```

[House Report 115-197]
[From the U.S. Government Publishing Office]

115th Congress   }                                      {       Report
                        HOUSE OF REPRESENTATIVES
 1st Session     }                                      {      115-197

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

 
          BUILDING SUPPORTIVE NETWORKS FOR WOMEN VETERANS ACT

                                _______
                                

 June 28, 2017.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

    Mr. Roe of Tennessee, from the Committee on Veterans' Affairs, 
                        submitted the following

                              R E P O R T

                         [To accompany H.R. 91]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 91) 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.......................................     3
Committee Consideration..........................................     3
Committee Votes..................................................     3
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..........................................     4
Congressional Budget Office Estimate.............................     4
Federal Mandates Statement.......................................     5
Advisory Committee Statement.....................................     5
Constitutional Authority Statement...............................     5
Applicability to Legislative Branch..............................     5
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. 91 was introduced by Representative Julia Brownley of 
California, the Ranking Member of the Committee on Veterans' 
Affairs Subcommittee on Health, on January 3, 2017.
    H.R. 91 would require the Department of Veterans Affairs 
(VA) to carry out a permanent program to provide reintegration 
and readjustment services in group retreat settings to women 
veterans newly separated from service in the Armed Forces after 
a prolonged deployment.

                  Background and Need for Legislation

Section 2. Counseling in retreat settings for women veterans newly 
        separated from service in the Armed Forces

    While women have served in the military since the American 
Revolution, women have only relatively recently come to 
represent a sizable portion of the veteran population. Today, 
women veterans number almost 2 million out of 21.6 million 
total veterans in the United States.\1\
---------------------------------------------------------------------------
    \1\U.S. Department of Veterans Affairs, Office of Suicide 
Prevention. Suicide among Veterans and Other Americans 2001-2014. 
August 3, 2016. https://www.mentalhealth.va.gov/docs/
2016suicidedatareport.pdf.
---------------------------------------------------------------------------
    There are indications both that military service and 
veteran status may affect women differently than men and that 
women veterans may lack access to valuable peer support 
opportunities once they have separated from service. For 
example, a report by the Disabled American Veterans (DAV) found 
that women face barriers to full integration into military 
service, to recognition as veterans, and to VA services and 
benefits.\2\ According to DAV, ``[t]he vast majority of these 
deficiencies result from a disregard for the differing needs of 
women veterans and a focusing on the 80 percent solutions for 
men who dominate in both numbers and the public 
consciousness.''\3\
---------------------------------------------------------------------------
    \2\ Disabled American Veterans. Women Veterans: The Long Journey 
Home. September 24, 2014. https://www.dav.org/wp-content/uploads/women-
veterans-study.pdf.
    \3\Ibid.
---------------------------------------------------------------------------
    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 a pilot program through the 
Readjustment Counseling Service (RCS) 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. Each group retreat was required 
to include the following components: 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. Over the 
course of the pilot program, a total of 12 retreats were 
provided to 272 women veterans between 2011 and 2016.\4\ 
According to VA, the retreats held to-date have focused on 
building trust and developing peer support in a therapeutic 
environment and data has shown that retreat participants saw 
increased coping abilities and decreased symptoms associated 
with posttraumatic stress disorder. VA also found that 87 
percent of retreat participants scored higher on the Ryff Scale 
of Psychological Well Being immediately post-retreat and 84 
percent showed a decrease in stress symptoms that persisted two 
months post-retreat.\5\
---------------------------------------------------------------------------
    \4\United States Cong. House Committee on Veterans' Affairs 
Subcommittee on Health. Legislative Hearing. March 29, 2017. 115th 
Cong. 1st sess. Washington: GPO, 2017 (statement from Jennifer S. Lee, 
Deputy Under Secretary for Health for Policy and Services, Veterans 
Health Administration, U.S. Department of Veterans Affairs).
    \5\Ibid.
---------------------------------------------------------------------------
    In light of the positive outcomes of the current pilot 
program and the Committee's commitment to ensuring that VA is 
properly addressing the unique needs of women veterans, section 
2 of the bill 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.

                                Hearings

    On March 29, 2017, the Subcommittee on Health conducted a 
legislative hearing on a number of bills including H.R. 91.
    The following witnesses testified: The Honorable David. P. 
Roe M.D. of Tennessee; The Honorable Jackie Walorski of 
Indiana; The Honorable Doug Collins of Georgia; The Honorable 
Mike Coffman of Colorado; The Honorable Stephen Knight of 
California; The Honorable Ann M. Kuster of New Hampshire; 
Jennifer S. Lee, M.D., the Deputy Under Secretary for Health 
for Policy and Services for the Veterans Health Administration 
of the U.S. Department of Veterans Affairs who was accompanied 
by Susan Blauert, the Chief Counsel for the Health Care Law 
Group of the Office of the General Counsel for the U.S. 
Department of Veterans Affairs; Kayda Keleher, Legislative 
Associate for the National Legislative Service of the Veterans 
of Foreign Wars of the United States; Shurhonda Y. Love, the 
Assistant National Legislative Director for the Disabled 
American Veterans; and, Sarah S. Dean, the Associate 
Legislative Director for the Paralyzed Veterans of America.
    Statements for the record were submitted by: The Honorable 
Lee Zeldin of New York; The American Legion; the National 
Association of State Veteran Homes; Swords to Plowshares; and, 
the Wounded Warrior Project.

                       Subcommittee Consideration

    On April 6, 2017, the Subcommittee on Health met in an open 
markup session, a quorum being present, and ordered H.R. 91 to 
be reported favorably to the full Committee by voice vote.

                        Committee Consideration

    On May 17, 2017, the Full Committee met in open markup 
session, a quorum being present, and ordered H.R. 91 to be 
reported favorably to the House of Representatives by voice 
vote. A motion by Representative Tim Walz of Minnesota, Ranking 
Member of the Committee on Veterans' Affairs, to report H.R. 91 
favorably to the House of Representatives was agreed to by 
voice vote.

                            Committee Votes

    In compliance with clause 3(b) of rule XIII of the Rules of 
the House of Representatives, there were no recorded votes 
taken on amendments or in connection with ordering H.R. 91 
reported to the House.

                      Committee Oversight Findings

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

         Statement of General Performance Goals and Objectives

    In accordance with clause 3(c)(4) of rule XIII of the Rules 
of the House of Representatives, the Committee's performance 
goals and objectives are to improve the provision of 
reintegration and readjustment services to women veterans who 
are recently separated from service after a prolonged 
deployment.

   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. 91 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. 
91 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. 91 provided by the Director of the Congressional 
Budget Office pursuant to section 402 of the Congressional 
Budget Act of 1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                      Washington, DC, May 20, 2017.
Hon. Phil Roe, M.D.,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 91, the Building 
Supportive Networks for Women Veterans Act.
    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. 91--Building Supportive Networks for Women Veterans Act

    H.R. 91 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 to the Congress 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 270 women participated in the program at 12 retreats 
over the 2011-2016 period at an average cost of $3,400 per 
participant. On the basis of information from VA, CBO expects 
that the department would use the authority provided under H.R. 
91 to hold six retreats a year. CBO estimates that implementing 
this program would cost $3 million over the 2018-2022 period 
after accounting for anticipated inflation; such spending would 
be subject to the availability of appropriated funds.
    Enacting the legislation would not affect direct spending 
or revenues; therefore, pay-as-you-go procedures do not apply. 
CBO estimates that enacting H.R. 91 would not increase net 
direct spending or on-budget deficits in any of the four 
consecutive 10-year periods beginning in 2028.
    H.R. 91 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. 91 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. 
91.

                 Statement of Constitutional Authority

    Pursuant to Article I, section 8 of the United States 
Constitution, H.R. 91 is authorized by Congress' power to 
``provide for the common Defense and general Welfare of the 
United States.''

                  Applicability to Legislative Branch

    The Committee finds that H.R. 91 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, 115th Cong. (2017), 
the Committee finds that no provision of H.R. 91 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, 115th Cong. (2017), 
the Committee estimates that H.R. 91 contains no directed 
rulemaking that would require the Secretary to prescribe 
regulations.

             Section-by-Section Analysis of the Legislation

Section 1. Short title

    Section 1 of the bill would provide a short title of the 
``Building Supportive Networks for Women Veterans Act''.

Section 2. Counseling in retreat settings for women veterans newly 
        separated from service in the armed forces

    Section 2(a)(1) of the bill would amend chapter 17 of title 
38, U.S.C., by inserting after section 1712C a new section, 
``1712D. Counseling in retreat settings for women veterans 
newly separated.'' The new section 1712D would require the 
Secretary of Veterans Affairs, beginning on January 1, 2018, to 
carry out a program through the Readjustment Counseling Service 
(RCS) 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. A veteran's participation in the program would be 
voluntary and 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, 2018, and each 
even-numbered year thereafter.
    Section 2(a)(2) of the bill would amend the table of 
sections at the beginning of chapter 17 of title 38, U.S.C., by 
inserting after 1712C the following new item: ``1712D. 
Counseling in retreat settings for women veterans newly 
separated.''.
    Section 2(b) of the bill would repeal section 203 of the 
Caregivers and Veterans Omnibus Health Services Act of 2010 (38 
U.S.C. 1712A note) effective December 31, 2017.

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

         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

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

           *       *       *       *       *       *       *

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

           *       *       *       *       *       *       *

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

  (a) Program.--(1) Commencing on January 1, 2018, 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, 2018, and 
each even-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, 2017.
  [(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, 2011, 2015, 2016, and 2017, $2,000,000 to 
carry out the pilot program.]

           *       *       *       *       *       *       *

                                  [all]
```