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108th Congress Report
HOUSE OF REPRESENTATIVES
1st Session 108-198
======================================================================
VETERANS HEALTH CARE IMPROVEMENT ACT OF 2003
_______
July 10, 2003.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Smith of New Jersey, from the Committee on Veterans' Affairs,
submitted the following
R E P O R T
[To accompany H.R. 2357]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred the
bill (H.R. 2357) to amend title 38, United States Code, to
establish standards of access to care for veterans seeking
health care from the Department of Veterans Affairs, and for
other purposes, having considered the same, reports favorably
thereon with amendments and recommends that the bill as amended
do pass.
The amendments are as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Veterans Health Care Improvement Act
of 2003''.
SEC. 2. APPOINTMENT OF CHIROPRACTORS IN THE VETERANS HEALTH
ADMINISTRATION.
(a) Appointments.--Section 7401 of title 38, United States Code, is
amended--
(1) by inserting ``and chiropractic care'' in the matter
preceding paragraph (1) after ``medical care''; and
(2) by inserting ``chiropractors,'' in paragraph (1) after
``podiatrists,''.
(b) Qualifications of Appointees.--Section 7402(b) of such title is
amended--
(1) by redesignating paragraph (10) as paragraph (11); and
(2) by inserting after paragraph (9) the following new
paragraph (10):
``(10) Chiropractor.--To be eligible to be appointed to a
chiropractor position, a person must--
``(A) hold the degree of doctor of chiropractic, or its
equivalent, from a college of chiropractic approved by the
Secretary; and
``(B) be licensed to practice chiropractic in a State.''.
(c) Period of Appointments and Promotions.--Section 7403(a)(2) of
such title is amended by adding at the end the following new
subparagraph:
``(H) Chiropractors.''.
(d) Grades and Pay Scales.--Section 7404(b)(1) of such title is
amended by striking the third center heading in the table and inserting
the following:
``CLINICAL PODIATRIST, CHIROPRACTOR, AND OPTOMETRIST SCHEDULE''.
(e) Temporary and Part-Time Appointments.--Section 7405(a) of such
title is amended--
(1) by adding at the end of paragraph (1) the following new
subparagraph:
``(E) Chiropractors.''; and
(2) by adding at the end of paragraph (2) the following new
subparagraph:
``(D) Chiropractors.''.
(f) Residencies and Internships.--Section 7406(c) of such title is
amended--
(1) in paragraph (1)--
(A) by inserting ``and chiropractic'' after
``medical'' the first place it appears; and
(B) by inserting ``or chiropractic'' after
``medical'' the second place it appears;
(2) in paragraph (2)(B), by inserting ``or chiropractic''
after ``medical'' the first place it appears; and
(3) in paragraph (3)(A), by inserting ``or chiropractic''
after ``medical''.
(g) Malpractice and Negligence Protection.--Section 7316(a) of such
title is amended--
(1) in paragraph (1), by inserting ``or chiropractic'' after
``medical'' each place it appears; and
(2) in paragraph (2)--
(A) by inserting ``or chiropractic'' after
``medical'' the first place it appears; and
(B) by inserting ``chiropractor,'' after
``podiatrist,''.
(h) Treatment as Scarce Medical Specialists for Contracting
Purposes.--Section 7409(a) of such title is amended by inserting
``chiropractors,'' in the second sentence after ``optometrists,''.
(i) Reimbursement of Continuing Professional Education Expenses.--
Section 7411 of such title is amended by striking ``or dentist'' and
inserting ``, dentist, or chiropractic''.
(j) Collective Bargaining Exemption.--Section 7421(b) of such title
is amended by adding at the end the following new paragraph:
``(8) Chiropractors.''.
(k) Effective Date.--The amendments made by this section shall take
effect at the end of the 180-day period beginning on the date of the
enactment of this Act.
SEC. 3. ELIGIBILITY FOR DEPARTMENT OF VETERANS AFFAIRS HEALTH CARE OF
CERTAIN FILIPINO WORLD WAR II VETERANS RESIDING IN
THE UNITED STATES.
(a) Eligibility.--The text of section 1734 of title 38, United States
Code, is amended to read as follows:
``(a) The Secretary shall furnish hospital and nursing home care and
medical services to any individual described in subsection (b) in the
same manner, and subject to the same terms and conditions, as apply to
the furnishing of such care and services to individuals who are
veterans as defined in section 101(2) of this title. Any disability of
an individual described in subsection (b) that is a service-connected
disability for purposes of this subchapter (as provided for under
section 1735(2) of this title) shall be considered to be a service-
connected disability for purposes of furnishing care and services under
the preceding sentence.
``(b) Subsection (a) applies to any individual who is a Commonwealth
Army veteran or new Philippine Scout and who--
``(1) is residing in the United States; and
``(2) is a citizen of the United States or an alien lawfully
admitted to the United States for permanent residence.''.
(b) Limitation.--(1) The amendment made by subsection (a) shall take
effect on the date on which the Secretary of Veterans Affairs submits
to the Committees on Veterans' Affairs of the Senate and House of
Representatives and publishes in the Federal Register a certification
described in paragraph (2).
(2) A certification referred to in paragraph (1) is a certification
that sufficient resources are available for the fiscal year during
which the certification is submitted to carry out section 1734 of title
38, United States Code, as amended by such amendment, during that
fiscal year at each significantly affected health care facility of the
Department of Veterans Affairs.
(3) For purposes of paragraph (2), the term ``significantly affected
health care facility'' means a health care facility at which, as
determined by the Secretary, it is reasonably foreseeable that the
implementation of the provisions of section 1734 of title 38, United
States Code, as amended by subsection (a), will result in a significant
increase in the use of health care resources due to the number of
veterans described in subsection (b) of that section who are considered
to be likely to seek hospital or nursing home care or medical services,
as authorized by subsection (a) of that section, at that facility.
Amend the title so as to read:
A bill to amend title 38, United States Code, to provide
for the appointment of chiropractors in the Veterans Health
Administration of the Department of Veterans Affairs and to
provide eligibility for Department of Veterans Affairs health
care for certain Filipino World War II veterans residing in the
United States.
Introduction
The reported bill reflects the Committee's consideration of
several bills introduced during the 108th Congress, including
H.R. 2357, H.R. 2414, and H.R. 2352. On June 5, 2003, Honorable
Ginny Brown-Waite, Honorable Christopher H. Smith, and
Honorable Jeff Miller introduced H.R. 2357, to amend title 38,
United States Code, to establish standards of access to care
for veterans seeking health care from the Department of
Veterans Affairs, and for other purposes. On June 10, 2003,
Honorable Jerry Moran, Honorable Christopher H. Smith,
Honorable Lane Evans, Honorable Bob Filner, and Honorable Luis
V. Gutierrez introduced H.R. 2414, to amend title 38, United
States Code, to provide for the appointment of chiropractors in
the Veterans Health Administration of the Department of
Veterans Affairs, and for other purposes. On June 5, 2003,
Honorable Rob Simmons, Honorable Bob Filner, Honorable Ciro D.
Rodriguez, Honorable Lane Evans, Honorable Randy ``Duke''
Cunningham, Honorable Neil Abercrombie, Honorable Dana
Rohrabacher, Honorable Susan A. Davis, Honorable Darrell E.
Issa, and Honorable Christopher H. Smith introduced H.R. 2352,
to amend title 38, United States Code, to provide eligibility
for Department of Veterans Affairs health care for certain
Filipino World War II veterans residing in the United States.
On June 13, 2002, the Subcommittee on Health held a hearing
on the health care of Filipino World War II veterans within the
Department of Veterans Affairs. Witnesses who appeared before
the subcommittee included His Excellency Albert Del Rosario,
Ambassador to the United States, Embassy of the Philippines;
Honorable Anthony J. Principi, Secretary, Department of
Veterans Affairs, accompanied by Mr. John H. Thompson, Deputy
General Counsel; Honorable Daniel K. Inouye, United States
Senator for the State of Hawaii; Honorable Benjamin Gilman,
Member of Congress from the State of New York; Honorable Randy
``Duke'' Cunningham, Member of Congress from the State of
California; Honorable Dana Rohrabacher, Member of Congress from
the State of California; Honorable Patsy T. Mink, Member of
Congress from the State of Hawaii; Honorable Juanita Millender-
McDonald, Member of Congress from the State of California;
Honorable Robert A. Underwood, Member of Congress from the
Territory of Guam; Mr. Lou Diamond Phillips, actor and Filipino
Veterans Activist, Los Angeles, California; Mr. Fritz Friedman,
Chair, Assembly for Justice, Los Angeles, California; Mr. Resty
Supnet, President, Filipino World War II Veterans Foundation of
San Diego County, accompanied by Mr. Romy Monteyro; Mr. Patrick
Ganio, President, American Coalition for Filipino Veterans; Ms.
Susan Espiritu Maquindang, Executive Director, Filipino-
American Service Group; Ms. Lourdes Santos Tancinco, President,
San Francisco Veterans Equity Center; Ms. Joy J. Ilem,
Assistant National Legislative Director, Disabled American
Veterans; Mr. Richard Weidman, Director of Government
Relations, Vietnam Veterans of America; and Mr. James Fischl,
Director of National Veterans Affairs and Rehabilitation
Commission, The American Legion. Written testimonies were
received from Honorable Barbara Boxer, United States Senator
from the State of California; Honorable Barbara Lee, Member of
Congress from the State of California; Honorable Nancy Pelosi,
Member of Congress from the State of California; Honorable
Maxine Waters, Member of Congress from the State of California;
General Tagumpay Nanadiego, Former Special Presidential
Representative, Embassy of the Philippines; Ms. Wendy Lawrence,
Associate Director, National Legislative Service, Veterans of
Foreign Wars; and Mr. Richard Jones, National Legislative
Director, AMVETS.
On June 24, 2003, the Subcommittee on Health met and
unanimously ordered H.R. 2357, as amended, reported favorably
to the full Committee.
On June 26, 2003, the full Committee met and ordered H.R.
2357, as amended, reported favorably to the House by voice
vote.
Summary of the Reported Bill
H.R. 2357, as amended, would:
1. LAuthorize the Secretary of Veterans Affairs to appoint
chiropractors to the Veterans Health Administration under title
38, United States Code.
2. LRequire chiropractors to meet the following criteria
for Department appointment: hold a degree of doctor of
chiropractic or its equivalent from a college of chiropractic
approved by the Secretary and be licensed to practice
chiropractic in a State.
3. LRequire chiropractors to be placed under the same
grades and pay scale as certain other health care providers.
4. LAuthorize the Secretary to appoint chiropractors on a
full-time, part-time, temporary or without-compensation basis,
as well as on a fee basis.
5. LAuthorize the Secretary to appoint chiropractors to
intern or residency positions.
6. LProvide chiropractors protection against malpractice
and negligence liability.
7. LPermit the Secretary to enter into contracts with non-
VA institutions should chiropractic services be unavailable.
8. LRequire the Secretary to reimburse any full-time board
certified chiropractor for expenses incurred, up to $1,000 a
year, for continuing professional education.
9. LRequire chiropractors to observe VA's prescribed
hours, conditions of employment, and leaves of absence for
clinical professionals.
10. LAuthorize VA to provide hospital and nursing home care
and medical services to certain Filipino World War II veterans
of the Philippines Commonwealth Army and former Philippines
``New Scout'' veterans who permanently reside in the United
States, in the same manner as provided to U.S. veterans.
11. LProvide that this health care authority for Filipino
WWII veterans would not take effect until the Secretary issues
a certification to Congress and a notice to the public that
resources are sufficient at those VA facilities where the
majority of Filipino veterans are authorized to receive care.
Background and Discussion
Chiropractic Services.--The Committee's previously
expressed concerns continue regarding veterans who are enrolled
in VA's health care system and who are unable to receive
chiropractic care. VA has resisted authorizing this type of
specialty care. The Committee has found that chiropractic care
is an effective therapy in a number of instances, and can be
less costly than other medical approaches to low back pain,
back spasm, and other maladies of the spinal region, including
health problems caused by the aging process and physical
exertion.
Section 303 of Public Law 106-117, the Veterans Millennium
Health Care and Benefits Act, requires the Under Secretary for
Health to establish a defined policy regarding the role of
chiropractic care for veterans enrolled in the Veterans Health
Administration (VHA). Almost a year after enactment of that
measure, the Under Secretary published VHA Directive 2000-014,
establishing what the Department deemed to be a responsive
policy on VA chiropractic care. However, the Committee found
the policy to be unacceptable. It did not improve veterans'
access to chiropractic care in VHA.
As a result, Congress enacted section 204 of the Department
of Veterans Affairs Health Care Programs Enhancement Act of
2001 (Public Law 107-135). This Act requires the Secretary to
create a program to provide chiropractic care and services for
veterans who are enrolled in VA's health care system, and
specifies that each of VA's 21 geographic service areas
establish at least one chiropractic care program. This law also
requires establishment of a chiropractic advisory committee
within the Department, and charges the Committee to provide
assistance to the Secretary in the development and
implementation of the chiropractic health program the law
authorizes, including recommendations on scope of practice,
qualifications, privileging and credentialing matters, among
other factors that might influence the employment of
chiropractors and the deployment of a new nationwide VA
chiropractic program.
While some progress has been made because of the presence
of the advisory committee, the Department has contended that
formal organizational, qualification, and classification
studies are needed due to VA's lack of a specified employment
authority in title 38 of the United States Code to authorize
the appointment of VA chiropractors. The Committee believes
that VA already possesses authority for these employment
matters within the parameters of title 38, United States Code.
VA studies could consume years of work, would be a waste of
money and may be used to effectively block direct employment of
chiropractors.
The Committee bill would address the issue of authority for
VA to appoint chiropractors in VHA so that those veterans who
are in need of chiropractic care may receive it in VA
facilities by VA-appointed chiropractors. This bill would allow
doctors of chiropractic to work alongside other health care
providers already practicing within VA's health care system.
The Committee believes that this can be accomplished by
establishing a fair compensation schedule comparable to those
used to set salaries for other categories of health care
providers already authorized in title 38, United States Code.
Chiropractors would be added to the authorization of
compensation for physicians, dentists, podiatrists, and
optometrists.
Currently, VA patients who desire to use the services of a
chiropractor may only obtain such services on a fee or contract
basis, causing administrative expenses and inconveniencing
eligible veterans. This bill would permit the Secretary to
appoint chiropractors on a full-time, part-time, or
intermittent basis, as interns or residents, similar to its
authority for appointment of medical practitioners. Also, the
Secretary would be required to ensure that chiropractors were
placed appropriately within the system to work with other
health care practitioners.
Health Care Benefits for Filipino WWII Veterans in the
U.S.--The Filipino soldiers of World War II served side-by-side
with forces from the United States, exhibiting great courage at
the epic battles of Bataan and Corregidor and contributing to
the successful outcome of the war. After the Philippines became
independent, Congress passed the Rescission Act of 1946,
reducing or eliminating many of the veterans' benefits Filipino
veterans had been eligible for based on service in the
Commonwealth Army. Today, almost 60 years later, 60,000 World
War II Filipino veterans are alive and continue to seek
restoration of these benefits.
On June 13, 2002, (107th Congress), the Subcommittee on
Health held a hearing to consider the provision of health care
to certain Filipino World War II veterans by the Department of
Veterans Affairs. His Excellency Albert Del Rosario, Ambassador
to the United States, Embassy of the Philippines, was among the
distinguished witnesses who appeared before the Subcommittee in
support of expanding access to VA health care for World War II
Filipino veterans.
On July 22, 2002, H.R. 3645, the Veterans Health Care and
Procurement Improvement Act of 2002, passed the House. Section
5 of that measure contained a provision to provide certain
Filipino veterans of World War II who now live in the United
States health care benefits on the same basis as if they were
veterans of the U.S. armed services. The Senate, however, did
not act on the legislation prior to adjournment of the 107th
Congress.
The reported bill is similar to section 5 of H.R. 3645; it
would provide health care benefits to approximately 14,000
Commonwealth Army and New Philippines Scout veterans who are
permanent and legal residents of the United States. In
addition, the bill would require the Secretary to issue a
certification and a public notice attesting that sufficient
resources are available at those Department facilities where
the majority of these veterans would receive their care. The
Administration supports this provision. See ``Additional Views
from Administration'', p. 10. The Congressional Budget Office
estimates that the proposal would cost about $61 million over
the 2004-2008 period.
Section-By-Section Analysis
Section 1 of the bill would provide that this Act may be
cited as the ``Veterans Health Care Improvement Act of 2003''.
Section 2(a) of the bill would amend section 7401 of title
38, United States Code, to include ``chiropractic care'' and
``chiropractors'' so the Secretary may appoint such personnel
as necessary for the chiropractic care of veterans.
Section 2(b) of the bill would amend section 7402(b) of
title 38, United States Code, to add eligibility requirements
for a doctor of chiropractic to be appointed to VA; the
requirements would be (1) a degree of doctor of chiropractic,
or its equivalent, from a college of chiropractic approved by
the Secretary; and (2) the individual must be licensed to
practice chiropractic in a State.
Section 2(c) of the bill would amend section 7403(a)(2) of
title 38, United States Code, to allow chiropractors, along
with other health care professionals, to be appointed to VA if
their qualifications meet VA's hiring criteria.
Section 2(d) of the bill would amend section 7404(b)(1) of
title 38, United States Code, to include chiropractors in the
prescribed pay grades along with certain other health care
professionals.
Section 2(e) of the bill would amend Section 7405(a) of
title 38, United States Code, to (1) allow chiropractors to be
employed on a temporary, full-time, part-time, or without
compensation basis, and (2) allow chiropractors to be employed
on a fee basis.
Section 2(f) of the bill would amend section 7406(c) of
title 38, United States Code, so that (1) VA may contract with
a designated administrative agency to place qualified persons
from chiropractic schools or chiropractic installations in
intern or residency positions in VA; (2) VA may pay a stipend
to a designated administrative agency for those chiropractors
in intern or residency positions; (3) the acceptance of
stipends by the designated agency shall be in lieu of and
constitute a waiver of any payment of stipends or employee
benefits to which such chiropractors in intern or residency
positions at VA may be entitled to under the provisions of
title 38, United States Code, or title 5, United States Code;
and (4) the designated administrative agency employing
chiropractors in intern or residency positions makes all
appropriate tax deductions and maintains all appropriate
records pertinent to such deductions and maintains leave
accrual records for such individuals.
Section 2(g) of the bill would amend section 7316(a) of
title 38, United States Code, to include chiropractors among
those VA medical care employees covered by federal malpractice
and negligence protections.
Section 2(h) of the bill would amend section 7409(a) of
title 38, United States Code, so that the Secretary may enter
into contracts with non-Department institutions to supply
scarce chiropractic specialist services at VA facilities.
Section 2(i) of the bill would expand the group of health
care professionals listed in section 7411 of title 38, United
States Code, to allow VA chiropractors to be reimbursed up to
$1,000 a year for continuing professional education.
Section 2(j) of the bill would amend section 7421(b) of
title 38, United States Code, so that chiropractors would be
required to follow the hours, conditions of employment, and
leaves of absence regulations the Secretary prescribes.
Section 2(k) of the bill would require the amendments made
by this section to take effect at the end of the 180-day period
beginning on the date of the enactment of this Act.
Section 3(a) of the bill would amend section 1734 of title
38, United States Code, to authorize the Secretary to furnish
hospital and nursing home care and medical services to any
individual who is a Commonwealth Army veteran or new Philippine
Scout who is residing in the United States and who is a citizen
of the United States or who is an alien lawfully admitted to
the United States for permanent residence. Such care and
services would be subject to the same terms and conditions as
they apply to individuals who are veterans as defined in
section 101(2) of title 38, United States Code. Service-
connected disabilities for purposes of this subchapter (as
provided for under section 1735(2) of title 38, United States
Code), would be considered to be a service-connected disability
for purposes of furnishing such care and services.
Section 3(b) of the bill would provide that the amendment
made by subsection 3(a) shall take effect on the date on which
the Secretary submits to the Committees on Veterans' Affairs of
the Senate and House of Representatives, and publishes in the
Federal Register a certification that sufficient resources are
available to carry out the purpose of section 3 of the bill for
the fiscal year during which the certification is submitted and
at those facilities where the majority of these veterans would
receive their care and services.
Performance Goals and Objectives
The Department of Veterans Affairs' performance goals and
objectives are established in annual performance plans and are
subject to the Committee's regular oversight and evaluation by
the U.S. General Accounting Office. VA also publishes a
performance and accountability report for each fiscal year.
Statement of the Views of the Administration
Health Care Benefits for Filipino WWII Veterans in the U.S.
Testimony of Honorable Anthony J. Principi, Secretary, Department of
Veterans Affairs, Health Subcommittee Hearing on the health care of
Filipino World War II veterans within the Department of Veterans
Affairs
June 13, 2002
Before I address the subject of today's hearing, let me first
reiterate what has been said concerning last November's meeting between
President Bush and President Arroyo of the Philippines. In
commemorating the 50th anniversary of the signing of the U.S.
Philippine Mutual Defense Treaty, they reaffirmed the strength and
warmth of bilateral relations and agreed that the alliance of the
United States and the Philippines remains vital to both nations,
particularly in the wake of the September 11 attacks. Their meeting was
characterized by sincerity and candor and heralded a new era of
comprehensive cooperation and friendship between the United States and
the Philippines. President Bush also agreed to review the services and
benefits that the United States provides for Filipino veterans, and
that review has already yielded results.
Mr. Chairman, I am second to none in my admiration of the
sacrifices made by Filipinos during World War II. These brave soldiers
were called on to defend the Philippine people against superior forces,
and, in the face of what should have been a devastating loss, they
performed magnificently. The world is indebted to Filipino veterans for
their contribution to the Allied victory in World War II.
The Department of Veterans Affairs (VA) has long recognized the
unique status and contributions of Filipino veterans. During World War
II, the Philippine Islands was a U.S. territory, and its troops fought
under U.S. command. There has been no other similar arrangement in
recent American history. The special circumstances of Filipino veterans
have also been recognized in law. Soon after World War II, legislation
was enacted making disabled Filipino veterans and their survivors
eligible for compensation at the rate of one Philippine peso for each
dollar of compensation authorized. A later change authorized
compensation at half the rate paid to U.S. veterans and survivors. In
late 2000, Congress increased the rate of compensation for certain
Filipino veterans and expanded access to health care and burial
services.
Specifically with regard to health care, prior to October 27, 2000,
the law authorized VA to provide care in the Manila Outpatient Clinic
only for the service-connected conditions of U.S. veterans. The term
``U.S. veterans'' includes members of the Old Philippine Scouts. With
enactment of Public Law 106-377 in October of 2000, Congress authorized
VA to begin providing care in the clinic for the non-service-connected
conditions of those same U.S. veterans. Filipino veterans, however,
including Commonwealth Army veterans and New Philippine Scouts, are not
eligible for VA health care in the Philippines. The Philippine
Government provides health care to eligible Filipino veterans.
The law regarding care of Filipino veterans residing in the United
States also changed. Prior to the enactment of Public Law 106-377, VA
was authorized to provide care in the United States only for the
service-connected conditions of Commonwealth Army veterans, members of
recognized guerilla groups, and New Philippine Scouts. Public Law 106-
377 authorized VA to begin providing hospital care, nursing home care,
and medical services to veterans of the Commonwealth Army and
recognized guerilla forces that have service-connected disabilities on
the same basis as U.S. veterans. In short the change allowed these
veterans to seek care for their non-service-connected conditions. The
change in law did not expand eligibility for New Philippine Scout
veterans. They continue to be eligible for care in the United States
only on a discretionary basis (within the limits of VA resources) and
only for service-connected disabilities.
* * * * * * *
Mr. Chairman, VA continues to work with the White House to explore
opportunities to enhance our assistance to Filipino veterans. Section
1731 of Title 38 authorizes the President to assist the Republic of the
Philippines in fulfilling its responsibilities in providing medical
care and treatment for Commonwealth Army veterans and new Philippine
Scouts. I am working to utilize this authority to provide grants of
equipment, as well as assistance in installation and maintenance of the
equipment, to the Philippine government to improve care at the Veterans
Memorial Medical Center in Manila. I anticipate the equipment grants
would be for $500,000 per year.
Mr. Chairman, we look forward to working with Congress to provide
appropriate benefits and services for this deserving group of
individuals. I personally support the proposal to include former
members of the New Philippine Scouts in the ranks of Filipino veterans
who are eligible for burial benefits. I believe enactment of
legislation to provide for those benefits is possible if the number of
beneficiaries, and hence the cost of enactment, is so small that
enactment would not trigger the PAYGO requirements of the Omnibus
Budget Reconciliation Act of 1990.
ADDITIONAL VIEWS FROM ADMINISTRATION
In a letter dated May 12, 2003, Secretary Principi
transmitted a draft bill, ``To amend title 38, United States
Code, to improve benefits for Filipino veterans of World War II
and survivors off such veterans, and for other purposes'' to
the Speaker of the House, Honorable J. Dennis Hastert. The
proposed legislation would extend health care and certain other
benefits to certain Filipino veterans residing legally in the
United States. Secretary Principi stated:
Currently, both Commonwealth Army veterans and new Philippine
Scouts are eligible for treatment of service-connected disabilities
within the limits of Department facilities. However, Commonwealth Army
veterans are also eligible for treatment of non service-connected
disabilities in the same manner as a veteran, if they are in receipt of
certain compensation and reside legally in the United States. The
proposal would extend to new Philippine Scouts who reside legally in
the United States the same eligibility for medical care and services of
non-service connected disabilities that currently exists for
Commonwealth Army veterans, while eliminating the receipt-of-
compensation requirement for these veterans and scouts. It would also
apply the facilities-resources limitation to all care furnished under
this section.
Congressional Budget Office Cost Estimate
The following letter was received from the Congressional
Budget Office concerning the cost of the reported bill:
U.S. Congress,
Congressional Budget Office,
Washington, DC, June 30, 2003
Hon. Christopher H. Smith
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. 2357, the Veterans
Health Care Improvement Act of 2003.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Sam
Papenfuss, who can be reached at 226-2840.
Sincerely,
Douglas Holtz-Eakin,
Director
Enclosure.
Congressional Budget Office Cost Estimate
H.R. 2357, Veterans Health Care Improvement Act of 2003
As ordered reported by the House Committee on Veterans' Affairs on June
26, 2003
Summary
H.R. 2357 would provide new health care benefits to certain
Filipino veterans and make it easier for the Department of
Veterans Affairs (VA) to hire certain health care workers. The
bill would modify the eligibility criteria to allow a greater
number of Filipino veterans living in the United States to
receive health care from VA. H.R. 2357 also would make it
easier for VA to hire chiropractors by specifically listing
chiropractors as medical professionals that VA could hire. In
addition, the bill would grant VA the authority to treat
chiropractors like other medical professionals with regard to
malpractice and negligence, reimbursement of certain education
expenses, and collective bargaining.
CBO estimates that implementing the bill would cost $7
million in 2004 and $61 million over the 2004-2008 period,
assuming appropriation of the estimated amounts.
H.R. 2357 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA)
and would not affect the budgets of state, local, or tribal
governments.
Estimated cost to the federal government
The estimated budgetary impact of H.R. 2357 is shown in the
following table. This estimate assumes the legislation will be
enacted by the end of fiscal year 2003, that the necessary
funds for implementing the bill will be provided for each year,
and that outlays will follow historical spending patterns for
existing or similar programs. The costs of this legislation
fall within budget function 700 (veterans benefits and
services).
By Fiscal Year, in Millions of Dollars
-----------------------------------------------------
2003 2004 2005 2006 2007 2008
----------------------------------------------------------------------------------------------------------------
Spending Under Current Law for Veterans' Medical Care
Estimated Authorization Level 1......................... 25,279 26,153 26,987 27,890 28,824 29,452
Estimated Outlays....................................... 25,677 26,179 26,783 27,655 28,583 29,271
Proposed Changes
Estimated Authorization Level........................... 0 8 16 14 13 12
Estimated Outlays....................................... 0 7 15 14 13 12
Spending Under H.R. 2357 for Veterans' Medical Care
Estimated Authorization Level........................... 25,279 26,161 27,003 27,904 28,837 29,464
Estimated Outlays....................................... 25,677 26,186 26,798 27,669 28,596 29,283
----------------------------------------------------------------------------------------------------------------
1 The 2003 level is the estimated net amount appropriated for that year. No full-year appropriation has yet been
provided for fiscal year 2004. The current-law amounts for the 2004-2008 period assume that appropriations
remain at the 2003 level with adjustments for anticipated inflation.
Health Care for Filipino Veterans. Under current law, only
certain Filipino veterans who served during World War II are
eligible for health care benefits from VA. Under section 2 of
the bill, any individual who is a veteran of the Philippine
Commonwealth Army or a former New Philippine Scout living
legally in the United States would be eligible for VA health
care benefits provided by VA. Using information from VA, CBO
estimates that in 2004 about 9,500 Filipino veterans would
qualify for this new benefit and that they would be classified
as Category 5 veterans, based on income and other factors.
Based on average enrollment and use rates for Category 5
veterans, CBO estimates that about 35 percent of these veterans
would use VA health care benefits in 2004 at an estimated cost
of $5,100 per person. After adjusting for mortality, CBO
expects that the number of eligible Filipino veterans using VA
health care benefits would grow to 2,900 in 2005 as more of
these veterans become aware of the benefit, and then gradually
decline to about 1,900 by 2008. Accordingly, CBO estimates that
implementing this section would cost $7 million in 2004 and $61
million over the 2004-2008 period, assuming appropriation of
the estimated amounts.
Chiropractors. Under current law, VA is required to make
chiropractic care available to veterans at least one site in
each of VA's 21 geographic service areas. Section 1 would make
it easier for VA to appoint and hire chiropractors by
specifying that they be treated as other medical professionals
like podiatrists and optometrists. Based on information from
VA, CBO does not expect that implementing this provision would
increase the level of spending for chiropractic care that VA
would provide beyond what VA is already required to provide
under the current law. Thus, the primary effect would be to
facilitate the establishment of chiropractic care that VA is
already undertaking.
Intergovernmental and private-sector impact
H.R. 2357 contains no intergovernmental or private-sector
mandates as defined in UMRA and would not affect the budgets of
state, local, or tribal governments.
Estimate prepared by:
Federal Costs: Sam Papenfuss (226-2840)
Impact on State, Local, and Tribal Governments: David
Conway and Gregory Waring (225-3220)
Impact on the Private Sector: Allison Percy (226-2900)
Estimate approved by:
Paul R. Cullinan
Chief for Human Resources Cost Estimates Unit, Budget
Analysis Division
Statement of Federal Mandates
The preceding Congressional Budget Office cost estimate
states that the bill contains no intergovernmental or private
sector mandates as defined in the Unfunded Mandates Reform Act.
Statement of Constitutional Authority
Pursuant to Article I, section 8 of the United States
Constitution, the reported bill is authorized by Congress'
power to ``provide for the common Defense and general Welfare
of the United States.''
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 italics, existing law in which no change
is proposed is shown in roman):
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italics, existing law in which no change
is proposed is shown in roman):
TITLE 38, UNITED STATES CODE
* * * * * * *
PART II--GENERAL BENEFITS
* * * * * * *
CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE
* * * * * * *
SUBCHAPTER IV--HOSPITAL CARE AND MEDICAL TREATMENT FOR VETERANS IN THE
REPUBLIC OF THE PHILIPPINES
* * * * * * *
Sec. 1734. Hospital and nursing home care and medical services in the
United States
[(a) The Secretary, within the limits of Department
facilities, may furnish hospital and nursing home care and
medical services to Commonwealth Army veterans and new
Philippine Scouts for the treatment of the service-connected
disabilities of such veterans and scouts.
[(b) An individual who is in receipt of benefits under
subchapter II or IV of chapter 11 of this title paid by reason
of service described in section 107(a) of this title who is
residing in the United States and who is a citizen of, or an
alien lawfully admitted for permanent residence in, the United
States shall be eligible for hospital and nursing home care and
medical services in the same manner as a veteran, and the
disease or disability for which such benefits are paid shall be
considered to be a service-connected disability for purposes of
this chapter.]
(a) The Secretary shall furnish hospital and nursing home
care and medical services to any individual described in
subsection (b) in the same manner, and subject to the same
terms and conditions, as apply to the furnishing of such care
and services to individuals who are veterans as defined in
section 101(2) of this title. Any disability of an individual
described in subsection (b) that is a service-connected
disability for purposes of this subchapter (as provided for
under section 1735(2) of this title) shall be considered to be
a service-connected disability for purposes of furnishing care
and services under the preceding sentence.
(b) Subsection (a) applies to any individual who is a
Commonwealth Army veteran or new Philippine Scout and who--
(1) is residing in the United States; and
(2) is a citizen of the United States or an alien
lawfully admitted to the United States for permanent
residence.
* * * * * * *
PART V--BOARDS, ADMINISTRATIONS, AND SERVICES
* * * * * * *
CHAPTER 73--VETERANS HEALTH ADMINISTRATION--ORGANIZATION AND FUNCTIONS
* * * * * * *
SUBCHAPTER II--GENERAL AUTHORITY AND ADMINISTRATION
* * * * * * *
Sec. 7316. Malpractice and negligence suits: defense by United States
(a)(1) The remedy--
(A) against the United States provided by sections
1346(b) and 2672 of title 28, or
(B) through proceedings for compensation or other
benefits from the United States as provided by any
other law, where the availability of such benefits
precludes a remedy under section 1346(b) or 2672 of
title 28,
for damages for personal injury, including death, allegedly
arising from malpractice or negligence of a medical or
chiropractic care employee of the Administration in furnishing
medical or chiropractic care or treatment while in the exercise
of that employee's duties in or for the Administration shall be
exclusive of any other civil action or proceeding by reason of
the same subject matter against the medical or chiropractic
care employee (or employee's estate) whose act or omission gave
rise to such claim.
(2) For purposes of paragraph (1), the term ``medical or
chiropractic care employee of the Administration'' means a
physician, dentist, podiatrist, chiropractor, optometrist,
nurse, physician assistant, expanded-function dental auxiliary,
pharmacist, or paramedical (such as medical and dental
technicians, nursing assistants, and therapists), or other
supporting personnel.
* * * * * * *
CHAPTER 74--VETERANS HEALTH ADMINISTRATION--
PERSONNEL
* * * * * * *
SUBCHAPTER I--APPOINTMENTS
Sec. 7401. Appointments in Veterans Health Administration
There may be appointed by the Secretary such personnel as the
Secretary may find necessary for the medical care and
chiropractic care of veterans (in addition to those in the
Office of the Under Secretary for Health appointed under
section 7306 of this title), as follows:
(1) Physicians, dentists, podiatrists, chiropractors,
optometrists, registered nurses, physician assistants,
and expanded-function dental auxiliaries.
* * * * * * *
Sec. 7402. Qualifications of appointees
(a) * * *
(b)(1) * * *
* * * * * * *
(10) Chiropractor.--To be eligible to be appointed to a
chiropractor position, a person must--
(A) hold the degree of doctor of chiropractic, or its
equivalent, from a college of chiropractic approved by
the Secretary; and
(B) be licensed to practice chiropractic in a State.
[(10)] (11) Other Health-Care Positions.--To be appointed as
a physician assistant, expanded-function dental auxiliary,
certified or registered respiratory therapist, licensed
physical therapist, licensed practical or vocational nurse,
occupational therapist, dietitian, microbiologist, chemist,
biostatistician, medical technologist, dental technologist, or
other position, a person must have such medical, dental,
scientific, or technical qualifications as the Secretary shall
prescribe.
* * * * * * *
Sec. 7403. Period of appointments; promotions
(a)(1) * * *
(2) This section applies to the following persons appointed
under this chapter:
(A) * * *
* * * * * * *
(H) Chiropractors.
* * * * * * *
Sec. 7404. Grades and pay scales
(a) * * *
(b)(1) The grades for positions provided for in paragraph (1)
of section 7401 of this title shall be as follows. The annual
ranges of rates of basic pay for those grades shall be
prescribed from time to time by Executive order as authorized
by chapter 53 of title 5 or as otherwise authorized by law:
physician and dentist schedule
Director grade.
* * * * * * *
[clinical podiatrist and optometrist schedule]
clinical podiatrist, chiropractor, and optometrist schedule
Chief grade.
* * * * * * *
Sec. 7405. Temporary full-time appointments, part-time appointments,
and without-compensation appointments
(a) The Secretary, upon the recommendation of the Under
Secretary for Health, may employ, without regard to civil
service or classification laws, rules, or regulations,
personnel as follows:
(1) On a temporary full-time basis, part-time basis,
or without compensation basis, persons in the following
positions:
(A) * * *
* * * * * * *
(E) Chiropractors.
(2) On a fee basis, persons in the following
positions:
(A) * * *
* * * * * * *
(D) Chiropractors.
* * * * * * *
Sec. 7406. Residencies and internships
(a) * * *
* * * * * * *
(c)(1) In order to carry out more efficiently the provisions
of subsection (a)(1), the Secretary may contract with one or
more hospitals, medical and chiropractic schools, or medical or
chiropractic installations having hospital facilities and
participating with the Department in the training of interns or
residents to provide, by the designation of one such
institution to serve as a central administrative agency, for
the central administration--
(A) * * *
* * * * * * *
(2) The Secretary may pay to such designated agency, without
regard to any other law or regulation governing the expenditure
of Government moneys either in advance or in arrears, an amount
to cover the cost for the period such intern or resident serves
in a Department facility furnishing hospital care or medical
services of--
(A) * * *
(B) hospitalization, medical or chiropractic care,
and life insurance and any other employee benefits as
are agreed upon by the participating institutions for
the period that such intern or resident serves in a
Department facility furnishing hospital care or medical
services;
* * * * * * *
(3)(A) Any amounts paid by the Secretary to such central
administrative agency to cover the cost of hospitalization,
medical or chiropractic care, or life insurance or other
employee benefits shall be in lieu of any benefits of like
nature to which such intern or resident may be entitled under
the provisions of title 5, and the acceptance of stipends and
employee benefits from the designated central administrative
agency shall constitute a waiver by the recipient of any claim
such recipient might have to any payment of stipends or
employee benefits to which such recipient may be entitled under
this title or title 5.
* * * * * * *
Sec. 7409. Contracts for scarce medical specialist services
(a) The Secretary may enter into contracts with institutions
and persons described in subsection (b) to provide scarce
medical specialist services at Department facilities. Such
services may include the services of physicians, dentists,
podiatrists, optometrists, chiropractors, nurses, physician
assistants, expanded-function dental auxiliaries, technicians,
and other medical support personnel.
* * * * * * *
Sec. 7411. Full-time board-certified physicians and dentists:
reimbursement of continuing professional education
expenses
The Secretary shall reimburse any full-time board-certified
physician [or dentist], dentist, or chiropractic appointed
under section 7401(1) of this title for expenses incurred, up
to $1,000 per year, for continuing professional education.
* * * * * * *
SUBCHAPTER II--COLLECTIVE BARGAINING AND PERSONNEL ADMINISTRATION
Sec. 7421. Personnel administration: in general
(a) * * *
(b) Subsection (a) refers to the following positions:
(1) * * *
* * * * * * *
(8) Chiropractors.
* * * * * * *
