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108th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 2d Session                                                     108-534

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



 
        HOMELESS VETERANS ASSISTANCE REAUTHORIZATION ACT OF 2004

                                _______
                                

  June 9, 2004.--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. 4248]

      [Including cost estimate of the Congressional Budget Office]

  The Committee on Veterans' Affairs, to whom was referred the 
bill (H.R. 4248) to amend title 38, United States Code, to 
extend the authority of the Secretary of Veterans Affairs to 
make grants to expand or modify existing comprehensive service 
programs for homeless veterans, and for other purposes, having 
considered the same, report favorably thereon with an amendment 
and recommend that the bill as amended do pass.

  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 ``Homeless Veterans Assistance 
Reauthorization Act of 2004''.

SEC. 2. EXTENSION OF AUTHORITY FOR SECRETARY OF VETERANS AFFAIRS TO 
                    MAKE GRANTS FOR ASSISTANCE TO HOMELESS VETERANS.

  Section 2011(a)(2) of title 38, United States Code, is amended by 
striking ``September 30, 2005'' and inserting ``September 30, 2008''.

SEC. 3. AUTHORIZATION OF APPROPRIATIONS.

  Section 2013 of title 38, United States Code, is amended--
          (1) in paragraph (4), by striking ``$75,000,000'' and 
        inserting ``$100,000,000''; and
          (2) by adding at the end the following new paragraphs:
          ``(5) $100,000,000 for fiscal year 2006.
          ``(6) $100,000,000 for fiscal year 2007.
          ``(7) $100,000,000 for fiscal year 2008.''.

SEC. 4. PERMANENT AUTHORITY FOR SECRETARY OF VETERANS AFFAIRS TO 
                    OPERATE SEXUAL TRAUMA COUNSELING PROGRAM.

  Section 1720D(a) of title 38, United States Code, is amended--
          (1) in paragraph (1), by striking ``During the period through 
        December 31, 2004, the'' and inserting ``The''; and
          (2) in paragraph (2), by striking ``, during the period 
        through December 31, 2004,''.

                              Introduction

    The reported bill reflects the Committee's consideration of 
two bills in the 108th Congress, H.R. 4248 and H.R. 3849. On 
April 29, 2004, Honorable Christopher H. Smith and Honorable 
Lane Evans introduced H.R. 4248, the Homeless Veterans 
Assistance Reauthorization Act of 2004. On February 26, 2004, 
Honorable Ciro R. Rodriguez, Honorable Lane Evans, and 
Honorable Luis V. Gutierrez introduced H.R. 3849, the Military 
Sexual Trauma Counseling Act of 2004.
    On May 6, 2004, the Subcommittee on Health held a 
legislative hearing to consider four bills and one draft 
legislative proposal. Among the bills discussed, testimony was 
received on H.R. 4248, to extend the authority of the Secretary 
to make grants to provide programs for homeless veterans 
through fiscal year 2008 and increase authority for 
appropriations from $75 million to $100 million; and H.R. 3849, 
to provide permanent authority for the Secretary to operate a 
program to provide counseling and treatment for veterans who 
while in military service experienced sexual trauma.
    Witnesses who appeared before the Subcommittee included 
Honorable Gordon H. Mansfield, Deputy Secretary of Veterans 
Affairs, who was accompanied by Honorable Tim S. McClain, 
General Counsel; Jonathan B. Perlin, M.D., Acting Under 
Secretary for Health; and Mr. Thomas J. Hogan, Deputy Assistant 
Secretary for Human Resources Management. Witnesses also 
included Linda S. Schwartz, R.N., Dr.PH, Commissioner of the 
Connecticut Department of Veterans Affairs; Andrea Mengel, 
Ph.D., R.N., Head, Department of Nursing, Community College of 
Philadelphia, representing the American Association of 
Community Colleges; Mr. Robert Van Keuren, Chair of the VA 
Advisory Committee on Homeless Veterans and Ms. Marsha Four, 
R.N., Chair of the VA Advisory Committee on Women Veterans; Ms. 
Cathleen C. Wimblemo, Deputy Director, Health Care, The 
American Legion; Mr. Rick Weidman, Director, Government 
Relations, Vietnam Veterans of America; Mr. Richard Jones, 
National Legislative Director, AMVETS; Mr. Richard Fuller, 
National Legislative Director, Paralyzed Veterans of America; 
Mr. Dennis Cullinan, National Legislative Director, Veterans of 
Foreign Wars; and Mr. Adrian M. Atizado, Assistant National 
Legislative Director, Disabled American Veterans.
    On May 13, 2004, the Subcommittee on Health met and 
unanimously ordered H.R. 4248, as amended, reported favorably 
to the full Committee by voice vote.
    On May 18, 2004, the full Committee held an oversight 
hearing on the status of homeless assistance programs for 
veterans conducted by the Department of Veterans Affairs (VA), 
including its coordination with community-based providers and 
other Federal agencies, principally the Departments of Health 
and Human Services (HHS) and Housing and Urban Development 
(HUD). The hearing provided an overview of VA's homeless 
assistance programs; the relationships that exist between VA 
and community-based providers; and a review of the Homeless 
Veterans Comprehensive Assistance Act of 2001 (P.L. 107-95), 
with an assessment of VA's progress in implementing this law. 
The Committee also examined the status of VA's implementation 
of the transitional housing authority passed by Congress in 
Public Law 105-368, the Veterans Programs Enhancement Act of 
1998.
    Witnesses who appeared before the Committee unanimously 
supported the homeless provisions in H.R. 4248 and included Mr. 
John Kuhn, LCSW, MPH, Homeless Program Coordinator, New Jersey 
Health Care System, Department of Veterans Affairs, who was 
accompanied by three veterans: Mr. Robert Valentino, Mr. Ralph 
Owens, and Mr. Thaddeus McNair. Richard McCormick, Ph.D., of 
Hudson, OH, also testified as a former Capital Asset 
Realignment for Enhanced Services (CARES) Commissioner and 
former VA employee with over 30 years of service as a clinician 
and mental health administrator in the Veterans Health 
Administration (VHA), which included responsibility for 
directing all mental health and homeless services in VISN 10, 
as well as national roles such as Co-Chair of the Committee on 
the Care of Severely Mentally Ill Veterans. Witnesses also 
included Honorable Gordon H. Mansfield, Deputy Secretary of 
Veterans Affairs, who was accompanied by Mr. Peter H. 
Dougherty, Director, Office of Homeless Veterans, Programs; Ms. 
M. Gay Koerber, Associate Chief Consultant, Health Care for 
Homeless Veterans; and Mr. Claude B. Hutchison, Jr., Director, 
Office of Asset Enterprise Management. Ms. Patricia Carlile, 
Deputy Assistant Secretary for Special Needs Programs, 
testified on behalf of HUD; and Mr. Don Winstead, Deputy 
Assistant Secretary for Planning and Evaluation, Office of 
Human Services Policy, represented HHS. Representing community-
based providers were Ms. Linda Boone, Executive Director of the 
National Coalition for Homeless Veterans, Washington, DC; Mr. 
William G. D'Arcy, Catholic Charities of the Archdiocese of 
Chicago, Chicago, IL; Mr. James W. Manning, Commissioner, 
Housing Authority of the Township of Neptune, Neptune, NJ; and 
Mr. Carlos Martinez, President and CEO of the American GI 
Forum, National Veterans Outreach Program, Inc., San Antonio, 
TX.
    On May 19, 2004, the full Committee met and unanimously 
ordered H.R. 4248, as amended, reported favorably to the House 
by voice vote.

                      Summary of the Reported Bill

    H.R. 4248, as amended, would:

    1. LExtend the authority of the Secretary to make grants to 
expand or modify existing programs for homeless veterans from 
September 30, 2005 to September 30, 2008.

    2. LIncrease the authorization for the grant and per diem 
program for homeless veterans from $75 million to $100 million, 
for fiscal year 2005 through fiscal year 2008.

    3. LMake permanent the authority of the Secretary to 
provide sexual trauma counseling to veterans.

                       Background and Discussion

    Extension of authority for Secretary of Veterans Affairs to 
make grants for assistance to homeless veterans.--VA estimates 
that there are 200,000 or more homeless veterans living on the 
streets on any given night. Other organizations dedicated to 
assisting homeless populations believe the number is closer to 
300,000. For these veterans, access to VA benefits, specialized 
services and effective outreach are vital components to any 
hope of individual stability and improvement in their 
prospects.
    Public Law 107-95, the Homeless Veterans Comprehensive 
Assistance Act of 2001, authorized the Secretary to make grants 
for comprehensive service programs for homeless veterans. VA's 
Homeless Grant and Per Diem program is one such program 
established under this law to provide competitive grants to 
community-based, faith-based, and public organizations that 
offer transitional housing or service centers for homeless 
veterans. With grants and per diem-only awards, VA is 
contributing support for approximately 10,000 community-based 
supportive housing beds and services to homeless veterans in 
all 50 states and the District of Columbia. The current 
authority for this program would expire on September 30, 2005.
    VA cost projections for the Homeless Grant and Per Diem 
program are that spending will increase to about $100 million 
by 2015. To meet this growing need, the President's budget 
proposal for fiscal year 2005 requested an increase in the VA's 
grant and per diem program authorization from $75 million to 
$100 million.
    The Committee bill would extend the program authority 
through fiscal year 2008 and authorize an increase in the 
authorization of appropriations from $75 million to $100 
million.

    Permanent authority for Secretary of Veterans Affairs to 
operate sexual trauma counseling program.--Public Law 102-585, 
the Veterans Health Care Act of 1992, included provisions 
authorizing VA to provide mental health counseling for women 
veterans who had experienced sexual trauma while serving on 
active military duty. In 1994, Public Law 103-452, the Veterans 
Health Programs Extension Act of 1994, broadened eligibility 
for sexual trauma counseling and treatment for veterans of 
either gender who may have experienced sexual trauma while 
serving on active duty.
    Individuals who experience sexual trauma may have a variety 
of psychological and physical health effects, but commonly have 
problems with interpersonal relationships, difficulty with 
concentration, and issues with self-medication through 
substance abuse.
    As of August 2003, VA reported that 31,423 males and 27,385 
female veterans responded positively to relevant screenings, 
indicating unwanted sexual experiences had occurred during 
their military service periods. With the expanded role of the 
U.S. military, including Reservists and National Guard, in 
operations in Iraq and Afghanistan and other overseas 
deployments, VA expects a rise in the number of veterans 
seeking such counseling and treatment in the future. Under 
current law, the authority to provide sexual trauma counseling 
for eligible individuals expires on December 31, 2004.
    The Committee bill would recognize the continuing need for 
these programs within VA by permanently authorizing the 
counseling authority.

                      Section-By-Section Analysis

    Section 1 of the bill would name this Act the ``Homeless 
Veterans Assistance Reauthorization Act of 2004.''

    Section 2 of the bill would amend section 2011(a)(2) of 
title 38, United States Code, to extend the authority of the 
Secretary to make grants for assistance to homeless veterans 
through September 30, 2008.

    Section 3 of the bill would amend section 2013 of title 38, 
United States Code, to authorize an increase in appropriations 
to support grants for homeless veterans from $75,000,000 to 
$100,000,000 in each fiscal year beginning in 2005 through 
2008.

    Section 4 of the bill would amend section 1720D(a) of title 
38, United States Code, to make permanent the authority of the 
Secretary to provide sexual trauma counseling and appropriate 
care and services to eligible veterans.

                    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

  STATEMENT OF THE HONORABLE GORDON H. MANSFIELD, DEPUTY SECRETARY OF 
   VETERANS AFFAIRS, BEFORE THE SUBCOMMITTEE ON HEALTH, COMMITTEE ON 
            VETERANS AFFAIRS, U.S. HOUSE OF REPRESENTATIVES

                              May 6, 2004

    Good morning, Mr. Chairman and Members of the Subcommittee.
    I am pleased to be here to present the Department's views on 
several bills and a draft bill, which pertain primarily to veteran's 
health care and related administrative matters.
          * * * * * * *

                               H.R. 4248

    H.R. 4248 would extend to September 30, 2008, VA's authority to 
carry out the Homeless Providers Grant and Per Diem Program. Currently, 
authority for the program will expire on September 30, 2005. It would 
also authorize $100 million in appropriations for each of fiscal years 
2005, 2006, 2007, and 2008. Currently, $75 million is authorized for 
fiscal year 2005.
    VA strongly supports H.R. 4248. VA's Homeless Providers Grant and 
Per Diem Program is a highly successful collaborative effort between VA 
and non-profit organizations and local and state government agencies to 
furnish needed outreach, supportive services, and transitional housing 
services to homeless veterans. Since the program was authorized in 
1992, VA has obligated $76 million to the grant component of the 
program. These funds have resulted in the development of 6,400 
transitional housing beds and 17 independent service centers and the 
purchase of 128 vans.
    Similar success is found with the per diem component of the 
program. The most recent awards were used to support 1,583 beds in 80 
programs. To date, under the per diem-only program, 3,799 new beds are 
either operational or coming on-line.
    Still VA needs to continue working with its community partners to 
develop more transitional housing for homeless veteran across the 
country. VA estimates the cost associated with enactment of this 
proposal to be $8,956,672 above the current authorized level for fiscal 
year 2005. We estimate that to ensure full funding for this program for 
fiscal years 2006, 2007, and 2008, we will require $91,698,224, 
$81,996,208, and $86,282,778, respectively. We therefore welcome the 
Committee's proposal to increase the level of authorized appropriations 
for this program.
                                 ______
                                 

                               H.R. 3849

    H.R. 3849 would permanently authorize VA's program to provide 
counseling services and care for sexual trauma. Currently, VA's 
authority for this program extends only through December 31, 2004.
    VA strongly supports making this treatment authority permanent. The 
number of women veterans seeking VA counseling and treatment for 
military sexual trauma continues to increase at a substantial rate. 
Likewise, the number of women who serve in the Armed Forces, the 
Reserves, and the National Guard continues to grow. VA must therefore 
be able to provide needed sexual trauma counseling and related health 
care to these current and future veterans without any lapse in program 
authority. Enactment of H.R. 3849 would achieve that goal. VA estimates 
there would be no additional costs associated with enactment of this 
proposal.
          * * * * * * *

               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 4, 2004
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. 4248, the Homeless 
Veterans Assistance Reauthorization Act of 2004.
    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

                                                       June 4, 2004

  H.R. 4248--Homeless Veterans Assistance Reauthorization Act of 2004

As ordered reported by the House Committee on Veterans' Affairs on May 
                                19, 2004

SUMMARY

    H.R. 4248 would authorize appropriations for the Department 
of Veterans Affairs (VA) to provide assistance to homeless 
veterans. The bill also would permanently extend the authority 
for VA to provide counseling to those veterans who have 
suffered from sexual trauma.
    CBO estimates that implementing this bill would cost $30 
million in 2005 and $375 million over the 2005-2009 period, 
assuming appropriation of the estimated amounts. Enacting the 
bill would not affect direct spending or revenues.
    H.R. 4248 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA) 
and would impose no costs on state, local, or tribal 
governments.

ESTIMATED COST TO THE FEDERAL GOVERNMENT

    The estimated budgetary impact of H.R. 4248 is shown in the 
following table. The costs of this legislation fall within 
budget function 700 (veterans benefits and services).






                                                                   By Fiscal Year, in Millions of Dollars
                                                           -----------------------------------------------------
                                                              2004     2005     2006     2007     2008     2009
----------------------------------------------------------------------------------------------------------------

                                   SPENDING SUBJECT TO APPROPRIATION

Spending Under Current Law for Assistance for Homeless
 Veterans and Sexual Trauma Counseling
  BudgetAuthority/Authorization Level a...................       79       78        0        0        0        0
  Estimated Outlays.......................................       79       77        7        0        0        0
Proposed Changes
  Assistance for Homeless Veterans
    Authorization Level...................................        0       25      100      100      100        0
    Estimated Outlays.....................................        0       23       92       99       99       10
  Sexual Trauma Counseling
    Estimated Authorization Level.........................        0        7       11       11       12       12
    Estimated Outlays.....................................        0        7       10       11       12       12
      Total Changes
        Estimated Authorization Level.....................        0       32      111      111      112       12
        Estimated Outlays.................................        0       30      102      110      111       22
Spending Under H.R. 4248 for Assistance for Homeless
 Veterans and Sexual Trauma Counseling
  Estimated Authorization Level...........................       79      110      111      111      112       12
  Estimated Outlays.......................................       79      107      109      110      111       22
----------------------------------------------------------------------------------------------------------------

a The 2004 level is the estimated amount appropriated for that year. No appropriation has yet been provided for
  fiscal year 2005. The amount in 2005 represents a current authorization of $75 million for assistance for
  homeless veterans and $3 million for sexual trauma counseling.




BASIS OF ESTIMATE

    This estimate assumes that H.R. 4248 will be enacted near 
the start of fiscal year 2005, and that the authorized and 
estimated amount will be appropriated for each year.

Assistance for Homeless Veterans

    Section 2 would authorize the appropriation of $100 million 
in 2005, instead of the $75 million that is authorized under 
current law, for the purpose of providing assistance to 
homeless veterans. It also would authorize $100 million a year 
over the 2006-2008 period for the same purpose. These funds 
would be spent on providing grants to organizations to help 
them furnish, expand, or modify services to homeless veterans, 
including transitional housing, outreach programs, 
rehabilitative services, and vocational counseling and 
training. In addition, VA could use the funds to provide per 
diem payments to those organizations that provide such services 
to homeless veterans. CBO estimates that implementing this 
provision would cost $23 million in 2005 and $323 million over 
the 2005-2009 period, assuming appropriation of the authorized 
amounts.

Sexual Trauma Counseling

    Section 3 would permanently extend a provision allowing VA 
to provide counseling to veterans who suffered from sexual 
trauma while serving on active duty. Under current law, the 
authority to provide such counseling expires on December 31, 
2004. Using information from VA, CBO estimates that about 2 
percent (approximately 100,000) of veterans who received care 
from VA were eligible to receive counseling for sexual trauma 
in 2003. Data from VA although incomplete, suggests that about 
5,000, or 5 percent, of those eligible veterans received such 
counseling in 2003, at an average per capita cost of almost 
$2,000. Assuming that about this same number of veterans 
receives counseling for sexual trauma each year over the 2005-
2009 period, CBO estimates that permanently extending this 
provision would cost $7 million in 2005 and $52 million over 
the 2005-2009 period, assuming appropriation of the necessary 
amounts.

INTERGOVERNMENTAL AND PRIVATE-SECTOR IMPACT

    H.R. 4248 contains no intergovernmental or private-sector 
mandates as defined in UMRA. Public agencies would be eligible 
to receive grants to provide and enhance services to homeless 
veterans; any costs incurred by those governments would be 
voluntary.

estimate prepared by:

    Federal Costs: Sam Papenfuss (226-2840)
  Impact on State, Local, and Tribal Governments: Melissa 
    Merrell (225-3220)
  Impact on the Private Sector: Chad Goldberg (226-2900)

estimate approved by:

  Peter H. Fontaine, Deputy Assistant Director for Budget 
    Analysis

                     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):

TITLE 38, UNITED STATES CODE

           *       *       *       *       *       *       *


PART II--GENERAL BENEFITS

           *       *       *       *       *       *       *


CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE

           *       *       *       *       *       *       *


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

           *       *       *       *       *       *       *


Sec. 1720D. Counseling and treatment for sexual trauma

  (a)(1) [During the period through December 31, 2004, the] The 
Secretary shall operate a program under which the Secretary 
provides counseling and appropriate care and services to 
veterans who the Secretary determines require such counseling 
and care and services to overcome psychological trauma, which 
in the judgment of a mental health professional employed by the 
Department, resulted from a physical assault of a sexual 
nature, battery of a sexual nature, or sexual harassment which 
occurred while the veteran was serving on active duty.
  (2) In furnishing counseling to a veteran under this 
subsection, the Secretary may[, during the period through 
December 31, 2004,] provide such counseling pursuant to a 
contract with a qualified mental health professional if (A) in 
the judgment of a mental health professional employed by the 
Department, the receipt of counseling by that veteran in 
facilities of the Department would be clinically inadvisable, 
or (B) Department facilities are not capable of furnishing such 
counseling to that veteran economically because of geographical 
inaccessibility.

           *       *       *       *       *       *       *


CHAPTER 20--BENEFITS FOR HOMELESS VETERANS

           *       *       *       *       *       *       *


             SUBCHAPTER II--COMPREHENSIVE SERVICE PROGRAMS

Sec. 2011. Grants

  (a) Authority To Make Grants.--(1) * * *
  (2) The authority of the Secretary to make grants under this 
section expires on September 30, [2005] 2008.

           *       *       *       *       *       *       *


Sec. 2013. Authorization of appropriations

  There are authorized to be appropriated to carry out this 
subchapter amounts as follows:
          (1) * * *

           *       *       *       *       *       *       *

          (4) [$75,000,000] $100,000,000 for fiscal year 2005.

           *       *       *       *       *       *       *

          (5) $100,000,000 for fiscal year 2006.
          (6) $100,000,000 for fiscal year 2007.
          (7) $100,000,000 for fiscal year 2008.

           *       *       *       *       *       *       *