59–006 

110TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 1st Session 110–268 

VETERANS’ HEALTH CARE IMPROVEMENT ACT OF 2007 

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. 2874] 

[Including cost estimate of the Congressional Budget Office] 

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

bill (H.R. 2874) to amend title 38, United States Code, to make certain improvements in the provision of health care to veterans, and 

for other purposes, having considered the same, report favorably 

thereon with an amendment and recommend that the bill as 

amended do pass. 

CONTENTS 

Page 

Purpose and Summary ............................................................................................ 7 

Background and Discussion .................................................................................... 9 

Legislative History .................................................................................................. 12 

Section-by-Section .................................................................................................... 13 

Committee Consideration ........................................................................................ 15 

Rollcall Votes ............................................................................................................ 15 

Application of Law to the Legislative Branch ....................................................... 15 

Statement of Oversight Findings and Recommendations of the Committee ...... 15 

Statement of General Performance Goals and Objectives .................................... 15 

Constitutional Authority Statement ...................................................................... 15 

Federal Advisory Committee Act ............................................................................ 15 

Unfunded Mandate Statement ............................................................................... 15 

Earmark Identification ............................................................................................ 16 

Committee Estimate ................................................................................................ 16 

Budget Authority and Congressional Budget Office Cost Estimate .................... 16 

Changes in Existing Law Made by the Bill as Reported ...................................... 21 

The amendment is as follows: 

Strike all after the enacting clause and insert the following: 


rfrederick on PROD1PC67 with HEARING
2 

SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

(a) SHORT TITLE.—This Act may be cited as the ‘‘Veterans’ Health Care Improvement Act of 2007’’. 

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

Sec. 1. Short title; table of contents. 

Sec. 2. Grants for support of therapeutic readjustment programs for veterans. 

Sec. 3. Transportation grants for rural veterans service organizations. 

Sec. 4. Permanent treatment authority for participants in Department of Defense chemical and biological testing conducted by Deseret Test Center (including Project Shipboard Hazard and Defense). 

Sec. 5. Extension of expiring collections authorities. 

Sec. 6. Readjustment and mental health services for Operation Enduring Freedom and Operation Iraqi Freedom Veterans. 

Sec. 7. Expansion and extension of authority for program of referral and counseling services for at-risk veterans 

transitioning from certain institutions. 

Sec. 8. Permanent authority for domiciliary services for homeless veterans and enhancement of capacity of 

domiciliary care programs for female veterans. 

Sec. 9. Financial assistance for supportive services for very low-income veteran families in permanent housing. 

Sec. 10. Expansion of eligibility for dental care. 

Sec. 11. Technical amendments. 

SEC. 2. GRANTS FOR SUPPORT OF THERAPEUTIC READJUSTMENT PROGRAMS FOR VETERANS. 

(a) GRANT PROGRAM.—Subchapter II of chapter 5 of title 38, United States Code, 

is amended by inserting after section 521 the following new section: 

‘‘§ 521A. Assistance to therapeutic readjustment programs 

‘‘(a) GRANT PROGRAM.—The Secretary of Veterans Affairs may make grants to 

qualified entities described in subsection (b) to conduct workshop programs that 

have been shown to assist in the therapeutic readjustment and rehabilitation of participants to assist in the therapeutic readjustment of covered veterans. 

‘‘(b) QUALIFIED ENTITIES.—In order to qualify for grant assistance under subsection (a), a private nonprofit entity must have, as determined by the Secretary, 

experience and expertise in offering programs to assist in the therapeutic readjustment of participants and that such programs will likely assist covered veterans. 

‘‘(c) AMOUNT OF GRANT; USE OF FUNDS.—A grant under this section shall not exceed $100,000 for any calendar year and shall be used by the recipient exclusively 

for the benefit of covered veterans. 

‘‘(d) APPLICATION.—An application for a grant under this section shall include details regarding the extent and nature of the proposed program, the therapeutic readjustment and rehabilitation benefits expected to be achieved by participants, and 

any other information the Secretary determines may be necessary to assist the Secretary in ensuring that covered veterans receive therapeutic readjustment and rehabilitation benefits. 

‘‘(e) COVERED VETERANS.—For the purposes of this subsection, a ‘covered veteran’

is a veteran who served on active duty in a theater of combat operations (as determined by the Secretary in consultation with the Secretary of Defense) during a period of war after the Persian Gulf War, or in combat against a hostile force during 

a period of hostilities (as defined in section 1712A(a)(2)(B) of this title) after November 11, 1998, and who is discharged or released from active military, naval, or air 

service on or after September 11, 2001. 

‘‘(f) REPORTS.—Not later than 60 days after the last day of a fiscal year, the Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and House 

of Representatives a report detailing the number and amount of grants made under 

this section during the previous fiscal year, the total number of covered veterans 

participating in workshop programs funded by such grants, a description of the programs, and the therapeutic benefits to covered veterans of participation in the various programs funded. 

‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There is authorized to be appropriated 

for each of fiscal years 2008 through 2011 $2,000,000 to carry out this section. 

‘‘(h) TERMINATION.—The authority of the Secretary to make a grant under subsection (a) shall terminate on September 30, 2011.’’. 

(b) CLERICAL AMENDMENT.—The table of sections at the beginning of such chapter 

is amended by inserting after the item relating to section 521 the following new 

item: 

‘‘521A. Assistance to therapeutic readjustment programs.’’. 

SEC. 3. TRANSPORTATION GRANTS FOR RURAL VETERANS SERVICE ORGANIZATIONS. 

(a) GRANT PROGRAM.—Subchapter I of chapter 17 of title 38, United States Code, 

is amended by adding at the end the following new section: 


rfrederick on PROD1PC67 with HEARING
3 

‘‘§ 1709. Grants for provision of transportation to Department medical facilities for veterans in remote rural areas 

‘‘(a) GRANTS AUTHORIZED.—(1) The Secretary shall establish a grant program to 

provide innovative transportation options to veterans in remote rural areas. 

‘‘(2) Grants awarded under this section may be used by State veterans’ service 

agencies, veterans service organizations, and private nonprofit entities to assist veterans in remote rural areas to travel to Department medical facilities. 

‘‘(3) The amount of a grant under this section may not exceed $50,000. 

‘‘(4) The recipient of a grant under this section shall not be required to provide 

matching funds as a condition for receiving such grant. 

‘‘(b) REGULATIONS.—The Secretary shall prescribe regulations for—

‘‘(1) evaluating grant applications under this section; and 

‘‘(2) otherwise administering the program established by this section. 

‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There is authorized to be appropriated 

$3,000,000 for each of fiscal years 2008 through 2012 to carry out this section.’’. 

(b) CLERICAL AMENDMENT.—The table of sections at the beginning of such chapter 

is amended by inserting after the item relating to section 1708 the following new 

item: 

‘‘1709. Grants for provision of transportation to Department medical facilities for veterans in remote rural 

areas.’’. 

SEC. 4. PERMANENT TREATMENT AUTHORITY FOR PARTICIPANTS IN DEPARTMENT OF DEFENSE CHEMICAL AND BIOLOGICAL TESTING CONDUCTED BY DESERET TEST CENTER (INCLUDING PROJECT SHIPBOARD HAZARD AND DEFENSE). 

Section 1710(e)(3) of title 38, United States Code, is amended—

(1) in subparagraph (B), by inserting ‘‘and’’ after the semicolon; 

(2) in subparagraph (C), by striking ‘‘; and’’ and inserting a period; and 

(3) by striking subparagraph (D). 

SEC. 5. EXTENSION OF EXPIRING COLLECTIONS AUTHORITIES. 

(a) HEALTH CARE COPAYMENTS.—Section 1710(f)(2)(B) is amended by striking 

‘‘2007’’ and inserting ‘‘2009’’. 

(b) MEDICAL CARE COST RECOVERY.—Section 1729(a)(2)(E) is amended by striking 

‘‘2007’’ and inserting ‘‘2009’’. 

SEC. 6. READJUSTMENT AND MENTAL HEALTH SERVICES FOR COVERED VETERANS. 

(a) PROVISION OF READJUSTMENT COUNSELING AND MENTAL HEALTH SERVICES.—

Subchapter II of chapter 17 of title 38, United States Code, is amended by inserting 

after section 1712B the following new section: 

‘‘§ 1712C. Provision of readjustment counseling and mental health services 

for covered veterans 

‘‘(a) PROGRAM REQUIRED.—The Secretary shall carry out a program to provide 

peer outreach services, peer support services, and readjustment and mental health 

services to covered veterans. 

‘‘(b) CONTRACTS WITH COMMUNITY MENTAL HEALTH CENTERS.—In carrying out 

the program required by subsection (a), the Secretary shall contract with community 

mental health centers and other qualified entities to provide the services referred 

to in that paragraph in areas the Secretary determines are not adequately served 

by health care facilities of the Department. Such contracts shall require each community health center or other entity—

‘‘(1) to the extent practicable, to employ covered veterans trained under subsection (c); 

‘‘(2) to the extent practicable, to use telehealth services for the provision of 

such services; 

‘‘(3) to participate in the training program under subsection (d); 

‘‘(4) to comply with applicable protocols of the Department before incurring 

any liability on behalf of the Department for the provision of such the services; 

‘‘(5) to submit annual reports to the Secretary containing, with respect to the 

program required by subsection (a) and for the last full calendar year ending 

before the submission of such report—

‘‘(A) the number of veterans served, veterans diagnosed, and courses of 

treatment provided to veterans as part of the program required by subsection (a); and 

‘‘(B) demographic information for such services, diagnoses, and courses of 

treatment; 

‘‘(6) to provide to the Secretary such clinical summary information as the Secretary may require for each veteran for whom the center or entity provides 

mental health services under the contract; and 

‘‘(7) to meet such other requirements as the Secretary may require. 


rfrederick on PROD1PC67 with HEARING
4 

‘‘(c) TRAINING PROGRAM FOR VETERANS.—In carrying out the program required by 

subsection (a), the Secretary shall contract with a nonprofit mental health organization to carry out a program to train covered veterans to provide peer outreach and 

peer support services. ‘‘(d) TRAINING PROGRAM FOR CLINICIANS.—The Secretary shall conduct a training 

program for clinicians of community mental health centers or other entities that 

have entered into contracts with the Secretary under subsection (b) to ensure that 

such clinicians are able to provide the services required by subsection (a) in a manner that—

‘‘(1) recognizes factors that are unique to the experience of veterans who 

served on active duty in Operation Iraqi Freedom or Operation Enduring Freedom (including the combat and military training experiences of such veterans); 

and ‘‘(2) utilizes best practices and technologies. ‘‘(e) COVERED VETERANS.—For the purposes of this subsection, a ‘covered veteran’ is a veteran who served on active duty in a theater of combat operations (as determined by the Secretary in consultation with the Secretary of Defense) during a period of war after the Persian Gulf War, or in combat against a hostile force during 

a period of hostilities (as defined in section1712A(a)(2)(B) of this title) after November 11, 1998, and who is discharged or released from active military, naval, or air 

service on or after September 11, 2001’’. (b) CLERICAL AMENDMENT.—The table of sections at the beginning of such chapter 

is amended by inserting after the item relating to section 1712B the following new 

item: 

‘‘1712C. Provision of readjustment counseling and mental health services for covered veterans.’’. 

SEC. 7. EXPANSION AND EXTENSION OF AUTHORITY FOR PROGRAM OF REFERRAL AND 

COUNSELING SERVICES FOR AT-RISK VETERANS TRANSITIONING FROM CERTAIN 

INSTITUTIONS. 

(a) PROGRAM AUTHORITY.—Subsection (a) of section 2023 of title 38, United States 

Code, is amended by striking ‘‘a demonstration program for the purpose of determining the costs and benefits of providing’’ and inserting ‘‘a program to provide’’. (b) SCOPE OF PROGRAM.—Subsection (b) of such section is amended— (1) by striking ‘‘DEMONSTRATION’’ in the subsection heading; 

(2) by striking ‘‘demonstration’’; and 

(3) by striking ‘‘in at least six locations’’ and inserting ‘‘in at least 12 locations’’. (c) EXTENSION OF AUTHORITY.—Subsection (d) of such section is amended by striking ‘‘shall cease’’ and all that follows and inserting ‘‘shall cease on September 30, 

2011.’’. (d) CONFORMING AMENDMENTS.— (1) SCOPE OF PROGRAM.—Subsection (c)(1) of such section is amended by striking ‘‘demonstration’’. 

(2) SECTION HEADING.—The heading of such section is amended to read as follows: 

‘‘§ 2023. Referral and counseling services: veterans at risk of homelessness 

who are transitioning from certain institutions’’. 

(3) OTHER CONFORMING AMENDMENT.—Section 2022(f)(2)(C) of such title is 

amended by striking ‘‘demonstration’’. 

(e) CLERICAL AMENDMENT.—The table of sections at the beginning of chapter 20 

of such title is amended by striking the item relating to section 2023 and inserting 

the following new item: 

‘‘2023. Referral and counseling services: veterans at risk of homelessness who are transitioning from certain 

institutions.’’. 

SEC. 8. PERMANENT AUTHORITY FOR DOMICILIARY SERVICES FOR HOMELESS VETERANS 

AND ENHANCEMENT OF CAPACITY OF DOMICILIARY CARE PROGRAMS FOR FEMALE VETERANS. 

Subsection (b) of section 2043 of title 38, United States Code, is amended to read 

as follows: 

‘‘(b) ENHANCEMENT OF CAPACITY OF DOMICILIARY CARE PROGRAMS FOR FEMALE

VETERANS.—The Secretary shall take appropriate actions to ensure that the domiciliary care programs of the Department are adequate, with respect to capacity and 

safety, to meet the needs of veterans who are women.’’. 

SEC. 9. FINANCIAL ASSISTANCE FOR SUPPORTIVE SERVICES FOR VERY LOW-INCOME VETERAN FAMILIES IN PERMANENT HOUSING. 

(a) PURPOSE.—The purpose of this section is to facilitate the provision of supportive services for very low-income veteran families in permanent housing. 

(b) AUTHORIZATION OF FINANCIAL ASSISTANCE.—


rfrederick on PROD1PC67 with HEARING
5 

(1) IN GENERAL.—Subchapter V of chapter 20 of title 38, United States Code, 

is amended by adding at the end the following new section: 

‘‘§ 2044. Financial assistance for supportive services for very low-income 

veteran families residing in permanent housing 

‘‘(a) DISTRIBUTION OF FINANCIAL ASSISTANCE.—

‘‘(1) The Secretary shall provide financial assistance to eligible entities approved under this section to provide and coordinate the provision of the supportive services for very low-income veteran families residing in permanent 

housing. 

‘‘(2)(A) Financial assistance under this section shall consist of payments for 

each such family for which an approved eligible entity provides or coordinates 

the provision of supportive services. 

‘‘(B) The Secretary shall establish a formula for determining the rate of payments provided to a very low-income veteran family receiving supportive services under this section. The rate shall be adjusted not less than once annually 

to reflect changes in the cost of living. In calculating the payment formula 

under this subparagraph, the Secretary may consider geographic cost of living 

variances, family size, and the cost of services provided. 

‘‘(3) In providing financial assistance under paragraph (1), the Secretary shall 

give preference to an entity that provides or coordinates the provision of supportive services for very low-income veteran families who are transitioning from 

homelessness to permanent housing. 

‘‘(4) The Secretary shall ensure that, to the extent practicable, financial assistance under this subsection is equitably distributed across geographic regions, including rural communities and tribal lands. 

‘‘(5) Each entity receiving financial assistance under this section to provide 

supportive services to a very low-income veteran family shall notify the family 

that such services are being paid for, in whole or in part, by the Department. 

‘‘(6) The Secretary may require an entity receiving financial assistance under 

this section to submit a report to the Secretary describing the supportive services provided with such financial assistance. 

‘‘(b) APPLICATION FOR FINANCIAL ASSISTANCE.—

‘‘(1) An eligible entity seeking financial assistance under subsection (a) shall 

submit to the Secretary an application in such form, in such manner, and containing such commitments and information as the Secretary determines to be 

necessary. 

‘‘(2) An application submitted under paragraph (1) shall contain—

‘‘(A) a description of the supportive services proposed to be provided by 

the eligible entity; 

‘‘(B) a description of the types of very low-income veteran families proposed to be provided such services; 

‘‘(C) an estimate of the number of very low-income veteran families proposed to be provided such services; 

‘‘(D) evidence of the experience of the eligible entity in providing supportive services to very low-income veteran families; and 

‘‘(E) a description of the managerial capacity of the eligible entity to—

‘‘(i) coordinate the provision of supportive services with the provision 

of permanent housing, by the eligible entity or by other organizations; 

‘‘(ii) continuously assess the needs of very low-income veteran families for supportive services; 

‘‘(iii) coordinate the provision of supportive services with the services 

of the Department; 

‘‘(iv) tailor supportive services to the needs of very low-income veteran families; and 

‘‘(v) continuously seek new sources of assistance to ensure the longterm provision of supportive services to very low-income veteran families. 

‘‘(3) The Secretary shall establish criteria for the selection of eligible entities 

to receive financial assistance under this section. 

‘‘(c) TECHNICAL ASSISTANCE.—

‘‘(1) The Secretary shall provide training and technical assistance to eligible 

entities that receive financial assistance under this section with respect to the 

planning, development, and provision of supportive services to very low-income 

veteran families occupying permanent housing. 

‘‘(2) The Secretary may provide the training described in paragraph (1) directly or through grants or contracts with appropriate public or nonprofit private entities. 


rfrederick on PROD1PC67 with HEARING
6 

‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There is authorized to be appropriated, for each fiscal year, $25,000,000, to carry out this section, of which not more than 

$750,000 for each fiscal year may be used to provide technical assistance under subsection (c). ‘‘(e) DEFINITIONS.—For the purposes of this section: ‘‘(1) The term ‘very low-income veteran family’ means a veteran family whose 

income does not exceed 50 percent of the median income for the area, as determined by the Secretary in accordance with this paragraph, except that— ‘‘(A) the Secretary shall make appropriate adjustments to the income requirement under subparagraph (A) based on family size; and ‘‘(B) the Secretary may establish an income ceiling higher or lower than 

50 percent of the median income for an area if the Secretary determines 

that such variations are necessary because the area has unusually high or 

low construction costs, fair market rents (as determined under section 8 of 

the United States Housing Act of 1937 (42 U.S.C. 1437f)), or family incomes. ‘‘(C) the Secretary shall establish criteria for determining the need for 

specific supportive services (as defined by paragraph (8)) of individual very 

low income veteran families occupying permanent housing. ‘‘(2) The term ‘veteran family’ includes a veteran who is a single person and 

a family in which the head of household or the spouse of the head of household 

is a veteran. 

‘‘(3) The term ‘consumer cooperative’ has the meaning given such term in section 202 of the Housing Act of 1959 (12 U.S.C. 1701q). 

‘‘(4) The term ‘eligible entity’ means—

‘‘(A) a private nonprofit organization; or 

‘‘(B) a consumer cooperative. 

‘‘(5) The term ‘homeless’ has the meaning given the term in section 103 of the 

McKinney-Vento Homeless Assistance Act (42 U.S.C. 11302). 

‘‘(6) The term ‘permanent housing’ means community-based housing without 

a designated length of stay. 

‘‘(7) The term ‘private nonprofit organization’ means—

‘‘(A) any incorporated private institution or foundation—

‘‘(i) no part of the net earnings of which inures to the benefit of any 

member, founder, contributor, or individual; 

‘‘(ii) which has a governing board that is responsible for the operation 

of the supportive services provided under this section; and 

‘‘(iii) which is approved by the Secretary as to financial responsibility; 

‘‘(B) a for-profit limited partnership, the sole general partner of which is 

an organization meeting the requirements of clauses (i), (ii), and (iii) of subparagraph (A); 

‘‘(C) a corporation wholly owned and controlled by an organization meeting the requirements of clauses (i), (ii), and (iii) of subparagraph (A); and 

‘‘(D) a tribally designated housing entity (as defined in section 4 of the 

Native American Housing Assistance and Self-Determination Act of 1996 

(25 U.S.C. 4103)). 

‘‘(8) The term ‘supportive services’ means the following: 

‘‘(A) Services provided by an eligible entity or subcontractors that address 

the needs of very low-income veteran families occupying permanent housing, including—

‘‘(i) outreach services; 

‘‘(ii) health care services, including diagnosis, treatment, and counseling for mental health and substance abuse disorders and for posttraumatic stress disorder, if such services are not readily available 

through the Department of Veterans Affairs medical center serving the 

geographic area in which the veteran family is housed; 

‘‘(iii) habilitation and rehabilitation services; 

‘‘(iv) case management services; 

‘‘(v) daily living services; 

‘‘(vi) personal financial planning; 

‘‘(vii) transportation services; 

‘‘(viii) vocational counseling; 

‘‘(ix) employment and training; 

‘‘(x) educational services; 

‘‘(xi) assistance in obtaining veterans benefits and other public benefits, including health care provided by the Department; 

‘‘(xii) assistance in obtaining income support; 

‘‘(xiii) assistance in obtaining health insurance; 

‘‘(xiv) fiduciary and representative payee services; 


rfrederick on PROD1PC67 with HEARING
7 

‘‘(xv) legal services to assist the veteran family with reconsiderations 

or appeals of veterans and public benefit claim denials and to resolve 

outstanding warrants that interfere with the family’s ability to obtain 

or retain housing or supportive services; 

‘‘(xvi) child care; 

‘‘(xvii) housing counseling; 

‘‘(xviii) other services necessary for maintaining independent living; 

and 

‘‘(xix) coordination of services described in this paragraph. 

‘‘(B) Services provided by an eligible entity or subcontractors, including 

services described in clauses (i) through (xix) of subparagraph (A), that are 

delivered to very low-income veteran families who are homeless and who 

are scheduled to become residents of permanent housing within 90 days of 

the date on which the service is provided pending the location or development of housing suitable for permanent housing. 

‘‘(C) Services provided by an eligible entity or subcontractors, including 

services described in clauses (i) through (xix) of subparagraph (A), for very 

low-income veteran families who have voluntarily chosen to seek other 

housing after a period of tenancy in permanent housing, that are provided, 

for a period of 90 days beginning on the date on which such a family exits 

permanent housing or until such a family commences receipt of other housing services adequate to meet the needs of the family, but only to the extent 

that services under this paragraph are designed to support such a family 

in the choice to transition into housing that is responsive to the individual 

needs and preferences of the family.’’. 

(2) CLERICAL AMENDMENT.—The table of sections at the beginning of such 

chapter is amended by inserting after the item relating to section 2043 the following new item: 

‘‘2044. Financial assistance for supportive services for very low-income veteran families residing in permanent 

housing.’’. 

SEC. 10. EXPANSION OF ELIGIBILITY FOR DENTAL CARE. 

Section 2062(b) of title 38, United States Code, is amended by striking ‘‘60 consecutive days’’ both places it appears and inserting ‘‘30 consecutive days’’. 

SEC. 11. TECHNICAL AMENDMENTS. 

Title 38, United States Code, is amended—

(1) in each of sections 1708(d), 7314(f), 7320(j)(2), 7325(i)(2), and 7328(i)(2), 

by striking ‘‘medical care account’’ and inserting ‘‘medical services account’’; 

(2) in section 1712A—

(A) by striking subsection (g); 

(B) by redesignating subsections (d), (e), (f), and (i) as subsections (c) 

through (f), respectively; and 

(C) in subsection (f)(1), as so redesignated, by striking ‘‘(including a Resource Center designated under subsection (h)(3)(A) of this section)’’; 

(3) in section 2065(b)(3)(C), by striking ‘‘)’’; 

(4) in the table of sections at the beginning of chapter 36, by striking the item 

relating to section 3684A and inserting the following new item: 

‘‘3684A. Procedures relating to computer matching program.’’; 

(5) in section 3684(a)(1), by striking ‘‘34,,’’ and inserting ‘‘34,’’; 

(6) in section 4110(c)(1), by striking ‘‘15’’ and inserting ‘‘16’’; 

(7) in the table of sections at the beginning of chapter 51, by striking the item 

relating to section 5121 and inserting the following new item: 

‘‘5121. Payment of certain accrued benefits upon death of a beneficiary.’’; 

(8) in section 7458(b)(2), by striking ‘‘pro rated’’ and inserting ‘‘pro-rated’’; and 

(9) in section 8117(a)(1), by striking ‘‘such such’’ and inserting ‘‘such’’. 

PURPOSE AND SUMMARY

H.R. 2874, the ‘‘Veterans Health Care Improvement Act of 2007,’’

was introduced on June 27, 2007, by Representative Michael H. 

Michaud of Maine, the Chairman of the Subcommittee on Health. 

The legislation would make certain improvements in the ability of 

the Department of Veterans Affairs (VA) to provide treatment and 

care to veterans suffering from mental health issues as well as vetVerDate Aug 31 2005 07:53 Jul 28, 2007 Jkt 059006 PO 00000 Frm 00007 Fmt 6659 Sfmt 6602 E:\HR\OC\HR268.XXX HR268

rfrederick on PROD1PC67 with HEARING
8 

erans who are homeless. This bill would further assist low-income 

veteran families living in permanent housing. 

H.R. 2874 would: 

1. Authorize VA to establish a grant program for nonprofit entities to conduct workshops to assist in the therapeutic readjustment 

and rehabilitation of Operation Enduring Freedom or Operation 

Iraqi Freedom (OEF/OIF) veterans. VA would determine that a 

nonprofit entity has the experience and expertise to conduct such 

programs and require the grants be used exclusively for the benefit 

of veterans. VA would submit a report to the House and Senate 

Veterans’ Affairs Committees detailing the number of grants made 

each fiscal year, and the total number of veterans participating in 

workshop programs funded by the grants. The amount of the 

grants would be limited to $100,000 for each calendar year and 

there would be $2 million authorized each fiscal year to carry out 

the program. Authority for the grant program would terminate on 

September 20, 2011. 

2. Require VA to establish a grant program for rural veterans 

service organizations, State veterans’ service agencies, and nonprofits to provide innovative transportation options to veterans in 

remote rural areas to travel to VA medical facilities. Limit grants 

to $50,000 and authorize appropriations of $3 million for each fiscal 

year from 2008 to 2012 to carry out the program. 

3. Make permanent VA’s authority to provide veterans who participated in a test conducted by the Department of Defense Deseret 

Test Center from 1962 through 1973 higher priority for hospital 

care, medical services and nursing home care without requirement 

for proof of service-connection. 

4. Extend through September 30, 2009, VA’s authority to require certain non-service connected veterans to pay a $10 per diem copayment when they receive VA hospital care. 

5. Extend through October 1, 2009, VA’s authority to bill a service-connected patient’s third-party insurance carrier for the cost of 

care VA provides the veteran for any non-service-connected disability. 

6. Require VA to provide for readjustment counseling and mental 

health services for OEF/OIF veterans through programs which 

would provide peer outreach services, peer support services, and readjustment and mental health services. Such services would include contracting with community mental health centers in areas 

not adequately served by VA and contracting with nonprofit mental 

health organizations to train OEF/OIF veterans in outreach and 

peer support. Directs VA to conduct training programs for clinicians that have contracts with VA to provide such services. 

7. Expand the counseling services for at-risk veterans 

transitioning from certain institutions to at least 12 locations and 

extends authority for programs to September 30, 2011. 

8. Require the Secretary to ensure that VA domiciliary programs 

are adequate in capacity and safety to meet the needs of women 

veterans. 

9. Require VA to provide financial assistance to eligible entities 

to provide supportive services for very low-income veteran families 

residing in permanent housing. 

10. Modify the requirement for a homeless veteran to be eligible 

for dental care by reducing, from 60 to 30, the number of consecuVerDate Aug 31 2005 07:53 Jul 28, 2007 Jkt 059006 PO 00000 Frm 00008 Fmt 6659 Sfmt 6602 E:\HR\OC\HR268.XXX HR268

rfrederick on PROD1PC67 with HEARING
9 

tive days a homeless veteran must participate in a VA-sponsored 

rehabilitation program. 

11. Make technical amendments to title 38, United States Code. 

BACKGROUND AND DISCUSSION

The Mental Health Assessment Team IV Report (MHAT IV) is 

the fourth in a series of studies since 2003 to assess the mental 

health and well-being of the deployed forces serving in Iraq. 

The MHAT IV central findings included: 

• The level of combat is the main determinant of a Soldier’s or 

Marine’s mental health status. • Multiple deployers reported higher acute stress than first-time 

deployers. Deployment length was related to higher rates of mental 

health problems and marital problems. • Although demographic differences exist between the deployed 

OIF Soldiers and the Army population, 2003–2006 OIF suicide 

rates are higher than the average Army rate, 16.1 vs. 11.6 Soldier 

suicides per year per 100,000. • There is no standardized joint reporting system for monitoring 

mental health status and suicide surveillance of service members 

in a combat/deployed environment. 

The mental health and well-being of the newest generation of 

veterans is a leading cause of concern for VA. VA reported in the 

April 2007 quarterly Analysis of VA Health Care Utilization 

Among US Southwest Asian War Veterans, Operation Enduring 

Freedom, Operation Iraqi Freedom, that of those Southwest Asian 

War veterans that have separated, 33 percent have sought VA 

health care since FY 2002. Additionally, mental disorders rank second for frequency of possible diagnoses among recent OEF/OIF veterans, at a rate of 36.6 percent, it is second only to diseases of the 

musculoskeletal system at 43.4 percent. VA reports that of the 

83,889 patients that have received a diagnosis of a possible mental 

disorder, Post-traumatic Stress Disorder (PTSD) is the number one 

health concern with 39,243 veterans receiving at least a provisional 

diagnosis. Nondependent abuse of drugs and depressive disorders 

are number two and three. Early intervention and early treatment 

are essential to the successful treatment of PTSD. 

The composition of the combat forces in OEF/OIF is unique from 

previous conflicts. There is a heavy reliance on the National Guard 

and Reserve forces. Though only 19 percent of the nation lives in 

rural America, 44 percent of military recruits come from rural 

areas and nearly one-third of those who have been killed in Iraq 

are from small towns and communities across the nation. Another 

very important aspect of OEF/OIF is the prevalence of repeated deployments. 

VA’s primary challenge in serving veterans who reside in rural 

areas is to effectively address access to quality care in areas where 

veteran populations are dispersed over a large geographical area. 

H.R. 2874 would authorize VA to establish a new grant program 

to conduct therapeutic workshops that would allow the veteran to 

express thoughts and feelings through such programs as art, writing and music. Additionally, to address the readjustment counseling and mental health concerns of veterans who live in rural 

areas or areas where VA does not have adequate readjustment 

counseling and mental health services available, this legislation 


rfrederick on PROD1PC67 with HEARING
10 

would require VA to contract with mental health centers and nonprofit mental health organizations to provide peer-to-peer counseling and outreach training. It further requires VA to train mental 

health clinicians to VA standards in order to maintain the highest 

quality of care provided to veterans. 

This legislation also begins to address the difficult task of providing access to health care in rural areas by authorizing VA to establish a grant program that would provide grants to State veterans’ service agencies, nonprofits and veterans service organizations (VSOs) to develop new and innovative ways to provide transportation to veterans who reside in rural areas. 

This legislation also addresses issues of homelessness. VA is the 

largest single provider of direct services to homeless veterans, 

reaching 100,000 or 25 percent of homeless veterans a year 

through their various programs. Like their non-veteran counterparts, veterans are at high risk of homelessness due to extremely 

low or no livable income, extreme shortage of affordable housing, 

and lack of access to health care. 

Prior to becoming homeless, a large number of veterans at risk 

of homelessness have struggled with PTSD, or have addictions acquired during, or worsened by, their military service. H.R. 2874 begins to address the needs of homeless veterans by extending and 

expanding VA’s authority for counseling services for at risk veterans transitioning from certain institutions and authorizing VA to 

provide financial assistance to provide supportive services for very 

low-income veteran families residing in permanent housing. 

GRANTS FOR SUPPORT OF THERAPEUTIC READJUSTMENT PROGRAMS

FOR VETERANS

This legislation would allow VA to establish a new grant program for nonprofit entities to conduct workshops to assist in the 

therapeutic readjustment and rehabilitation of OEF/OIF combat 

veterans. VA currently works with organizations to provide disabled veterans with opportunities for self-development and for improving their quality of life through sports, recreational, and artistic activities. Additionally, VA medical facilities incorporate creative arts into their recreation therapy programs. Through these 

therapeutic readjustment programs, veterans will benefit from 

workshops or programs that allow them to express themselves and 

become healthy and productive members of society. 

TRANSPORTATION GRANTS FOR RURAL VETERANS SERVICE

ORGANIZATIONS

This legislation would establish a new grant program to provide 

transportation options to veterans living in rural areas. These 

grants will assist veterans in gaining access to quality health care. 

The Committee strongly recommends VA give preference in awarding these grants to VSOs; veterans helping veterans create an atmosphere of camaraderie and trust that is familiar to those who 

have served. 


rfrederick on PROD1PC67 with HEARING
11 

PERMANENT TREATMENT AUTHORITY FOR PARTICIPANTS IN DEPART- MENT OF DEFENSE CHEMICAL AND BIOLOGICAL TESTING CON- DUCTED BY DESERET TEST CENTER (INCLUDING PROJECT SHIPBOARD

HAZARD AND DEFENSE)

Under current law, VA is authorized to provide higher priority 

health care to veterans who participated in Project Shipboard Hazard and Defense (SHAD), Project 112 or related land-based tests 

conducted by the Department of Defense Deseret Test Center, from 

1962 through 1973, for any illness, without those veterans needing 

an adjudicated service-connected disability to establish their priority for care. This legislation would make permanent this special 

treatment authority that will expire on December 31, 2007. The 

Committee believes that these veterans should receive free VA 

medical care for conditions that may have resulted from their participation in military testing conducted by the Department of Defense Deseret Test Center. The VA requested this authority be 

made permanent. 

EXTENSION OF EXPIRING COLLECTIONS AUTHORITIES

Public Law 101–508, the ‘‘Omnibus Budget Reconciliation Act of 

1990,’’ required certain non-service connected veterans with higher 

incomes to pay a per diem copayment when they receive VA hospital care and allows VA to collect from a service-connected patient’s insurance company for the cost of care provided for any nonservice-connected disability. The VA requested this authority be 

made permanent. This legislation would extend this authority until 

2009. 

EXPANSION AND EXTENSION OF AUTHORITY FOR PROGRAM OR REFERRAL AND COUNSELING SERVICES FOR AT RISK VETERANS

TRANSITIONING FROM CERTAIN INSTITUTIONS

This legislation would expand and extend the counseling services 

for at-risk veterans programs from six to at least 12 locations 

throughout the Veterans Health Administration. Significant numbers of incarcerated veterans are at risk for homelessness, substance abuse, mental illness, and chronic illness and infectious disease upon release. These veterans often need multiple services, including medical services, psychiatric care, substance abuse treatment, transitional housing, vocational/employment assistance, and 

veterans’ benefits services. 

PERMANENT AUTHORITY FOR DOMICILIARY SERVICES FOR HOMELESS

VETERANS AND ENHANCEMENT OF CAPACITY OF DOMICILIARY SERVICES FOR HOMELESS VETERANS AND ENHANCEMENT OF CAPACITY

OF DOMICILIARY CARE PROGRAMS FOR FEMALE VETERANS

By 2010, it is projected that there will be 1.8 million women veterans. Today’s female servicemember is much more likely to be exposed to combat or combat-like conditions than her predecessors in 

past conflicts. Women veterans now represent nearly four percent 

of the homeless veteran population as opposed to three percent five 

years ago. VA’s domiciliary care programs are essential in assisting 

veterans and providing needed services to help them recover and 

become productive citizens again. This legislation enhances the capacity of domiciliary care programs for female veterans. 


rfrederick on PROD1PC67 with HEARING
12 

FINANCIAL ASSISTANCE FOR SUPOPRTIVE SERVICES FOR VERY LOWINCOME VETERAN FAMILIES IN PERMANENT HOUSING

The U.S. Census Bureau estimates that 1.5 million of our nation’s veterans live in poverty, including 702,000 veterans with disabilities and 404,000 veterans in households with children. Of the 

1.5 million poor veterans 634,000 live in extreme poverty. These 

veterans face insecurity in housing as well as health and vocational 

challenges. Gaining access to supportive services has also proven to 

be difficult. This contributes to their inability to sustain housing 

and maintain independence for more costly public institutional care 

and support. This legislation would authorize the Secretary to provide financial assistance to nonprofit organizations and consumer 

cooperatives to provide and coordinate the provision of supportive 

services that address the needs of very low-income veterans occupying permanent housing. Veterans transitioning from homelessness to permanent housing, poor disabled and older veterans requiring supportive services in home based settings, and poor veterans in rural areas with distance barriers to centrally located 

services would benefit from this legislation. 

EXPANSION OF ELIGIBILITY FOR DENTAL CARE

VA can provide dental services to eligible homeless veterans as 

long as they have been receiving care for a period of 60 consecutive 

days in a domiciliary, therapeutic residence, community residential 

care coordinated by VA, or a setting for which the VA provides 

funds to a grant and per diem provider. Dental care includes treatment necessary for the veterans to gain or regain employment, and 

alleviate pain for moderate, severe, or severe and complicated gingival and periodontal pathology. 

The VA believes that the 60-day requirement serves as an incentive to keep the veteran in the rehabilitation program the veteran 

is in so they can receive the full range of services offered by VA. 

The Committee believes there are other incentives the VA offers to 

homeless veterans that would keep them in such a program including food, shelter and safety. This legislation would reduce the number of days that a homeless veteran would have to wait to receive 

dental treatment from 60 days to 30 days. 

TECHNICAL AMENDMENTS

This section makes several technical amendments to title 38, 

United States Code. 

LEGISLATIVE HISTORY

On April 18, 2007, the Subcommittee on Health held a hearing 

entitled ‘‘Access to VA Health Care: How Easy is it for Veterans: 

Addressing the Gaps.’’

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

hearing on a number of bills introduced by 110th Congress, including two Discussion Drafts of legislation concerning mental health 

and homeless veterans’ issues. 

H.R. 2874, as amended, contains provisions from H.R. 2005, introduced by Representative John Salazar of Texas; H.R. 2689, introduced by Representative Ciro Rodriguez of Texas; and, H.R. 


rfrederick on PROD1PC67 with HEARING
13 

2378, introduced by Representative Stephanie Herseth Sandlin of 

South Dakota. 

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

2874. The markup was recessed and on July 11, 2007, the Subcommittee on Health continued the markup. Chairman Michaud introduced an Amendment in the Nature of a Substitute to H.R. 2874 

which was agreed to by the Subcommittee by voice vote. Ranking 

Member Miller ordered it reported favorably to the Committee. 

On July 17, 2007, the full Committee met in open markup session and approved a number of bills, including H.R. 2874, as 

amended. The Committee, by voice vote, ordered H.R. 2874, as 

amended, reported favorably to the House of Representatives. 

SECTION-BY-SECTION

Section 1. Short title 

This section would provide the short title of H.R. 2874 as the 

‘‘Veterans’ Health Care Improvement Act of 2007.’’

Section 2. Grants for support of therapeutic readjustment programs 

for veterans 

This section would create a new section in Subchapter II of chapter 5 of title 38, United States Code. New section 521A would authorize the VA to make grants to qualifying nonprofit entities to 

conduct workshop programs that have been shown to assist in 

therapeutic readjustment and rehabilitation of participants. VA 

would determine, through an application process, what entities are 

most qualified to receive the grant. VA would be required to submit 

to the House and Senate Committees on Veterans’ Affairs, a detailed report on the number and amount of grants made during the 

previous fiscal year, the total number of veterans participating in 

workshop programs, and a description of the programs and the 

therapeutic benefits to veterans who participate. 

Section 3. Transportation grants for rural veterans service organizations 

This section would create a new section under subchapter I of 

chapter 17 of title 38, United States Code. New section 1709 would 

authorize VA to establish a grant program to provide innovative 

transportation options to veterans living in rural areas. Grants 

may be awarded to State veterans’ service agencies, veterans’ service organizations, and nonprofits to help veterans living in rural 

areas travel to VA medical centers. The Secretary would be required to prescribe regulations for evaluating grant applications 

and administering the program. 

Section 4. Permanent treatment authority for participants in Department of Defense chemical and biological testing conducted 

by Deseret Test Center (including Project Shipboard hazard 

and Defense) 

This section would make permanent VA’s authority to treat participants in the Department of Defense (DOD) chemical biological 

testing conducted by Deseret Test Center (including SHAD) 


rfrederick on PROD1PC67 with HEARING
14 

Section 5. Extension of expiring collections authorities 

This section extends the expiring collection authorities from 2007 

to 2009 for health care copayments and medical care cost recovery. 

Section 6. Readjustment and mental health services for Operation 

Enduring Freedom and Operation Iraqi Freedom veterans 

This section would create a new section 1712C that would authorize the Secretary to carry out programs to provide peer outreach services, peer support services, and readjustment and mental 

health services to OEF/OIF veterans. The VA would contract with 

community mental health centers in areas not adequately served 

by VA. These contracts should employ veterans, use telehealth 

services, participate in training programs, and comply with protocols subscribed to by VA. The centers would be required to submit 

a report to the Secretary on an annual basis that details the number of veterans served, diagnosed, and courses of treatment provided to veterans. Also included in the report would be demographic information and clinical summary information, as the Secretary may require, on each veteran. The VA would contract with 

a nonprofit mental health organization to train veterans to provide 

peer outreach and peer support services. VA would be required to 

conduct a training program for clinicians to ensure that each are 

able to provide the services that utilize best practices and technologies. 

Section 7. Expansion and extension of authority for program of referral and counseling services for at-risk veterans transitioning 

from certain institutions 

This section would expand and extend the counseling services for 

at-risk veterans programs to at least 12 locations until September 

30, 2011. 

Section 8. Permanent authority for domiciliary services for homeless 

veterans and enhancement of capacity of domiciliary services 

for homeless veterans and enhancement of capacity of domiciliary care programs for female veterans 

This section would require the VA to ensure that VA domiciliary 

programs are adequate in capacity and safety to meet the needs of 

women veterans. 

Section 9. Financial assistance for supportive services for very lowincome veterans families in permanent housing 

This section would create a new section 2044 that would authorize VA to provide financial assistance to eligible entities to provide 

supportive services for very low-income veteran families residing in 

permanent housing. VA may give preference to an entity that provides or coordinates supportive services for very low-income veteran families who are transitioning from homelessness to permanent housing. Eligible entities would apply to VA for financial assistance and VA would be required to ensure that assistance is equitably distributed across geographic regions, including rural communities and tribal lands. VA would also provide training and technical assistance to eligible entities that provide supportive services 

to very low-income veterans. To carry out this section, $25,000,000 

would be authorized to be appropriated each fiscal year. 


rfrederick on PROD1PC67 with HEARING
15 

Section 10. Expansion of eligibility for dental care 

This section would amend section 2062(b) of title 38, United 

States Code to allow homeless veterans to become eligible for dental care after 30 consecutive days of receiving treatment rather 

than 60 consecutive days. 

COMMITTEE CONSIDERATION

On July 17, 2007, the Committee ordered H.R. 2874, 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. 2874, 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. 

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. 2874. 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 proviVerDate Aug 31 2005 07:53 Jul 28, 2007 Jkt 059006 PO 00000 Frm 00015 Fmt 6659 Sfmt 6602 E:\HR\OC\HR268.XXX HR268

rfrederick on PROD1PC67 with HEARING
16 

sions 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. 2874, 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. 

2874, 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. 

BUDGET AUTHORITY AND CONGRESSIONAL BUDGET OFFICE COST

ESTIMATE

U.S. CONGRESS, 

CONGRESSIONAL BUDGET OFFICE, 

Washington, DC, July 27, 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. 2874, the Veterans’

Health Care Improvement Act of 2007. 

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. 2874—Veterans’ Health Care Improvement Act of 2007 

Summary: H.R. 2874 contains provisions that would both increase and decrease spending for veterans’ health care. The bill 

would expand certain health care benefits available for veterans 

and would create new programs to help low-income veterans and 

veterans in rural areas. H.R. 2874 also would extend for two years 

the authority of the Department of Veterans Affairs (VA) to collect 

certain payments for medical care. 

The bill also would require VA to implement a new program to 

provide readjustment counseling and mental health care services to 

recent veterans. CBO does not have sufficient information about 

how VA might implement this requirement to estimate the cost. 

CBO estimates that the net effect of implementing the remainder 

of H.R. 2874 would be to reduce costs for veterans’ health care by 

$22 million in 2008 and to increase costs by $199 million over the 


rfrederick on PROD1PC67 with HEARING
17 

2008–2012 period, assuming the availability of appropriated funds. 

Enacting the bill would not affect direct spending or revenues. 

H.R. 2874 contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act (UMRA); 

any costs to state, local, or tribal governments would be incurred 

voluntarily. 

Estimated cost to the Federal Government: The estimated budgetary impact of H.R. 2874 is shown in Table 1. The costs of this 

legislation fall within budget function 700 (veterans benefits and 

services). 

TABLE 1.—ESTIMATED BUDGETARY IMPACT OF H.R. 2847 a

By fiscal year, in millions of dollars— 

2008 2009 2010 2011 2012 

CHANGES IN SPENDING SUBJECT TO APPROPRIATION 

Estimated Authorization Level ...................................................................................... 42 43 43 43 38 

Estimated Outlays ......................................................................................................... ¥22 33 100 46 42 

a This table does not include the costs for implementing section 6 of H.R. 2874, which CBO cannot estimate at this time. 

Basis of estimate: For this estimate, CBO assumes that the legislation will be enacted near the start of fiscal year 2008, that the 

estimated amounts will be appropriated each year, and that outlays will follow historical spending patterns for the VA medical 

services program. 

Offsetting collections 

VA has a number of authorities that allow it to bill third-party 

insurance for care given to veterans, and to collect a variety of fees 

and copayments from veterans. Two specific authorities will expire 

at the end of fiscal year 2007. Those expiring authorities allow VA 

to collect a $10 daily payment for hospital stays from certain veterans and to bill insurance companies for care given to veterans 

who have a disability related to their service, but who are being 

treated for a nonservice-related condition. Based on information 

from VA, CBO estimates that the department will collect about 

$525 million in 2007 as a result of those two expiring authorities. 

Section 5 would allow VA to continue collecting those monies for 

another two years—until September 30, 2009. All VA collections 

are currently deposited into the Medical Care Collections Fund 

(MCCF). Amounts deposited to the MCCF are considered to be offsets to discretionary appropriations and spending from the MCCF 

is subject to annual appropriation action. Accounting for inflation 

and increased usage, CBO estimates that implementing this provision would increase—relative to current law—offsetting collections deposited to the MCCF by $582 million in 2008 and about $1.2 billion over the 2008–2009 period. 

TABLE 2.—COMPONENTS OF THE ESTIMATED CHANGES IN SPENDING SUBJECT TO APPROPRIATION 

UNDER H.R. 2847 a

By fiscal year, in millions of dollars— 

2008 2009 2010 2011 2012 

Offsetting Collections: 

Estimated Authorization Level ............................................................................... 0 0 0 0 0 

Estimated Outlays .................................................................................................. ¥58 ¥9 57 3 1 


rfrederick on PROD1PC67 with HEARING
18 

TABLE 2.—COMPONENTS OF THE ESTIMATED CHANGES IN SPENDING SUBJECT TO APPROPRIATION 

UNDER H.R. 2847 a—Continued 

By fiscal year, in millions of dollars—

2008 2009 2010 2011 2012 

Help for Very-Low Income Veterans: 

Authorization Level ................................................................................................. 25 25 25 25 25 

Estimated Outlays .................................................................................................. 23 25 25 25 25 

Dental Benefits for Homeless Veterans: 

Estimated Authorization Level ............................................................................... 7 7 7 7 8 

Estimated Outlays .................................................................................................. 6 7 7 7 8 

Transportation Grants: 

Authorization Level ................................................................................................. 3 3 3 3 3 

Estimated Outlays .................................................................................................. 3 3 3 3 3 

Veterans Released from Prison: 

Estimated Authorization Level ............................................................................... 4 4 4 4 0 

Estimated Outlays .................................................................................................. 1 3 4 4 3 

Therapeutic Readjustment Grants: 

Authorization Level ................................................................................................. 2 2 2 2 0 

Estimated Outlays .................................................................................................. 2 2 2 2 0 

Chemical and Biological Testing Participants: 

Estimated Authorization Level ............................................................................... 1 2 2 2 2 

Estimated Outlays .................................................................................................. 1 2 2 2 2 

Total Changes: a

Estimated Authorization Level ...................................................................... 42 43 43 43 38 

Estimated Outlays ......................................................................................... ¥22 33 100 46 42 

aThis table does not include the cost of implementing section 6 of H.R. 2874, which CBO cannot estimate at this time. 

Subject to annual appropriation action, VA can spend the money 

in the MCCF to provide medical care for veterans. CBO estimates 

that implementing section 5 would increase discretionary spending 

on medical care for veterans by $523 million in 2008 and $1.1 billion over the 2008–2012 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. This results in outlay savings in the first two years and costs 

in later years. Therefore, CBO estimates that the net budgetary 

impact of implementing H.R. 2874 would be a reduction in discretionary outlays of $58 million in 2008 and $6 million over the 

2008–2012 period. 

Help for very-low income veterans 

Section 9 would authorize the appropriation of $25 million a year 

to provide financial assistance to qualified nonprofit organizations 

and consumer cooperatives that provide supportive services to verylow income veterans who live in permanent housing, with preference given to those entities that help veterans make a transition 

from homelessness to permanent housing. Very-low income veterans would be defined as those having an income that is less than 

half of the median income for the area in which the veteran lives. 

The authorized funding would support a wide array of services, including outreach, health care, counseling, transportation, assistance with daily living, and assistance in obtaining veterans benefits and other public benefits, among others. CBO estimates that 

implementing this section would cost $23 million in 2008 and $123 

million over the 2008–2012 period. 


rfrederick on PROD1PC67 with HEARING
19 

Dental benefits for homeless veterans 

Section 10 would expand a benefit program that provides dental 

care to certain veterans. Under current law, veterans who have received 60 consecutive days of care through a VA program that provides rehabilitation and treatment for homeless veterans may receive dental care to alleviate pain, as part of treatment for a more 

severe periodontal disease, or to aid in getting a job. Section 10 

would decrease the required number of days of care to 30, allowing 

homeless veterans who are receiving shorter-term treatment, such 

as for substance abuse, to receive the dental benefit. 

In late 2006, VA implemented a Homeless Veterans Dental Initiative to address the concern that homeless veterans were not able 

to get appointments for dental care because priority is given to veterans returning from overseas deployments. In 2008, VA plans to 

use $10 million for this purpose. VA reports that, to date, about 

4,500 veterans have received treatment under this program and 

that an additional 2,500 veterans would be eligible for the benefit 

under H.R. 2874. At an average cost of about $2,500 per veteran 

in 2007, and adjusting for medical inflation, CBO estimates that 

implementing this provision would increase the cost of this program by $6 million in 2008 and $35 million over the 2008–2012 period. 

Transportation grants 

Section 3 would authorize the appropriation of $3 million each 

year from 2008 through 2012 to provide grants to organizations 

that would assist veterans in rural areas to travel to VA medical 

facilities. Eligible entities would include state veterans agencies 

and nonprofit organizations. CBO estimates that implementing this 

section would cost $3 million in 2008 and $15 million over the 

2008–2012 period. 

Veterans released from prison 

VA is currently working with the Department of Labor (DOL) on 

a demonstration program to provide counseling and referrals to 

veterans leaving penal institutions who are at risk of becoming 

homeless. VA hires case managers to oversee the program while 

DOL administers the grants to nonprofit organizations that provide 

the counseling and referrals. Under current law, the program is 

being conducted at six sites and will expire on September 30, 2007. 

Section 7 would double the number of program sites and extend the 

authority through fiscal year 2011. CBO estimates that, in total, 

implementing this provision would cost about $1 million in 2008 

and $15 million over the 2008–2011 period. 

Based on information from VA that six case managers would be needed to oversee the 12 sites at an average cost of $80,000 per 

person, CBO estimates that such additional staff would cost VA 

less than $500,000 in 2008 and $2 million over the 2008–2011 period. 

Under this program, DOL issued grants totaling over $1.6 million in 2007 through nonprofit organizations to provide counseling 

and referral services to almost 1,000 veterans leaving penal institutions. CBO estimates that increasing the size of the program would 

increase costs for such grants by less than $500,000 in 2008 and 

by $13 million over the 2008–2011 period. 


rfrederick on PROD1PC67 with HEARING
20 

Therapeutic readjustment grants 

Section 2 would authorize the appropriation of $2 million in each 

year from 2008 through 2011 to be given as grants to nonprofit organizations that would provide therapeutic readjustment and rehabilitation programs to veterans who served in areas of combat after 

November 11, 1998. All grantees must show that their programs 

assist in the readjustment and rehabilitation of participants. CBO 

estimates that implementing this section would cost $2 million in 

2008 and $8 million over the 2008–2011 period. 

Chemical and biological testing participants 

From 1962 to 1973, the Department of Defense conducted certain 

tests to determine the vulnerability of personnel, buildings, and 

ships to various biological and chemical threats. Veterans who were 

exposed to agents used in those tests are eligible to receive free 

health care from VA, though copayments are required for treatment for diseases or injuries that are obviously not related to military service. The authority to provide this benefit expires on December 31, 2007. Section 4 would make this authority permanent. 

Based on data provided by VA that about 300 such veterans are 

receiving health care from the agency at an average cost of $5,800 

in 2007, CBO estimates that implementing this section would cost 

$1 million in 2008 and $9 million over the 2008–2012 period. 

Mental health care and readjustment counseling 

Section 6 would require VA to implement a new program to provide readjustment counseling and mental health care to veterans 

who have served in combat operations since November 11, 1998, 

and left active-duty service after September 11, 2001. The program 

would include peer outreach and support services. In areas of the 

country where the Secretary determines there is inadequate coverage by VA medical facilities, the department would be required 

to contract with community mental health centers to provide these 

services. VA would be required to provide training to clinicians in 

those centers to ensure that the services provided are appropriate 

for veterans of Operation Iraqi Freedom and Operation Enduring 

Freedom. In addition, VA would be required to contract with nonprofit organizations to train combat veterans to provide peer outreach and support services. 

VA has not yet determined how it would implement the requirements of this section. According to VA, it currently has over 200 

contracts with private-sector agencies to provide readjustment 

counseling to veterans, primarily in rural areas. However, other 

than ensuring that the agency is qualified to provide counseling, 

VA does not provide additional assistance to ensure that the services provided are appropriate for veterans who served in Iraq and 

Afghanistan. VA conducts training programs for veterans to provide peer outreach, but it does this with its own resources and not 

through contracts with nonprofit organizations. Because VA is not 

yet able to specify how its current programs would change under 

the requirements of this provision, CBO cannot estimate the costs 

of implementing section 6. Depending on how VA decides to implement those requirements, costs could range from a negligible 

amount to several million dollars a year. 


rfrederick on PROD1PC67 with HEARING
21 

Intergovernmental and private-sector impact: H.R. 2874 contains 

no intergovernmental or private-sector mandates as defined in 

URMA. Programs authorized in the bill would benefit state, local, 

and tribal governments that provide transportation or housing assistance to veterans. Any costs they might incur to comply with reporting requirements of the programs would be incurred voluntarily. 

Estimate prepared by: Federal Costs: Michelle S. Patterson; Impact on State, Local, and Tribal Governments: Lisa RamirezBranum; Impact on the Private Sector: Victoria Liu. 

Estimate approved by: Peter H. Fontaine, Deputy 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, 

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 I—GENERAL PROVISIONS 

* * * * * * * 

CHAPTER 5—AUTHORITY AND DUTIES OF THE 

SECRETARY 

Sec. 

SUBCHAPTER I—GENERAL AUTHORITIES 

501. Rules and regulations. 

* * * * * * * 

SUBCHAPTER II—SPECIFIED FUNCTIONS 

521. Assistance to certain rehabilitation activities. 

521A. Assistance to therapeutic readjustment programs. 

* * * * * * * 

SUBCHAPTER II—SPECIFIED FUNCTIONS 

* * * * * * * 

§ 521A. Assistance to therapeutic readjustment programs 

(a) GRANT PROGRAM.—The Secretary of Veterans Affairs may 

make grants to qualified entities described in subsection (b) to conduct workshop programs that have been shown to assist in the 

therapeutic readjustment and rehabilitation of participants to assist 

in the therapeutic readjustment of covered veterans. 

(b) QUALIFIED ENTITIES.—In order to qualify for grant assistance 

under subsection (a), a private nonprofit entity must have, as determined by the Secretary, experience and expertise in offering programs to assist in the therapeutic readjustment of participants and 

that such programs will likely assist covered veterans. 


rfrederick on PROD1PC67 with HEARING
22 

(c) AMOUNT OF GRANT; USE OF FUNDS.—A grant under this sec- tion shall not exceed $100,000 for any calendar year and shall be 

used by the recipient exclusively for the benefit of covered veterans. 

(d) APPLICATION.—An application for a grant under this section 

shall include details regarding the extent and nature of the proposed program, the therapeutic readjustment and rehabilitation 

benefits expected to be achieved by participants, and any other information the Secretary determines may be necessary to assist the Secretary in ensuring that covered veterans receive therapeutic readjustment and rehabilitation benefits. 

(e) COVERED VETERANS.—For the purposes of this subsection, a ‘‘covered veteran’’ is a veteran who served on active duty in a theater 

of combat operations (as determined by the Secretary in consultation with the Secretary of Defense) during a period of war after the 

Persian Gulf War, or in combat against a hostile force during a period of hostilities (as defined in section 1712A(a)(2)(B) of this title) 

after November 11, 1998, and who is discharged or released from 

active military, naval, or air service on or after September 11, 2001. 

(f) REPORTS.—Not later than 60 days after the last day of a fiscal 

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

the number and amount of grants made under this section during 

the previous fiscal year, the total number of covered veterans participating in workshop programs funded by such grants, a description 

of the programs, and the therapeutic benefits to covered veterans of 

participation in the various programs funded. 

(g) AUTHORIZATION OF APPROPRIATIONS.—There is authorized to 

be appropriated for each of fiscal years 2008 through 2011 

$2,000,000 to carry out this section. 

(h) TERMINATION.—The authority of the Secretary to make a grant 

under subsection (a) shall terminate on September 30, 2011. 

* * * * * * * 

PART II—GENERAL BENEFITS 

* * * * * * * 

CHAPTER 17—HOSPITAL, NURSING HOME, 

DOMICILIARY, AND MEDICAL CARE 

Sec. 

SUBCHAPTER I—GENERAL 

1701. Definitions. 

* * * * * * * 

1709. Grants for provision of transportation to Department medical facilities for 

veterans in remote rural areas. 

SUBCHAPTER II—HOSPITAL, NURSING HOME, OR DOMICILIARY CARE AND 

MEDICAL TREATMENT 

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

* * * * * * * 

1712C. Provision of readjustment counseling and mental health services for covered 

veterans. 

* * * * * * * 


rfrederick on PROD1PC67 with HEARING
23 

SUBCHAPTER I—GENERAL 

* * * * * * * 

§ 1708. Temporary lodging 

(a) * * * 

* * * * * * * 

(d) The Secretary may establish charges for providing lodging 

under this section. The proceeds from such charges shall be credited to the ømedical care account¿ medical services account and 

shall be available until expended for the purposes of providing such 

lodging. 

* * * * * * * 

§ 1709. Grants for provision of transportation to Department 

medical facilities for veterans in remote rural areas 

(a) GRANTS AUTHORIZED.—(1) The Secretary shall establish a 

grant program to provide innovative transportation options to veterans in remote rural areas. 

(2) Grants awarded under this section may be used by State veterans’ service agencies, veterans service organizations, and private 

nonprofit entities to assist veterans in remote rural areas to travel 

to Department medical facilities. 

(3) The amount of a grant under this section may not exceed $50,000. 

(4) The recipient of a grant under this section shall not be required to provide matching funds as a condition for receiving such 

grant. 

(b) REGULATIONS.—The Secretary shall prescribe regulations for— (1) evaluating grant applications under this section; and 

(2) otherwise administering the program established by this 

section. 

(c) AUTHORIZATION OF APPROPRIATIONS.—There is authorized to 

be appropriated $3,000,000 for each of fiscal years 2008 through 

2012 to carry out this section. 

SUBCHAPTER II—HOSPITAL, NURSING HOME, OR 

DOMICILIARY CARE AND MEDICAL TREATMENT 

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

(a) * * * 

* * * * * * * 

(e)(1) * * * 

* * * * * * * 

(3) Hospital care, medical services, and nursing home care may 

not be provided under or by virtue of subsection (a)(2)(F)— (A) * * * 

(B) in the case of care for a veteran described in paragraph (1)(C), after December 31, 2002; and 

(C) in the case of care for a veteran described in paragraph (1)(D), after a period of 2 years beginning on the 

date of the veteran’s discharge or release from active military, naval, or air serviceø; and¿. 


rfrederick on PROD1PC67 with HEARING
24 

ø(D) in the case of care for a veteran described in paragraph (1)(E), after December 31, 2007.¿ 

* * * * * * * 

(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, ø2007¿ 2009, an amount equal 

to $10 for every day the veteran receives hospital care and 

$5 for every day the veteran receives nursing home care. 

* * * * * * * 

§ 1712A. Eligibility for readjustment counseling and related 

mental health services 

(a) * * * 

* * * * * * * 

ø(d)¿ (c) The Under Secretary for Health may provide for such 

training of professional, paraprofessional, and lay personnel as is 

necessary to carry out this section effectively, and, in carrying out 

this section, may utilize the services of paraprofessionals, individuals who are volunteers working without compensation, and individuals who are veteran-students (as described in section 3485 of 

this title) in initial intake and screening activities. 

ø(e)¿ (d)(1) * * * 

* * * * * * * 

ø(f)¿ (e) The Secretary, in cooperation with the Secretary of Defense, shall take such action as the Secretary considers appropriate 

to notify veterans who may be eligible for assistance under this section of such potential eligibility. 

ø(g)(1)(A) Except as provided in subparagraph (C) of this paragraph, the Secretary may close or relocate a center in existence on 

January 1, 1988, only as described in the national plan required by 

paragraph (3) of this subsection (or in a revision to such plan under 

paragraph (4) of this subsection in which the closure or relocation 

of that center is proposed). 

ø(B) A closure or relocation of a center which is proposed in such 

national plan may be carried out only after the end of the 120-day 

period beginning on the date on which the national plan is submitted. A closure or relocation of a center not proposed in such 

plan may be carried out only after the end of the 60-day period beginning on the date the Secretary submits a revision to such plan 

in which the closure or relocation of that center is proposed. 

ø(C) The Secretary may relocate a center in existence on January 

1, 1988, without regard to the national plan (including any revision 

to such plan) if such relocation is to a new location away from a 

Department general health-care facility when such relocation is necessitated by circumstances beyond the control of the Department. 

Such a relocation may be carried out only after the end of the 30- 

day period beginning on the date on which the Secretary notifies 

the Committees on Veterans’ Affairs of the Senate and the House 


rfrederick on PROD1PC67 with HEARING
25 

of Representatives of the proposed relocation, of the circumstances 

making it necessary, and of the reason for the selection of the new 

site for the center. 

ø(2)(A) Not later than April 1, 1988, the Secretary shall submit 

to the Committees on Veterans’ Affairs of the Senate and House of 

Representatives a report on the Secretary’s evaluation of the effectiveness in helping to meet the readjustment needs of veterans who 

served on active duty during the Vietnam era of the readjustment 

counseling and mental health services provided pursuant to this 

section (and of outreach efforts with respect to such counseling and 

services). Such report shall give particular attention, in light of the 

results of the study required by section 102 of the Veterans’ Health 

Care Amendments of 1983 (Public Law 98–160), to the provision of 

such counseling and services to veterans with post-traumatic stress 

disorder and to the diagnosis and treatment of such disorder. 

ø(B) The report required by subparagraph (A) of this paragraph 

shall include—

ø(i) the opinion of the Secretary with respect to (I) the 

extent to which the readjustment needs of veterans who 

served on active duty during the Vietnam era remain 

unmet, and (II) the extent to which the provision of readjustment counseling services under this section in centers 

is needed to meet such needs; and 

ø(ii) in light of the opinion submitted pursuant to clause 

(i) of this subparagraph, such recommendations for amendments to this subsection and for other legislative and administrative action as the Secretary considers appropriate. 

ø(3)(A) The Secretary, after considering the recommendations of 

the Under Secretary for Health, shall submit to such committees 

a report setting forth a national plan for all centers in existence on 

January 1, 1988. Such national plan shall set forth the Secretary’s 

proposals as to each such center for a period (to be determined by 

the Secretary) of not less than 12 months beginning on the date of 

the submission of the report. The plan shall include, as to each center, whether the Secretary proposes to relocate the center to a general Department facility, relocate the center to a new location away 

from a general Department facility, expand the center in the same 

location, or close the center. The plan shall also set forth any proposal of the Secretary to open additional centers. 

ø(B) The plan shall include the Secretary’s evaluation as to how, 

in light of each of the criteria described in subparagraph (C) of this 

paragraph, the proposal set forth in the plan for each center covered by the plan would ensure the continued availability and effective furnishing of readjustment counseling services to eligible veterans needing such services in the geographic area served by that 

center. 

ø(C) The Secretary shall make the evaluation described in subparagraph (B) of this paragraph with respect to any center in light 

of the following: 

ø(i) The distribution of Vietnam-era veterans in the geographic area served by the center and the relationships between the location of such center and the general Department facility and such distribution. 

ø(ii) The distance between the center and the general 

Department facility. 


rfrederick on PROD1PC67 with HEARING
26 

ø(iii) The availability of other entities (such as State, 

local, or private outreach facilities) which provide assistance to Vietnam-era veterans in the area served by the 

center. 

ø(iv) The availability of transportation to, and parking 

at, the center and the general Department facility. 

ø(v) The availability, cost, and suitability of the space at 

the general Department facility. 

ø(vi) The overall cost impact of the proposed closure or 

relocation, including a comparison of the recurring nonpersonnel costs of providing readjustment counseling to the 

same estimated number of veterans at the center and the 

general Department facility. 

ø(vii) The workload trends over the two previous fiscal 

years, and projected over the next fiscal year (or longer), 

at the center. 

ø(viii) Such other factors as the Secretary determines to 

be relevant to making the evaluation described in subparagraph (B) of this paragraph. 

ø(D) For the purposes of this paragraph, the term ‘‘general Department facility’’ means a Department facility which is not a center and at which readjustment counseling would be furnished in a 

particular geographic area upon the closure or relocation of a center. 

ø(4) After submitting the plan required by paragraph (3) of this 

subsection, the Secretary may submit to the committees a revision 

to such plan in order to modify the proposal set forth in the plan 

as to any center. Any such revision shall include, with respect to 

each center addressed in the revision, a description of the Secretary’s evaluation of the matters specified in paragraphs (3)(B) 

and (3)(C) of this subsection. 

ø(5) For purposes of determining a period of time under paragraph (1)(B) of this subsection, if the national plan (or a revision 

to the national plan) is submitted to the committees during the 

121-day period beginning 60 days before and ending 60 days after 

the final day of a session of the Congress, it shall be deemed to 

have been submitted on the sixty-first day after the final day of 

such session.¿ 

ø(i)¿ (f) For the purposes of this section: 

(1) The term ‘‘center’’ means a facility ø(including a Resource 

Center designated under subsection (h)(3)(A) of this section)¿ 

which is operated by the Department for the provision of services under this section and which (A) is situated apart from 

Department general health-care facilities, or (B) was so situated but has been relocated to a Department general healthcare facility. 

* * * * * * * 

§ 1712C. Provision of readjustment counseling and mental 

health services for covered veterans 

(a) PROGRAM REQUIRED.—The Secretary shall carry out a program to provide peer outreach services, peer support services, and 

readjustment and mental health services to covered veterans. 

(b) CONTRACTS WITH COMMUNITY MENTAL HEALTH CENTERS.—In 

carrying out the program required by subsection (a), the Secretary 


rfrederick on PROD1PC67 with HEARING
27 

shall contract with community mental health centers and other 

qualified entities to provide the services referred to in that paragraph in areas the Secretary determines are not adequately served 

by health care facilities of the Department. Such contracts shall require each community health center or other entity—

(1) to the extent practicable, to employ covered veterans 

trained under subsection (c); 

(2) to the extent practicable, to use telehealth services for the 

provision of such services; 

(3) to participate in the training program under subsection 

(d); 

(4) to comply with applicable protocols of the Department before incurring any liability on behalf of the Department for the 

provision of such the services; 

(5) to submit annual reports to the Secretary containing, with 

respect to the program required by subsection (a) and for the 

last full calendar year ending before the submission of such report—

(A) the number of veterans served, veterans diagnosed, 

and courses of treatment provided to veterans as part of the 

program required by subsection (a); and 

(B) demographic information for such services, diagnoses, 

and courses of treatment; 

(6) to provide to the Secretary such clinical summary information as the Secretary may require for each veteran for whom 

the center or entity provides mental health services under the 

contract; and 

(7) to meet such other requirements as the Secretary may require. 

(c) TRAINING PROGRAM FOR VETERANS.—In carrying out the program required by subsection (a), the Secretary shall contract with 

a nonprofit mental health organization to carry out a program to 

train covered veterans to provide peer outreach and peer support 

services. 

(d) TRAINING PROGRAM FOR CLINICIANS.—The Secretary shall 

conduct a training program for clinicians of community mental 

health centers or other entities that have entered into contracts with 

the Secretary under subsection (b) to ensure that such clinicians are 

able to provide the services required by subsection (a) in a manner 

that—

(1) recognizes factors that are unique to the experience of veterans who served on active duty in Operation Iraqi Freedom or 

Operation Enduring Freedom (including the combat and military training experiences of such veterans); and 

(2) utilizes best practices and technologies. 

(e) COVERED VETERANS.—For the purposes of this subsection, a 

‘‘covered veteran’’ is a veteran who served on active duty in a theater 

of combat operations (as determined by the Secretary in consultation with the Secretary of Defense) during a period of war after the 

Persian Gulf War, or in combat against a hostile force during a period of hostilities (as defined in section1712A(a)(2)(B) of this title) 

after November 11, 1998, and who is discharged or released from 

active military, naval, or air service on or after September 11, 2001. 

* * * * * * * 


rfrederick on PROD1PC67 with HEARING
28 

SUBCHAPTER III—MISCELLANEOUS PROVISIONS RELATING 

TO HOSPITAL AND NURSING HOME CARE AND MEDICAL 

TREATMENT OF VETERANS 

* * * * * * * 

§ 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, ø2007¿ 2009, under this chapter to a veteran who—

(i) * * * 

* * * * * * * 

CHAPTER 20—BENEFITS FOR HOMELESS VETERANS 

SUBCHAPTER I—PURPOSE; DEFINITIONS; ADMINISTRATIVE MATTERS 

Sec. 

2001. Purpose. 

* * * * * * * 

SUBCHAPTER III—TRAINING AND OUTREACH 

* * * * * * * 

2023. Referral and counseling services: veterans at risk of homelessness who are 

transitioning from certain institutions. 

* * * * * * * 

SUBCHAPTER V—HOUSING ASSISTANCE 

* * * * * * * 

2044. Financial assistance for supportive services for very low-income veteran families residing in permanent housing. 

* * * * * * * 

SUBCHAPTER III—TRAINING AND OUTREACH 

* * * * * * * 

§ 2022. Coordination of outreach services for veterans at 

risk of homelessness 

(a) * * * 

* * * * * * * 

(f) REPORTS.—(1) * * * 

(2) Not later than December 31, 2005, the Secretary shall submit 

to the committees referred to in paragraph (1) an interim report on 

outreach activities carried out by the Secretary with respect to 

homeless veterans. The report shall include the following: 

(A) * * * 

* * * * * * * 


rfrederick on PROD1PC67 with HEARING
29 

(C) A description of the implementation and operation of 

the ødemonstration¿ program under section 2023 of this 

title. 

* * * * * * * 

ø§ 2023. Demonstration program of referral and counseling 

for veterans transitioning from certain institutions 

who are at risk for homelessness¿ 

§ 2023. Referral and counseling services: veterans at risk of 

homelessness who are transitioning from certain institutions 

(a) PROGRAM AUTHORITY.—The Secretary and the Secretary of 

Labor (hereinafter in this section referred to as the ‘‘Secretaries’’) 

shall carry out øa demonstration program for the purpose of determining the costs and benefits of providing¿ a program to provide 

referral and counseling services to eligible veterans with respect to 

benefits and services available to such veterans under this title and 

under State law. 

(b) LOCATION OF øDEMONSTRATION¿ PROGRAM.—The ødemonstration¿ program shall be carried out øin at least six locations¿ in at 

least 12 locations. One location shall be a penal institution under 

the jurisdiction of the Bureau of Prisons. 

(c) SCOPE OF PROGRAM.—(1) To the extent practicable, the ødemonstration¿ program shall provide both referral and counseling 

services, and in the case of counseling services, shall include counseling with respect to job training and placement (including job 

readiness), housing, health care, and other benefits to assist the eligible veteran in the transition from institutional living. 

* * * * * * * 

(d) DURATION.—The authority of the Secretaries to provide referral and counseling services under the demonstration program 

øshall cease on September 30, 2007.¿ shall cease on September 30, 

2011. 

* * * * * * * 

SUBCHAPTER V—HOUSING ASSISTANCE 

* * * * * * * 

§ 2043. Domiciliary care programs 

(a) * * * 

ø(b) AUTHORIZATION OF APPROPRIATIONS.—There are authorized 

to be appropriated to the Secretary $5,000,000 for each of fiscal 

years 2003 and 2004 to establish the programs referred to in subsection (a).¿ 

(b) ENHANCEMENT OF CAPACITY OF DOMICILIARY CARE PROGRAMS

FOR FEMALE VETERANS.—The Secretary shall take appropriate actions to ensure that the domiciliary care programs of the Department are adequate, with respect to capacity and safety, to meet the 

needs of veterans who are women. 


rfrederick on PROD1PC67 with HEARING
30 

§ 2044. Financial assistance for supportive services for very 

low-income veteran families residing in permanent 

housing 

(a) DISTRIBUTION OF FINANCIAL ASSISTANCE.— (1) The Secretary shall provide financial assistance to eligible 

entities approved under this section to provide and coordinate 

the provision of the supportive services for very low-income veteran families residing in permanent housing. 

(2)(A) Financial assistance under this section shall consist of 

payments for each such family for which an approved eligible 

entity provides or coordinates the provision of supportive services. 

(B) The Secretary shall establish a formula for determining 

the rate of payments provided to a very low-income veteran family receiving supportive services under this section. The rate 

shall be adjusted not less than once annually to reflect changes 

in the cost of living. In calculating the payment formula under 

this subparagraph, the Secretary may consider geographic cost 

of living variances, family size, and the cost of services provided. 

(3) In providing financial assistance under paragraph (1), the 

Secretary shall give preference to an entity that provides or coordinates the provision of supportive services for very low-income veteran families who are transitioning from homelessness 

to permanent housing. 

(4) The Secretary shall ensure that, to the extent practicable, 

financial assistance under this subsection is equitably distributed across geographic regions, including rural communities 

and tribal lands. 

(5) Each entity receiving financial assistance under this section to provide supportive services to a very low-income veteran 

family shall notify the family that such services are being paid 

for, in whole or in part, by the Department. 

(6) The Secretary may require an entity receiving financial 

assistance under this section to submit a report to the Secretary 

describing the supportive services provided with such financial 

assistance. 

(b) APPLICATION FOR FINANCIAL ASSISTANCE.— (1) An eligible entity seeking financial assistance under subsection (a) shall submit to the Secretary an application in such 

form, in such manner, and containing such commitments and 

information as the Secretary determines to be necessary. 

(2) An application submitted under paragraph (1) shall contain—

(A) a description of the supportive services proposed to be 

provided by the eligible entity; 

(B) a description of the types of very low-income veteran 

families proposed to be provided such services; 

(C) an estimate of the number of very low-income veteran 

families proposed to be provided such services; 

(D) evidence of the experience of the eligible entity in providing supportive services to very low-income veteran families; and 

(E) a description of the managerial capacity of the eligible entity to—


rfrederick on PROD1PC67 with HEARING
31 

(i) coordinate the provision of supportive services 

with the provision of permanent housing, by the eligible entity or by other organizations; 

(ii) continuously assess the needs of very low-income 

veteran families for supportive services; 

(iii) coordinate the provision of supportive services 

with the services of the Department; 

(iv) tailor supportive services to the needs of very 

low-income veteran families; and 

(v) continuously seek new sources of assistance to ensure the long-term provision of supportive services to 

very low-income veteran families. 

(3) The Secretary shall establish criteria for the selection of 

eligible entities to receive financial assistance under this section. 

(c) TECHNICAL ASSISTANCE.—

(1) The Secretary shall provide training and technical assistance to eligible entities that receive financial assistance under 

this section with respect to the planning, development, and provision of supportive services to very low-income veteran families 

occupying permanent housing. 

(2) The Secretary may provide the training described in paragraph (1) directly or through grants or contracts with appropriate public or nonprofit private entities. 

(d) AUTHORIZATION OF APPROPRIATIONS.—There is authorized to 

be appropriated, for each fiscal year, $25,000,000, to carry out this 

section, of which not more than $750,000 for each fiscal year may 

be used to provide technical assistance under subsection (c). 

(e) DEFINITIONS.—For the purposes of this section: 

(1) The term ‘‘very low-income veteran family’’ means a veteran family whose income does not exceed 50 percent of the median income for the area, as determined by the Secretary in accordance with this paragraph, except that— (A) the Secretary shall make appropriate adjustments to 

the income requirement under subparagraph (A) based on 

family size; and 

(B) the Secretary may establish an income ceiling higher 

or lower than 50 percent of the median income for an area 

if the Secretary determines that such variations are necessary because the area has unusually high or low construction costs, fair market rents (as determined under section 8 of the United States Housing Act of 1937 (42 U.S.C. 

1437f)), or family incomes. 

(C) the Secretary shall establish criteria for determining 

the need for specific supportive services (as defined by paragraph (8)) of individual very low income veteran families 

occupying permanent housing. 

(2) The term ‘‘veteran family’’ includes a veteran who is a single person and a family in which the head of household or the 

spouse of the head of household is a veteran. 

(3) The term ‘‘consumer cooperative’’ has the meaning given 

such term in section 202 of the Housing Act of 1959 (12 U.S.C. 

1701q). 

(4) The term ‘‘eligible entity’’ means—

(A) a private nonprofit organization; or 


rfrederick on PROD1PC67 with HEARING
32 

(B) a consumer cooperative. 

(5) The term ‘‘homeless’’ has the meaning given the term in 

section 103 of the McKinney-Vento Homeless Assistance Act (42 

U.S.C. 11302). 

(6) The term ‘‘permanent housing’’ means community-based 

housing without a designated length of stay. 

(7) The term ‘‘private nonprofit organization’’ means—

(A) any incorporated private institution or foundation—

(i) no part of the net earnings of which inures to the 

benefit of any member, founder, contributor, or individual; 

(ii) which has a governing board that is responsible 

for the operation of the supportive services provided 

under this section; and 

(iii) which is approved by the Secretary as to financial responsibility; 

(B) a for-profit limited partnership, the sole general partner of which is an organization meeting the requirements 

of clauses (i), (ii), and (iii) of subparagraph (A); 

(C) a corporation wholly owned and controlled by an organization meeting the requirements of clauses (i), (ii), and 

(iii) of subparagraph (A); and 

(D) a tribally designated housing entity (as defined in 

section 4 of the Native American Housing Assistance and 

Self-Determination Act of 1996 (25 U.S.C. 4103)). 

(8) The term ‘‘supportive services’’ means the following: 

(A) Services provided by an eligible entity or subcontractors that address the needs of very low-income veteran families occupying permanent housing, including—

(i) outreach services; 

(ii) health care services, including diagnosis, treatment, and counseling for mental health and substance 

abuse disorders and for post-traumatic stress disorder, 

if such services are not readily available through the 

Department of Veterans Affairs medical center serving 

the geographic area in which the veteran family is 

housed; 

(iii) habilitation and rehabilitation services; 

(iv) case management services; 

(v) daily living services; 

(vi) personal financial planning; 

(vii) transportation services; 

(viii) vocational counseling; 

(ix) employment and training; 

(x) educational services; 

(xi) assistance in obtaining veterans benefits and 

other public benefits, including health care provided by 

the Department; 

(xii) assistance in obtaining income support; 

(xiii) assistance in obtaining health insurance; 

(xiv) fiduciary and representative payee services; 

(xv) legal services to assist the veteran family with 

reconsiderations or appeals of veterans and public benefit claim denials and to resolve outstanding warrants 


rfrederick on PROD1PC67 with HEARING
33 

that interfere with the family’s ability to obtain or retain housing or supportive services; 

(xvi) child care; 

(xvii) housing counseling; 

(xviii) other services necessary for maintaining independent living; and 

(xix) coordination of services described in this paragraph. 

(B) Services provided by an eligible entity or subcontractors, including services described in clauses (i) through 

(xix) of subparagraph (A), that are delivered to very low-income veteran families who are homeless and who are 

scheduled to become residents of permanent housing within 

90 days of the date on which the service is provided pending the location or development of housing suitable for permanent housing. 

(C) Services provided by an eligible entity or subcontractors, including services described in clauses (i) through 

(xix) of subparagraph (A), for very low-income veteran families who have voluntarily chosen to seek other housing 

after a period of tenancy in permanent housing, that are 

provided, for a period of 90 days beginning on the date on 

which such a family exits permanent housing or until such 

a family commences receipt of other housing services adequate to meet the needs of the family, but only to the extent 

that services under this paragraph are designed to support 

such a family in the choice to transition into housing that 

is responsive to the individual needs and preferences of the 

family. 

* * * * * * * 

SUBCHAPTER VII—OTHER PROVISIONS 

* * * * * * * 

§ 2062. Dental care 

(a) * * * 

(b) ELIGIBLE VETERANS.—Subsection (a) applies to a veteran—

(1) who is enrolled for care under section 1705(a) of this title; 

and 

(2) who, for a period of ø60 consecutive days¿ 30 consecutive 

days, is receiving care (directly or by contract) in any of the following settings: 

(A) * * * 

* * * * * * * 

(3) For purposes of paragraph (2), in determining whether a 

veteran has received treatment for a period of ø60 consecutive 

days¿ 30 consecutive days, the Secretary may disregard breaks 

in the continuity of treatment for which the veteran is not responsible. 

* * * * * * * 

§ 2065. Annual report on assistance to homeless veterans 

(a) * * * 


rfrederick on PROD1PC67 with HEARING
34 

(b) GENERAL CONTENTS OF REPORT.—Each report under subsection (a) shall include the following: 

(1) * * * 

* * * * * * * 

(3) The Secretary’s evaluation of the effectiveness of the programs of the Department in providing assistance to homeless 

veterans, including—

(A) * * * 

* * * * * * * 

(C) contract care programs for alcohol and drug-dependence or use disabilitiesø)¿. 

* * * * * * * 

PART III—READJUSTMENT AND RELATED 

BENEFITS 

* * * * * * * 

CHAPTER 36—ADMINISTRATION OF EDUCATIONAL 

BENEFITS 

SUBCHAPTER I—STATE APPROVING AGENCIES 

Sec. 

3670. Scope of approval. 

* * * * * * * 

SUBCHAPTER II—MISCELLANEOUS PROVISIONS 

* * * * * * * 

ø3684A. Procedures relating to computer matching programs.¿ 

3684A. Procedures relating to computer matching program. 

* * * * * * * 

SUBCHAPTER II—MISCELLANEOUS PROVISIONS 

* * * * * * * 

§ 3684. Reports by veterans, eligible persons, and institutions; reporting fee 

(a)(1) Except as provided in paragraph (2) of this subsection, the 

veteran or eligible person and the educational institution offering 

a course in which such veteran or eligible person is enrolled under 

chapter 31, ø34,,¿ 34, 35, or 36 of this title shall, without delay, 

report to the Secretary, in the form prescribed by the Secretary, 

such enrollment and any interruption or termination of the education of each such veteran or eligible person. The date of such 

interruption or termination will be the last date of pursuit, or, in 

the case of correspondence training, the last date a lesson was 

serviced by a school. 

* * * * * * * 

CHAPTER 41—JOB COUNSELING, TRAINING, AND 

PLACEMENT SERVICE FOR VETERANS 

* * * * * * * 


rfrederick on PROD1PC67 with HEARING
35 

§ 4110. Advisory Committee on Veterans Employment, Training, and Employer Outreach 

(a) * * * 

* * * * * * * 

(c)(1) The Secretary of Labor shall appoint at least 12, but no 

more than ø15¿ 16, individuals to serve as members of the advisory 

committee as follows: 

(A) * * * 

* * * * * * * 

PART IV—GENERAL ADMINISTRATIVE 

PROVISIONS 

* * * * * * * 

CHAPTER 51—CLAIMS, EFFECTIVE DATES, AND 

PAYMENTS 

SUBCHAPTER I—CLAIMS 

Sec. 

5100. Definition of ‘‘claimant’’. 

* * * * * * * 

ø5121. Payment of certain accrued benefits upon death of beneficiary.¿ 

5121. Payment of certain accrued benefits upon death of a beneficiary. 

* * * * * * * 

PART V—BOARDS, ADMINISTRATIONS, AND 

SERVICES 

* * * * * * * 

CHAPTER 73—VETERANS HEALTH ADMINISTRATIONORGANIZATION AND FUNCTIONS 

* * * * * * * 

SUBCHAPTER II—GENERAL AUTHORITY AND 

ADMINISTRATION 

* * * * * * * 

§ 7314. Geriatric research, education, and clinical centers 

(a) * * * 

* * * * * * * 

(f) There are authorized to be appropriated such sums as may be 

necessary for the support of the research and education activities 

of the centers established pursuant to subsection (a). The Under 

Secretary for Health shall allocate to such centers from other funds 

appropriated generally for the Department ømedical care account¿ 

medical services account and medical and prosthetics research account, as appropriate, such amounts as the Under Secretary for 

Health determines appropriate. 

* * * * * * * 


rfrederick on PROD1PC67 with HEARING
36 

§ 7320. Centers for mental illness research, education, and 

clinical activities 

(a) * * * 

* * * * * * * 

(j)(1) * * * 

(2) In addition to funds appropriated for a fiscal year pursuant 

to the authorization of appropriations in paragraph (1), the Under 

Secretary for Health shall allocate to such centers from other funds 

appropriated for that fiscal year generally for the Department of 

Veterans Affairs ømedical care account¿ medical services account 

and the Department of Veterans Affairs medical and prosthetics research account such amounts as the Under Secretary for Health 

determines appropriate to carry out the purposes of this section. 

* * * * * * * 

§ 7325. Medical emergency preparedness centers 

(a) * * * 

* * * * * * * 

(i) FUNDING.—(1) * * * 

(2) In addition to funds appropriated for a fiscal year specifically 

for the activities of the centers pursuant to paragraph (1), the 

Under Secretary for Health shall allocate to such centers from 

other funds appropriated for that fiscal year generally for the Department ømedical care account¿ medical services account and the 

Department medical and prosthetics research account such 

amounts as the Under Secretary determines appropriate to carry 

out the purposes of this section. Any determination by the Under 

Secretary under the preceding sentence shall be made in consultation with the Assistant Secretary with responsibility for operations, 

preparedness, security, and law enforcement functions. 

* * * * * * * 

§ 7328. Medical preparedness centers 

(a) * * * 

* * * * * * * 

(i) FUNDING.—(1) * * * 

(2) In addition to any amounts appropriated for a fiscal year specifically for the activities of the centers pursuant to paragraph (1), 

the Under Secretary for Health shall allocate to the centers from 

other funds appropriated for that fiscal year generally for the Department ømedical care account¿ medical services account and the 

Department medical and prosthetic research account such amounts 

as the Under Secretary determines necessary in order to carry out 

the purposes of this section. 

* * * * * * * 

CHAPTER 74—VETERANS HEALTH ADMINISTRATION - 

PERSONNEL 

* * * * * * * 


rfrederick on PROD1PC67 with HEARING
37 

SUBCHAPTER IV—PAY FOR NURSES AND OTHER HEALTHCARE PERSONNEL 

* * * * * * * 

§ 7458. Recruitment and retention bonus pay 

(a) * * * 

(b)(1) * * * 

(2) In the case of an agreement for employment on less than a 

full-time basis, the amount of bonus pay shall be øpro rated¿ prorated accordingly. 

* * * * * * * 

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 

* * * * * * * 

§ 8117. Emergency preparedness 

(a) READINESS OF DEPARTMENT MEDICAL CENTERS.—(1) The Secretary shall take appropriate actions to provide for the readiness 

of Department medical centers to protect the patients and staff of 

such centers from a public health emergency (as defined in section 

2801 of the Public Health Service Act) or otherwise to respond to 

øsuch such¿ such an emergency so as to enable such centers to fulfill their obligations as part of the Federal response to such emergencies. 

* * * * * * * 

Æ 


rfrederick on PROD1PC67 with HEARING