59–006 

110TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 1st Session 110–267 

PROHIBITION ON COLLECTION OF COPAYMENTS FOR ALL 

HOSPICE CARE FURNISHED BY DEPARTMENT OF VETERANS AFFAIRS 

JULY 27, 2007.—Committed to the Committee of the Whole House on the State of 

the Union and ordered to be printed 

Mr. FILNER, from the Committee on Veterans’ Affairs, 

submitted the following 

R E P O R T 

[To accompany H.R. 2623] 

[Including cost estimate of the Congressional Budget Office] 

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

bill (H.R. 2623) to amend title 38, United States Code, to prohibit 

the collection of copayments for all hospice care furnished by the 

Department of Veterans Affairs, having considered the same, report favorably thereon with an amendment and recommend that 

the bill as amended do pass. 

CONTENTS 

Page 

Purpose and Summary ............................................................................................ 2 

Background and Discussion .................................................................................... 2 

Legislative History .................................................................................................. 3 

Section-by-Section .................................................................................................... 3 

Committee Consideration ........................................................................................ 3 

Rollcall Votes ............................................................................................................ 3 

Application of Law to the Legislative Branch ....................................................... 4 

Statement of Oversight Findings and Recommendations of the Committee ...... 4 

Statement of General Performance Goals and Objectives .................................... 4 

Constitutional Authority Statement ...................................................................... 4 

Federal Advisory Committee Act ............................................................................ 4 

Unfunded Mandate Statement ............................................................................... 4 

Earmark Identification ............................................................................................ 4 

Committee Estimate ................................................................................................ 4 

Budget Authority and Congressional Budget Office Cost Estimate .................... 5 

Changes in Existing Law Made by the Bill as Reported ...................................... 5 


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The amendment is as follows: 

Strike all after the enacting clause and insert the following: 

SECTION 1. PROHIBITION ON COLLECTION OF COPAYMENTS FOR ALL HOSPICE CARE FURNISHED BY DEPARTMENT OF VETERANS AFFAIRS. 

Title 38, United States Code, is amended— (1) in section 1710(f)(1), by inserting ‘‘(except if such care constitutes hospice 

care)’’ after ‘‘nursing home care’’; 

(2) in section 1710(g)(1), by inserting ‘‘(except if such services constitute hospice care)’’ after ‘‘medical services’’; and 

(3) in section 1710B(c)(2), by striking subparagraph (B) and inserting after 

subparagraph (A) the following new subparagraph (B): ‘‘(B) to a veteran being furnished inpatient or outpatient hospice care by the 

Department; or’’. 

PURPOSE AND SUMMARY

H.R. 2623, to amend title 38, United States Code, to prohibit the 

collection of copayments for all hospice care furnished by the Department of Veterans Affairs, was introduced on June 7, 2007, by 

Representative Jeff Miller of Florida, the Ranking Member of the 

Subcommittee on Health. The legislation would enable the VA to 

provide hospice care to eligible veterans without collecting copayments. 

H.R. 2623 would: 

1. Prohibit the collection of copayments for all hospice care provided by the VA. 

BACKGROUND AND DISCUSSION

Hospice and palliative care is a continuum of comfort-oriented 

and supportive services provided across settings, including hospitals, extended care facilities, outpatient clinics and private residences. 

The Department of Veterans Affairs (VA) offers a complement of 

hospice and palliative care options as part of the comprehensive 

health care benefit provided to all enrolled veterans. In FY 2006, 

every VA facility offered some form of hospice and end-of-life care 

service. In comparison, according to a recent survey, only onefourth of other hospitals had a palliative care program. The VA’s 

Hospice and Palliative Care Program has transformed much of the 

end-of-life care provided or purchased by VA. In fact, 42 percent of 

all veterans who died in a VA facility received prior consultation 

from a palliative care team. Palliative care consults in VA hospitals 

more than doubled between FY 2003 and FY 2006 and surpassed 

20,000 in FY 2006. The number of veterans receiving VA-paid 

home hospice care tripled between FY 2003 and FY 2005, and increased another 30 percent in FY 2006, reaching an average daily 

census of 427 veterans. 

VA has reported that they track copayment amounts for inpatient services and outpatient services collectively rather than by individual services. It is, therefore, difficult to determine the exact 

amount of revenue VA has received from hospice care copayments. 

However, VA estimates a total of $343,542 in annual revenue: 

$183,180 for home hospice care, and $160,362 for inpatient hospice 

care. 

Under current law, a veteran receiving hospice care in a nursing 

home is exempt from any applicable copayments. However, if the 

hospice care is provided in any other setting, such as in an acuteVerDate Aug 31 2005 05:22 Jul 28, 2007 Jkt 059006 PO 00000 Frm 00002 Fmt 6659 Sfmt 6602 E:\HR\OC\HR267.XXX HR267

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care hospital or at home, the veteran may be subject to an inpatient or outpatient primary care copayment. 

VA’s current policy penalizes a veteran who chooses to remain at 

home for their hospice care or who, out of medical necessity, receives hospice care in an acute care setting. 

H.R. 2623 would correct this inequity by exempting all hospice 

care provided through VA from copayment requirements. In addition, this legislation would also align VA with the Medicare program, which does not impose copayments for hospice care regardless of the setting. 

LEGISLATIVE HISTORY

On May 9, 2007, the Subcommittee on Health held a hearing entitled ‘‘The State of VA’s Long-Term Care Program Present and Future.’’ Testimony at this hearing included a discussion regarding 

the copayment requirements for veterans receiving hospice care. 

On June 14, 2007, the Subcommittee on Health held a legislative 

hearing on a number of bills, including H.R. 2623, introduced during the 110th Congress. 

On June 28, 2007, the Subcommittee on Health marked up H.R. 

2623. An Amendment in the Nature of a Substitute was offered by 

Representative Miller that was agreed to by voice vote. The Subcommittee ordered H.R. 2623, as amended, reported favorably to 

the full Committee. 

On July 17, 2007, the full Committee met in open markup session and approved a number of bills, including H.R. 2623, as 

amended. The full Committee, by voice vote, ordered H.R. 2623, as 

amended, reported favorably to the House of Representatives. 

SECTION-BY-SECTION

Section 1. Prohibition on collection of copayments for all hospice 

care furnished by Department of Veterans Affairs 

This section would amend sections 1710(f)(1), 1710(g)(1), and 

1710B(c)(2) of title 38, United States Code, to enable the Secretary 

to furnish hospice care to all eligible veterans without requiring the 

veteran to pay any applicable copayments. 

COMMITTEE CONSIDERATION

On July 17, 2007, the Committee ordered H.R. 2623, as amended, reported favorably to the House of Representatives by voice 

vote. 

ROLLCALL VOTES

The Committee held no rollcall votes on this bill. A motion to 

order H.R. 2623, as amended, reported favorably to the House of 

Representatives was agreed to by voice vote. 

APPLICATION OF LAW TO THE LEGISLATIVE BRANCH

Section 102(b)(3) of Public Law 104–1 requires a description of 

the application of this bill to the legislative branch where the bill 

relates to the terms and conditions of employment or access to public services and accommodations. This bill does not relate to employment or access to public services and accommodations. 


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STATEMENT OF OVERSIGHT FINDINGS AND RECOMMENDATIONS OF

THE COMMITTEE

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 reflected in the descriptive portions of this report. 

CONSTITUTIONAL AUTHORITY STATEMENT

Under clause 3(d)(1) of rule XIII of the Rules of the House of 

Representatives, the Committee must include a statement citing 

the specific powers granted to Congress to enact the law proposed 

by H.R. 2623. The Committee finds that Article 1, Section 8 of the 

Constitution of the United States grants Congress the power to 

enact this law. 

FEDERAL ADVISORY COMMITTEE ACT

The Committee finds that the legislation does not establish or 

authorize the establishment of an advisory committee within the 

definition of 5 U.S.C. App., section 5(b). 

UNFUNDED MANDATE STATEMENT

Section 423 of the Congressional Budget and Impoundment Control Act (as amended by section 101(a)(2) of the Unfunded Mandate 

Reform Act, P.L. 104–4) requires a statement whether the provisions of the reported bill include unfunded mandates. In compliance with this requirement the Committee has received a letter 

from the Congressional Budget Office that is included herein. 

EARMARK IDENTIFICATION

H.R. 2623, as amended, does not contain any congressional earmarks, limited tax benefits, or limited tariff benefits as defined in 

clause 9(d), 9(e), or 9(f) of rule XXI of the Rules of the House of 

Representatives. 

COMMITTEE ESTIMATE

Clause 3(d)(2) of rule XIII of the Rules of the House of Representatives requires an estimate and a comparison by the Committee of the costs that would be incurred in carrying out H.R. 

2623, as amended. However, clause 3(d)(3)(B) of that rule provides 

that this requirement does not apply when the Committee has included in its report a timely submitted cost estimate of the bill prepared by the Director of the Congressional Budget Office under section 402 of the Congressional Budget Act. 


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BUDGET AUTHORITY AND CONGRESSIONAL BUDGET OFFICE COST

ESTIMATE

U.S. CONGRESS, 

CONGRESSIONAL BUDGET OFFICE, 

Washington, DC, July 24, 2007. 

Hon. BOB FILNER, 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. 2623, a bill to amend title 

38, United States Code, to prohibit the collection of copayments for 

all hospice care furnished by the Department of Veterans Affairs. 

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

to provide them. The CBO staff contact is Michelle S. Patterson. 

Sincerely, 

PETER R. ORSZAG, Director. 

Enclosure. 

H.R. 2623—A bill to amend title 38, United States Code, to prohibit 

the collection of copayments for all hospice care furnished by 

the Department of Veterans Affairs 

H.R. 2623 would prohibit the Department of Veterans Affairs 

(VA) from collecting copayments from veterans receiving hospice 

care. This would apply to care received at both inpatient and outpatient facilities. Depending upon where veterans get hospice care, 

copayments range from $15 per day to a maximum of $97 per day. 

Most veterans receiving this type of care from VA are not charged 

copayments—only veterans whose disabilities are unrelated to 

their military service and whose incomes are above a certain level 

are required to make copayments. 

Based on information from VA that 435 veterans made copayments averaging about $800 last year for hospice care, CBO estimates that implementing H.R. 2623 would decrease collections by 

less than $500,000 each year and by about $2 million over the 

2008–2012 period. Those collections are considered to be offsets to 

discretionary appropriations. As part of the annual appropriations 

process, the Congress gives VA authority to spend those collections. 

Therefore, if it wished to maintain the same level of health care 

services for veterans, the Congress would need to appropriate additional funds each year to make up for the loss of copayments under 

this bill. Under those circumstances, implementing H.R. 2623 

would cost about $2 million over the 2008–2012 period. Enacting 

this bill would not affect direct spending or receipts. 

H.R. 2623 contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act and would 

impose no costs on state, local, or tribal governments. 

The CBO staff contact for this estimate is Michelle S. Patterson. 

This estimate was approved by Robert A. Sunshine, Assistant Director for Budget Analysis. 

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, 


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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): 

TITLE 38, UNITED STATES CODE 

* * * * * * * 

PART II—GENERAL BENEFITS 

* * * * * * * 

CHAPTER 17—HOSPITAL, NURSING HOME, 

DOMICILIARY, AND MEDICAL CARE 

* * * * * * * 

SUBCHAPTER II—HOSPITAL, NURSING HOME, OR 

DOMICILIARY CARE AND MEDICAL TREATMENT 

§ 1710. Eligibility for hospital, nursing home, and domiciliary care 

(a) * * * 

* * * * * * * 

(f)(1) The Secretary may not furnish hospital care or nursing 

home care (except if such care constitutes hospice care) under this 

section to a veteran who is eligible for such care under subsection 

(a)(3) of this section unless the veteran agrees to pay to the United 

States the applicable amount determined under paragraph (2) or 

(4) of this subsection. 

* * * * * * * 

(g)(1) The Secretary may not furnish medical services (except if 

such services constitute hospice care) under subsection (a) of this 

section (including home health services under section 1717 of this 

title) to a veteran who is eligible for hospital care under this chapter by reason of subsection (a)(3) of this section unless the veteran 

agrees to pay to the United States in the case of each outpatient 

visit the applicable amount or amounts established by the Secretary by regulation. 

* * * * * * * 

§ 1710B. Extended care services 

(a) * * * 

* * * * * * * 

(c)(1) * * * 

(2) Paragraph (1) shall not apply—

(A) * * * 

ø(B) to a veteran being furnished hospice care under this 

section; or¿ 


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(B) to a veteran being furnished inpatient or outpatient hospice care by the Department; or 

* * * * * * * 

Æ 


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