```

[House Report 115-869]
[From the U.S. Government Publishing Office]

115th Congress    }                                  {        Report
                        HOUSE OF REPRESENTATIVES
 2d Session       }                                  {        115-869

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

 
                    VA COST SAVINGS ENHANCEMENTS ACT

                                _______
                                

 July 24, 2018.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

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

                              R E P O R T

                        [To accompany H.R. 5974]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 5974) to direct the Secretary of Veterans 
Affairs to use on-site regulated medical waste treatment 
systems at certain Department of Veterans Affairs facilities, 
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..............................................     2
Background and Need for Legislation..............................     2
Hearings.........................................................     3
Subcommittee Consideration.......................................     4
Committee Consideration..........................................     4
Committee Votes..................................................     4
Committee Oversight Findings.....................................     4
Statement of General Performance Goals and Objectives............     4
New Budget Authority, Entitlement Authority, and Tax Expenditures     4
Earmarks and Tax and Tariff Benefits.............................     5
Committee Cost Estimate..........................................     5
Congressional Budget Office Estimate.............................     5
Federal Mandates Statement.......................................     6
Advisory Committee Statement.....................................     6
Constitutional Authority Statement...............................     6
Applicability to Legislative Branch..............................     6
Statement on Duplication of Federal Programs.....................     6
Disclosure of Directed Rulemaking................................     7
Section-by-Section Analysis of the Legislation...................     7
Changes in Existing Law Made by the Bill as Reported.............     7

                               AMENDMENT

    The amendment is as follows:
    Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Department of Veterans Affairs 
Creation of On-Site Treatment Systems Affording Veterans Improvements 
and Numerous General Safety Enhancements Act'' or the ``VA COST SAVINGS 
Enhancements Act''.

SEC. 2. USE OF ON-SITE REGULATED MEDICAL WASTE TREATMENT SYSTEMS AT 
                    DEPARTMENT OF VETERANS AFFAIRS FACILITIES.

  (a) Identification of Facilities.--The Secretary of Veterans Affairs 
shall identify Department of Veterans Affairs facilities that would 
benefit from cost savings associated with the use of an on-site 
regulated medical waste treatment system over a five-year period.
  (b) Regulated Medical Waste Cost Analysis Model.--For purposes of 
carrying out subsection (a), the Secretary shall develop a uniform 
regulated medical waste cost analysis model to be used to determine the 
cost savings associated with the use of an on-site regulated medical 
waste treatment system at Department facilities. Such model shall be 
designed to calculate savings based on--
          (1) the cost of treating regulated medical waste at an off-
        site location under a contract with a non-Department entity, 
        compared to
          (2) the cost of treating regulated medical waste on-site, 
        based on the equipment specification of treatment system 
        manufacturers, with capital costs amortized over a ten-year 
        period.
  (c) Installation.--At each Department facility identified under 
subsection (a), the Secretary shall secure, install, and operate an on-
site regulated medical waste treatment system.
  (d) Use of Blanket Purchase Agreement.--Any medical waste treatment 
system purchased pursuant to this section shall be purchased under the 
blanket purchase agreement known as the ``VHA Regulated Medical Waste 
On-Site Treatment Equipment Systems Blanket Purchase Agreement'' or any 
successor, contract, agreement, or other arrangement.
  (e) Regulated Medical Waste Defined.--In this section, the term 
``regulated medical waste'' has the meaning given such term under 
section 173.134(a)(5) of title 49, Code of Federal Regulations, 
concerning regulated medical waste and infectious substances, or any 
successor regulation, except that, in the case of an applicable State 
law that is more expansive, the definition in the State law shall 
apply.

                          PURPOSE AND SUMMARY

    H.R. 5974, as amended, the Department of Veterans Affairs 
Creation of On-Site Treatment Systems Affording Veterans 
Improvements and Numerous General Safety Enhancements (VA COST 
SAVINGS) Act, would require VA to establish a uniform, 
regulated medical waste cost analysis model to be used to 
determine the cost savings associated with on-site medical 
waste disposal and to install and operate on-site medical waste 
treatment facilities at locations determined to benefit from 
supplanting off-site disposal services. Representative Jeff 
Dunham of California introduced H.R. 5974 on May 25, 2018.

                  BACKGROUND AND NEED FOR LEGISLATION

    According to the World Health Organization, 15 percent of 
all waste generated by healthcare activities is considered 
infectious, toxic or radioactive waste--collectively referred 
to as regulated medical waste.\1\ Proper containment and 
removal of regulated medical waste prevents contamination and 
the spread of infectious conditions. The management and 
disposal of regulated medical waste is required at virtually 
every clinical site operated by the Veterans Health 
Administration (VHA)--with approximately 80 percent of VHA 
facilities outsourcing to contractors who specialize in off-
site disposal.
---------------------------------------------------------------------------
    \1\http://www.who.int/news-room/fact-sheets/detail/health-care-
waste
---------------------------------------------------------------------------
    While off-site disposal is a relatively safe and effective 
method, on-site disposal often provides a cheaper, safer, and 
more environmentally-friendly means of disposal. The on-site 
disposal of regulated medical waste is also beneficial in 
emergency and contingency scenarios, where off-site disposal 
services may be interrupted.
    According to the bill sponsor, the World Health 
Organization and the Centers for Disease Control and Prevention 
(CDC) both consider on-site waste management to be a medical 
best practice as well as a cost-effective alternate to off-site 
waste management. VA has also acknowledged the cost, readiness, 
and environmental benefits of on-site disposal of regulated 
medical waste, and has issued a blanket purchase agreement for 
on-site regulated medical waste treatment equipment; however, 
only 20 percent of VHA facilities have installed on-site 
sterilization equipment.\2\
---------------------------------------------------------------------------
    \2\https://www.voa.va.gov/DocumentView.aspx?DocumentID=3944
---------------------------------------------------------------------------
    H.R. 5974, as amended, would direct VA to establish a 
standardized cost analysis model by which each VA medical 
facility can be evaluated to determine if the use of on-site 
sterilization and disposal equipment would be beneficial and to 
identify those facilities which would benefit over a 5-year 
baseline. The Committee believes that H.R. 5974, as amended, 
would both improve VA's emergency preparedness and improve the 
stewardship of taxpayer resources.

                                HEARINGS

    On June 13, 2018, the Subcommittee on Health conducted a 
legislative hearing on a number of bills including H.R. 5974, 
as amended.
    The following witnesses testified:
          The Honorable Vicky Hartzler, U.S. House of 
        Representatives, 4th District, Missouri; The Honorable 
        Marcy Kaptur, U.S. House of Representatives, 9th 
        District, Ohio; The Honorable Matt Cartwright, U.S. 
        House of Representatives, 17th District, Pennsylvania; 
        The Honorable Clay Higgins, U.S. House of 
        Representatives, 3rd District, Louisiana; The Honorable 
        Mike Bost, U.S. House of Representatives, 12th 
        District, Illinois; The Honorable Jeff Denham, U.S. 
        House of Representatives, 10th District, California; 
        The Honorable Jenniffer Gonzalez-Colon, U.S. House of 
        Representatives, Puerto Rico; The Honorable Brad 
        Wenstrup, U.S. House of Representatives, 2nd District, 
        Ohio; Roscoe Butler, Deputy Director for Health Care, 
        The American Legion; Jeremy Villanueva, Associate 
        National Legislative Director, Disabled American 
        Veterans; Kayda Keleher, Associate Director, Veterans 
        of Foreign Wars of the United States; Jessica Bonjorni, 
        Acting Assistant Deputy Under Secretary for Health for 
        Workforce Services, U.S. Department of Veterans 
        Affairs, who was accompanied by Dayna Cooper, MSN, RN, 
        Director of Home and Community-Based Programs, Veterans 
        Health Administration, U.S. Department of Veterans 
        Affairs.
    Statements for the record were submitted by:
          American Orthotic and Prosthetic Association, 
        Paralyzed Veterans of America, and Military Officers 
        Association of America.

                       SUBCOMMITTEE CONSIDERATION

    On June 27, 2018, the Subcommittee on Health met in open 
markup session, a quorum being present and favorably forwarded 
H.R. 5974, as amended, to the Full Committee. During 
consideration of the bills, the following amendment was 
considered and agreed to by voice vote:

          An amendment offered by Representative Radewagen of 
        American Samoa, which would include a technical 
        correction to appropriately identify the nature of the 
        current blanket purchase agreement, and to include any 
        successor agreements.

                        COMMITTEE CONSIDERATION

    On July 12, 2018, the full Committee met in open markup 
session, a quorum being present, and ordered H.R. 5974, as 
amended, to be reported favorably to the House of 
Representatives by voice vote. No amendments were offered to 
H.R. 5974, as amended.

                            COMMITTEE VOTES

    In compliance with clause 3(b) of rule XIII of the Rules of 
the House of Representatives, there were no recorded votes 
taken on amendments or in connection with ordering H.R. 5974, 
as amended, reported to the House. A motion by Representative 
Walz of Minnesota to report H.R. 5974, as amended, favorably to 
the House of Representatives was adopted by voice vote.

                      COMMITTEE OVERSIGHT FINDINGS

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

         STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

    In accordance with clause 3(c)(4) of rule XIII of the Rules 
of the House of Representatives, the Committee's performance 
goals and objectives are to improve VA's emergency preparedness 
and stewardship of taxpayer resources.

   NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX EXPENDITURES

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

                  EARMARKS AND TAX AND TARIFF BENEFITS

    H.R. 5974, as amended, does not contain any Congressional 
earmarks, limited tax benefits, or limited tariff benefits as 
defined in clause 9 of rule XXI of the Rules of the House of 
Representatives.

                        COMMITTEE COST ESTIMATE

    The Committee adopts as its own the cost estimate on H.R. 
5974, as amended, prepared by the Director of the Congressional 
Budget Office pursuant to section 402 of the Congressional 
Budget Act of 1974.

               CONGRESSIONAL BUDGET OFFICE COST ESTIMATE

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
for H.R. 5974, as amended, provided by the Director of the 
Congressional Budget Office pursuant to section 402 of the 
Congressional Budget Act of 1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                     Washington, DC, July 19, 2018.
Hon. Phil Roe, M.D.,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 5974, the 
Department of Veterans Affairs Creation of On-Site Treatment 
Systems Affording Veterans Improvements and Numerous General 
Safety Enhancements Act.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Ann E. 
Futrell.
            Sincerely,
                                             Mark P. Hadley
                                        (For Keith Hall, Director).
    Enclosure.

H.R. 5974--Department of Veterans Affairs Creation of On-Site Treatment 
        Systems Affording Veterans Improvements and Numerous General 
        Safety Enhancements Act

    H.R. 5974 would require the Department of Veterans Affairs 
(VA) to identify medical facilities that could reduce costs by 
using on-site equipment to dispose of medical waste and to 
purchase such equipment for those facilities. Currently, VA 
disposes of regulated medical waste (RMW) by the following 
methods: contracts with off-site facilities, sharing agreements 
with other federal agencies, and various forms of on-site 
activities. In 2017, VA spent roughly $10 million to dispose of 
RMW.
    Under this bill, VA would be required to develop a cost 
analysis model which would compare the costs of contracting 
with nondepartment entities to treat medical waste at off-site 
locations to the costs of treating medical waste at VA medical 
facilities. The bill specifies that the model must amortize 
capital costs over a 10-year period. For facilities where that 
analysis showed savings over a 5-year period, VA would be 
required to purchase, install, and operate on-site equipment to 
dispose of medical waste.
    Although the model would spread the initial costs of 
procuring and installing a disposal system over ten years, 
those capital costs would need to be obligated when the 
purchase agreement is finalized. Thus, CBO expects that most 
cases in which the model indicates a five-year savings would, 
in fact, result in costs over the first five years. However, 
because the costs of disposing of RMW vary based on state and 
local laws and regulations, CBO cannot project the outcome of 
VA's analysis. Thus, CBO is unable to estimate the magnitude of 
the cost of implementing H.R. 5974 at this time.
    Enacting H.R. 5974 would not affect direct spending or 
revenues; therefore, pay-as-you-go procedures do not apply.
    CBO estimates that enacting H.R. 5974 would not increase 
net direct spending or on-budget deficits in any of the four 
consecutive 10-year periods beginning in 2029.
    H.R. 5974 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act.
    The CBO staff contact for this estimate is Ann E. Futrell. 
The estimate was reviewed by Leo Lex, Deputy Assistant Director 
for Budget Analysis.

                       FEDERAL MANDATES STATEMENT

    The Committee adopts as its own the estimate of Federal 
mandates regarding H.R. 5974, as amended, prepared by the 
Director of the Congressional Budget Office pursuant to section 
423 of the Unfunded Mandates Reform Act.

                      ADVISORY COMMITTEE STATEMENT

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act would be created by H.R. 
5974, as amended.

                 STATEMENT OF CONSTITUTIONAL AUTHORITY

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

                  APPLICABILITY TO LEGISLATIVE BRANCH

    The Committee finds that H.R. 5974, as amended, does not 
relate to the terms and conditions of employment or access to 
public services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

              STATEMENT ON DUPLICATION OF FEDERAL PROGRAMS

    Pursuant to clause 3(c)(5) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that no provision 
of H.R. 5974, as amended, establishes or reauthorizes a program 
of the Federal Government known to be duplicative of another 
Federal program, a program that was included in any report from 
the Government Accountability Office to Congress pursuant to 
section 21 of Public Law 111-139, or a program related to a 
program identified in the most recent Catalog of Federal 
Domestic Assistance.

                   DISCLOSURE OF DIRECTED RULEMAKING

    Pursuant to section 3(i) of H. Res. 5, 115th Cong. (2017), 
the Committee estimates that H.R. 5974, as amended, contains no 
directed rulemaking that would require the Secretary to 
prescribe regulations.

             SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Short title

    Section 1 of the bill would establish the short title of 
the bill as the ``Department of Veterans Affairs Creation of 
On-Site Treatment Systems Affording Veterans Improvements and 
Numerous General Safety Enhancements (VA COST SAVINGS) Act.''

Section 2. Use of on-site regulated medical waste treatment systems at 
        Department of Veterans Affairs facilities

    Section 2 of the bill would require the Department of 
Veterans Affairs to establish a cost analysis model to evaluate 
whether a facility would benefit from purchasing on-site waste 
disposal equipment or if an off-site waste disposal contract is 
more appropriate. Further, this section would require VA to 
purchase and install on-site waste disposal equipment at those 
facilities identified to benefit from it.

         CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

    If enacted, this bill would make no changes in existing 
law.

                                  [all]
```