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[House Report 114-319]
[From the U.S. Government Publishing Office]

114th Congress   }                                       {      Report
                        HOUSE OF REPRESENTATIVES
 1st Session     }                                       {     114-319

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  TO AMEND TITLE 38, UNITED STATES CODE, TO MAKE PERMANENT THE PILOT 
  PROGRAM ON COUNSELING IN RETREAT SETTINGS FOR WOMEN VETERANS NEWLY 
               SEPARATED FROM SERVICE IN THE ARMED FORCES

                                _______
                                

November 2, 2015.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

    Mr. Miller of Florida, from the Committee on Veterans' Affairs, 
                        submitted the following

                              R E P O R T

                        [To accompany H.R. 1575]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 1575) to amend title 38, United States Code, to 
make permanent the pilot program on counseling in retreat 
settings for women veterans newly separated from service in the 
Armed Forces, having considered the same, report favorably 
thereon without amendment and recommend that the bill do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     2
Background and Need for Legislation..............................     2
Hearings.........................................................     3
Subcommittee Consideration.......................................     4
Committee Consideration..........................................     4
Committee Votes..................................................     4
Committee Oversight Findings.....................................     4
Statement of General Performance Goals and Objectives............     4
New Budget Authority, Entitlement Authority, and Tax Expenditures     4
Earmarks and Tax and Tariff Benefits.............................     4
Committee Cost Estimate..........................................     5
Congressional Budget Office Estimate.............................     5
Federal Mandates Statement.......................................     6
Advisory Committee Statement.....................................     6
Constitutional Authority Statement...............................     6
Applicability to Legislative Branch..............................     6
Statement on Duplication of Federal Programs.....................     6
Disclosure of Directed Rulemaking................................     6
Section-by-Section Analysis of the Legislation...................     6
Changes in Existing Law Made by the Bill as Reported.............     7

                          Purpose and Summary

    H.R. 1575, to amend title 38, U.S.C., to make permanent the 
pilot program on counseling in retreat settings for women 
veterans newly separated from service in the Armed Forces, was 
introduced on March 24, 2015, by Representative Corrine Brown 
of Florida. It was ordered to be favorably reported to the full 
House on May 21, 2015, by voice vote. H.R. 1575 would require 
the Department of Veterans Affairs (VA) to make permanent a 
pilot program on counseling in retreat settings for women 
veterans newly separated from service in the Armed Forces and 
to report to Congress biennially on the program.

                  Background and Need for Legislation

    While women have served in the military since the American 
Revolution and have been officially recognized as permanent 
members of the Armed Forces since 1948, women have only 
relatively recently come to represent a significant portion of 
the veteran population. Today, there are more than 2 million 
women veterans in the United States, representing 9.2 percent 
of the total veteran population. By 2020, women are expected to 
encompass 10.5 percent of the total veteran population.
    Women veterans transitioning from active duty experience 
readjustment issues such as post-traumatic stress disorder 
(PTSD), military sexual trauma, substance abuse, and 
homelessness similar to their male counterparts, yet there are 
indications that military service may affect women differently 
than men. Research has shown that women exposed to stressful 
situations like combat or military sexual trauma react 
differently than their male counterparts, and female veterans 
commit suicide at nearly six times the rate of other women.\1\ 
In addition, women veterans differ from their male counterparts 
in that they often lack access to peer support opportunities 
with fellow women veterans once they have separated from 
service.
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    \1\LA Times ``Suicide rate of female military veterans is called 
`staggering'''  http://www.latimes.com/nation/la-na-female-veteran-
suicide-20150608-story.html#page=1, June 8, 2015.
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    Ensuring that VA is properly addressing the unique needs of 
women veterans is an essential component of the Committee's 
oversight efforts. During the 111th Congress, the Caregivers 
and Veterans Omnibus Health Services Act of 2010 (P.L. 111-163, 
124 Stat. 1130) required VA to conduct, through the 
Readjustment Counseling Service Vet Center Program (RCS), a 
pilot program to evaluate the feasibility and advisability of 
providing reintegration and readjustment services in group 
retreat settings to women veterans recently separated from 
service in the Armed Forces after a prolonged deployment. To be 
included in each group retreat were:
           Information and counseling on reintegration 
        into the veteran's family; employment and community;
           Financial counseling;
           Occupational counseling;
           Information and counseling on stress 
        reduction; and
           Information and counseling on conflict 
        resolution.
    The pilot program ran for two years. According to the 
mandated report, VA conducted six retreats in 2011 and 2012. A 
total of 134 women veterans from 37 states and territories, 
including Alaska, Hawaii, and Guam, and ranging in age from 21 
to 69 years old participated in the six retreats.
    Over the course of the pilot program, evaluation data was 
gathered pre-retreat, immediately post-retreat, and 2-month 
post-retreat. Written feedback from the veteran participants 
immediately after the retreats was unanimously positive for 
both years and RCS received several letters from participants 
expressing their gratitude for the opportunity. More 
importantly, the majority of the women veterans who 
participated in the retreats showed improvements in their 
psychological well-being, decreased stress symptoms, improved 
stress coping skills, and a reduction in the severity of their 
PTSD symptoms immediately both following the retreat and 2-
months post retreat.\2\
---------------------------------------------------------------------------
    \2\See, Department of Veterans Affairs Report on the Pilot Program 
on Counseling in Retreat Settings for Women Veterans Newly Separated 
from Service in the Armed Forces Pursuant to the Requirements of Public 
Law 111-163, Section 203.
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    Given these positive outcomes, VA agreed in testimony 
before the Subcommittee on Health, on April 23, 2015, that 
providing counseling in retreat settings is beneficial for 
newly-separated women veterans and authorization to provide 
them should be made permanent. The Committee concurs.
    H.R. 1575 would make the pilot program of counseling in 
retreat settings for women veterans newly separated from 
service a permanent part of VA's programs for women veterans 
and would require VA to report to Congress biennially on the 
retreats.

                                Hearings

    On April 23, 2015, the Subcommittee on Health conducted a 
legislative hearing on: draft legislation to improve 
reproductive treatment provided to certain disabled veterans; 
draft legislation to direct VA to submit an annual report on 
the Veterans Health Administration; H.R. 271; H.R. 627; H.R. 
1369; H.R. 1575; and H.R. 1769. The following witnesses 
testified:
    The Honorable Gus Bilirakis of Florida; the Honorable 
Janice Hahn of California; the Honorable Jackie Walorski of 
Indiana; Blake Ortner, the Deputy Government Relations Director 
of the Paralyzed Veterans of America; Louis J. Celli Jr., the 
Director of the National Veterans Affairs and Rehabilitation 
Division for the American Legion; John Rowan, the National 
President of the Vietnam Veterans of America; Adrian Atizado, 
the Assistant National Legislative Director for the Disabled 
American Veterans; and, Rajiv Jain M.D., the Assistant Deputy 
Under Secretary for Health for Patient Care Services for the 
Veterans Health Administration of the U.S. Department of 
Veterans Affairs. Dr. Jain was accompanied by Janet Murphy, the 
Acting Deputy Under Secretary for Health for Operations and 
Management for the Veterans Health Administration of the U.S. 
Department of Veterans Affairs, and Jennifer Gray, Attorney for 
the Office of the General Counsel of the U.S. Department of 
Veterans Affairs.
    Statements for the Record were submitted by:
    The Honorable Corrine Brown of Florida, the Ranking Member 
of the Full Committee; the American Health Care Association; 
the American Society for Reproductive Medicine; Concerned 
Veterans for America; RESOLVE: National Infertility 
Association; Veterans of Foreign Wars of the United States; 
and, Wounded Warrior Project.

                       Subcommittee Consideration

    On May 15, 2015, the Subcommittee on Health met in an open 
markup session, a quorum being present, and favorably forwarded 
H.R. 1575 to the full Committee by voice vote.

                        Committee Consideration

    On May 21, 2015, the full Committee met in an open markup 
session, a quorum being present, and ordered H.R. 1575 reported 
favorably to the House of Representatives by voice vote.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list the recorded 
votes on the motion to report the legislation and amendments 
thereto. There were no recorded votes in connection with 
ordering H.R. 1575 reported to the House. A motion by Ranking 
Member Corrine Brown of Florida to report H.R. 1575 favorably 
to the House of Representatives was agreed to by voice vote.

                      Committee Oversight Findings

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

         Statement of General Performance Goals and Objectives

    In accordance with clause 3(c)(4) of rule XIII of the Rules 
of the House of Representatives, the Committee's establishes 
the following performance related goals and objectives for this 
legislation:
    The Secretary of the Department of Veterans' Affairs will 
make the pilot program on counseling in retreat settings for 
women veterans newly separated from service permanent and 
report to Congress on a biennial basis on the program's status, 
outcomes, and costs.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

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

                  Earmarks and Tax and Tariff Benefits

    H.R. 1575 does not contain any Congressional earmarks, 
limited tax benefits, or limited tariff benefits as defined in 
clause 9 of rule XXI of the Rules of the House of 
Representatives.

                        Committee Cost Estimate

    The Committee adopts as its own the cost estimate on H.R. 
1575 prepared by the Director of the Congressional Budget 
Office pursuant to section 402 of the Congressional Budget Act 
of 1974.

               Congressional Budget Office Cost Estimate

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
for H.R. 1575 provided by the Congressional Budget Office 
pursuant to section 402 of the Congressional Budget Act of 
1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                      Washington, DC, June 9, 2015.
Hon. Jeff Miller,
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. 1575, a bill to 
amend title 38, United States Code, to make permanent the pilot 
program on counseling in retreat settings for women veterans 
newly separated from service in the Armed Forces.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Ann E. 
Futrell.
                                Sincerely,
                                                        Keith Hall.
    Enclosure.

H.R. 1575--A bill to amend title 38, United States Code, to make 
        permanent the pilot program on counseling in retreat settings 
        for women veterans newly separated from service in the Armed 
        Forces

    H.R. 1575 would require the Department of Veterans Affairs 
(VA) to establish a permanent program that provides counseling 
in group retreat settings to certain women veterans who have 
recently separated from military service. The bill also would 
require the VA to submit a biennial report on the outcomes of 
the program.
    VA is completing the final year of a pilot program that 
provides similar services to women veterans. According to VA, 
roughly 130 women participated in the program at six retreats 
over a two-year period, and three more retreats are planned for 
2015. VA reported annual spending for the pilot program of 
roughly $66,000 for each retreat. Based on information from VA 
on their intent to use the authority provided under H.R. 1575 
to hold six retreats a year, CBO estimates that implementing 
this program would cost $3 million over the 2016-2020 period, 
assuming appropriation of the necessary amounts.
    Enacting H.R. 1575 would not affect direct spending or 
revenues; therefore, pay-as-you-go procedures do not apply.
    H.R. 1575 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act and 
would not affect the budgets of state, local, or tribal 
governments.
    The CBO staff contact for this estimate is Ann E. Futrell. 
The estimate was approved by H. Samuel Papenfuss, Deputy 
Assistant Director for Budget Analysis.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates regarding H.R. 1575 prepared by the Director of the 
Congressional Budget Office pursuant to section 423 of the 
Unfunded Mandates Reform Act.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act would be created by H.R. 
1575.

                 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.''

                  Applicability to Legislative Branch

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

              Statement on Duplication of Federal Programs

    Pursuant to section 3(g) of H. Res. 5, 114th Cong. (2015), 
the Committee finds that no provision of H.R. 1575, establishes 
or reauthorizes a program of the Federal Government known to be 
duplicative of another Federal program, a program that was 
included in any report from the Government Accountability 
Office to Congress pursuant to section 21 of Public Law 111-
139, or a program related to a program identified in the most 
recent Catalog of Federal Domestic Assistance.

                   Disclosure of Directed Rulemaking

    Pursuant to section 3(i) of H. Res. 5, 114th Cong. (2015), 
the Committee estimates that H.R. 1575 does not require 
directed rule making.

             Section-by-Section Analysis of the Legislation

Section 1. Counseling in retreat settings for women veterans newly 
        separated from service in the Armed Forces

    Section 1(a) of the bill would amend chapter 17 of title 
38, U.S.C., by inserting a new section 1712C. This section 
would require VA, beginning on January 1, 2016, to carry out, 
through the Readjustment Counseling Service (RCS), a program to 
provide reintegration and readjustment services in group 
retreat settings to women veterans who are newly separated from 
service in the Armed Forces after a prolonged deployment. 
Veteran's participation in the program would be voluntary. 
Services provided under the program would include: (1) 
information on reintegration into the family, employment, and 
community of the veteran; (2) financial counseling; (3) 
occupational counseling; (4) information and counseling on 
stress reduction; (5) information and counseling on conflict 
resolution; and, (6) such other information and counseling as 
the Secretary considers appropriate to assist the veteran in 
reintegrating into her family, job, and community. VA would be 
required to report to the Committees on Veterans' Affairs of 
the House of Representatives and the Senate a report on the 
program by no later than December 31, 2017, and each odd-
numbered year thereafter.
    Section 1(b) of the bill would amend the table of sections 
at the beginning of chapter 17 of title 38, U.S.C., by 
inserting after 1712B the following new item, as added by 
section 1(a) of the bill: ``1712C. Counseling in retreat 
settings for women veterans newly separated.''
    Section 1(c) of the bill would, effective December 31, 
2015, repeal section 201 of the Caregivers and Veterans Omnibus 
Health Services Act of 2010 (38 U.S.C. 1712A note).

         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 italic, and existing law in which no 
change is proposed is shown in roman):

                      TITLE 38, UNITED STATES CODE

           *       *       *       *       *       *       *
PART II--GENERAL BENEFITS

           *       *       *       *       *       *       *

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

                          SUBCHAPTER I--GENERAL

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

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

     * * * * * * *
1712C. Counseling in retreat settings for women veterans newly 
          separated.

           *       *       *       *       *       *       *

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

           *       *       *       *       *       *       *

Sec. 1712C. Counseling in retreat settings for women veterans newly 
                    separated

  (a) Program.--(1) Commencing on January 1, 2016, the 
Secretary shall carry out, through the Readjustment Counseling 
Service of the Veterans Health Administration, a program to 
provide reintegration and readjustment services described in 
subsection (b) in group retreat settings to women veterans who 
are recently separated from service in the Armed Forces after a 
prolonged deployment.
  (2) The participation of a veteran in the program under 
paragraph (1) shall be at the election of the veteran.
  (b) Covered Services.--The services provided to a woman 
veteran under the program under subsection (a)(1) shall include 
the following:
          (1) Information on reintegration into the family, 
        employment, and community of the veteran.
          (2) Financial counseling.
          (3) Occupational counseling.
          (4) Information and counseling on stress reduction.
          (5) Information and counseling on conflict 
        resolution.
          (6) Such other information and counseling as the 
        Secretary considers appropriate to assist the veteran 
        in reintegration into the family, employment, and 
        community of the veteran.
  (c) Biennial Reports.--Not later than December 31, 2017, and 
each odd-numbered year thereafter, the Secretary shall submit 
to the Committees on Veterans' Affairs of the House of 
Representatives and the Senate a report on the program under 
subsection (a)(1).

           *       *       *       *       *       *       *

                              ----------                              

      CAREGIVERS AND VETERANS OMNIBUS HEALTH SERVICES ACT OF 2010

           *       *       *       *       *       *       *
TITLE II--WOMEN VETERANS HEALTH CARE MATTERS

           *       *       *       *       *       *       *

[SEC. 203. PILOT PROGRAM ON COUNSELING IN RETREAT SETTINGS FOR WOMEN 
                    VETERANS NEWLY SEPARATED FROM SERVICE IN THE ARMED 
                    FORCES.

  [(a) Pilot Program Required.--
          [(1) In general.-- Commencing not later than 180 days 
        after the date of the enactment of this Act, the 
        Secretary of Veterans Affairs shall carry out, through 
        the Readjustment Counseling Service of the Veterans 
        Health Administration, a pilot program to evaluate the 
        feasibility and advisability of providing reintegration 
        and readjustment services described in subsection (b) 
        in group retreat settings to women veterans who are 
        recently separated from service in the Armed Forces 
        after a prolonged deployment.
          [(2) Participation at election of veteran.-- The 
        participation of a veteran in the pilot program under 
        this section shall be at the election of the veteran.
  [(b) Covered Services.--The services provided to a woman 
veteran under the pilot program shall include the following:
          [(1) Information on reintegration into the veteran's 
        family, employment, and community.
          [(2) Financial counseling.
          [(3) Occupational counseling.
          [(4) Information and counseling on stress reduction.
          [(5) Information and counseling on conflict 
        resolution.
          [(6) Such other information and counseling as the 
        Secretary considers appropriate to assist a woman 
        veteran under the pilot program in reintegration into 
        the veteran's family, employment, and community.
  [(c) Locations.--The Secretary shall carry out the pilot 
program at not fewer than three locations selected by the 
Secretary for purposes of the pilot program.
  [(d) Termination.--The authority to carry out a pilot program 
under this section shall terminate on December 31, 2015.
  [(e) Report.--Not later than 180 days after the completion of 
the pilot program, the Secretary shall submit to Congress a 
report on the pilot program. The report shall contain the 
findings and conclusions of the Secretary as a result of the 
pilot program, and shall include such recommendations for the 
continuation or expansion of the pilot program as the Secretary 
considers appropriate.
  [(f) Authorization of Appropriations.--There is authorized to 
be appropriated to the Secretary of Veterans Affairs for each 
of fiscal years 2010 and 2011, $2,000,000 to carry out the 
pilot program.]

           *       *       *       *       *       *       *

                                  [all]
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