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110th Congress Report
HOUSE OF REPRESENTATIVES
1st Session 110-267
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PROHIBITION ON COLLECTION OF COPAYMENTS FOR ALL HOSPICE CARE FURNISHED
BY DEPARTMENT OF VETERANS AFFAIRS
_______
July 27, 2007.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Filner, from the Committee on Veterans' Affairs, submitted the
following
R E P O R T
[To accompany H.R. 2623]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred the
bill (H.R. 2623) to amend title 38, United States Code, to
prohibit the collection of copayments for all hospice care
furnished by the Department of Veterans Affairs, having
considered the same, report favorably thereon with an amendment
and recommend that the bill as amended do pass.
CONTENTS
Page
Purpose and Summary.............................................. 2
Background and Discussion........................................ 2
Legislative History.............................................. 3
Section-by-Section............................................... 3
Committee Consideration.......................................... 3
Rollcall Votes................................................... 3
Application of Law to the Legislative Branch..................... 4
Statement of Oversight Findings and Recommendations of the
Committee...................................................... 4
Statement of General Performance Goals and Objectives............ 4
Constitutional Authority Statement............................... 4
Federal Advisory Committee Act................................... 4
Unfunded Mandate Statement....................................... 4
Earmark Identification........................................... 4
Committee Estimate............................................... 4
Budget Authority and Congressional Budget Office Cost Estimate... 5
Changes in Existing Law Made by the Bill as Reported............. 5
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. PROHIBITION ON COLLECTION OF COPAYMENTS FOR ALL HOSPICE CARE
FURNISHED BY DEPARTMENT OF VETERANS AFFAIRS.
Title 38, United States Code, is amended--
(1) in section 1710(f)(1), by inserting ``(except if such
care constitutes hospice care)'' after ``nursing home care'';
(2) in section 1710(g)(1), by inserting ``(except if such
services constitute hospice care)'' after ``medical services'';
and
(3) in section 1710B(c)(2), by striking subparagraph (B) and
inserting after subparagraph (A) the following new subparagraph
(B):
``(B) to a veteran being furnished inpatient or outpatient
hospice care by the Department; or''.
Purpose and Summary
H.R. 2623, to amend title 38, United States Code, to
prohibit the collection of copayments for all hospice care
furnished by the Department of Veterans Affairs, was introduced
on June 7, 2007, by Representative Jeff Miller of Florida, the
Ranking Member of the Subcommittee on Health. The legislation
would enable the VA to provide hospice care to eligible
veterans without collecting copayments.
H.R. 2623 would:
1. Prohibit the collection of copayments for all hospice
care provided by the VA.
Background and Discussion
Hospice and palliative care is a continuum of comfort-
oriented and supportive services provided across settings,
including hospitals, extended care facilities, outpatient
clinics and private residences.
The Department of Veterans Affairs (VA) offers a complement
of hospice and palliative care options as part of the
comprehensive health care benefit provided to all enrolled
veterans. In FY 2006, every VA facility offered some form of
hospice and end-of-life care service. In comparison, according
to a recent survey, only one-fourth of other hospitals had a
palliative care program. The VA's Hospice and Palliative Care
Program has transformed much of the end-of-life care provided
or purchased by VA. In fact, 42 percent of all veterans who
died in a VA facility received prior consultation from a
palliative care team. Palliative care consults in VA hospitals
more than doubled between FY 2003 and FY 2006 and surpassed
20,000 in FY 2006. The number of veterans receiving VA-paid
home hospice care tripled between FY 2003 and FY 2005, and
increased another 30 percent in FY 2006, reaching an average
daily census of 427 veterans.
VA has reported that they track copayment amounts for
inpatient services and outpatient services collectively rather
than by individual services. It is, therefore, difficult to
determine the exact amount of revenue VA has received from
hospice care copayments. However, VA estimates a total of
$343,542 in annual revenue: $183,180 for home hospice care, and
$160,362 for inpatient hospice care.
Under current law, a veteran receiving hospice care in a
nursing home is exempt from any applicable copayments. However,
if the hospice care is provided in any other setting, such as
in an acute-care hospital or at home, the veteran may be
subject to an inpatient or outpatient primary care copayment.
VA's current policy penalizes a veteran who chooses to
remain at home for their hospice care or who, out of medical
necessity, receives hospice care in an acute care setting.
H.R. 2623 would correct this inequity by exempting all
hospice care provided through VA from copayment requirements.
In addition, this legislation would also align VA with the
Medicare program, which does not impose copayments for hospice
care regardless of the setting.
Legislative History
On May 9, 2007, the Subcommittee on Health held a hearing
entitled ``The State of VA's Long-Term Care Program Present and
Future.'' Testimony at this hearing included a discussion
regarding the copayment requirements for veterans receiving
hospice care.
On June 14, 2007, the Subcommittee on Health held a
legislative hearing on a number of bills, including H.R. 2623,
introduced during the 110th Congress.
On June 28, 2007, the Subcommittee on Health marked up H.R.
2623. An Amendment in the Nature of a Substitute was offered by
Representative Miller that was agreed to by voice vote. The
Subcommittee ordered H.R. 2623, as amended, reported favorably
to the full Committee.
On July 17, 2007, the full Committee met in open markup
session and approved a number of bills, including H.R. 2623, as
amended. The full Committee, by voice vote, ordered H.R. 2623,
as amended, reported favorably to the House of Representatives.
Section-by-Section
Section 1. Prohibition on collection of copayments for all hospice care
furnished by Department of Veterans Affairs
This section would amend sections 1710(f)(1), 1710(g)(1),
and 1710B(c)(2) of title 38, United States Code, to enable the
Secretary to furnish hospice care to all eligible veterans
without requiring the veteran to pay any applicable copayments.
Committee Consideration
On July 17, 2007, the Committee ordered H.R. 2623, as
amended, reported favorably to the House of Representatives by
voice vote.
Rollcall Votes
The Committee held no rollcall votes on this bill. A motion
to order H.R. 2623, as amended, reported favorably to the House
of Representatives was agreed to by voice vote.
Application of Law to the Legislative Branch
Section 102(b)(3) of Public Law 104-1 requires a
description of the application of this bill to the legislative
branch where the bill relates to the terms and conditions of
employment or access to public services and accommodations.
This bill does not relate to employment or access to public
services and accommodations.
Statement of Oversight Findings and Recommendations of the Committee
In compliance with clause 3(c)(1) of rule XIII and clause
(2)(b)(1) of rule X of the Rules of the House of
Representatives, the Committee's oversight findings and
recommendations are reflected in the descriptive portions of
this report.
Statement of General Performance Goals and Objectives
In accordance with clause (3)(c)(4) of rule XIII of the
Rules of the House of Representatives, the Committee's
performance goals and objectives are reflected in the
descriptive portions of this report.
Constitutional Authority Statement
Under clause 3(d)(1) of rule XIII of the Rules of the House
of Representatives, the Committee must include a statement
citing the specific powers granted to Congress to enact the law
proposed by H.R. 2623. The Committee finds that Article 1,
Section 8 of the Constitution of the United States grants
Congress the power to enact this law.
Federal Advisory Committee Act
The Committee finds that the legislation does not establish
or authorize the establishment of an advisory committee within
the definition of 5 U.S.C. App., section 5(b).
Unfunded Mandate Statement
Section 423 of the Congressional Budget and Impoundment
Control Act (as amended by section 101(a)(2) of the Unfunded
Mandate Reform Act, P.L. 104-4) requires a statement whether
the provisions of the reported bill include unfunded mandates.
In compliance with this requirement the Committee has received
a letter from the Congressional Budget Office that is included
herein.
Earmark Identification
H.R. 2623, as amended, does not contain any congressional
earmarks, limited tax benefits, or limited tariff benefits as
defined in clause 9(d), 9(e), or 9(f) of rule XXI of the Rules
of the House of Representatives.
Committee Estimate
Clause 3(d)(2) of rule XIII of the Rules of the House of
Representatives requires an estimate and a comparison by the
Committee of the costs that would be incurred in carrying out
H.R. 2623, as amended. However, clause 3(d)(3)(B) of that rule
provides that this requirement does not apply when the
Committee has included in its report a timely submitted cost
estimate of the bill prepared by the Director of the
Congressional Budget Office under section 402 of the
Congressional Budget Act.
Budget Authority and Congressional Budget Office Cost Estimate
U.S. Congress,
Congressional Budget Office,
Washington, DC, July 24, 2007.
Hon. Bob Filner,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 2623, a bill to
amend title 38, United States Code, to prohibit the collection
of copayments for all hospice care furnished by the Department
of Veterans Affairs.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Michelle S.
Patterson.
Sincerely,
Peter R. Orszag, Director.
Enclosure.
H.R. 2623--A bill to amend title 38, United States Code, to prohibit
the collection of copayments for all hospice care furnished by
the Department of Veterans Affairs
H.R. 2623 would prohibit the Department of Veterans Affairs
(VA) from collecting copayments from veterans receiving hospice
care. This would apply to care received at both inpatient and
outpatient facilities. Depending upon where veterans get
hospice care, copayments range from $15 per day to a maximum of
$97 per day. Most veterans receiving this type of care from VA
are not charged copayments--only veterans whose disabilities
are unrelated to their military service and whose incomes are
above a certain level are required to make copayments.
Based on information from VA that 435 veterans made
copayments averaging about $800 last year for hospice care, CBO
estimates that implementing H.R. 2623 would decrease
collections by less than $500,000 each year and by about $2
million over the 2008-2012 period. Those collections are
considered to be offsets to discretionary appropriations. As
part of the annual appropriations process, the Congress gives
VA authority to spend those collections. Therefore, if it
wished to maintain the same level of health care services for
veterans, the Congress would need to appropriate additional
funds each year to make up for the loss of copayments under
this bill. Under those circumstances, implementing H.R. 2623
would cost about $2 million over the 2008-2012 period. Enacting
this bill would not affect direct spending or receipts.
H.R. 2623 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act and
would impose no costs on state, local, or tribal governments.
The CBO staff contact for this estimate is Michelle S.
Patterson. This estimate was approved by Robert A. Sunshine,
Assistant Director for Budget Analysis.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italic, existing law in which no change is
proposed is shown in roman):
TITLE 38, UNITED STATES CODE
* * * * * * *
PART II--GENERAL BENEFITS
* * * * * * *
CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE
* * * * * * *
SUBCHAPTER II--HOSPITAL, NURSING HOME, OR DOMICILIARY CARE AND MEDICAL
TREATMENT
Sec. 1710. Eligibility for hospital, nursing home, and domiciliary care
(a) * * *
* * * * * * *
(f)(1) The Secretary may not furnish hospital care or nursing
home care (except if such care constitutes hospice care) under
this section to a veteran who is eligible for such care under
subsection (a)(3) of this section unless the veteran agrees to
pay to the United States the applicable amount determined under
paragraph (2) or (4) of this subsection.
* * * * * * *
(g)(1) The Secretary may not furnish medical services (except
if such services constitute hospice care) under subsection (a)
of this section (including home health services under section
1717 of this title) to a veteran who is eligible for hospital
care under this chapter by reason of subsection (a)(3) of this
section unless the veteran agrees to pay to the United States
in the case of each outpatient visit the applicable amount or
amounts established by the Secretary by regulation.
* * * * * * *
Sec. 1710B. Extended care services
(a) * * *
* * * * * * *
(c)(1) * * *
(2) Paragraph (1) shall not apply--
(A) * * *
[(B) to a veteran being furnished hospice care under
this section; or]
(B) to a veteran being furnished inpatient or
outpatient hospice care by the Department; or
* * * * * * *
