99–006

107TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 1st Session 107–242

DISABLED VETERANS SERVICE DOG AND HEALTH CARE

IMPROVEMENT ACT OF 2001

OCTOBER 16, 2001.—Committed to the Committee of the Whole House on the State

of the Union and ordered to be printed

Mr. SMITH of New Jersey, from the Committee on Veterans’ Affairs,

submitted the following

R E P O R T

[To accompany H.R. 2792]

[Including cost estimate of the Congressional Budget Office]

The Committee on Veterans’ Affairs, to whom was referred the

bill (H.R. 2792) to amend title 38, United States Code, to authorize

the Secretary of Veterans Affairs to make service dogs available to

disabled veterans and to make various other improvements in

health care benefits provided by the Department of Veterans Affairs, and for other purposes, having considered the same, reports

favorably thereon with an amendment and recommends that the

bill as amended do pass.

The amendment is as follows:

Strike all after the enacting clause and insert the following:

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

(a) SHORT TITLE.—This Act may be cited as the ‘‘Disabled Veterans Service Dog

and Health Care Improvement Act of 2001’’.

(b) TABLE OF CONTENTS.—The table of contents of this Act is as follows:

Sec. 1. Short title; table of contents.

TITLE I—VETERANS HEALTH CARE IMPROVEMENT

Sec. 101. Authorization for Secretary of Veterans Affairs to provide service dogs for disabled veterans.

Sec. 102. Maintenance of capacity for specialized treatment and rehabilitative needs of disabled veterans.

Sec. 103. Threshold for veterans health care eligibility means test to reflect locality cost-of-living variations.

Sec. 104. Assessment and report on special telephone services for veterans.

Sec. 105. Recodification of bereavement counseling authority and certain other health-related authorities.

Sec. 106. Extension of expiring collections authorities.

TITLE II—CHIROPRACTIC SERVICES PROGRAM

Sec. 201. Chiropractic Service established in the Veterans Health Administration.

Sec. 202. Availability of chiropractic care to veterans.

Sec. 203. Chiropractic providers.

Sec. 204. Scope of services; enrollment.

Sec. 205. Training and information.

Sec. 206. Advisory committee.

Sec. 207. Implementation report.

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TITLE III—NATIONAL COMMISSION ON VA NURSING

Sec. 301. Establishment of Commission.

Sec. 302. Duties of Commission.

Sec. 303. Reports.

Sec. 304. Powers.

Sec. 305. Personnel matters.

Sec. 306. Termination of the Commission.

TITLE I—VETERANS HEALTH CARE

IMPROVEMENT

SEC. 101. AUTHORIZATION FOR SECRETARY OF VETERANS AFFAIRS TO PROVIDE SERVICE

DOGS FOR DISABLED VETERANS.

(a) AUTHORITY.—Section 1714 of title 38, United States Code, is amended—

(1) in subsection (b)—

(A) by striking ‘‘seeing-eye or’’ the first place it appears;

(B) by striking ‘‘who are entitled to disability compensation’’ and inserting

‘‘who are enrolled under section 1705 of this title’’;

(C) by striking ‘‘, and may pay’’ and all that follows through ‘‘such seeingeye or guide dogs’’; and

(D) by striking ‘‘handicap’’ and inserting ‘‘disability’’; and

(2) by adding at the end the following new subsections:

‘‘(c) The Secretary may, in accordance with the priority specified in section 1705

of this title, provide—

‘‘(1) service dogs trained for the aid of the hearing impaired to veterans who

are hearing impaired and are enrolled under section 1705 of this title; and

‘‘(2) service dogs trained for the aid of persons with spinal cord injury or dysfunction or other chronic impairment that substantially limits mobility to veterans with such injury, dysfunction, or impairment who are enrolled under section 1705 of this title.

‘‘(d) In the case of a veteran provided a dog under subsection (b) or (c), the Secretary may pay travel and incidental expenses for that veteran under the terms and

conditions set forth in section 111 of this title to and from the veteran’s home for

expenses incurred in becoming adjusted to the dog.’’.

(b) CLERICAL AMENDMENTS.—

(1) The heading for such section is amended to read as follows:

‘‘§ 1714. Fitting and training in use of prosthetic appliances; guide dogs;

service dogs’’.

(2) The item relating to such section in the table of sections at the beginning

of chapter 17 of such title is amended to read as follows:

‘‘1714. Fitting and training in use of prosthetic appliances; guide dogs; service dogs.’’.

SEC. 102. MAINTENANCE OF CAPACITY FOR SPECIALIZED TREATMENT AND REHABILITATIVE

NEEDS OF DISABLED VETERANS.

(a) MAINTENANCE OF CAPACITY ON A SERVICE-NETWORK BASIS.—Section 1706(b) of

title 38, United States Code, is amended—

(2) in paragraph (1)—

(A) in the first sentence, by inserting ‘‘(and each geographic service area

of the Veterans Health Administration)’’ after ‘‘ensure that the Department’’; and

(B) in clause (B), by inserting ‘‘(and each geographic service area of the

Veterans Health Administration)’’ after ‘‘overall capacity of the Department’’; and

(2) by redesignating paragraphs (2) and (3) as paragraphs (4) and (5), respectively;

(3) by inserting after paragraph (1) the following new paragraphs (2) and (3):

‘‘(2) For purposes of paragraph (1), the capacity of the Department (and each geographic service area of the Veterans Health Administration) to provide for the specialized treatment and rehabilitative needs of disabled veterans (including veterans

with spinal cord dysfunction, traumatic brain injury, blindness, prosthetics and sensory aids, and mental illness) within distinct programs or facilities shall be measured for seriously mentally ill veterans as follows (with all such data to be provided

by geographic service area and totaled nationally):

‘‘(A) For mental health intensive community-based care, the number of discrete intensive care teams constituted to provide such intensive services to seriously mentally ill veterans and the number of veterans provided such care.

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‘‘(B) For opioid substitution programs and for traumatic brain injury, the

number of patients treated annually and the amounts expended.

‘‘(C) For dual-diagnosis patients, the number treated annually and the

amounts expended.

‘‘(D) For substance abuse programs—

‘‘(i) the number of substance-use disorder beds (whether hospital, nursing

home, or other designated beds) employed and the average bed occupancy

of such beds;

‘‘(ii) the percentage of unique patients admitted directly to substance

abuse outpatient care during the fiscal year who had two or more additional

visits to specialized substance abuse outpatient care within 30 days of their

first visit, with a comparison from 1996 until the date of the report;

‘‘(iii) the percentage of unique inpatients with substance abuse diagnoses

treated during the fiscal year who had one or more specialized substance

abuse clinic visits within three days of their index discharge, with a comparison from 1996 until the date of the report; and

‘‘(iv) the percentage of unique outpatients seen in a facility or service network during the fiscal year who had one or more specialized substance

abuse clinic visits, with a comparison from 1996 until the date of the report.

‘‘(E) For mental health programs, the number and type of staff that are available at each facility to provide specialized mental health treatment, including

satellite clinics, outpatient programs, and community-based outpatient clinics,

with a trend line comparison from 1996 to the date of the report.

‘‘(F) The number of such clinics providing mental health care, the number and

type of mental health staff at each such clinic, and the type of mental health

programs at each such clinic.

‘‘(3) For purposes of paragraph (1), the capacity of the Department (and each geographic service area of the Veterans Health Administration) to provide for the specialized treatment and rehabilitative needs of disabled veterans within distinct programs or facilities shall be measured for veterans with spinal cord dysfunction, traumatic brain injury, blindness, or prosthetics and sensory aids as follows (with all

such data to be provided by geographic service area and totaled nationally):

‘‘(A) For spinal cord injury/dysfunction specialized centers and for blind rehabilitation specialized centers, the number of staffed beds and the number of fulltime equivalent employees assigned to provide care at such centers.

‘‘(B) For prosthetics and sensory aids, the annual amount expended.’’.

(b) EXTENSION OF ANNUAL REPORT REQUIREMENT.—Paragraph (3) of such section,

as so redesignated, is amended—

(1) by striking ‘‘April 1, 1999, April 1, 2000, and April 1, 2001’’ and inserting

‘‘April 1 of each year through 2004’’; and

(2) by adding at the end the following new sentence: ‘‘The accuracy of each

such report shall be certified by, or otherwise commented upon by, the Inspector

General of the Department.’’.

SEC. 103. THRESHOLD FOR VETERANS HEALTH CARE ELIGIBILITY MEANS TEST TO REFLECT

LOCALITY COST-OF-LIVING VARIATIONS.

(a) REVISED THRESHOLD.—Subsection (b) of section 1722 of title 38, United States

Code, is amended to read as follows:

‘‘(b)(1) For purposes of subsection (a)(3), the income threshold applicable to a veteran is the amount determined under paragraph (2).

‘‘(2) The amount determined under this paragraph for a veteran is the greater of

the following:

‘‘(A) For any calendar year after 2000—

‘‘(i) in the case of a veteran with no dependents, $23,688, as adjusted

under subsection (c); or

‘‘(ii) in the case of a veteran with one or more dependents, $28,429, as

so adjusted, plus $1,586, as so adjusted, for each dependent in excess of

one.

‘‘(B) The amount in effect under the HUD Low Income Index that is applicable in the area in which the veteran resides.

‘‘(3) For purposes of paragraph (2)(B), the term ‘HUD Low Income Index’ means

the family income ceiling amounts determined by the Secretary of Housing and

Urban Development under section 3(b)(2) of the United States Housing Act of 1937

(42 U.S.C. 1437a(b)(2)) for purposes of the determination of ‘low-income families’

under that section.’’.

(c) CONFORMING AMENDMENT.—(1) Subsection (a)(3) of such section is amended by

striking ‘‘amount set forth in’’ and inserting ‘‘income threshold determined under’’.

(2) Subsection (c) of such section is amended by striking ‘‘subsection (b)’’ and inserting ‘‘subsection (b)(2)(A)’’.

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(d) LIMITATION ON RESOURCE REALLOCATIONS.— Within the amount appropriated

to the Department of Veterans Affairs for medical care for each of fiscal years 2002

through 2006. the amount that would otherwise be allocated by the Secretary to any

geographic service region of the Veterans Health Administration in accordance with

the established resource allocation procedures of the Department may not be increased or decreased by more than 5 percent by reason of the implementation of this

section.

(e) EFFECTIVE DATE.—The amendments made by this section shall take effect on

April 1, 2002.

SEC. 104. ASSESSMENT AND REPORT ON SPECIAL TELEPHONE SERVICES FOR VETERANS.

(a) ASSESSMENT OF CURRENT SERVICES.—The Secretary of Veterans Affairs shall

carry out an assessment of all special telephone services for veterans (such as

helplines and hotlines) provided by the Department of Veterans Affairs. The assessment shall include the geographical coverage, availability, utilization, effectiveness,

management, coordination, staffing, and cost of those services. As part of such assessment, the Secretary shall conduct a survey of veterans to measure their satisfaction with current special telephone services and the demand for additional services.

(b) REPORT.—Not later than one year after the date of the enactment of this Act,

the Secretary shall submit to Congress a report on the assessment carried out under

subsection (a). The Secretary shall include in the report recommendations regarding

any needed improvement to such services and recommendations regarding contracting for the performance of such services.

SEC. 105. RECODIFICATION OF BEREAVEMENT COUNSELING AUTHORITY AND CERTAIN

OTHER HEALTH-RELATED AUTHORITIES.

(a) STATUTORY REORGANIZATION.—Subchapter I of chapter 17 of title 38, United

States Code, is amended—

(1) in section 1701(6)—

(A) by striking subparagraph (B) and the sentence following that subparagraph;

(B) by striking ‘‘services—’’ in the matter preceding subparagraph (A) and

inserting ‘‘services, the following:’’; and

(C) by striking subparagraph (A) and inserting the following:

‘‘(A) Surgical services.

‘‘(B) Dental services and appliances as described in sections 1710 and 1712

of this title.

‘‘(C) Optometric and podiatric services.

‘‘(D) Preventive health services.

‘‘(E) In the case of a person otherwise receiving care or services under this

chapter—

‘‘(i) wheelchairs, artificial limbs, trusses, and similar appliances;

‘‘(ii) special clothing made necessary by the wearing of prosthetic appliances; and

‘‘(iii) such other supplies or services as the Secretary determines to be

reasonable and necessary.

‘‘(F) Travel and incidental expenses pursuant to section 111 of this title.’’; and

(2) in section 1707—

(A) by inserting ‘‘(a)’’ at the beginning of the text of the section; and

(B) by adding at the end the following:

‘‘(b) The Secretary may furnish sensori-neural aids only in accordance with guidelines prescribed by the Secretary.’’.

(b) CONSOLIDATION OF PROVISIONS RELATING TO PERSONS OTHER THAN VETERANS.—Such chapter is further amended by adding at the end the following new

subchapter:

‘‘SUBCHAPTER VIII—HEALTH CARE OF PERSONS OTHER THAN VETERANS

‘‘§ 1782. Counseling, training, and mental health services for immediate

family members

‘‘(a) COUNSELING FOR FAMILY MEMBERS OF VETERANS RECEIVING SERVICE-CON- NECTED TREATMENT.—In the case of a veteran who is receiving treatment for a service-connected disability pursuant to paragraph (1) or (2) of section 1710(a) of this

title, the Secretary shall provide to individuals described in subsection (c) such consultation, professional counseling, training, and mental health services as are necessary in connection with that treatment.

‘‘(b) COUNSELING FOR FAMILY MEMBERS OF VETERANS RECEIVING NON-SERVICECONNECTED TREATMENT.—In the case of a veteran who is eligible to receive treatment for a non-service-connected disability under the conditions described in paragraph (1), (2), or (3) of section 1710(a) of this title, the Secretary may, in the discreVerDate 13-OCT-2001 22:25 Oct 16, 2001 Jkt 099006 PO 00000 Frm 00004 Fmt 6659 Sfmt 6621 E:\HR\OC\HR242.XXX pfrm01 PsN: HR242
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tion of the Secretary, provide to individuals described in subsection (c) such consultation, professional counseling, training, and mental health services as are necessary in connection with that treatment if— ‘‘(1) those services were initiated during the veteran’s hospitalization; and ‘‘(2) the continued provision of those services on an outpatient basis is essential to permit the discharge of the veteran from the hospital. ‘‘(c) ELIGIBLE INDIVIDUALS.—Individuals who may be provided services under this

subsection are— ‘‘(1) the members of the immediate family or the legal guardian of a veteran; or‘‘(2) the individual in whose household such veteran certifies an intention to

live. ‘‘(d) TRAVEL AND TRANSPORTATION AUTHORIZED.—Services provided under subsections (a) and (b) may include, under the terms and conditions set forth in section

111 of this title, travel and incidental expenses of individuals described in subsection (c) in the case of— ‘‘(1) a veteran who is receiving care for a service-connected disability; and

‘‘(2) a dependent or survivor receiving care under the last sentence of section

1783(b) of this title.

‘‘§ 1783. Bereavement counseling

‘‘(a) DEATHS OF VETERANS.—In the case of an individual who was a recipient of

services under section 1782 of this title at the time of the death of the veteran, the

Secretary may provide bereavement counseling to that individual in the case of a

death—

‘‘(1) that was unexpected; or

‘‘(2) that occurred while the veteran was participating in a hospice program

(or a similar program) conducted by the Secretary. ‘‘(b) DEATHS IN ACTIVE SERVICE.—The Secretary may provide bereavement counseling to an individual who is a member of the immediate family of a member of

the Armed Forces who dies in the active military, naval, or air service in the line

of duty and under circumstances not due to the person’s own misconduct. ‘‘(c) BEREAVEMENT COUNSELING DEFINED.—For purposes of this section, the term ‘bereavement counseling’ means such counseling services, for a limited period, as the

Secretary determines to be reasonable and necessary to assist an individual with

the emotional and psychological stress accompanying the death of another individual.

‘‘§ 1784. Humanitarian care

‘‘The Secretary may furnish hospital care or medical services as a humanitarian

service in emergency cases, but the Secretary shall charge for such care and services

at rates prescribed by the Secretary.’’. (c) TRANSFER OF CHAMPVA SECTION.—Section 1713 of such title is— (1) transferred to subchapter VIII of chapter 17 of such title, as added by subsection (b), and inserted after the subchapter heading;

(2) redesignated as section 1781; and

(3) amended by adding at the end of subsection (b) the following new sentence: ‘‘A dependent or survivor receiving care under the preceding sentence

shall be eligible for the same medical services as a veteran, including services

under sections 1782 and 1783 of this title.’’. (d) REPEAL OF RECODIFIED AUTHORITY.—Section 1711 of such title is amended by

striking subsection (b).

(e) CROSS REFERENCE AMENDMENTS.—Such title is further amended as follows:

(1) Section 103(d)(5)(B) is amended by striking ‘‘1713’’ and inserting ‘‘1781’’. (2) Sections 1701(5) is amended by striking ‘‘1713(b)’’ in subparagraphs (B)

and (C)(i) and inserting ‘‘1781(b)’’. (3) Section 1712A(b) is amended— (A) in the last sentence of paragraph (1), by striking ‘‘section 1711(b)’’ and

inserting ‘‘section 1784’’; and

(A) in paragraph (2), by striking ‘‘section 1701(6)(B)’’ and inserting ‘‘sec- tions 1782 and 1783’’. (4) Section 1729(f) is amended by striking ‘‘section 1711(b)’’ and inserting ‘‘section 1784’’.

(5) Section 1729A(b) is amended—

(A) by redesignating paragraph (7) as paragraph (8); and

(B) by inserting after paragraph (6) the following new paragraph (7):

‘‘(7) Section 1784 of this title.’’.

(6) Section 8111(g) is amended—

(A) in paragraph (4), by inserting ‘‘services under sections 1782 and 1783

of this title’’ after ‘‘of this title,’’; and

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(B) in paragraph (5), by striking ‘‘section 1711(b) or 1713’’ and inserting

‘‘section 1782, 1783, or 1784’’.

(7) Section 8111A(a)(2) is amended by inserting ‘‘, and the term ‘medical services’ includes services under sections 1782 and 1783 of this title’’ before the period at the end.

(8) Section 8152(1) is amended by inserting ‘‘services under sections 1782 and

1783 of this title,’’ after ‘‘of this title),’’.

(9) Sections 8502(b), 8520(a), and 8521 are amended by striking ‘‘the last sentence of section 1713(b)’’ and inserting ‘‘the penultimate sentence of section

1781(b)’’.

(f) CLERICAL AMENDMENTS.—

(1) The table of sections at the beginning of such chapter is amended—

(A) by striking the item relating to section 1707 and inserting the following:

‘‘1707. Limitations.’’;

(B) by striking the item relating to section 1713; and

(C) by adding at the end the following:

‘‘SUBCHAPTER VIII—HEALTH CARE OF PERSONS OTHER THAN VETERANS

‘‘1781. Medical care for survivors and dependents of certain veterans.

‘‘1782. Counseling, training, and mental health services for immediate family members.

‘‘1783. Bereavement counseling.

‘‘1784. Humanitarian care.’’.

(2) The heading for section 1707 is amended to read as follows:

‘‘§ 1707. Limitations’’.

SEC. 106. EXTENSION OF EXPIRING COLLECTIONS AUTHORITIES.

(a) HEALTH CARE COPAYMENTS.—Section 1710(f)(2)(B) of title 38, United States

Code, is amended by striking ‘‘September 30, 2002’’ and inserting ‘‘September 30,

2007’’.

(b) MEDICAL CARE COST RECOVERY.—Section 1729(a)(2)(E) of such title is amended by striking ‘‘October 1, 2002’’ and inserting ‘‘October 1, 2007’’.

TITLE II—CHIROPRACTIC SERVICES

SEC. 201. CHIROPRACTIC SERVICE ESTABLISHED IN THE VETERANS HEALTH ADMINISTRATION.

(a) NEW SERVICE IN VETERANS HEALTH ADMINISTRATION.—Section 7305 of title 38,

United States Code, is amended—

(1) by redesignating paragraph (7) as paragraph (8); and

(2) by inserting after paragraph (6) the following new paragraph (7):

‘‘(7) A Chiropractic Service.’’.

(b) DIRECTOR.—Section 7306(a) of such title—

(1) by redesignating paragraphs (7) through (10) as paragraphs (8) through

(11), respectively; and

(2) by inserting after paragraph (6) the following new paragraph (7):

‘‘(7) A Director of Chiropractic Service, who shall be a qualified doctor of

chiropractic and who shall be responsible to the Secretary for the operation of

the Chiropractic Service.’’.

SEC. 202. AVAILABILITY OF CHIROPRACTIC CARE TO VETERANS.

(a) ESTABLISHMENT.—The Secretary of Veterans Affairs shall establish a program

to provide chiropractic care to veterans through all Department of Veterans Affairs

medical centers.

(b) IMPLEMENTATION.—The program under this section shall be implemented at

Department of Veterans Affairs medical centers as follows:

(1) At not less than 30 medical centers by the end of fiscal year 2002.

(2) At not less than 60 medical centers by the end of fiscal year 2003,

(3) At not less than 90 medical centers by the end of fiscal year 2004.

(4) At not less than 120 medical centers by the end of fiscal year 2005.

(5) At all of the Department of Veterans Affairs medical centers by the end

of fiscal year 2006.

(c) INITIAL PARTICIPATING MEDICAL CENTERS.—The initial 30 medical centers at

which the program is to be carried out shall be designated by the Secretary not later

than 60 days after the date of the enactment of this Act. In designating those medical centers, the Secretary shall select medical centers to reflect geographic diverVerDate 13-OCT-2001 22:25 Oct 16, 2001 Jkt 099006 PO 00000 Frm 00006 Fmt 6659 Sfmt 6621 E:\HR\OC\HR242.XXX pfrm01 PsN: HR242
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sity, facilities of various size and capabilities, and the range of services in the Department health care system.

SEC. 203. CHIROPRACTIC PROVIDERS.

The program under section 202 shall be carried out through personal service contracts and with appointments of licensed chiropractors for delivery of chiropractic

services at Department of Veterans Affairs medical centers.

SEC. 204. SCOPE OF SERVICES; ENROLLMENT.

(a) SCOPE OF SERVICES.—The chiropractic services provided under section 202

shall include, at a minimum, care for neuro-musculoskeletal conditions.

(b) ENROLLMENT.—A veteran enrolled under section 1705 of title 38, United States

Code, may, as part of such enrollment, choose a chiropractor as the veteran’s primary care provider. A veteran with a primary care provider other than a chiropractor may be referred to chiropractic services for neuro-musculoskeletal conditions

by a medical provider.

SEC. 205. TRAINING AND INFORMATION.

(a) PRIMARY CARE TEAMS.—The Secretary shall provide training and materials relating to chiropractic services to members of Department health care providers assigned to primary care teams for the purposes of familiarizing those providers with

the benefits of appropriate use of chiropractic services.

(b) FUTURE PROGRAM SITES.—During the period covered by section 202(b), the

Secretary shall provide materials relating to chiropractic services to medical centers

and other health care facilities of the Department not yet participating in the program in order to ensure that health care providers at those facilities are aware of

chiropractic care as a future referral source.

(c) APPROVAL OF MATERIALS.—The Secretary may approve materials to be furnished under subsections (a) and (b) only after consulting with, and receiving the

views of, the advisory committee established under section 206.

SEC. 206. ADVISORY COMMITTEE.

(a) ESTABLISHMENT.—The Secretary shall establish an advisory committee to review implementation of the program under this title.

(b) MEMBERS.—In appointing the members of the advisory committee, the Secretary shall include on the advisory committee—

(1) members of the chiropractic profession;

(2) persons who are experts in human resources appointments in the Federal

service;

(3) persons with expertise in academic matters;

(4) persons with knowledge of credentialing and the granting of professional

privileging to health care practitioners; and

(5) other persons as determined necessary by the Secretary and the functional

needs of the advisory committee in establishing the chiropractic health program.

(c) FUNCTIONS.—The advisory committee shall provide advice to the Secretary

on—

(1) the granting of professional privileges for chiropractors at Department

medical centers;

(2) the scope of practice of chiropractors at Department medical centers;

(3) training materials; and

(4) such other matters as are determined appropriate by the Secretary.

SEC. 207. IMPLEMENTATION REPORT.

Not later than 18 months after the date of the enactment of this Act, the Secretary shall submit to the Committees on Veterans Affairs of the Senate and House

of Representatives a report on the implementation of this title.

TITLE III—NATIONAL COMMISSION ON VA

NURSING

SEC. 301. ESTABLISHMENT OF COMMISSION.

(a) ESTABLISHMENT.—There is hereby established in the Department of Veterans

Affairs a commission to be known as the ‘‘National Commission on VA Nursing’’

(hereinafter in this title referred to as the ‘‘Commission’’).

(b) COMPOSITION.—(1) The Commission shall be composed of 12 members.

(2) Eleven members shall be appointed by the Secretary of Veterans Affairs, as

follows:

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(A) Three shall be recognized representatives of employees, including nurses,

of the Department of Veterans Affairs.

(B) Three shall be representatives of professional associations of nurses of the

Department or similar organizations affiliated with the Department’s health

care practitioners.

(C) Two shall be representatives of trade associations representing the nursing profession.

(D) Two shall be nurses from nursing schools affiliated with the Department

of Veterans Affairs.

(E) One shall be a representative of veterans.

(3) The Nurse Executive of the Department of Veterans Affairs shall be an ex officio member of the Commission.

(d) CHAIRMAN OF COMMISSION.—The Secretary of Veterans Affairs shall designate

one of the members of the Commission to serve as chairman of the Commission.

(e) PERIOD OF APPOINTMENT; VACANCIES.—Members shall be appointed for the life

of the Commission. Any vacancy in the Commission shall be filled in the same manner as the original appointment.

(f) INITIAL ORGANIZATION REQUIREMENTS.—All appointments to the Commission

shall be made not later than 60 days after the date of the enactment of this Act.

The Commission shall convene its first meeting not later than 60 days after the date

as of which all members of the Commission have been appointed.

SEC. 302. DUTIES OF COMMISSION.

(a) ASSESSMENT.—The Commission shall— (1) consider legislative and organizational policy changes to enhance the recruitment and retention of nurses by the Department of Veterans Affairs; and

(2) assess the future of the nursing profession within the Department.

(b) RECOMMENDATION.—The Commission shall recommend legislative and organizational policy changes to enhance the recruitment and retention of nurses in the

Department.

SEC. 303. REPORTS.

(a) COMMISSION REPORT.—The Commission shall, not later than two years after

the date of its first meeting, submit to Congress and the Secretary of Veterans Affairs a report on the Commission’s findings and conclusions.

(b) SECRETARY OF VETERANS AFFAIRS REPORT.—Not later than 60 after the date

of the Commission’s report under subsection (a), the Secretary shall submit to Congress a report— (1) providing the Secretary’s views on the Commission’s findings and conclusions; and

(2) explaining what actions, if any, the Secretary intends to take to implement the recommendations of the Commission and the Secretary’s reasons for

doing so.

SEC. 304. POWERS.

(a) HEARINGS.—The Commission or, at its direction, any panel or member of the

Commission, may, for the purpose of carrying out the provisions of this title, hold

hearings and take testimony to the extent that the Commission or any member considers advisable.

(b) INFORMATION.—The Commission may secure directly from any Federal department or agency information that the Commission considers necessary to enable the

Commission to carry out its responsibilities under this title.

SEC. 305. PERSONNEL MATTERS.

(a) PAY OF MEMBERS.—Members of the Commission shall serve without pay by

reason of their work on the Commission.

(b) TRAVEL EXPENSES.—The members of the Commission shall be allowed travel

expenses, including per diem in lieu of subsistence, at rates authorized for employees of agencies under subchapter I of chapter 57 of title 5, United States Code, while

away from their homes or regular places of business in the performance of services

for the Commission.

(c) STAFF.—(1) The Secretary may, without regard to the provisions of title 5,

United States Code, governing appointments in the competitive service, appoint a

staff director and such additional personnel as may be necessary to enable the Commission to perform its duties.

(2) The Secretary may fix the pay of the staff director and other personnel appointed under paragraph (1) without regard to the provisions of chapter 51 and subchapter III of chapter 53 of title 5, United States Code, relating to classification of

positions and General Schedule pay rates, except that the rate of pay fixed under

this paragraph for the staff director may not exceed the rate payable for level V of

the Executive Schedule under section 5316 of such title and the rate of pay for other

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personnel may not exceed the maximum rate payable for grade GS–15 of the General Schedule.

(d) DETAIL OF GOVERNMENT EMPLOYEES.—Upon request of the Secretary, the head

of any Federal department or agency may detail, on a nonreimbursable basis, any

personnel of that department or agency to the Commission to assist it in carrying

out its duties.

SEC. 306. TERMINATION OF THE COMMISSION.

The Commission shall terminate 90 days after the date of the submission of its

report under section 303(a).

INTRODUCTION

The reported bill, in the nature of a substitute to H.R. 2792, the

Disabled Veterans Service Dog and Health Care Improvement Act

of 2001, reflects the Committee’s consideration of matters necessary to make a number of improvements in the Department of

Veterans Affairs health care programs.

On April 3, 2001, the Subcommittee on Health held a hearing

concerning the current state of the VA health care system. Those

testifying at the hearing included: the Honorable Thomas L.

Garthwaite, Under Secretary for Health, Department of Veterans

Affairs; Dr. Frances M. Murphy, Deputy Undersecretary for

Health, Department of Veterans Affairs; Dr. John G. Clarkson,

Senior Vice President Medical Affairs and Dean, University of

Miami School of Medicine, Miami, FL; Dr. George Thibault, Chairman, Special Medical Advisory Group, Department of Veterans Affairs, Vice President and Chairman of Clinical Affairs, Partners

Health Care, Inc.; Mr. James R. Fischl, Director, National Veterans

Affairs and Rehabilitation Commission, The American Legion; Mr.

Paul A. Hayden, Associate Director, National Legislative Service,

Veterans of Foreign Wars; Ms. Joy J. Ilem, Assistant National Legislative Director, Disabled American Veterans; Mr. John Bollinger,

Deputy Executive Director, Paralyzed Veterans of America; Mr.

Richard Jones, National Legislative Director, AMVETS; Mr. Bobby

J. Harnage, Sr., National President, American Federation of Government Employees; Ms. Ellen M Pitts, R.N., President, VA Medical Center, Brockton, MA, Local R1–187, National Association of

Government Employees; and Ms. Elaine Gerace, R.N., Divisional

President, VA Medical Center, Syracuse, NY, Local 200B, Service

Employees International Union.

On June 20, 2001, the Subcommittee on Health held a hearing

on mental health, substance use disorders, and homelessness in the

veteran population, and the Department’s policies in dealing with

these difficult challenges. Those testifying at the hearing included:

the Honorable Thomas Garthwaite, Under Secretary for Health,

Department of Veterans Affairs; Mr. Peter H. Dougherty, Director,

Homeless Veterans Programs, Office of Public and Intergovernmental Affairs, Department of Veterans Affairs; Dr. Paul Errera,

Connecticut VA Health System, Former Director, VHA Mental

Health and Behavioral Sciences; Dr. Laurent S. Lehmann, Chief

Consultant, Mental Health and Behavioral Sciences Services, Department of Veterans Affairs; Dr. Miklos Losonczy, New Jersey VA

Health System Co-chair, VA Advisory Committee on Serious Mental Illness; Dr. Richard McCormick, Ohio VA Health System, Cochair, VA Advisory Committee on Serious Mental Illness; Dr. Bruce

Rounsaville, Connecticut VA Health System, Professor of Psychiatry, Yale University; Ms. Linda Boone, Executive Director, NaVerDate 13-OCT-2001 22:25 Oct 16, 2001 Jkt 099006 PO 00000 Frm 00009 Fmt 6659 Sfmt 6601 E:\HR\OC\HR242.XXX pfrm01 PsN: HR242
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tional Coalition for Homeless Veterans; Dennis Culhane, Ph.D., Associate Professor, University of Pennsylvania, Fred Frese, Ph.D.,

Chair, Veterans Committee, National Alliance for the Mentally Ill;

Mr. Ralph Ibson, Vice President for Government Affairs, National

Mental Health Association; Mr. Richard Fuller, National Legislative Director, Paralyzed Veterans of America; Ms. Joy Ilem, Assistant National Legislative Director, Disabled American Veterans; Ms.

Linda Spoonster-Schwartz, Associate Research Scientist, Yale University School of Nursing; and Mr. Richard Weidman, Executive

Director, Government Relations, Vietnam Veterans of America.

On September 6, 2001, the Subcommittee on Health, Committee

on Veterans’ Affairs held a legislative hearing on H.R. 2792, the

Disabled Veterans Service Dog and Health Care Improvement Act

of 2001. Those testifying at the hearing included: the Honorable

Lois Capps, U.S. House of Representatives; the Honorable Dave

Weldon, U.S. House of Representatives; the Honorable Roger Wicker, U.S. House of Representatives; Ms. Beth Barkley, Vice President, A Rinty for Kids, Inc., (with service dogs ‘‘Rin Tin Tin #8’’,

‘‘Fearghas’’, and ‘‘Gustav’’); the Honorable Anthony J. Principi, Secretary of Veterans Affairs, Department of Veterans Affairs; Dr.

Frances Murphy, Deputy Under Secretary for Health, Department

of Veterans Affairs; Mr. Richard Fuller, National Legislative Director, Paralyzed Veterans of America; Ms. Joy Ilem, Assistant National Legislative Director, Disabled American Veterans; Mr.

Thomas H. Miller, Executive Director, Blinded Veterans Association; and Ms. Jacqueline Garrick, Deputy Director, American Legion; and Mr. Richard Jones, National Legislative Director,

AMVETS.

On September 24, 2001, the Subcommittee on Health held a

hearing in Wichita, Kansas, on health systems and health care related issues and concerns. Those testifying at the hearing included:

Mr. James R. Franklin, Vietnam Veteran, Liberal, Kansas; Mr.

Olen Mitchell, World War II Veteran, Hutchinson, Kansas; Mr.

Scott Ratzlaff, Desert Storm Veteran, Colby, Kansas; Ms. Tamina

Fromme, Vietnam Veteran, Dodge City, Kansas; Mr. Kent Hill, Director, VA Medical and Regional Office Center, Wichita, Kansas;

Dr. L.S. Raju, VA Community Based Outpatient Clinic, Liberal,

Kansas; Ms. Leann Zimmerman, Nurse Practitioner, VA Community Based Outpatient Clinic, Hays, Kansas; Dr. Peter Almenoff,

VISN 15 Network Medical Director, VA Heartland Network, Kansas City, Missouri.

Through these hearings, meetings and through other mechanisms of oversight, the Subcommittee and full Committee on Veterans Affairs considered the following bills: H.R. 2792; H.R. 1136;

H.R. 1435; and H.R. 936, dealing with a variety of matters pertaining to health care, specialized resources and human services offered to the Nation’s veterans by the Department of Veterans Affairs and other agencies of the federal government.

On October 4, 2001, the Subcommittee on Health met and unanimously ordered H.R. 2792 reported favorably to the full Committee

with an amendment in the nature of a substitute.

On October 10, 2001, the full Committee met and ordered H.R.

2792 reported favorably to the House with an amendment in the

nature of a substitute by voice vote.

11

SUMMARY OF THE REPORTED BILL

H.R. 2792, as amended, would:

1. Authorize service dogs be provided by VA to a veteran suffering from spinal cord injuries or dysfunction, other diseases

causing physical immobility, hearing loss or other types of disabilities susceptible to improvement or enhanced functioning

in activities of daily living through employment of a service

dog. A veteran would be required to be enrolled in VA care as

a prerequisite to eligibility for a service dog. Service dogs

would be provided in accordance with existing priorities for all

VA health care enrollment.

2. Strengthen the mandate for VA to maintain capacity in specialized medical programs for veterans by requiring each Veterans Integrated Service Network to maintain a proportional

share of national capacity in certain specialized health care

programs for veterans (those with serious mental illness, including substance use disorders, spinal cord, brain injured

and blinded veterans; veterans who need prosthetics and sensory aids); and extend capacity reporting requirement for 3

years.

3. Modify VA’s system of determining nonservice-connected veterans’ ‘‘ability to pay’’ for VA health care services by introducing (generally as an upper income bound compared to current income limits) the ‘‘Low Income Housing Index’’ employed

by the Department of Housing and Urban Development

(HUD). This index is used to determine family income thresholds for HUD housing assistance eligibility. This index is adjusted for all Standard Metropolitan Statistical Areas (SMSA),

and is updated periodically by HUD to reflect economic

changes within the SMSAs. This change in law would be

phased in with no VISN experiencing greater than 5 percent

change in funding allocation than would otherwise occur.

4. Require the Secretary of Veterans Affairs to assess all special

telephone services made available to veterans, such as ‘‘help

lines’’ and ‘‘hotlines.’’ The assessment would include geographical coverage, availability, utilization, effectiveness,

management, coordination, staffing, cost, and a survey of veterans to measure effectiveness of these telephone services and

future needs. A report to Congress would be required within

1 year of enactment.

5. Extend expiring authority for VA to collect proceeds from veterans’ health insurance policies for care provided for non-service connected care.

6. Establish a VA chiropractic services program, to be implemented in a 5-year period; authorize VA to employ chiropractors as federal employees and obtain chiropractic services

through contracts; create a VA advisory committee on chiropractic health care; authorize chiropractors to function as VA

primary care providers; authorize appointment of a director of

chiropractic service reporting to the Secretary, with the same

authority as other service directors in the VA health care

system.

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7. Establish a National Commission on VA nursing, consisting of

12 members appointed by the Secretary; their review would

include legislative and organizational policy changes to enhance recruitment and retention of nurses and assess future

of the nursing profession in the VA; a report to Congress

would be required within 2 years of establishment.

BACKGROUND AND DISCUSSION

Authorization for Service Dogs for Disabled Veterans.—The Department of Veterans Affairs (VA) is authorized to provide blinded

veterans with guide dogs to aid them in adjusting to blindness and

severe vision impairments. Many veterans who are enrolled in VA

health care are suffering from mobility or hearing impairments

would benefit greatly from use of service dogs, but VA is not authorized to furnish assistive animals under current law. A service

dog would not only provide a companion to the disabled veteran,

but could also reduce the amount of time and resources needed

from an aide for activities of daily living.

With proper training, service dogs can perform tasks such as

opening and closing doors, turning switches on and off, assisting a

person from a sitting or lying position, providing help in and out

of bathtubs or showers, picking up and retrieving objects, pulling

wheelchairs, or helping a person with clothing, including helping to

dress and undress. The benefits service dogs provide are well

known and documented in medical journals, studies, and personal

testimony. The testimony received at the Subcommittee’s hearing

on September 6, 2001, supported extending this special benefit to

enrolled veterans.

The reported bill expands the authority of the Department of

Veterans Affairs to provide service dogs to veterans, but in accordance with current enrollment priorities. In the Committee’s view,

section 101 would strengthen VA benefits to hearing impaired and

mobility-impaired veterans to improve the quality of life.

Maintenance of Capacity in Specialized Programs.—Congress

provided a mandate in legislation (Public Law 104–262) that requires VA to maintain nationwide capacity to provide for specialized treatment and rehabilitative needs for veterans, including

those with amputations, spinal cord injury or dysfunction, traumatic brain injury, and severe, chronic, disabling mental illnesses,

including schizophrenia, PTSD and substance-use disorders. To

validate VA’s compliance with capacity maintenance, the legislation

requires an annual report to Congress. The emphasis in the law is

clearly on VA maintaining specialized capacity, including appropriate VA inpatient care and VA intensive-case management—approaches that a number of studies have shown to be more effective

than primary care in the treatment of persons with mental illnesses. There is little question that primary care costs less, but its

effectiveness as a substitute for these traditional VA programs for

its most vulnerable patients is still uncertain.

The Committee has been made well aware that there have been

recurring problems with VA’s observance of the capacity law, and

the most recent report submitted to the Congress by VA confirms

their continued existence. According to the report, the three largest

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ability to identify VA patients receiving care in specialized programs, and 3) lack of outcome measures to assess program effectiveness. Several years of these reports, all claiming the same

kinds of continuing data and definitional difficulties, causes the

Committee to question whether VA is in full compliance with the

law. The report requirement was designed to ensure that Congress

has a fair and frank depiction of resource investment in VA’s mental health, drug abuse, blind rehabilitation, and other specialized

care programs. The Congress recognizes that optimal treatment

modalities may change over time, but has directed the Secretary to

ensure that overall capacity for service delivery is not lost.

The Committee’s bill would strengthen the requirement for VA

to maintain capacity by applying the requirement both nationally

and to the 22 Veterans Health Administration patient care networks. The Committee bill would also add new reporting requirements to better elucidate for Congress VA’s changing capacity to

provide and maintain care systems for the most seriously mentally

ill and substance-addicted patients; veterans who need prosthetics

and sensory aids services; and programs in spinal cord injury and

blind rehabilitation, among others.

Threshold for Means Test to Reflect Cost of Living.—Section 103

of the Committee bill would modify the ‘‘means test’’ employed by

the Department of Veterans Affairs to determine eligible veterans’ enrollment priority, as set forth in section 1722 of title 38, United

States Code. Enrollment priority is important because veterans in

lower categories (i.e., VA priority levels 6 and 7) whose incomes are

above current means test levels (in 2001, $23,688 per year for a

single veteran) are required to make co-payments for their care.

These copayments must be made for hospitalization (the current

Medicare first-day deductible of $792 plus $10.00 per day); nursing

home care (one-half the Medicare hospitalization first-day deductible for each 90 days plus $5.00 per day); outpatient services

($50.80 per day); and pharmaceutical services ($2.00 for each 30-

day supply of medication). The Secretary of Veterans Affairs is authorized to limit veterans’ enrollment and access to VA health services because of budgetary limitations.

VA’s national income threshold is insensitive to regional variations in cost of living, cost of health care, cost of housing, employment factors, rural or urban influences and other matters that determine or heavily affect an individual veterans’ ability to pay. One

method of ensuring equity for veterans in access to VA health care

would be adjustment of the national means test by locality, to more

accurately reflect well-recognized differences in geographic cost-ofliving.

The HUD low-income limits are established under Section 3 of

the U.S. Housing Act of 1937, as amended. HUD income limits are

currently used to determine eligibility in 22 separate federal programs, including a number of tax incentive programs. Although

HUD acknowledges that its income estimates are not completely

reliable for every metropolitan area, it regularly corrects estimating errors and assesses data sources for the most reliable and

up-to-date information. The limits are a viable method to aid VA

in establishing a proxy for a veteran’s ability to pay on a regional

basis. HUD defines ‘‘low income’’ families as those with incomes

that do not exceed 80 percent of the median family incomes for the

14

areas in which they reside. Limits are established for 2,680 geographic areas, including Metropolitan Statistical Areas (MSAs),

Primary Metropolitan Statistical Areas (PMSAs) and counties.

Using the HUD low-income limits in place of VA’s current means

test threshold would mean that all veterans residing in a defined

locality would have a means test threshold adjusted to reflect the

cost-of-living determined for that particular defined area. This new

threshold would be more indicative of the veteran’s ability to defray

the cost of care. Furthermore, to ensure that no veterans would be

dislodged from Category 5 into Category 7 and thus compelled to

make copayments, when these new thresholds were implemented,

the bill would maintain the existing national income threshold as

the lowest figure for any means test variation, even if the HUD formula were to determine in a given instance that the low-income

rate for a particular area is actually below the VA’s national income threshold. This would provide assurance that existing category 5 veterans would not be affected by the application of the

HUD limits, but some current ‘‘higher income’’ veterans whose incomes now place them above the margin would move to category

5 as a consequence of the new means test system.

Use of the HUD low-income rates to augment VA’s current, single means test standard would create a more realistic, equitable

system to reflect cost-of-living variations from one locality to another. This new methodology would affirm Congressional intent

that VA provide care for poor veterans on a high-priority basis.

To address concerns about the potential effect of using the alternative HUD low-income limits on VA’s internal allocation system,

the bill includes a provision that no VHA geographic service area’s

allocation could be increased or decreased by more than 5 percent

in any year due to the application of the HUD limits in determination of a veterans’ priority of enrollment in VA care.

Assessment and Report on Special Telephone Services.—The Committee is concerned about the status of the variety of telephone

services VA may be making available to veterans in both its health

care and benefits programs, and in particular, any telephone ‘‘hotlines’’ or ‘‘help lines’’ focused on providing information to veterans

who may be in crisis or who are homeless and in need of urgent

services or information. Section 104 directs the Secretary to study

the availability, utilization, effectiveness, and cost of these VA services. The study would include a survey of veterans who have used

such services in the past as to whether they are satisfied with the

current availability of services and the demand for additional services. The study should assess VA capabilities to offer local referrals

for the provision of emergency shelter and food for homeless veterans, VA substance use disorder rehabilitation sources, opportunities for employment and training, and small business assistance

programs, if appropriate.

The report of the Secretary would be required within 180 days

of enactment of the Committee’s bill.

Extension of Collections Authorities.—VA is authorized to retain

third-party recoveries and other co-payments from the provision of

health-care services to certain non-service connected veterans and

to use those resources to provide additional care to veterans. This

authority allows VA necessary flexibility to enhance funding

15

through user fees that Congress would otherwise have to provide

through appropriations.

Since this fund was restructured in the Balanced Budget Act of

1997, enabling VA to retain and expend funds thus collected, the

Department has in fact retained $139.5 million in fiscal year 1997,

$560.1 million in fiscal year 1998, $573.6 million in fiscal year

1999, and $563.8 million in fiscal year 2000. The Department estimates that it will retain $675 million in fiscal year 2001. Extending

the authority to collect third-party insurance proceeds for care provided to service-connected veterans for non-service connected conditions to September 30, 2007, will allow VA to continue providing

health care to many enrolled veterans.

Chiropractic Services in the Department of Veterans’ Affairs.—

Title II of the bill establishes a new chiropractic health benefit

within the Department of Veterans Affairs. The Committee believes the Department is long overdue in establishing a firm, comprehensive policy to provide a full scope of chiropractic service to

veterans. Over the last 106 years, chiropractic health science has

become the third-largest physician-level health care profession in

the world. Doctors of chiropractic are licensed in all 50 states as

health care service providers.

The Committee bill would establish chiropractic services immediately in the Department, but would provide a 5-year phase-in period to enable the health care facilities of the Department to fully

implement the national program. A minimum of 30 VA medical

centers would be required to make chiropractic services available

to veterans annually, beginning in 2002, so that all VA medical

centers will be providing chiropractic services within 5 years of enactment of the Committee bill. The Committee bill specifically directs VA to activate a chiropractic service for veterans through

both direct employment of doctors of chiropractic and by obtaining

their services for veterans through available contracting

mechanisms.

The Committee bill also requires the establishment of a national

office of chiropractic, headed by an appointed Director, who shall

be appointed within 90 days of enactment, and who reports to the

Secretary of Veterans Affairs. The establishment of a chiropractic

service in the Department will be guided by an advisory committee

on chiropractic, whose members shall included chiropractors,

human resources specialists and others whose expertise will facilitate optimal establishment of chiropractic within the health benefits available to veterans.

National Commission on VA Nursing.—Title III of H.R. 2792

would establish a national VA commission on nursing. The Committee, through meetings and other interactions with VA officials,

reports from associations representing the nursing and allied nursing professions, reports and hearings from other committees of the

House and Senate, and from reports and testimony of the General

Accounting Office, is aware of a conundrum concerning the present

state of nursing in the Department of Veterans Affairs, as well as

the future of nursing in the United States. To better assist the

Committee and Congress in dealing with necessary actions to sustain a dependable source of nursing staff for the VA health care

system, the bill authorizes the establishment of an independent naVerDate 13-OCT-2001 22:25 Oct 16, 2001 Jkt 099006 PO 00000 Frm 00015 Fmt 6659 Sfmt 6601 E:\HR\OC\HR242.XXX pfrm01 PsN: HR242
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tional nursing commission. This body is to include representatives

of trade associations, professional associations representing VA

nurses, unions and academic nursing. It should reflect the full

spectrum of nursing professionals within the Department.

The commission will be required to assemble and meet as an

independent activity, assess the current and projected supply and

demand of nursing professionals, review any relevant reports or assessments from available literature, consult as necessary with academic institutions, the Secretary, elements of the Veterans Health

Administration and other health care providers, and report to Congress within 2 years its findings, conclusions and recommendations.

The report would be required to be reviewed by the Secretary of

Veterans Affairs, and the Secretary would be required to report

VA’s views and recommendations on the national commission’s report within 60 days of its receipt.

SECTION-BY-SECTION ANALYSIS

Section 1. Short Title

Section 1(a) declares the title of this Act to be the ‘‘Disabled Veterans Service Dog and Health Care Improvement Act of 2001.’’ Section 1(b) sets forth the table of contents, including Title I, Veterans

Health Care Improvement; Title II, Chiropractic Services Program;

and Title III, National Commission on VA Nursing.

TITLE I – VETERANS HEALTH CARE IMPROVEMENT

Section 101. Authorization for Secretary of Veterans Affairs to provide Service Dogs for Disabled Veterans

Section 101 would amend the existing law to expand the Department’s authority to provide guide dogs to blind veterans. Current

law limits the provision of guide dogs to blind veterans who are entitled to disability compensation. The bill removes that language,

and provides the benefit to all enrolled veterans. This provision

would also authorize the Department to provide service dogs to veterans who are hearing impaired or who have spinal cord injury or

dysfunction or other chronic impairment that substantially limits

mobility. The provision states that these services are to be provided

in accordance with the priority specified in section 1705.

Existing statutory authority allows the Department to pay for

certain travel and incidental expenses incurred by veterans while

adjusting to guide dogs. Section 101 would amend the language to

allow these expenses for all guide dogs or service dogs covered by

this legislation.

Section 102. Maintaining Capacity

Section 102 addresses the Department’s statutory obligation to

maintain the capacity to provide for the specialized treatment and

rehabilitative needs of disabled veterans, including veterans with

spinal cord dysfunction, blindness, amputations, and mental illness. Congress imposed this requirement with the enactment of the

Veterans’ Health Care Eligibility Reform Act of 1996, Public Law

104–262. The law requires that capacity be maintained at its 1996

level. The bill would amend the statute to require that the Department maintain this capacity not only in the Department as a

17

whole, but within each geographic service area, or VISN, of the

Veterans Health Administration.

Section 102 would amend 38 U.S.C. § 1706(b) to provide detail on

how VA is to measure the capacity to provide specialized treatment

and rehabilitative needs of disabled veterans within distinct programs or facilities. It states that the distinct programs or facilities

must be measured for seriously ill veterans in different ways for

different types of services provided. All of the data must be provided by geographic service area and totaled nationally.

For mental health intensive community-based care, capacity is to

be measured by the number of discrete intensive care teams constituted to provide such intensive services to seriously mentally ill

veterans and the number of veterans provided such care. For opioid

substitution programs and for traumatic brain injury, capacity is to

be measured by the number of patients treated annually and the

amounts expended. For dual-diagnosis patients, capacity is to be

measured by the number treated annually and the amounts expended. For substance abuse programs, capacity is to be measured

by four different measures. First, it is measured by the number of

substance-use disorder beds employed (hospital, nursing home or

other designated beds) and the average bed occupancy of such beds.

The second measure is the percentage of unique patients admitted

directly to substance abuse outpatient care during the fiscal year

who had two or more additional visits to specialized substance

abuse outpatient care within 30 days of their first visit, with a

comparison from 1996 until the date of the report. The third measure is the percentage of unique inpatients with substance abuse diagnoses treated during the fiscal year who had one or more specialized substance abuse clinic visits within three days of their index

discharge, with a comparison from 1996 until the date of the report. Finally, the fourth measure of capacity for substance abuse

programs is the percentage of unique outpatients seen in a facility

or service network during the fiscal year who had one or more specialized substance abuse clinic visits, with a comparison from 1996

until the date of the report. For mental health programs, capacity

is to be measured by the number and type of staff that are available at each facility to provide specialized mental health treatment,

including satellite clinics, outpatient programs, and communitybased clinics, with a trend line comparison from 1996 to the date

of the report. The measurement should indicate the number of clinics providing mental health care, the number and type of mental

health staff at each such clinic, and the type of mental health programs at each such clinic. For spinal cord injury specialized centers

and for blind rehabilitation specialized centers, capacity is to be

measured by the number of beds in the centers, and by the number

of staff assigned on a full-time basis to provide care in such centers. For prosthetics and sensory aids, capacity is to be measured

by the annual amount expended.

The Department’s obligation to report on compliance with this requirement is extended through 2004. Section 102 adds a new requirement that the Inspector General of the Department certify or

comment on the accuracy of each such capacity report.

18

Section 103.—Means Test Threshold

Section 103 would amend 38 U.S.C. § 1722 to establish new geographically based income thresholds for determining a non-serviceconnected veteran’s priority for receiving VA care and whether the

veteran must agree to pay copayments in order to receive that care.

It would utilize low-income limits developed by the Department of

Housing and Urban Development (HUD) to establish these alternative income thresholds. The income threshold for the veteran

would be either the specific income threshold set forth on a national basis, or the low-income limits set by HUD—whichever is

greater.

Section 103 also includes a limitation on resource allocation by

capping the amount of money that can be reallocated because of

this provision. Within the amount appropriated to the Department

for medical care for each of fiscal years 2002 through 2006, the

amount that would otherwise be allocated by the Secretary to any

geographic service region of the Veterans Health Administration in

accordance with the established resource allocation procedures of

the Department may not be increased or decreased by more than

5 percent because of this new provision.

Section 104.—Assessment and Report on Special Telephone Services

for Veterans

Section 104 is a provision that requires the Secretary to assess

all special telephone services for veterans (such as help lines and

hotlines) provided by the Department. The assessment will include

the geographic coverage, availability, utilization, effectiveness,

management, coordination, staffing, and cost of those services. The

assessment must also include a survey of veterans to measure satisfaction with the current special telephone services, as well as the

demand for additional services. The Secretary shall submit a report

to Congress on the assessment no later than one year after the enactment of this bill. The report must include recommendations regarding any needed improvement to the services, and recommendations regarding contracting for such services.

Section 105.—Recodification of Bereavement Counseling and other

Authorities

Section 105 would amend chapter 17 of title 38, United States

Code to consolidate and reorganize without substantive change, in

a new subchapter, all of the various legal authorities under which

VA provides services to non-veterans. It would reorganize 38 U.S.C.

§ 1701 by transferring one provision (pertaining to sensori-neural

aids) to section 1707.

Section 105 would create a new Subchapter VIII in Chapter 17

to incorporate provisions concerning counseling and bereavement

counseling services for family members. The new subchapter would

include a section on VA’s provision of counseling, training and mental health services for family members of veterans who are receiving certain service-connected and non-service-connected treatment.

A new section 1782 provides counseling, training, and mental

health services for immediate family members. Subsection (a) of

section 1782 states that in the case of a veteran who is receiving

treatment for a service-connected disability pursuant to paragraph

19

(1) or (2) of section 1710(a), the Secretary shall provide to individuals described in subsection (c) such consultation, professional

counseling, training, and mental health services as are necessary

in connection with that treatment. Subsection (b) of section 1782

states that in the case of a veteran who is eligible to receive treatment for a non-service-connected disability under certain conditions, the Secretary may, in the discretion of the Secretary, provide

to individuals described in subsection (c) such consultation, professional counseling, training, and mental health services as are necessary in connection with that treatment if those services were initiated during the veteran’s hospitalization; and if the continued

provision of those services on an outpatient basis is essential to

permit the discharge of the veteran from the hospital. Subsection

(c) of section 1782 identifies eligible individuals who may be provided services as members of the immediate family or the legal

guardian of a veteran; or the individual in whose household such

veteran certifies an intention to live. Subsection (d) allows certain

travel and transportation expenses of eligible individuals.

Section 105 would also recodify the Secretary’s authority to provide bereavement counseling following the death of certain veterans. Subsection (a) of the new Section 1783 states that in the

case of an individual who was a recipient of services under section

1782 of this title at the time of the death of the veteran, the Secretary may provide bereavement counseling to that individual in

the case of a death that was unexpected; or that occurred while the

veteran was participating in a hospice program (or a similar program) conducted by the Secretary. Subsection (b) states that the

Secretary may provide bereavement counseling to an individual

who is a member of the immediate family of a member of the

Armed Forces who dies in the active military, naval, or air service

in the line of duty and under circumstances not due to the person’s

own misconduct. Subsection (c) states that the term ’bereavement

counseling’ means such counseling services, for a limited period, as

the Secretary determines to be reasonable and necessary to assist

an individual with the emotional and psychological stress accompanying the death of another individual. The counseling described

in section 1782 and 1783 are currently authorized in the definition

of outpatient medical services.

Section 105 would place in the new subchapter the current dependent health care authorities (transferred from current section

1713 to the new section 1781). A new provision in the bill provides

that a dependent or survivor receiving VA-sponsored care would

also be eligible for the bereavement counseling and the other counseling, training and mental health services provided to family

members under this new subchapter.

The existing authority to provide hospital care or medical services as a humanitarian service in emergency cases would be moved

to this new subchapter from the current location in section 1711(b).

Section 105 also makes various technical changes to accommodate the reorganization. These changes would recodify the currently existing provisions, and consolidate and clarify the existing

statutory authority to provide care to non-veterans.

20

Section 106.—Extension of Expiring Collections Authorities

Section 106 would amend sections 1710(f)(2)(B) and 1729(a)(2)(E)

of title 38, United States Code, to extend VA’s authority to collect

per diem nursing home and hospital co-payments from certain veterans, and to collect third-party payments for the treatment of the

nonservice-connected disabilities of veterans with service-connected

disabilities.

TITLE II – CHIROPRACTIC SERVICES

Section 201.—Chiropractic Service Established in the Veterans

Health Administration

Section 201 amends 38 U.S.C. section 7305 to create a new position of Director of Chiropractic Service. The Director of the service

is to be a qualified doctor of chiropractic and is responsible to the

Secretary for the operation of the Chiropractic Service.

Section 202.—Availability of Chiropractic Care to Veterans

Section 202 requires the Secretary to establish a program to provide chiropractic care in all Veterans Affairs medical centers. The

provision phases in the program by requiring a chiropractic service

at not less than 30 medical centers by the end of fiscal year 2002;

at not less than 60 medical centers by the end of fiscal year 2003;

at not less than 90 medical centers by the end of fiscal year 2004;

and not less than 120 medical centers by the end of fiscal year

2005; and at all medical centers by the end of fiscal year 2006. The

Secretary shall designate the initial 30 medical centers not later

that 60 days after the date of enactment of this provision. The Secretary must select medical centers to reflect geographic diversity,

facilities of various size and capabilities, and the range of services

within medical centers in the Department health care system.

Section 203.—Chiropractic Providers

Section 203 states that the program under section 202 shall be

carried out through personal service contracts and with appointments of licensed chiropractors for delivery of chiropractic services

at Department of Veterans Affairs medical centers.

Section 204—Scope of Services; Enrollment

Section 204 stipulates that the chiropractic services provided

under section 202 shall include, at a minimum, care for neuro-musculoskeletal conditions. Veterans enrolled for care under section

1705 of title 38, United States Code, may choose a chiropractor as

the veteran’s primary care provider. Veterans with a primary care

provider other than a chiropractor may be referred to chiropractic

services for neuro-musculoskeletal conditions by another primary

care provider.

Section 205.—Training and Information

Section 205 requires the Secretary to provide training and materials relating to chiropractic services to members of Department

health care providers assigned to primary care teams in order to

familiarize those providers with the benefits of appropriate use of

chiropractic services. During the phase-in period described in section 202, the Secretary is required to provide materials relating to

21

chiropractic services to medical centers and other health care facilities of the Department that are not participating in the program

in order to ensure that health care providers at non-participating

facilities are aware of chiropractic care as a future referral source.

Section 206.—Advisory Committee

Section 206 directs the Secretary to establish an advisory committee to review the implementation of the chiropractic program in

Department medical facilities. In appointing members to the advisory committee, that Secretary shall include members of the chiropractic profession; persons who are experts in human resources appointments in the Federal service; persons with expertise in academic matters; persons with knowledge of credentialing and the

granting of professional privileging to health care practitioners;

and other persons determined necessary by the Secretary and the

functional needs of the advisory committee in establishing the

chiropractic health program. The advisory committee shall provide

advice to the Secretary on the granting of professional privileges

for chiropractors at Department medical centers; the scope of practice of chiropractors at Department medical centers; training materials; and such other matters as are determined appropriate by the

Secretary.

Section 207.—Implementation Report

No later than 18 months after the date of the enactment of this

bill, the Secretary shall submit to the Committees on Veterans Affairs of the Senate and House of Representatives a report on the

implementation of this title.

TITLE III – NATIONAL COMMISSION ON VA NURSING

Section 301.—Establishment of Commission

Section 301 establishes a commission known as the ‘‘National

Commission on VA Nursing.’’ The commission is to be composed of

12 members. Eleven members shall be appointed by the Secretary.

They include three recognized representatives of employees, including nurses, of the Department; three representatives of professional

associations of nurses of the Department or similar organizations

affiliated with the Department’s health care practitioners; two representatives of trade associations representing the nursing profession; two nurses from nursing schools affiliated with the Department; and one representative of veterans. The twelfth member, the

Nurse Executive of the Department, is be an ex officio member of

the commission. The Secretary shall designate one of the members

to serve as chairman of the Commission. Members shall be appointed for the life of the Commission. Any vacancy will be filled

in the same manner as the original appointment. The appointments are to be made no later that 60 days after enactment of this

Act. The Commission shall convene its first meeting not later than

60 days after the date as of which all members of the Commission

have been appointed.

Section 302.—Duties of the Commission

Section 302 describes the duties of the Commission. The Commission is to assess legislative and organizational policy changes to enVerDate 13-OCT-2001 22:25 Oct 16, 2001 Jkt 099006 PO 00000 Frm 00021 Fmt 6659 Sfmt 6601 E:\HR\OC\HR242.XXX pfrm01 PsN: HR242
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hance the recruitment and retention of nurses by the Department,

and the future of the nursing profession within the Department,

and recommend legislative and organization policy changes to enhance the recruitment and retention of nurses in the Department.

Section 303.—Reports

Section 303 states that the Commission shall submit to Congress

and the Secretary a report on its findings and conclusions. The report is due no later than two years after the date of the first meeting of the Commission. Not later than 60 days after the date of the

Commission’s report, the Secretary shall submit a report to Congress. The Secretary’s report to Congress shall provide the Secretary’s views on the Commission’s findings and conclusions. It

shall explain what actions, if any, the Secretary intends to take to

implement the recommendations of the Commission, and the Secretary’s reasons for doing so.

Section 304.—Powers

Section 304 states that the Commission or, at its direction, any

panel or member of the Commission, may hold hearings and take

testimony to the extent that the Commission or any member considers it advisable to do so. The Commission may secure directly

from any agency or department information that the Commission

considers necessary to enable it to carry out its responsibilities

under this title.

Section 305.—Personnel Matters

Section 305 states that the members of the Commission shall

serve on the Commission without pay. While performing services

for the Commission away from their homes or regular places of

business, Commission members shall be allowed travel expenses,

including per diem in lieu of subsistence, at rates authorized for

employees of agencies.

The Secretary may appoint a staff director and such additional

personnel as may be necessary to enable the Commission to perform its duties. The appointment may be made without regard to

the provisions of title 5, United States Code, governing appointments in the competitive service. The Secretary may fix the pay of

the staff director and the personnel without regard to the provisions of chapter 51 and subchapter III of chapter 53 of title 5,

United States Code, relating to the classification of positions and

General Schedule pay rates. The pay fixed for the staff director

may not exceed the rate payable for level V of the Executive Schedule under section 5316 of title 5, United States Code, and the rate

of pay for other personnel may note exceed the maximum rate payable for grade GS–15 of the General Schedule.

Upon the request of the Secretary, the head of any Federal department or agency may detail, on a nonreimbursable basis, any

personnel of that department or agency to the commission.

Section 306.—Termination of the Commission

The Commission shall terminate 90 days after the date of the

submission of its report.

23

PERFORMANCE GOALS AND OBJECTIVES

The reported bill would authorize health care benefits enhancements for veterans and VA program improvements, and require

certain assessments and reports to Congress. It would extend VA’s

specialized medical care capacity reporting for three years and

specify detailed reporting requirements. It would require a VA assessment and report within one year of enactment on VA’s specialized telephone services for veterans. It would establish a VA chiropractic services program over a five year period and require a report on implementation within 18 months after enactment. It also

would establish a National Commission on VA Nursing that would

be required to assess recruitment and retention of nurses, and assess the future of the nursing profession in the VA, with a report

required within two years of establishment. These programs, assessments and reports are subject to the Committee’s regular

oversight.

STATEMENT OF THE VIEWS OF THE ADMINISTRATION

STATEMENT OF ANTHONY J. PRINCIPI, SECRETARY, DEPARTMENT OF

VETERANS AFFAIRS, ON PROPOSED LEGISLATION, BEFORE THE

SUBCOMMITTEE ON HEALTH, COMMITTEE ON VETERANS’ AFFAIRS, UNITED STATES HOUSE OF REPRESENTATIVES, SEPTEMBER 6, 2001

Mr. Chairman and Members of the Subcommittee:

I am pleased to be here this morning to comment on H. R. 2792, the ‘‘Disabled

Veterans Service Dog and Health Care Improvement Act of 2001.’’ If enacted, this

bill would authorize the Secretary of Veterans Affairs to make service dogs available

to disabled veterans and to make various other changes in health care benefits provided by the Department of Veterans Affairs. This morning I would like to briefly

summarize the various sections of the bill, and provide VA’s views of these sections.

Section 2—Service Dogs

The bill would amend the existing law to expand VA’s authority to provide guide

dogs to blind veterans. Current law limits the provision of guide dogs to blind veterans who are entitled to disability compensation. The bill removes that limitation

and would authorize VA to provide service dogs to veterans who are hearing impaired or who have spinal cord injury or dysfunction or other chronic impairment

that substantially limits mobility. Service dogs can assist a disabled person in his

or her daily life and can assist that person during medical emergencies. They can

be trained in many tasks, including, but not limited to, pulling a wheelchair, carrying a back-pack, opening and closing doors, helping with dressing and undressing,

retrieving dropped items, picking up the telephone, and hitting a distress button on

the telephone. Some service dogs can perceive when the disabled individual is in distress and can find help. Dogs can also assist the hearing impaired by alerting them

to doorbells, ringing phones, smoke detectors, crying babies, and emergency sirens

on vehicles.

The existing statutory authority allows VA to pay for certain travel and incidental

expenses incurred by veterans while adjusting to seeing-eye or guide dogs. The bill

would amend the language to allow VA to pay these expenses for all guide dogs or

service dogs covered by this legislation.

Mr. Chairman, the benefit of guide dogs for the blind is well known, and we support having authority to also provide service dogs for veterans who are hearing impaired and who have spinal cord injuries or other chronic impairments, and to pay

for certain costs associated with adjusting to the dogs. However, we believe the provision of guide dogs and service dogs should continue to be limited to veterans who

are entitled to service-connected compensation. If this provision becomes law, we

would promulgate prescription criteria and guidelines to insure that we provide dogs

only to those veterans who can most benefit from them.

Section 3—Maintaining Capacity

Section 3 of the bill addresses VA’s statutory obligation to maintain the capacity

to provide for the specialized treatment and rehabilitative needs of disabled vetVerDate 13-OCT-2001 22:25 Oct 16, 2001 Jkt 099006 PO 00000 Frm 00023 Fmt 6659 Sfmt 6621 E:\HR\OC\HR242.XXX pfrm01 PsN: HR242
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erans, including veterans with spinal cord dysfunction, blindness, amputations, and

mental illness. As you know, Mr. Chairman, Congress imposed this requirement

with the enactment of the Veterans’ Health Care Eligibility Reform Act of 1996,

Public Law 104–262. The law requires that capacity be maintained at its 1996 level.

The bill would amend the statute to require that VA maintain this capacity not only

in the Department as a whole, but within each geographic service area, or VISN,

of the Veterans Health Administration. Additionally, the bill adds new language

stating that the capacity to provide specialized treatment and rehabilitative needs

of disabled veterans within distinct programs or facilities must be measured by the

annual amount spent for the care of such veterans in dedicated programs that provide these services through specialized staff. VA’s obligation to report on compliance

with this requirement is extended through 2004.

Mr. Chairman, we do not object to the provision which would require maintenance

of capacity within each geographic service area. This provision is consistent with our

desire to ensure that there is equality of access to quality specialized services. However, in order to accomplish this, we propose that the capacity be based on the enrolled veteran population in each geographic service area. In addition, we oppose the

provision that would measure capacity by dollars expended. The cost of care is not

an adequate measure, by itself, to demonstrate whether VA is maintaining the quality of and access to specialized care. Cost alone is not a valid and reliable measure

of capacity. Limiting the capacity report to measurement of dollars expended will

neither indicate nor ensure that VA is upholding its commitment to these high priority patients. Capacity must be measured by the actual number of patients receiving care in the specialized programs, the quality of the care provided, patients’

health outcomes, and patients’ access to that care, including waiting times for

appointments.

Furthermore, Mr. Chairman, it is currently not possible to know whether the

amount of care and the dollars expended in 1996 were optimal for measuring capacity in the targeted special programs. The care provided in 1996 provides only a

snapshot of what was then a rapidly changing VA health care delivery system. It

is not clear that 1996 can or should serve as a baseline out to 2004, as proposed

by this bill.

We understand that the staff of the Senate Veterans Affairs’ Committee is developing a different position with regard to VA’s obligation to maintain capacity. We

would be happy to work with both the Senate and House staff on this issue to develop amendments that would allow us to provide the best possible information on

VA’s capacity for treating veterans with specialized treatment and rehabilitative

needs.

Section 4—Means Test Threshold

Mr. Chairman, section 4 would establish new geographically based income thresholds for VA to use in determining a non-service-connected veteran’s priority for receiving VA care and whether the veteran must agree to pay copayments in order

to receive that care. This would be an alternative to the threshold presently set by

statute. As you know, Mr. Chairman, the law now requires that most veterans enroll in our health care system in order to receive care. Enrollees are placed in an

enrollment priority group that is based, in many instances, on their level of income

and net worth. Although we currently provide care to veterans in all enrollment priority groups, if there were medical care funding shortages in the future, it might

be necessary to determine that those non-service connected veterans with relatively

higher incomes must be disenrolled, meaning they could no longer receive VA care.

Current law establishes, on a National basis, the specific income thresholds that we

must use to determine the priority group of any given enrollee with no service-connected disability or other special status. We place higher income veterans in priority

group 7 and lower income veterans in priority group 5.

This provision would establish a new, geographically based income threshold that

VA could use for placing veterans in priority groups. It would utilize a poverty index

developed by the Department of Housing and Urban Development (HUD) to establish this alternative income threshold. The income threshold for the veteran would

be either the specific income thresholds set forth on a National basis, or the amount

set forth by the HUD index—whichever is greater. In most instances, this new income threshold would be greater than the current statutory income threshold used

for determining whether a veteran should be placed in priority group 5.

We are very interested in examining the use of geographically based income

thresholds for placing nonservice-connected veterans in different enrollment priority

groups. We recognize that the cost of living in large urban areas is much greater

than in many more rural parts of the country. What might be considered a reasonably high income in some locations may be totally inadequate in other higher cost

locations. However, at this time we cannot support the specific methodology proVerDate 13-OCT-2001 22:25 Oct 16, 2001 Jkt 099006 PO 00000 Frm 00024 Fmt 6659 Sfmt 6621 E:\HR\OC\HR242.XXX pfrm01 PsN: HR242
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posed in this bill. There are many poverty indices that are established in various

ways, and there are serious issues about what these indexes really measure. We believe further study is needed to determine the most appropriate method for tackling

this problem.

We are currently reviewing the various poverty indices in order to identify the

best way to proceed. We expect to have this work completed in September. We

would be happy to work with staff members from the Congressional Committees to

consider the alternative indices and other changes to ensure that the means test for

VA health care is equitable and affords reasonable access to VA health care services.

Section 5—Pilot Program for Coordination of Ambulatory Community Hospital Care

Section 5 is a provision that is essentially the same as a measure passed by the

House of Representatives last year despite the strong opposition of VA. The provision would establish a pilot program entitled ‘‘Coordination of Hospital Benefits Program.’’ The program would authorize special benefits for some veterans receiving

care in a VA outpatient clinic who need hospital care. Under the program, veterans

with third-party health plan coverage (including Medicare and Medicaid) may receive different hospital care benefits from those without third-party coverage. Veterans with no third-party coverage of any sort would be offered hospital care in the

nearest VA hospital with the ability to provide care. That facility may not be particularly close to where the veteran resides. On the other hand, veterans with thirdparty coverage would be offered a choice. First, they could choose to use the nearest

VA hospital. Alternatively, they could choose to use a private facility, with VA paying for certain costs, such as the health plan deductible, coinsurance, or the cost of

inpatient care or medical services that are not covered by the health plan.

The pilot program would be open only to veterans to whom VA ‘‘shall’’ furnish

care, essentially all enrollees except those in enrollment priority group 7. To be eligible, the veterans must also meet certain additional conditions. Specifically, participants must be enrolled to receive medical services from a VA outpatient clinic, require hospital care for a non service-connected condition that could not be provided

by a clinic operated by VA and elect to receive such care under the non-VA health

care plan. The program would be limited to veterans who have received VA care

during the 24-month period preceding the veteran’s application to enroll in the pilot

program. In designating the geographic areas in which to establish the program, VA

must ensure that at least 70 percent of the veterans who reside in a designated area

reside at least two hours’ driving distance from the closest VA medical center.

The provision also limits expenditures for the pilot program to $50 million in any

fiscal year. Moreover, funds from the proposal must come from the Medical Care

Collections Fund and no funds may be used that are otherwise available for treating

veterans requiring specialized care.

We strongly oppose this proposed pilot program. The proposal would create a disparate eligibility status based on a veteran’s third-party coverage and priority

group. We are also concerned that the program would undermine our ability to

maintain existing services, especially specialized medical services and programs for

veterans. Limiting care to general medical and surgical services would mean that

veterans needing specialty health services would still need to come to VA for care.

The health care covered by this proposal would be inpatient care for non-serviceconnected conditions. A veteran currently receiving care for a service-connected condition, for which VA does not or cannot contract locally, would also be forced to receive care in multiple locations. These types of disparities are not consistent with

our goals and strategies of improving access, convenience, and timeliness of VA

health care to all eligible veterans.

Funding for the program would be drawn from the Medical Care Collections Fund

(MCCF). The Fund’s collections, which are available to VA facilities to support current VA-provided medical care, would be reduced by this provision. MCCF collections supplement the dollars appropriated for medical care and are a necessary component of VHA’s budget. Use of MCCF funds for this pilot would negatively impact

care for veterans not enrolled in the pilot. In addition, this provision may affect the

Medicare Trust Fund.

The bill would also require that not less that 15 percent of the veterans participating in the pilot program are veterans who do not have a health-care plan. This

requirement is confusing, as the purpose of the pilot program is to allow VA to pay

for the out of pocket costs that veterans incur through non-VA health plans. It is

not clear how VA would achieve this goal for veterans who have no other health

care plan. The 15 percent limit might be a false floor or ceiling, depending on the

actual number of veterans at a particular pilot site that have no insurance. This

could affect the potential outcomes of the pilot. If there are a large number of insured veterans, the out-of-pocket expense covered by VA would be less that the exVerDate 13-OCT-2001 22:25 Oct 16, 2001 Jkt 099006 PO 00000 Frm 00025 Fmt 6659 Sfmt 6621 E:\HR\OC\HR242.XXX pfrm01 PsN: HR242
26

pense of covering the full care provided to an uninsured veteran. This could make

the pilot look financially successful. On the other hand, if the number of non-insured

veterans is high, the expenses could make the pilot program less financially viable.

The bill also defines the term ‘‘health-care plan’’ by cross-reference to section

1725(f). The bill states that the term ‘‘health-care plan’’ has the meaning given that

term in section 1725(f)(3). However, the referenced section does not define the term

health plan or health-care plan, but rather defines the term ‘‘third party’’ for purposes of reimbursement for emergency treatment. We believe that this reference

might be an error, and that the intended reference was to section 1725(f)(2). Section

1725(f)(2) defines the term ‘‘health-plan contract’’ which includes, among other

things, Medicare and Medicaid plans.

Section 6— Pilot Program for Contract Hospitalization and Fee Basis Ambulatory Care

This section of the bill would require the Secretary to conduct a three-year pilot

program in which veterans receiving fee basis and contract hospitalization would be

provided such care through a contractor who acts as a managed care coordinator.

The provision states that the program shall be conducted in four selected geographical areas that have mature managed care markets. To the extent practicable

all fee basis and contract hospitalization provided by VA in the selected geographical service areas would be provided through the contractor. The contractor

must be an experienced managed care coordinator with an in-place network of

credentialed providers. All enrolled veterans in a selected geographical service area

who are authorized to use non-VA care services through fee basis programs of the

Department, or who are eligible for contract hospitalization, would be automatically

enrolled for participation in the pilot program. Once approved to receive non-VA fee

basis care, or when they seek care for a health emergency, participants would be

given a directory of health care providers from which to choose.

In conducting the pilot program, VA would be required to use standards (commercial-industry or, in their absence, Department standards) for measuring access,

timeliness, patient satisfaction, and utilization management. The contractor must

establish a toll-free telephone system staffed by registered nurses to provide advice

and health care referral information to veterans enrolled in the pilot program on

a 24-hour a day, seven-day a week basis, and a veterans service telephone line for

the provision of information on eligibility, enrollment, and provider locations. The

program also must provide concurrent review, demand management, disease management and health and wellness programs.

Each medical center participating in the program must have a primary care manager. The primary care manager at each VA facility would be responsible for the

coordination and case management of each enrolled veteran who is participating in

the pilot program to ensure that such veterans receive the appropriate care, and

that veterans are brought back into the VA system for follow-up whenever possible

and appropriate. The pilot program includes extensive reporting requirements by

VA, and a mandatory review by the Comptroller General.

We are interested in a pilot program to examine the costs and benefits

of operating our fee basis program in a new manner; however, we are concerned about some of the restrictive requirements in this specific provision.

For example, we would like ensure that VA retains clinical control with respect to the type of care that the patient receives, as well as the amount

of care authorized. We would also want to ensure that the costs of any contract would be no more than the current cost for the fee basis program in

the selected locations. Finally, we believe that it would be appropriate for

VA to continue to provide the toll-free telephone system providing information on eligibility, enrollment and provider locations. We would be pleased

to work with staff members of the Committee to consider alternative language that would allow VA the flexibility to evaluate alternative delivery

systems without some of the limitations and requirements mandated by

this provision.

Section 7—Recodification of Bereavement Counseling and other

Authorities

Mr. Chairman, section 7 of the bill would consolidate, in a new subchapter of title

38, United States Code, all of the various legal authorities under which VA provides

services to non-veterans. The new subchapter would include a section on VA’s provision of counseling, training and mental health services for family members of veterans who are receiving treatment. It would also include a section on bereavement

counseling following the death of certain veterans. Both types of counseling are currently authorized in the definition of outpatient medical services. This change will

make the authority much clearer.

27

The authority under which we provide CHAMPVA benefits, presently section 1713

of title 38, would be transferred to this new subchapter. A new provision in the bill

provides that a dependent or survivor receiving CHAMPVA care would also be eligible for the bereavement counseling and the other counseling, training and mental

health services provided to family members under this new subchapter. Finally, the

existing authority to provide hospital care or medical services as a humanitarian

service in emergency cases would be moved to this new subchapter.

The proposed changes would recodify the currently existing provisions. We support this change, as it would consolidate and clarify the existing statutory authority

to provide care to non-veterans.

Section 8—Extension of Expiring Collections Authorities

Mr. Chairman, this final provision would amend title 38 to extend VA’s authority

to collect per diem nursing home and hospital co-payments from certain veterans,

and to collect third-party payments for the treatment of the nonservice-connected

disabilities of veterans with service-connected disabilities. We strongly support and

welcome the extensions proposed in this section. These collections constitute an important and necessary supplement to our annual appropriations.

Mr. Chairman, this ends my statement. I will be pleased to answer any questions

you may have.

CONGRESSIONAL BUDGET OFFICE COST ESTIMATE

The following letter was received from the Congressional Budget

Office concerning the cost of the reported bill:

U.S. CONGRESS,

CONGRESSIONAL BUDGET OFFICE,

Washington, DC, October 12, 2001.

Hon. CHRISTOPHER H. SMITH

Chairman, Committee on Veterans’ Affairs,

House of Representatives, Washington, DC.

DEAR MR. CHAIRMAN: The Congressional Budget Office has prepared the enclosed cost estimate for H.R. 2792, the Disabled Veterans Service Dog and Health Care Improvement Act of 2001.

If you wish further details on this estimate, we will be pleased

to provide them. The CBO staff contact is Sam Papenfuss, who can

be reached at 226–2840.

Sincerely,

DAN L. CRIPPEN,

Director.

Enclosure.

CONGRESSIONAL BUDGET OFFICE COST ESTIMATE

H.R. 2792, DISABLED VETERANS SERVICE DOG AND HEALTH CARE IMPROVEMENT ACT OF 2001, AS ORDERED REPORTED BY THE HOUSE

COMMITTEE ON VETERANS’ AFFAIRS ON OCTOBER 10, 2001

SUMMARY. H.R. 2792 would provide expanded benefits for some

veterans and would consolidate several existing provisions of law

that authorize health care for nonveterans into one chapter of Title

38 of the U.S. Code. The bill would direct the Department of Veterans Affairs (VA) to calculate the income thresholds for determining whether a veteran qualifies for free health care on a regional basis rather than using a single national level. The bill also

would require the VA to provide chiropractic care at all VA medical

centers by 2006. Finally, H.R. 2792 would extend the authority for

VA to collect certain payments from both veterans and insurance

companies.

28

H.R. 2792 would authorize funding or modify provisions governing discretionary spending for veterans’ programs, which CBO estimates would result in additional outlays of about $390 million

in 2002 and more than $3 billion 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.

H.R. 2792 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 H.R. 2792 is shown in the following

table. This estimate assumes the legislation will be enacted near

the start of calendar year 2002, that the necessary funds for implementing the bill will be provided for each year, and that outlays

will follow historical spending patterns for existing or similar programs. The costs of this legislation fall within budget function 700

(veterans benefits and services).

Table 1. Estimated Budgetary Impact of H.R. 2792

By Fiscal Year, in Millions of Dollars

2001 2002 2003 2004 2005 2006

Spending Under Current Law

for Veterans’ Medical Care

Estimated Authorization

Level 1 ........................................ 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

Income Threshold

Estimated Authorization

Level .................................. 0 420 550 680 700 710

Estimated Outlays ............ 0 380 530 660 690 700

Chiropractic Care

Estimated Authorization

Level .................................. 0 15 34 61 89 133

Estimated Outlays ............ 0 13 32 57 86 128

Offsetting Collections

Estimated Authorization

Level .................................. 0 0 0 0 0 0

Estimated Outlays ............ 0 0 ¥85 ¥25 ¥15 ¥16

Total Changes

Estimated Authorization

Level .................................. 0 435 584 741 789 843

Estimated Outlays ............ 0 393 477 692 761 812

Spending Under S. 1188

Estimated Authorization Level 20,863 22,301 22,694 23,580 24,336 25,128

Estimated Outlays ................... 20,418 21,894 22,497 23,305 24,059 24,840

1The 2001 level is the estimated net 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.

Income Threshold. Under current law, VA furnishes free medical care to veterans who meet certain eligibility requirements-one

of which is an income threshold. Any veteran who is eligible for

Medicaid, who receives a VA pension, or who has an income below

a statutory level (currently $23,688 for a veteran without a dependent) can receive free health care. Under the bill, veterans eligible

for low-income housing also would qualify for free medical care. In

general, the Department of Housing and Urban Development sets

29

eligibility for low-income housing at 80 percent of each county’s median income with adjustments for cost-of-living.

This provision would affect both veterans who currently receive

medical care from VA and those who do not currently use VA

health care services. CBO estimates that the total cost associated

with expanding eligibility for free VA medical care would be $380

million in 2002 and about $3 billion over the 2002–2006 period, assuming appropriation of the estimated amounts.

Current VA Health Care Users.—Using data from VA and the

Current Population Survey, CBO estimates that under this provision about 1.4 million veterans would become eligible for free

health care. CBO estimates that this number includes more than

250,000 veterans who currently use VA medical facilities but are

not presently eligible for free health care. Under the bill, these veterans would no longer need to make copayments when receiving

health care benefits. Because individuals use more health care

services when they do not face any out-of-pocket costs, the cost of

providing medical care would increase for those users who become

eligible for free health care. Using data from VA and from published research, CBO estimates that those veterans receiving free

health care would cost VA about $700 more per person in 2002.

Using that information and adjusting for inflation, CBO estimates

that providing free health care to veterans currently using VA

would cost about $170 million in 2002 and almost $1 billion over

the 2002–2006 period, assuming appropriation of the estimated

amounts.

Because the veterans discussed above would be eligible for free

health care, VA also would lose the copayments that these veterans

make when receiving care. CBO estimates that the lost copayments

would total about $40 million over the 2002–2006 period.

New VA Health Care Users.—CBO also estimates that some veterans who do not currently use VA medical facilities because of the

requirement to make copayments would do so once they became eligible for free health care. Currently, only about 20 percent of veterans eligible for free health care based on income actually use VA

medical facilities. CBO expects that an even lower percentage of

those who would become eligible for free health care would end up

using VA medical facilities, because some of those veterans have

access to health care from other sources. CBO estimates that eventually about 100,000 newly eligible veterans would begin using VA

medical care at a cost of more than $4,000 per person. CBO estimates that providing free health care to these veterans would cost

$210 million in 2002 and about $2 billion over the 2002–2006 period, assuming appropriation of the estimated amounts.

Chiropractic Care. Under current policy, VA does not employ

chiropractors and VA spends less than $500,000 a year for veterans

who see chiropractors outside of a VA hospital. Title II of H.R. 2792

would require that VA provide chiropractic care to veterans at all

of its medical centers. Under the bill, VA would have to provide

chiropractic services in at least 30 medical centers by the end of

fiscal year 2002 and in all 172 medical centers by the end of fiscal

year 2006. In addition to seeking chiropractic care for specific problems, veterans also would be able to choose a chiropractor as their

primary health care provider, instead of a medical doctor.

30

In order to provide chiropractic care at its medical centers, VA

would need to physically modify each medical center and purchase

basic chiropractic equipment. Extrapolating from a Department of

Defense (DoD) report that analyzed the costs of a pilot program

that provided chiropractic care at military hospitals, CBO estimates that the start-up costs for providing chiropractic care at VA

medical centers would average a little more than $100,000 per center. Additionally, based on the DoD experience and given the scope

of potential chiropractic usage, CBO estimates that each medical

center would need to provide a minimum of four chiropractors

along with the necessary support personnel. CBO estimates that it

would cost almost $800,000 in 2002 to staff and operate a chiropractic center. Accounting for both the gradual implementation

under the bill and a two-year adjustment period for each medical

center, CBO estimates that implementing title II would cost $13

million in 2002 and $316 million over the 2002–2006 period, assuming appropriation of the estimated amounts.

Offsetting Collections. Under current law VA has the authority to bill third-party insurance for veterans with a service-connected disability who receive care that is not related to the serviceconnected disability. VA also has the authority to collect a $10

daily payment for hospital stays and a $5 daily payment for nursing home stays from all veterans who do not qualify for free

healthcare. Both of these authorities expire on September 30, 2002.

These collections are currently deposited into the Medical Care Collections Fund (MCCF). Under current law, amounts deposited to

the MCCF are considered to be offsets to discretionary appropriations and spending from the MCCF is subject to annual appropriations. Section 107 would extend these authorities through September 30, 2007.

Based on information from VA, CBO estimates that in 2001 VA

will collect more than $190 million from third-party insurance companies and about $3 million from the daily payments. Accounting

for inflation and increased usage, CBO estimates that implementing this provision would increase offsetting collections deposited to the MCCF by $213 million in 2003 and $907 million over

the 2003–2006 period.

Subject to annual appropriations, VA can spend the money in the

MCCF to provide medical care for veterans. CBO estimates that

implementing section 107 would increase discretionary spending on

medical care for veterans by $128 million in 2003 and $766 million

over the 2003–2006 period, assuming appropriation of the collected

amounts. Because CBO assumes that VA will spend the collections,

the estimated budget authority for collections and spending offset

each other exactly, while the outlays lag behind spending.

Service Dogs. H.R. 2792 would authorize VA to provide service

dogs to veterans with certain disabilities. According to information

from VA, the department does not actually provide the service dogs

but serves as an intermediary between eligible veterans and the

nonprofit organizations that train the service dogs. Because these

organizations typically pay for the travel and training costs associated with a veteran receiving a guide dog, CBO estimates that this

provision would have no budgetary impact.

PAY-AS-YOU-GO CONSIDERATIONS: None

31

INTERGOVERNMENTAL AND PRIVATE-SECTOR IMPACT

.H.R. 2792 contains no intergovernmental or private-sector mandates as defined in UMRA and would impose no costs on state,

local, or tribal governments.

PREVIOUS CBO ESTIMATES. On September 10, 2001, CBO

prepared an estimate for S. 1188, the Department of Veterans Affairs Medical Programs Enhancement Act of 2001, as ordered reported by the Senate Committee on Veterans’ Affairs on August 2,

2001. The provision relating to determining income thresholds for

free medical care is the same in both bills. H.R. 2792 also includes

a requirement for chiropractic care and extends the authority for

VA to collect certain payments from veterans and insurance companies, while S. 1188 does not. S. 1188, in turn, provides increased

benefits to VA employees which H.R. 2792 does not.

ESTIMATE PREPARED BY:

Federal Costs: Sam Papenfuss.

Impact on State, Local, and Tribal Governments: Elyse

Goldman.

Impact on the Private Sector: Allison Percy.

ESTIMATE APPROVED BY:

Robert A. Sunshine, Assistant Director for Budget Analysis

STATEMENT OF FEDERAL MANDATES

The preceding Congressional Budget Office cost estimate states

that the bill contains no intergovernmental or private sector mandates as defined in the Unfunded Mandates Reform Act.

APPLICABILITY TO LEGISLATIVE BRANCH

The reported bill would not be applicable to the legislative

branch under the Congressional Accountability Act, Public Law

104–1, because the bill would only affect certain Department of

Veterans Affairs programs and benefits recipients.

STATEMENT OF CONSTITUTIONAL AUTHORITY

Pursuant to Article I, section 8 of the United States Constitution,

the reported bill is authorized by Congress’ power to ‘‘provide for

the common Defense and general Welfare of the United States.’’

CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

In compliance with clause 3(e) of rule XIII of the Rules of the

House of Representatives, changes in existing law made by the bill,

as reported, are shown as follows (existing law proposed to be omitted is enclosed in black brackets, new matter is printed in italics,

existing law in which no change is proposed is shown in roman):

TITLE 38, UNITED STATES CODE

* * * * * * *

32

PART I—GENERAL PROVISIONS

* * * * * * *

CHAPTER 1—GENERAL

* * * * * * *

§ 103. Special provisions relating to marriages

(a) * * *

* * * * * * *

(d)(1) * * *

* * * * * * *

(5) Paragraphs (2) and (3) apply with respect to benefits under

the following provisions of this title:

(A) * * *

(B) Section ø1713¿ 1781, relating to medical care for survivors and dependents of certain veterans.

* * * * * * *

PART II—GENERAL BENEFITS

* * * * * * *

CHAPTER 17—HOSPITAL, NURSING HOME,

DOMICILIARY, AND MEDICAL CARE

* * * * * * *

SUBCHAPTER I—GENERAL

Sec.

1701. Definitions.

* * * * * * *

ø1707. Restriction on use of funds for assisted suicide, euthanasia, or mercy killing.¿

1707. Limitations.

* * * * * * *

SUBCHAPTER II—HOSPITAL, NURSING HOME OR DOMICILIARY CARE AND MEDICAL

TREATMENT

* * * * * * *

ø1713. Medical care for survivors and dependents of certain veterans.

ø1714. Fitting and training in use of prosthetic appliances; seeing-eye dogs.¿

1714. Fitting and training in use of prosthetic appliances; guide dogs; service

dogs.

* * * * * * *

SUBCHAPTER VIII—HEALTH CARE OF PERSONS OTHER THAN VETERANS

1781. Medical care for survivors and dependents of certain veterans.

1782. Counseling, training, and mental health services for immediate family

members.

1783. Bereavement counseling.

1784. Humanitarian care.

SUBCHAPTER I—GENERAL

§ 1701. Definitions

For the purposes of this chapter—

33

(1) * * *

* * * * * * *

(5) The term ‘‘hospital care’’ includes—

(A) * * *

(B) such mental health services, consultation, professional

counseling, and training for the members of the immediate

family or legal guardian of a veteran, or the individual in

whose household such veteran certifies an intention to live, as

may be essential to the effective treatment and rehabilitation

of a veteran or dependent or survivor of a veteran receiving

care under the last sentence of section ø1713(b)¿ 1781(b) of

this title; and

(C)(i) medical services rendered in the course of the hospitalization of a dependent or survivor of a veteran receiving

care under the last sentence of section ø1713(b)¿ 1781(b) of

this title, and (ii) travel and incidental expenses for such dependent or survivor under the terms and conditions set forth

in section 111 of this title.

(6) The term ‘‘medical services’’ includes, in addition to medical

examination, treatment, and rehabilitative øservices—¿ services,

the following:

ø(A)(i) surgical services, dental services and appliances as

described in sections 1710 and 1712 of this title, optometric

and podiatric services, preventive health services, and (in the

case of a person otherwise receiving care or services under this

chapter) wheelchairs, artificial limbs, trusses, and similar appliances, special clothing made necessary by the wearing of

prosthetic appliances, and such other supplies or services as

the Secretary determines to be reasonable and necessary, except that the Secretary may not furnish sensori-neural aids

other than in accordance with guidelines which the Secretary

shall prescribe, and (ii) travel and incidental expenses pursuant to the provisions of section 111 of this title; and

ø(B)(i) such consultation, professional counseling, training,

and mental health services as are necessary in connection with

the treatment— ø(I) of the service-connected disability of a veteran pursuant to paragraph (1) or (2) of section 1710(a) of this title,

and

ø(II) in the discretion of the Secretary, of the non-service-connected disability of a veteran eligible for treatment

under paragraph (1), (2) or (3) of section 1710(a) of this

title where such services were initiated during the veteran’s hospitalization and the provision of such services on

an outpatient basis is essential to permit the discharge of

the veteran from the hospital,

øfor the members of the immediate family or legal guardian of

a veteran, or the individual in whose household such veteran

certifies an intention to live, as may be essential to the effective treatment and rehabilitation of the veteran (including,

under the terms and conditions set forth in section 111 of this

title, travel and incidental expenses of such family member or

individual in the case of a veteran who is receiving care for a

service-connected disability, or in the case of a dependent or

34

survivor of a veteran receiving care under the last sentence of

section 1713(b) of this title); and

ø(ii) in the case of an individual who was a recipient of services under subclause (i) of this clause at the time of— ø(I) the unexpected death of the veteran; or

ø(II) the death of the veteran while the veteran was participating in a hospice program (or a similar program) conducted by the Secretary,

øsuch counseling services, for a limited period, as the Secretary

determines to be reasonable and necessary to assist such individual with the emotional and psychological stress accompanying the veteran’s death.¿

(A) Surgical services.

(B) Dental services and appliances as described in sections

1710 and 1712 of this title.

(C) Optometric and podiatric services.

(D) Preventive health services.

(E) In the case of a person otherwise receiving care or services

under this chapter—

(i) wheelchairs, artificial limbs, trusses, and similar appliances;

(ii) special clothing made necessary by the wearing of

prosthetic appliances; and

(iii) such other supplies or services as the Secretary determines to be reasonable and necessary.

(F) Travel and incidental expenses pursuant to section 111 of

this title.

* * * * * * *

§ 1706. Management of health care: other requirements

(a) * * *

(b)(1) In managing the provision of hospital care and medical

services under such section, the Secretary shall ensure that the Department (and each geographic service area of the Veterans Health

Administration) maintains its capacity to provide for the specialized treatment and rehabilitative needs of disabled veterans (including veterans with spinal cord dysfunction, blindness, amputations, and mental illness) within distinct programs or facilities of

the Department that are dedicated to the specialized needs of those

veterans in a manner that (A) affords those veterans reasonable access to care and services for those specialized needs, and (B) ensures that overall capacity of the Department (and each geographic

service area of the Veterans Health Administration) to provide such

services is not reduced below the capacity of the Department, nationwide, to provide those services, as of October 9, 1996. The Secretary shall carry out this paragraph in consultation with the Advisory Committee on Prosthetics and Special Disabilities Programs

and the Committee on Care of Severely Chronically Mentally Ill

Veterans.

(2) For purposes of paragraph (1), the capacity of the Department

(and each geographic service area of the Veterans Health Administration) to provide for the specialized treatment and rehabilitative

needs of disabled veterans (including veterans with spinal cord dysfunction, traumatic brain injury, blindness, prosthetics and sensory

35

aids, and mental illness) within distinct programs or facilities shall

be measured for seriously mentally ill veterans as follows (with all

such data to be provided by geographic service area and totaled nationally):

(A) For mental health intensive community-based care, the

number of discrete intensive care teams constituted to provide

such intensive services to seriously mentally ill veterans and the

number of veterans provided such care.

(B) For opioid substitution programs and for traumatic brain

injury, the number of patients treated annually and the

amounts expended.

(C) For dual-diagnosis patients, the number treated annually

and the amounts expended.

(D) For substance abuse programs— (i) the number of substance-use disorder beds (whether

hospital, nursing home, or other designated beds) employed

and the average bed occupancy of such beds;

(ii) the percentage of unique patients admitted directly to

substance abuse outpatient care during the fiscal year who

had two or more additional visits to specialized substance

abuse outpatient care within 30 days of their first visit,

with a comparison from 1996 until the date of the report;

(iii) the percentage of unique inpatients with substance

abuse diagnoses treated during the fiscal year who had one

or more specialized substance abuse clinic visits within

three days of their index discharge, with a comparison from

1996 until the date of the report; and

(iv) the percentage of unique outpatients seen in a facility

or service network during the fiscal year who had one or

more specialized substance abuse clinic visits, with a comparison from 1996 until the date of the report.

(E) For mental health programs, the number and type of staff

that are available at each facility to provide specialized mental

health treatment, including satellite clinics, outpatient programs, and community-based outpatient clinics, with a trend

line comparison from 1996 to the date of the report.

(F) The number of such clinics providing mental health care,

the number and type of mental health staff at each such clinic,

and the type of mental health programs at each such clinic.

(3) For purposes of paragraph (1), the capacity of the Department

(and each geographic service area of the Veterans Health Administration) to provide for the specialized treatment and rehabilitative

needs of disabled veterans within distinct programs or facilities

shall be measured for veterans with spinal cord dysfunction, traumatic brain injury, blindness, or prosthetics and sensory aids as follows (with all such data to be provided by geographic service area

and totaled nationally):

(A) For spinal cord injury/dysfunction specialized centers

and for blind rehabilitation specialized centers, the number of

staffed beds and the number of full-time equivalent employees

assigned to provide care at such centers.

(B) For prosthetics and sensory aids, the annual amount expended.

ø(2)¿ (4) Not later than øApril 1, 1999, April 1, 2000, and April

1, 2001¿ April 1 of each year through 2004, the Secretary shall subVerDate 13-OCT-2001 22:25 Oct 16, 2001 Jkt 099006 PO 00000 Frm 00035 Fmt 6659 Sfmt 6601 E:\HR\OC\HR242.XXX pfrm01 PsN: HR242
36

mit to the Committees on Veterans’ Affairs of the Senate and

House of Representatives a report on the Secretary’s compliance,

by facility and by service-network, with the requirements of this

subsection. The accuracy of each such report shall be certified by,

or otherwise commented upon by, the Inspector General of the Department.

ø(3)¿ (5)(A) To ensure compliance with paragraph (1), the Under

Secretary for Health shall prescribe objective standards of job performance for employees in positions described in subparagraph (B)

with respect to the job performance of those employees in carrying

out the requirements of paragraph (1). Those job performance

standards shall include measures of workload, allocation of resources, and quality-of-care indicators.

* * * * * * *

ø§ 1707. Restriction on use of funds for assisted suicide, euthanasia, or mercy killing¿

§ 1707. Limitations

(a) Funds appropriated to carry out this chapter may not be used

for purposes that are inconsistent with the Assisted Suicide Funding Restriction Act of 1997.

(b) The Secretary may furnish sensori-neural aids only in accordance with guidelines prescribed by the Secretary.

* * * * * * *

SUBCHAPTER II—HOSPITAL, NURSING HOME OR

DOMICILIARY CARE AND MEDICAL TREATMENT

§ 1710. Eligibility for hospital, nursing home, and domiciliary care

(a) * * *

* * * * * * *

(f)(1) * * *

(2) A veteran who is furnished hospital care or nursing home

care under this section and who is required under paragraph (1) of

this subsection to agree to pay an amount to the United States in

order to be furnished such care shall be liable to the United States

for an amount equal to— (A) * * *

(B) before September 30, ø2002¿ 2007, an amount equal to $10 for every day the veteran receives hospital care and $5 for

every day the veteran receives nursing home care.

* * * * * * *

§ 1711. Care during examinations and in emergencies

(a) The Secretary may furnish hospital care incident to physical

examinations where such examinations are necessary in carrying

out the provisions of other laws administered by the Secretary.

ø(b) The Secretary may furnish hospital care or medical services

as a humanitarian service in emergency cases, but the Secretary

shall charge for such care at rates prescribed by the Secretary.¿

* * * * * * *

37

§ 1712A. Eligibility for readjustment counseling and related

mental health services

(a) * * *

(b)(1) If, on the basis of the assessment furnished under subsection (a) of this section, a physician or psychologist employed by

the Department (or, in areas where no such physician or psychologist is available, a physician or psychologist carrying out such function under a contract or fee arrangement with the Secretary) determines that the provision of mental health services to such veteran

is necessary to facilitate the successful readjustment of the veteran

to civilian life, such veteran shall, within the limits of Department

facilities, be furnished such services on an outpatient basis. For the

purposes of furnishing such mental health services, the counseling

furnished under subsection (a) of this section shall be considered to

have been furnished by the Department as a part of hospital care.

Any hospital care and other medical services considered necessary

on the basis of the assessment furnished under subsection (a) of

this section shall be furnished only in accordance with the eligibility criteria otherwise set forth in this chapter (including the eligibility criteria set forth in section ø1711(b)¿ 1784 of this title).

(2) Mental health services furnished under paragraph (1) of this

subsection may, if determined to be essential to the effective treatment and readjustment of the veteran, include such consultation,

counseling, training, services, and expenses as are described in

øsection 1701(6)(B)¿ sections 1782 and 1783 of this title.

* * * * * * *

ø§ 1714. Fitting and training in use of prosthetic appliances;

seeing-eye dogs¿

§ 1714. Fitting and training in use of prosthetic appliances;

guide dogs; service dogs

(a) * * *

(b) The Secretary may provide øseeing-eye or¿ guide dogs trained

for the aid of the blind to veterans øwho are entitled to disability

compensation, and may pay travel and incidental expenses (under

the terms and conditions set forth in section 111 of this title) to

and from their homes and incurred in becoming adjusted to such

seeing-eye or guide dogs¿ who are enrolled under section 1705 of

this title. The Secretary may also provide such veterans with mechanical or electronic equipment for aiding them in overcoming the

øhandicap¿ disability of blindness.

(c) The Secretary may, in accordance with the priority specified

in section 1705 of this title, provide—

(1) service dogs trained for the aid of the hearing impaired

to veterans who are hearing impaired and are enrolled under

section 1705 of this title; and

(2) service dogs trained for the aid of persons with spinal

cord injury or dysfunction or other chronic impairment that

substantially limits mobility to veterans with such injury, dysfunction, or impairment who are enrolled under section 1705 of

this title.

(d) In the case of a veteran provided a dog under subsection (b)

or (c), the Secretary may pay travel and incidental expenses for that

38

veteran under the terms and conditions set forth in section 111 of

this title to and from the veteran’s home for expenses incurred in becoming adjusted to the dog.

* * * * * * *

SUBCHAPTER III—MISCELLANEOUS PROVISIONS RELATING

TO HOSPITAL AND NURSING HOME CARE AND MEDICAL

TREATMENT OF VETERANS

* * * * * * *

§ 1722. Determination of inability to defray necessary expenses; income thresholds

(a) For the purposes of section 1710(a)(2)(G) of this title, a veteran shall be considered to be unable to defray the expenses of necessary care if—

(1) * * *

* * * * * * *

(3) the veteran’s attributable income is not greater than the

øamount set forth in¿ income threshold determined under subsection (b).

ø(b)(1) For purposes of subsection (a)(3), the income threshold for

the calendar year beginning on January 1, 1990, is—

ø(A) $17,240 in the case of a veteran with no dependents;

and

ø(B) $20,688 in the case of a veteran with one dependent,

plus $1,150 for each additional dependent.

ø(2) For a calendar year beginning after December 31, 1990, the

amounts in effect for purposes of this subsection shall be the

amounts in effect for the preceding calendar year as adjusted under

subsection (c) of this section.¿

(b)(1) For purposes of subsection (a)(3), the income threshold applicable to a veteran is the amount determined under paragraph (2).

(2) The amount determined under this paragraph for a veteran is

the greater of the following:

(A) For any calendar year after 2000—

(i) in the case of a veteran with no dependents, $23,688,

as adjusted under subsection (c); or

(ii) in the case of a veteran with one or more dependents,

$28,429, as so adjusted, plus $1,586, as so adjusted, for

each dependent in excess of one.

(B) The amount in effect under the HUD Low Income Index

that is applicable in the area in which the veteran resides.

(3) For purposes of paragraph (2)(B), the term ‘‘HUD Low Income

Index’’ means the family income ceiling amounts determined by the

Secretary of Housing and Urban Development under section 3(b)(2)

of the United States Housing Act of 1937 (42 U.S.C. 1437a(b)(2)) for

purposes of the determination of ‘‘low-income families’’ under that

section.

(c) Effective on January 1 of each year, the amounts in effect

under subsection (b)(2)(A) of this section shall be increased by the

percentage by which the maximum rates of pension were increased

39

under section 5312(a) of this title during the preceding calendar

year.

* * * * * * *

§ 1729. Recovery by the United States of the cost of certain

care and services

(a)(1) * * *

(2) Paragraph (1) of this subsection applies to a non-service-connected disability—

(A) * * *

* * * * * * *

(E) for which care and services are furnished before October

1, ø2002¿ 2007, under this chapter to a veteran who—

(i) has a service-connected disability; and

(ii) is entitled to care (or payment of the expenses of

care) under a health-plan contract.

* * * * * * *

(f) No law of any State or of any political subdivision of a State

and no provision of any contract or other agreement, shall operate

to prevent recovery or collection by the United States under this

section or with respect to care or services furnished under section

ø1711(b)¿ 1784 of this title.

* * * * * * *

§ 1729A. Department of Veterans Affairs Medical Care Collections Fund

(a) * * *

(b) Amounts recovered or collected after June 30, 1997, under

any of the following provisions of law shall be deposited in the

fund:

(1) * * *

* * * * * * *

(7) Section 1784 of this title.

ø(7)¿ (8) Public Law 87–693, popularly known as the ‘‘Federal Medical Care Recovery Act’’ (42 U.S.C. 2651 et seq.), to

the extent that a recovery or collection under that law is based

on medical care or services furnished under this chapter.

* * * * * * *

SUBCHAPTER VIII—HEALTH CARE OF PERSONS OTHER

THAN VETERANS

ø§ 1713.¿ § 1781. Medical care for survivors and dependents of certain veterans

(a) * * *

(b) In order to accomplish the purposes of subsection (a) of this

section, the Secretary shall provide for medical care in the same or

similar manner and subject to the same or similar limitations as

medical care is furnished to certain dependents and survivors of active duty and retired members of the Armed Forces under chapter

55 of title 10 (CHAMPUS), by—

40

(1) * * *

* * * * * * *

In cases in which Department medical facilities are equipped to

provide the care and treatment, the Secretary is also authorized to

carry out such purposes through the use of such facilities not being

utilized for the care of eligible veterans. A dependent or survivor receiving care under the preceding sentence shall be eligible for the

same medical services as a veteran, including services under sections 1782 and 1783 of this title.

* * * * * * *

§ 1782. Counseling, training, and mental health services for

immediate family members

(a) COUNSELING FOR FAMILY MEMBERS OF VETERANS RECEIVING

SERVICE-CONNECTED TREATMENT.—In the case of a veteran who is

receiving treatment for a service-connected disability pursuant to

paragraph (1) or (2) of section 1710(a) of this title, the Secretary

shall provide to individuals described in subsection (c) such consultation, professional counseling, training, and mental health services as are necessary in connection with that treatment.

(b) COUNSELING FOR FAMILY MEMBERS OF VETERANS RECEIVING

NON-SERVICE-CONNECTED TREATMENT.—In the case of a veteran

who is eligible to receive treatment for a non-service-connected disability under the conditions described in paragraph (1), (2), or (3)

of section 1710(a) of this title, the Secretary may, in the discretion

of the Secretary, provide to individuals described in subsection (c)

such consultation, professional counseling, training, and mental

health services as are necessary in connection with that treatment

if—

(1) those services were initiated during the veteran’s hospitalization; and

(2) the continued provision of those services on an outpatient

basis is essential to permit the discharge of the veteran from the

hospital.

(c) ELIGIBLE INDIVIDUALS.—Individuals who may be provided

services under this subsection are—

(1) the members of the immediate family or the legal guardian of a veteran; or

(2) the individual in whose household such veteran certifies

an intention to live.

(d) TRAVEL AND TRANSPORTATION AUTHORIZED.—Services provided under subsections (a) and (b) may include, under the terms

and conditions set forth in section 111 of this title, travel and incidental expenses of individuals described in subsection (c) in the case

of—

(1) a veteran who is receiving care for a service-connected disability; and

(2) a dependent or survivor receiving care under the last sentence of section 1783(b) of this title.

§ 1783. Bereavement counseling

(a) DEATHS OF VETERANS.—In the case of an individual who was

a recipient of services under section 1782 of this title at the time of

41

the death of the veteran, the Secretary may provide bereavement

counseling to that individual in the case of a death— (1) that was unexpected; or

(2) that occurred while the veteran was participating in a

hospice program (or a similar program) conducted by the Secretary.

(b) DEATHS IN ACTIVE SERVICE.—The Secretary may provide bereavement counseling to an individual who is a member of the immediate family of a member of the Armed Forces who dies in the

active military, naval, or air service in the line of duty and under

circumstances not due to the person’s own misconduct.

(c) BEREAVEMENT COUNSELING DEFINED.—For purposes of this

section, the term ‘‘bereavement counseling’’ means such counseling

services, for a limited period, as the Secretary determines to be reasonable and necessary to assist an individual with the emotional

and psychological stress accompanying the death of another individual.

§ 1784. Humanitarian care

The Secretary may furnish hospital care or medical services as a

humanitarian service in emergency cases, but the Secretary shall

charge for such care and services at rates prescribed by the Secretary.

* * * * * * *

PART V—BOARDS, ADMINISTRATIONS, AND

SERVICES

* * * * * * *

CHAPTER 73—VETERANS HEALTH ADMINISTRATION—

ORGANIZATION AND FUNCTIONS

* * * * * * *

§ 7305. Divisions of Veterans Health Administration

The Veterans Health Administration shall include the following:

(1) * * *

* * * * * * *

(7) A Chiropractic Service.

ø(7)¿ (8) Such other professional and auxiliary services as

the Secretary may find to be necessary to carry out the functions of the Administration.

§ 7306. Office of the Under Secretary for Health

(a) The Office of the Under Secretary for Health shall consist of

the following:

(1) * * *

* * * * * * *

(7) A Director of Chiropractic Service, who shall be a qualified doctor of chiropractic and who shall be responsible to the

Secretary for the operation of the Chiropractic Service.

ø(7)¿ (8) Such directors of such other professional or auxiliary services as may be appointed to suit the needs of the DeVerDate 13-OCT-2001 22:25 Oct 16, 2001 Jkt 099006 PO 00000 Frm 00041 Fmt 6659 Sfmt 6601 E:\HR\OC\HR242.XXX pfrm01 PsN: HR242
42

partment, who shall be responsible to the Under Secretary for

Health for the operation of their respective services.

ø(8)¿ (9) The Director of the National Center for Preventive

Health, who shall be responsible to the Under Secretary for

Health for the operation of the Center.

ø(9)¿ (10) The Advisor on Physician Assistants, who shall be

a physician assistant with appropriate experience and who

shall advise the Under Secretary for Health on all matters relating to the utilization and employment of physician assistants in the Administration.

ø(10)¿ (11) Such other personnel as may be authorized by

this chapter.

* * * * * * *

PART VI—ACQUISITION AND DISPOSITION OF

PROPERTY

* * * * * * *

CHAPTER 81—ACQUISITION AND OPERATION OF HOSPITAL AND DOMICILIARY FACILITIES; PROCUREMENT

AND SUPPLY; ENHANCED–USE LEASES OF REAL PROPERTY

* * * * * * *

SUBCHAPTER I—ACQUISITION AND OPERATION OF

MEDICAL FACILITIES

* * * * * * *

§ 8111. Sharing of Department and Department of Defense

health-care resources

(a) * * *

* * * * * * *

(g) For the purposes of this section:

(1) * * *

* * * * * * *

(4) The term ‘‘health-care resource’’ includes hospital care,

medical services, and rehabilitative services, as those terms

are defined in paragraphs (5), (6), and (8), respectively, of section 1701 of this title, services under sections 1782 and 1783

of this title any other health-care service, and any health-care

support or administrative resource.

(5) The term ‘‘primary beneficiary’’ (A) with respect to the

Department means a person who is eligible under this title

(other than under øsection 1711(b) or 1713¿ section 1782, 1783,

or 1784 or subsection (d) of this section) or any other provision

of law for care or services in Department medical facilities, and

(B) with respect to the Department of Defense, means a member or former member of the Armed Forces who is eligible for

care under section 1074 of title 10.

* * * * * * *

43

§ 8111A. Furnishing of health-care services to members of

the Armed Forces during a war or national emergency

(a)(1) * * *

(2) For the purposes of this section, the terms ‘‘hospital care’’, ‘‘nursing home care’’, and ‘‘medical services’’ have the meanings

given such terms by sections 1701(5), 101(28), and 1701(6) of this

title, respectively, and the term ‘‘medical services’’ includes services

under sections 1782 and 1783 of this title.

* * * * * * *

SUBCHAPTER IV—SHARING OF MEDICAL FACILITIES,

EQUIPMENT, AND INFORMATION

* * * * * * *

§ 8152. Definitions

For the purposes of this subchapter— (1) The term ‘‘health-care resource’’ includes hospital care

and medical services (as those terms are defined in section

1701 of this title), services under sections 1782 and 1783 of this

title, any other health-care service, and any health-care support or administrative resource.

* * * * * * *

CHAPTER 85—DISPOSITION OF DECEASED VETERANS’ PERSONAL PROPERTY

* * * * * * *

SUBCHAPTER I—PROPERTY LEFT ON DEPARTMENT

FACILITY

* * * * * * *

§ 8502. Disposition of unclaimed personal property

(a) * * *

(b) If any veteran (admitted as a veteran), or a dependent or survivor of a veteran receiving care under øthe last sentence of section

1713(b)¿ the penultimate sentence of section 1781(b) of this title,

upon such person’s last admission to, or during such person’s last

period of maintenance in, a Department facility, has personal property situated on such facility and shall have designated in writing

a person (natural or corporate) to receive such property when such

veteran, dependent or survivor dies, the Secretary or employee of

the Department authorized by the Secretary so to act, may transfer

possession of such personal property to the person so designated.

If there exists no person so designated by such veteran, dependent,

or survivor or if the one so designated declines to receive such

property, or failed to request such property within ninety days

after the Department mails to such designate a notice of death and

of the fact of such designation, a description of the property, and

an estimate of transportation cost, which shall be paid by such designate if required under the regulations hereinafter mentioned, or

if the Secretary declines to transfer possession to such designate,

possession of such property may in the discretion of the Secretary

44

or the Secretary’s designated subordinate, be transferred to the following persons in the order and manner herein specified unless the

parties otherwise agree in writing delivered to the Department,

namely, executor or administrator, or if no notice of appointment

received, to the spouse, children, grandchildren, parents, grandparents, siblings of the veteran. If claim is made by two or more

such relatives having equal priorities, as hereinabove prescribed, or

if there are conflicting claims the Secretary or the Secretary’s designee may in such case deliver the property either jointly or separately in equal values, to those equally entitled thereto or may

make delivery as may be agreed upon by those entitled, or may in

the discretion of the Secretary or the Secretary’s designee withhold

delivery from them and require the qualification of an administrator or executor of the veterans’ estate and thereupon make delivery to such.

* * * * * * *

SUBCHAPTER II—DEATH WHILE INMATE OF DEPARTMENT

FACILITY

§ 8520. Vesting of property left by decedents

(a) Whenever any veteran (admitted as a veteran), or a dependent or survivor of a veteran receiving care under øthe last sentence

of section 1713(b)¿ the penultimate sentence of section 1781(b) of

this title, shall die while a member or patient in any facility, or any

hospital while being furnished care or treatment therein by the Department, and shall not leave any surviving spouse, next of kin, or

heirs entitled, under the laws of the decedent’s domicile, to the decedent’s personal property as to which such person dies intestate,

all such property, including money and chooses in action, owned by

such person at the time of death and not disposed of by will or otherwise, shall immediately vest in and become the property of the

United States as trustee for the sole use and benefit of the General

Post Fund (hereinafter in this subchapter referred to as the

‘‘Fund’’), a trust fund prescribed by section 1321(a)(45) of title 31.

* * * * * * *

§ 8521. Presumption of contract for disposition of personalty

The fact of death of a veteran (admitted as such), or a dependent

or survivor of a veteran receiving care under øthe last sentence of

section 1713(b)¿ the penultimate sentence of section 1781(b) of this

title, in a facility or hospital, while being furnished care or treatment therein by the Department, leaving no spouse, next of kin, or

heirs, shall give rise to a conclusive presumption of a valid contract

for the disposition in accordance with this subchapter, but subject

to its conditions, of all property described in section 8520 of this

title owned by said decedent at death and as to which such person

dies intestate.

* * * * * * *

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