Vento Homeless Assistance Act (42 U.S.C. 
        11448).

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Sec. 4111. Homeless veterans' reintegration programs

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  (d) Authorization of Appropriations.--(1) There are 
authorized to be appropriated to carry out this section amounts 
as follows:

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          [(C) $20,000,000 for fiscal year 2002.
          [(D) $20,000,000 for fiscal year 2003.]
          (C) $50,000,000 for fiscal year 2002.
          (D) $50,000,000 for fiscal year 2003.
          (E) $50,000,000 for fiscal year 2004.
          (F) $50,000,000 for fiscal year 2005.
          (G) $50,000,000 for fiscal year 2006.

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HOMELESS VETERANS COMPREHENSIVE SERVICE PROGRAMS ACT OF 1992

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SEC. 3. GRANTS.

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    (b) Criteria for Award of Grants.--The Secretary shall 
establish criterria and requirements for the award of a grant 
under this section, including criteria for entities eligible to 
receive such grants. The Secretary shall publish such criteria 
and requirements in the Federal Register not later than 90 days 
after the date of the enactment of this Act (Nov. 10, 1992). In 
developing such criteria and requirements, the Secretary shall 
consult with organizations with experience in the area of 
providing service to homeless veterans and to the maximum 
extent possible shall take into account the findings of the 
assessment of the Secretary under section 107 of the Veterans' 
Medical Programs Amendments of 1992 (Pub. L. 102-405, 38 U.S.C. 
527 note). The criteria established under this section shall 
include the following:

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          (5) Provisions to ensure that an entity receiving a 
        grant shall meet fire and safety requirements 
        established by Secretary, which shall include such 
        State and community requirements that may apply[, but 
        fire and safety requirements applicable to buildings of 
        the Federal Government shall not apply to real property 
        to be used by a grantee in carrying out the grant] and 
        the fire and safety requirements applicable under the 
        Life Safety Code of the National Fire Protection 
        Association.

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SEC. 4. PER DIEM PAYMENTS.

  (a) Per Diem Payments for Furnishing Services To Homeless 
Veterans.--Subject to the availability of appropriations 
provided for under section 12 (set out below), the Secretary of 
Veterans Affairs, pursuant to such criteria as the Secretary 
shall prescribe, shall provide to a recipient of a grant under 
section 3 (or an entity eligible to receive a grant under 
section 3 which after the date of enactment of this Act (Nov. 
10, 1992) establishes a program which the Secretary determines 
carries out the purposes described in section 3) per diem 
payments [at such rates as the Secretary shall prescribe by 
regulation for services furnished to any homeless veteran--] at 
the same rates as the rates authorized for State homes for 
domiciliary care provided under section 1741 of title 38, 
United States Code, for services furnished to homeless 
veterans--

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  (e) Life Safety Code.--(1) Except as provided in paragraph 
(2), a per diem payment (or in-kind assistance in lieu of per 
diem payments) may not be provided under this section to a 
grant recipient unless the facilities of the grant recipient 
meet the fire and safety requirements applicable under the Life 
Safety Code of the National Fire Protection Association.
  (2) During the five-year period beginning on the date of the 
enactment of the Heather French Henry Homeless Veterans 
Assistance Act, paragraph (1) shall not apply to an entity that 
received a grant under section 3 before that date if the entity 
meets fire and safety requirements established by the 
Secretary.
  (3) From amounts available for purposes of this section 
pursuant to section 12, not less than $5,000,000 shall be used 
only for grants to assist entities covered by paragraph (2) in 
meeting the Life Safety Code of the National Fire Protection 
Association.

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[SEC. 12. AUTHORIZATION OF APPROPRIATIONS.

      [There are authorized to be appropriated to carry out 
this Act (other than section 8) $48,000,000 for each of fiscal 
years 1993 through 1997 and $50,000,000 for each of fiscal 
years 2000 and 2001. Nothing in this Act shall be construed to 
diminish funds for, continuation of, or expansion of existing 
programs administered by the Secretary of Veterans Affairs to 
serve veterans.]

SEC. 12. FUNDING.

  (a) Amounts for Grant and Per Diem Programs.--From amounts 
appropriated for `Medical Care' for any fiscal year, the 
Secretary may expend not more than $55,000,000 (as adjusted 
from time to time under subsection (b)) to carry out the 
transitional housing grant and per diem provider programs under 
sections 3 and 4 of this Act.
  (b) Periodic Increases.--The amount in effect under 
subsection (a) shall be increased for any fiscal year by the 
overall percentage increase in the Medical Care account for 
that fiscal year over the preceding fiscal year.

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McKINNEY-VENTO HOMELESS ASSISTANCE ACT

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SEC. 202. MEMBERSHIP.

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  (c) Meetings.--The Council shall meet at the call of its 
Chairperson or a majority of its members, but not less often 
than annually.

                               
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