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110th Congress Report
HOUSE OF REPRESENTATIVES
1st Session 110-268
======================================================================
VETERANS' HEALTH CARE IMPROVEMENT ACT OF 2007
_______
July 27, 2007.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Filner, from the Committee on Veterans' Affairs, submitted the
following
R E P O R T
[To accompany H.R. 2874]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred the
bill (H.R. 2874) to amend title 38, United States Code, to make
certain improvements in the provision of health care to
veterans, and for other purposes, having considered the same,
report favorably thereon with an amendment and recommend that
the bill as amended do pass.
CONTENTS
Page
Purpose and Summary.............................................. 7
Background and Discussion........................................ 9
Legislative History.............................................. 12
Section-by-Section............................................... 13
Committee Consideration.......................................... 15
Rollcall Votes................................................... 15
Application of Law to the Legislative Branch..................... 15
Statement of Oversight Findings and Recommendations of the
Committee...................................................... 15
Statement of General Performance Goals and Objectives............ 15
Constitutional Authority Statement............................... 15
Federal Advisory Committee Act................................... 15
Unfunded Mandate Statement....................................... 15
Earmark Identification........................................... 16
Committee Estimate............................................... 16
Budget Authority and Congressional Budget Office Cost Estimate... 16
Changes in Existing Law Made by the Bill as Reported............. 21
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Veterans' Health
Care Improvement Act of 2007''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Grants for support of therapeutic readjustment programs for
veterans.
Sec. 3. Transportation grants for rural veterans service organizations.
Sec. 4. Permanent treatment authority for participants in Department of
Defense chemical and biological testing conducted by Deseret Test
Center (including Project Shipboard Hazard and Defense).
Sec. 5. Extension of expiring collections authorities.
Sec. 6. Readjustment and mental health services for Operation Enduring
Freedom and Operation Iraqi Freedom Veterans.
Sec. 7. Expansion and extension of authority for program of referral
and counseling services for at-risk veterans transitioning from certain
institutions.
Sec. 8. Permanent authority for domiciliary services for homeless
veterans and enhancement of capacity of domiciliary care programs for
female veterans.
Sec. 9. Financial assistance for supportive services for very low-
income veteran families in permanent housing.
Sec. 10. Expansion of eligibility for dental care.
Sec. 11. Technical amendments.
SEC. 2. GRANTS FOR SUPPORT OF THERAPEUTIC READJUSTMENT PROGRAMS FOR
VETERANS.
(a) Grant Program.--Subchapter II of chapter 5 of title 38, United
States Code, is amended by inserting after section 521 the following
new section:
``Sec. 521A. Assistance to therapeutic readjustment programs
``(a) Grant Program.--The Secretary of Veterans Affairs may make
grants to qualified entities described in subsection (b) to conduct
workshop programs that have been shown to assist in the therapeutic
readjustment and rehabilitation of participants to assist in the
therapeutic readjustment of covered veterans.
``(b) Qualified Entities.--In order to qualify for grant assistance
under subsection (a), a private nonprofit entity must have, as
determined by the Secretary, experience and expertise in offering
programs to assist in the therapeutic readjustment of participants and
that such programs will likely assist covered veterans.
``(c) Amount of Grant; Use of Funds.--A grant under this section
shall not exceed $100,000 for any calendar year and shall be used by
the recipient exclusively for the benefit of covered veterans.
``(d) Application.--An application for a grant under this section
shall include details regarding the extent and nature of the proposed
program, the therapeutic readjustment and rehabilitation benefits
expected to be achieved by participants, and any other information the
Secretary determines may be necessary to assist the Secretary in
ensuring that covered veterans receive therapeutic readjustment and
rehabilitation benefits.
``(e) Covered Veterans.--For the purposes of this subsection, a
`covered veteran' is a veteran who served on active duty in a theater
of combat operations (as determined by the Secretary in consultation
with the Secretary of Defense) during a period of war after the Persian
Gulf War, or in combat against a hostile force during a period of
hostilities (as defined in section 1712A(a)(2)(B) of this title) after
November 11, 1998, and who is discharged or released from active
military, naval, or air service on or after September 11, 2001.
``(f) Reports.--Not later than 60 days after the last day of a fiscal
year, the Secretary shall submit to the Committees on Veterans' Affairs
of the Senate and House of Representatives a report detailing the
number and amount of grants made under this section during the previous
fiscal year, the total number of covered veterans participating in
workshop programs funded by such grants, a description of the programs,
and the therapeutic benefits to covered veterans of participation in
the various programs funded.
``(g) Authorization of Appropriations.--There is authorized to be
appropriated for each of fiscal years 2008 through 2011 $2,000,000 to
carry out this section.
``(h) Termination.--The authority of the Secretary to make a grant
under subsection (a) shall terminate on September 30, 2011.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item relating to section
521 the following new item:
``521A. Assistance to therapeutic readjustment programs.''.
SEC. 3. TRANSPORTATION GRANTS FOR RURAL VETERANS SERVICE ORGANIZATIONS.
(a) Grant Program.--Subchapter I of chapter 17 of title 38, United
States Code, is amended by adding at the end the following new section:
``Sec. 1709. Grants for provision of transportation to Department
medical facilities for veterans in remote rural
areas
``(a) Grants Authorized.--(1) The Secretary shall establish a grant
program to provide innovative transportation options to veterans in
remote rural areas.
``(2) Grants awarded under this section may be used by State
veterans' service agencies, veterans service organizations, and private
nonprofit entities to assist veterans in remote rural areas to travel
to Department medical facilities.
``(3) The amount of a grant under this section may not exceed
$50,000.
``(4) The recipient of a grant under this section shall not be
required to provide matching funds as a condition for receiving such
grant.
``(b) Regulations.--The Secretary shall prescribe regulations for--
``(1) evaluating grant applications under this section; and
``(2) otherwise administering the program established by this
section.
``(c) Authorization of Appropriations.--There is authorized to be
appropriated $3,000,000 for each of fiscal years 2008 through 2012 to
carry out this section.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item relating to section
1708 the following new item:
``1709. Grants for provision of transportation to Department medical
facilities for veterans in remote rural areas.''.
SEC. 4. PERMANENT TREATMENT AUTHORITY FOR PARTICIPANTS IN DEPARTMENT OF
DEFENSE CHEMICAL AND BIOLOGICAL TESTING CONDUCTED
BY DESERET TEST CENTER (INCLUDING PROJECT SHIPBOARD
HAZARD AND DEFENSE).
Section 1710(e)(3) of title 38, United States Code, is amended--
(1) in subparagraph (B), by inserting ``and'' after the
semicolon;
(2) in subparagraph (C), by striking ``; and'' and inserting
a period; and
(3) by striking subparagraph (D).
SEC. 5. EXTENSION OF EXPIRING COLLECTIONS AUTHORITIES.
(a) Health Care Copayments.--Section 1710(f)(2)(B) is amended by
striking ``2007'' and inserting ``2009''.
(b) Medical Care Cost Recovery.--Section 1729(a)(2)(E) is amended by
striking ``2007'' and inserting ``2009''.
SEC. 6. READJUSTMENT AND MENTAL HEALTH SERVICES FOR COVERED VETERANS.
(a) Provision of Readjustment Counseling and Mental Health
Services.--Subchapter II of chapter 17 of title 38, United States Code,
is amended by inserting after section 1712B the following new section:
``Sec. 1712C. Provision of readjustment counseling and mental health
services for covered veterans
``(a) Program Required.--The Secretary shall carry out a program to
provide peer outreach services, peer support services, and readjustment
and mental health services to covered veterans.
``(b) Contracts With Community Mental Health Centers.--In carrying
out the program required by subsection (a), the Secretary shall
contract with community mental health centers and other qualified
entities to provide the services referred to in that paragraph in areas
the Secretary determines are not adequately served by health care
facilities of the Department. Such contracts shall require each
community health center or other entity--
``(1) to the extent practicable, to employ covered veterans
trained under subsection (c);
``(2) to the extent practicable, to use telehealth services
for the provision of such services;
``(3) to participate in the training program under subsection
(d);
``(4) to comply with applicable protocols of the Department
before incurring any liability on behalf of the Department for
the provision of such the services;
``(5) to submit annual reports to the Secretary containing,
with respect to the program required by subsection (a) and for
the last full calendar year ending before the submission of
such report--
``(A) the number of veterans served, veterans
diagnosed, and courses of treatment provided to
veterans as part of the program required by subsection
(a); and
``(B) demographic information for such services,
diagnoses, and courses of treatment;
``(6) to provide to the Secretary such clinical summary
information as the Secretary may require for each veteran for
whom the center or entity provides mental health services under
the contract; and
``(7) to meet such other requirements as the Secretary may
require.
``(c) Training Program for Veterans.--In carrying out the program
required by subsection (a), the Secretary shall contract with a
nonprofit mental health organization to carry out a program to train
covered veterans to provide peer outreach and peer support services.
``(d) Training Program for Clinicians.--The Secretary shall conduct a
training program for clinicians of community mental health centers or
other entities that have entered into contracts with the Secretary
under subsection (b) to ensure that such clinicians are able to provide
the services required by subsection (a) in a manner that--
``(1) recognizes factors that are unique to the experience of
veterans who served on active duty in Operation Iraqi Freedom
or Operation Enduring Freedom (including the combat and
military training experiences of such veterans); and
``(2) utilizes best practices and technologies.
``(e) Covered Veterans.--For the purposes of this subsection, a
`covered veteran' is a veteran who served on active duty in a theater
of combat operations (as determined by the Secretary in consultation
with the Secretary of Defense) during a period of war after the Persian
Gulf War, or in combat against a hostile force during a period of
hostilities (as defined in section1712A(a)(2)(B) of this title) after
November 11, 1998, and who is discharged or released from active
military, naval, or air service on or after September 11, 2001''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item relating to section
1712B the following new item:
``1712C. Provision of readjustment counseling and mental health
services for covered veterans.''.
SEC. 7. EXPANSION AND EXTENSION OF AUTHORITY FOR PROGRAM OF REFERRAL
AND COUNSELING SERVICES FOR AT-RISK VETERANS
TRANSITIONING FROM CERTAIN INSTITUTIONS.
(a) Program Authority.--Subsection (a) of section 2023 of title 38,
United States Code, is amended by striking ``a demonstration program
for the purpose of determining the costs and benefits of providing''
and inserting ``a program to provide''.
(b) Scope of Program.--Subsection (b) of such section is amended--
(1) by striking ``Demonstration'' in the subsection heading;
(2) by striking ``demonstration''; and
(3) by striking ``in at least six locations'' and inserting
``in at least 12 locations''.
(c) Extension of Authority.--Subsection (d) of such section is
amended by striking ``shall cease'' and all that follows and inserting
``shall cease on September 30, 2011.''.
(d) Conforming Amendments.--
(1) Scope of program.--Subsection (c)(1) of such section is
amended by striking ``demonstration''.
(2) Section heading.--The heading of such section is amended
to read as follows:
``Sec. 2023. Referral and counseling services: veterans at risk of
homelessness who are transitioning from certain
institutions''.
(3) Other conforming amendment.--Section 2022(f)(2)(C) of
such title is amended by striking ``demonstration''.
(e) Clerical Amendment.--The table of sections at the beginning of
chapter 20 of such title is amended by striking the item relating to
section 2023 and inserting the following new item:
``2023. Referral and counseling services: veterans at risk of
homelessness who are transitioning from certain institutions.''.
SEC. 8. PERMANENT AUTHORITY FOR DOMICILIARY SERVICES FOR HOMELESS
VETERANS AND ENHANCEMENT OF CAPACITY OF DOMICILIARY
CARE PROGRAMS FOR FEMALE VETERANS.
Subsection (b) of section 2043 of title 38, United States Code, is
amended to read as follows:
``(b) Enhancement of Capacity of Domiciliary Care Programs for Female
Veterans.--The Secretary shall take appropriate actions to ensure that
the domiciliary care programs of the Department are adequate, with
respect to capacity and safety, to meet the needs of veterans who are
women.''.
SEC. 9. FINANCIAL ASSISTANCE FOR SUPPORTIVE SERVICES FOR VERY LOW-
INCOME VETERAN FAMILIES IN PERMANENT HOUSING.
(a) Purpose.--The purpose of this section is to facilitate the
provision of supportive services for very low-income veteran families
in permanent housing.
(b) Authorization of Financial Assistance.--
(1) In general.--Subchapter V of chapter 20 of title 38,
United States Code, is amended by adding at the end the
following new section:
``Sec. 2044. Financial assistance for supportive services for very low-
income veteran families residing in permanent
housing
``(a) Distribution of Financial Assistance.--
``(1) The Secretary shall provide financial assistance to
eligible entities approved under this section to provide and
coordinate the provision of the supportive services for very
low-income veteran families residing in permanent housing.
``(2)(A) Financial assistance under this section shall
consist of payments for each such family for which an approved
eligible entity provides or coordinates the provision of
supportive services.
``(B) The Secretary shall establish a formula for determining
the rate of payments provided to a very low-income veteran
family receiving supportive services under this section. The
rate shall be adjusted not less than once annually to reflect
changes in the cost of living. In calculating the payment
formula under this subparagraph, the Secretary may consider
geographic cost of living variances, family size, and the cost
of services provided.
``(3) In providing financial assistance under paragraph (1),
the Secretary shall give preference to an entity that provides
or coordinates the provision of supportive services for very
low-income veteran families who are transitioning from
homelessness to permanent housing.
``(4) The Secretary shall ensure that, to the extent
practicable, financial assistance under this subsection is
equitably distributed across geographic regions, including
rural communities and tribal lands.
``(5) Each entity receiving financial assistance under this
section to provide supportive services to a very low-income
veteran family shall notify the family that such services are
being paid for, in whole or in part, by the Department.
``(6) The Secretary may require an entity receiving financial
assistance under this section to submit a report to the
Secretary describing the supportive services provided with such
financial assistance.
``(b) Application for Financial Assistance.--
``(1) An eligible entity seeking financial assistance under
subsection (a) shall submit to the Secretary an application in
such form, in such manner, and containing such commitments and
information as the Secretary determines to be necessary.
``(2) An application submitted under paragraph (1) shall
contain--
``(A) a description of the supportive services
proposed to be provided by the eligible entity;
``(B) a description of the types of very low-income
veteran families proposed to be provided such services;
``(C) an estimate of the number of very low-income
veteran families proposed to be provided such services;
``(D) evidence of the experience of the eligible
entity in providing supportive services to very low-
income veteran families; and
``(E) a description of the managerial capacity of the
eligible entity to--
``(i) coordinate the provision of supportive
services with the provision of permanent
housing, by the eligible entity or by other
organizations;
``(ii) continuously assess the needs of very
low-income veteran families for supportive
services;
``(iii) coordinate the provision of
supportive services with the services of the
Department;
``(iv) tailor supportive services to the
needs of very low-income veteran families; and
``(v) continuously seek new sources of
assistance to ensure the long-term provision of
supportive services to very low-income veteran
families.
``(3) The Secretary shall establish criteria for the
selection of eligible entities to receive financial assistance
under this section.
``(c) Technical Assistance.--
``(1) The Secretary shall provide training and technical
assistance to eligible entities that receive financial
assistance under this section with respect to the planning,
development, and provision of supportive services to very low-
income veteran families occupying permanent housing.
``(2) The Secretary may provide the training described in
paragraph (1) directly or through grants or contracts with
appropriate public or nonprofit private entities.
``(d) Authorization of Appropriations.--There is authorized to be
appropriated, for each fiscal year, $25,000,000, to carry out this
section, of which not more than $750,000 for each fiscal year may be
used to provide technical assistance under subsection (c).
``(e) Definitions.--For the purposes of this section:
``(1) The term `very low-income veteran family' means a
veteran family whose income does not exceed 50 percent of the
median income for the area, as determined by the Secretary in
accordance with this paragraph, except that--
``(A) the Secretary shall make appropriate
adjustments to the income requirement under
subparagraph (A) based on family size; and
``(B) the Secretary may establish an income ceiling
higher or lower than 50 percent of the median income
for an area if the Secretary determines that such
variations are necessary because the area has unusually
high or low construction costs, fair market rents (as
determined under section 8 of the United States Housing
Act of 1937 (42 U.S.C. 1437f)), or family incomes.
``(C) the Secretary shall establish criteria for
determining the need for specific supportive services
(as defined by paragraph (8)) of individual very low
income veteran families occupying permanent housing.
``(2) The term `veteran family' includes a veteran who is a
single person and a family in which the head of household or
the spouse of the head of household is a veteran.
``(3) The term `consumer cooperative' has the meaning given
such term in section 202 of the Housing Act of 1959 (12 U.S.C.
1701q).
``(4) The term `eligible entity' means--
``(A) a private nonprofit organization; or
``(B) a consumer cooperative.
``(5) The term `homeless' has the meaning given the term in
section 103 of the McKinney-Vento Homeless Assistance Act (42
U.S.C. 11302).
``(6) The term `permanent housing' means community-based
housing without a designated length of stay.
``(7) The term `private nonprofit organization' means--
``(A) any incorporated private institution or
foundation--
``(i) no part of the net earnings of which
inures to the benefit of any member, founder,
contributor, or individual;
``(ii) which has a governing board that is
responsible for the operation of the supportive
services provided under this section; and
``(iii) which is approved by the Secretary as
to financial responsibility;
``(B) a for-profit limited partnership, the sole
general partner of which is an organization meeting the
requirements of clauses (i), (ii), and (iii) of
subparagraph (A);
``(C) a corporation wholly owned and controlled by an
organization meeting the requirements of clauses (i),
(ii), and (iii) of subparagraph (A); and
``(D) a tribally designated housing entity (as
defined in section 4 of the Native American Housing
Assistance and Self-Determination Act of 1996 (25
U.S.C. 4103)).
``(8) The term `supportive services' means the following:
``(A) Services provided by an eligible entity or
subcontractors that address the needs of very low-
income veteran families occupying permanent housing,
including--
``(i) outreach services;
``(ii) health care services, including
diagnosis, treatment, and counseling for mental
health and substance abuse disorders and for
post-traumatic stress disorder, if such
services are not readily available through the
Department of Veterans Affairs medical center
serving the geographic area in which the
veteran family is housed;
``(iii) habilitation and rehabilitation
services;
``(iv) case management services;
``(v) daily living services;
``(vi) personal financial planning;
``(vii) transportation services;
``(viii) vocational counseling;
``(ix) employment and training;
``(x) educational services;
``(xi) assistance in obtaining veterans
benefits and other public benefits, including
health care provided by the Department;
``(xii) assistance in obtaining income
support;
``(xiii) assistance in obtaining health
insurance;
``(xiv) fiduciary and representative payee
services;
``(xv) legal services to assist the veteran
family with reconsiderations or appeals of
veterans and public benefit claim denials and
to resolve outstanding warrants that interfere
with the family's ability to obtain or retain
housing or supportive services;
``(xvi) child care;
``(xvii) housing counseling;
``(xviii) other services necessary for
maintaining independent living; and
``(xix) coordination of services described in
this paragraph.
``(B) Services provided by an eligible entity or
subcontractors, including services described in clauses
(i) through (xix) of subparagraph (A), that are
delivered to very low-income veteran families who are
homeless and who are scheduled to become residents of
permanent housing within 90 days of the date on which
the service is provided pending the location or
development of housing suitable for permanent housing.
``(C) Services provided by an eligible entity or
subcontractors, including services described in clauses
(i) through (xix) of subparagraph (A), for very low-
income veteran families who have voluntarily chosen to
seek other housing after a period of tenancy in
permanent housing, that are provided, for a period of
90 days beginning on the date on which such a family
exits permanent housing or until such a family
commences receipt of other housing services adequate to
meet the needs of the family, but only to the extent
that services under this paragraph are designed to
support such a family in the choice to transition into
housing that is responsive to the individual needs and
preferences of the family.''.
(2) Clerical amendment.--The table of sections at the
beginning of such chapter is amended by inserting after the
item relating to section 2043 the following new item:
``2044. Financial assistance for supportive services for very low-
income veteran families residing in permanent housing.''.
SEC. 10. EXPANSION OF ELIGIBILITY FOR DENTAL CARE.
Section 2062(b) of title 38, United States Code, is amended by
striking ``60 consecutive days'' both places it appears and inserting
``30 consecutive days''.
SEC. 11. TECHNICAL AMENDMENTS.
Title 38, United States Code, is amended--
(1) in each of sections 1708(d), 7314(f), 7320(j)(2),
7325(i)(2), and 7328(i)(2), by striking ``medical care
account'' and inserting ``medical services account'';
(2) in section 1712A--
(A) by striking subsection (g);
(B) by redesignating subsections (d), (e), (f), and
(i) as subsections (c) through (f), respectively; and
(C) in subsection (f)(1), as so redesignated, by
striking ``(including a Resource Center designated
under subsection (h)(3)(A) of this section)'';
(3) in section 2065(b)(3)(C), by striking ``)'';
(4) in the table of sections at the beginning of chapter 36,
by striking the item relating to section 3684A and inserting
the following new item:
``3684A. Procedures relating to computer matching program.'';
(5) in section 3684(a)(1), by striking ``34,,'' and inserting
``34,'';
(6) in section 4110(c)(1), by striking ``15'' and inserting
``16'';
(7) in the table of sections at the beginning of chapter 51,
by striking the item relating to section 5121 and inserting the
following new item:
``5121. Payment of certain accrued benefits upon death of a
beneficiary.'';
(8) in section 7458(b)(2), by striking ``pro rated'' and
inserting ``pro-rated''; and
(9) in section 8117(a)(1), by striking ``such such'' and
inserting ``such''.
Purpose and Summary
H.R. 2874, the ``Veterans Health Care Improvement Act of
2007,'' was introduced on June 27, 2007, by Representative
Michael H. Michaud of Maine, the Chairman of the Subcommittee
on Health. The legislation would make certain improvements in
the ability of the Department of Veterans Affairs (VA) to
provide treatment and care to veterans suffering from mental
health issues as well as veterans who are homeless. This bill
would further assist low-income veteran families living in
permanent housing.
H.R. 2874 would:
1. Authorize VA to establish a grant program for nonprofit
entities to conduct workshops to assist in the therapeutic
readjustment and rehabilitation of Operation Enduring Freedom
or Operation Iraqi Freedom (OEF/OIF) veterans. VA would
determine that a nonprofit entity has the experience and
expertise to conduct such programs and require the grants be
used exclusively for the benefit of veterans. VA would submit a
report to the House and Senate Veterans' Affairs Committees
detailing the number of grants made each fiscal year, and the
total number of veterans participating in workshop programs
funded by the grants. The amount of the grants would be limited
to $100,000 for each calendar year and there would be $2
million authorized each fiscal year to carry out the program.
Authority for the grant program would terminate on September
20, 2011.
2. Require VA to establish a grant program for rural
veterans service organizations, State veterans' service
agencies, and nonprofits to provide innovative transportation
options to veterans in remote rural areas to travel to VA
medical facilities. Limit grants to $50,000 and authorize
appropriations of $3 million for each fiscal year from 2008 to
2012 to carry out the program.
3. Make permanent VA's authority to provide veterans who
participated in a test conducted by the Department of Defense
Deseret Test Center from 1962 through 1973 higher priority for
hospital care, medical services and nursing home care without
requirement for proof of service-connection.
4. Extend through September 30, 2009, VA's authority to
require certain non-service connected veterans to pay a $10 per
diem co-payment when they receive VA hospital care.
5. Extend through October 1, 2009, VA's authority to bill a
service-connected patient's third-party insurance carrier for
the cost of care VA provides the veteran for any non-service-
connected disability.
6. Require VA to provide for readjustment counseling and
mental health services for OEF/OIF veterans through programs
which would provide peer outreach services, peer support
services, and readjustment and mental health services. Such
services would include contracting with community mental health
centers in areas not adequately served by VA and contracting
with nonprofit mental health organizations to train OEF/OIF
veterans in outreach and peer support. Directs VA to conduct
training programs for clinicians that have contracts with VA to
provide such services.
7. Expand the counseling services for at-risk veterans
transitioning from certain institutions to at least 12
locations and extends authority for programs to September 30,
2011.
8. Require the Secretary to ensure that VA domiciliary
programs are adequate in capacity and safety to meet the needs
of women veterans.
9. Require VA to provide financial assistance to eligible
entities to provide supportive services for very low-income
veteran families residing in permanent housing.
10. Modify the requirement for a homeless veteran to be
eligible for dental care by reducing, from 60 to 30, the number
of consecutive days a homeless veteran must participate in a
VA-sponsored rehabilitation program.
11. Make technical amendments to title 38, United States
Code.
Background and Discussion
The Mental Health Assessment Team IV Report (MHAT IV) is
the fourth in a series of studies since 2003 to assess the
mental health and well-being of the deployed forces serving in
Iraq.
The MHAT IV central findings included:
The level of combat is the main determinant of a
Soldier's or Marine's mental health status.
Multiple deployers reported higher acute stress
than first-time deployers. Deployment length was related to
higher rates of mental health problems and marital problems.
Although demographic differences exist between the
deployed OIF Soldiers and the Army population, 2003-2006 OIF
suicide rates are higher than the average Army rate, 16.1 vs.
11.6 Soldier suicides per year per 100,000.
There is no standardized joint reporting system
for monitoring mental health status and suicide surveillance of
service members in a combat/deployed environment.
The mental health and well-being of the newest generation
of veterans is a leading cause of concern for VA. VA reported
in the April 2007 quarterly Analysis of VA Health Care
Utilization Among US Southwest Asian War Veterans, Operation
Enduring Freedom, Operation Iraqi Freedom, that of those
Southwest Asian War veterans that have separated, 33 percent
have sought VA health care since FY 2002. Additionally, mental
disorders rank second for frequency of possible diagnoses among
recent OEF/OIF veterans, at a rate of 36.6 percent, it is
second only to diseases of the musculoskeletal system at 43.4
percent. VA reports that of the 83,889 patients that have
received a diagnosis of a possible mental disorder, Post-
traumatic Stress Disorder (PTSD) is the number one health
concern with 39,243 veterans receiving at least a provisional
diagnosis. Nondependent abuse of drugs and depressive disorders
are number two andthree. Early intervention and early treatment
are essential to the successful treatment of PTSD.
The composition of the combat forces in OEF/OIF is unique
from previous conflicts. There is a heavy reliance on the
National Guard and Reserve forces. Though only 19 percent of
the nation lives in rural America, 44 percent of military
recruits come from rural areas and nearly one-third of those
who have been killed in Iraq are from small towns and
communities across the nation. Another very important aspect of
OEF/OIF is the prevalence of repeated deployments.
VA's primary challenge in serving veterans who reside in
rural areas is to effectively address access to quality care in
areas where veteran populations are dispersed over a large
geographical area.
H.R. 2874 would authorize VA to establish a new grant
program to conduct therapeutic workshops that would allow the
veteran to express thoughts and feelings through such programs
as art, writing and music. Additionally, to address the
readjustment counseling and mental health concerns of veterans
who live in rural areas or areas where VA does not have
adequate readjustment counseling and mental health services
available, this legislation would require VA to contract with
mental health centers and nonprofit mental health organizations
to provide peer-to-peer counseling and outreach training. It
further requires VA to train mental health clinicians to VA
standards in order to maintain the highest quality of care
provided to veterans.
This legislation also begins to address the difficult task
of providing access to health care in rural areas by
authorizing VA to establish a grant program that would provide
grants to State veterans' service agencies, nonprofits and
veterans service organizations (VSOs) to develop new and
innovative ways to provide transportation to veterans who
reside in rural areas.
This legislation also addresses issues of homelessness. VA
is the largest single provider of direct services to homeless
veterans, reaching 100,000 or 25 percent of homeless veterans a
year through their various programs. Like their non-veteran
counterparts, veterans are at high risk of homelessness due to
extremely low or no livable income, extreme shortage of
affordable housing, and lack of access to health care.
Prior to becoming homeless, a large number of veterans at
risk of homelessness have struggled with PTSD, or have
addictions acquired during, or worsened by, their military
service. H.R. 2874 begins to address the needs of homeless
veterans by extending and expanding VA's authority for
counseling services for at risk veterans transitioning from
certain institutions and authorizing VA to provide financial
assistance to provide supportive services for very low-income
veteran families residing in permanent housing.
GRANTS FOR SUPPORT OF THERAPEUTIC READJUSTMENT PROGRAMS FOR VETERANS
This legislation would allow VA to establish a new grant
program for nonprofit entities to conduct workshops to assist
in the therapeutic readjustment and rehabilitation of OEF/OIF
combat veterans. VA currently works with organizations to
provide disabled veterans with opportunities for self-
development and for improving their quality of life through
sports, recreational, and artistic activities. Additionally, VA
medical facilities incorporate creative arts into their
recreation therapy programs. Through these therapeutic
readjustment programs, veterans will benefit from workshops or
programs that allow them to express themselves and become
healthy and productive members of society.
TRANSPORTATION GRANTS FOR RURAL VETERANS SERVICE ORGANIZATIONS
This legislation would establish a new grant program to
provide transportation options to veterans living in rural
areas. These grants will assist veterans in gaining access to
quality health care. The Committee strongly recommends VA give
preference in awarding these grants to VSOs; veterans helping
veterans create an atmosphere of camaraderie and trust that is
familiar to those who have served.
PERMANENT TREATMENT AUTHORITY FOR PARTICIPANTS IN DEPARTMENT OF DEFENSE
CHEMICAL AND BIOLOGICAL TESTING CONDUCTED BY DESERET TEST CENTER
(INCLUDING PROJECT SHIPBOARD HAZARD AND DEFENSE)
Under current law, VA is authorized to provide higher
priority health care to veterans who participated in Project
Shipboard Hazard and Defense (SHAD), Project 112 or related
land-based tests conducted by the Department of Defense Deseret
Test Center, from 1962 through 1973, for any illness, without
those veterans needing an adjudicated service-connected
disability to establish their priority for care. This
legislation would make permanent this special treatment
authority that will expire on December 31, 2007. The Committee
believes that these veterans should receive free VA medical
care for conditions that may have resulted from their
participation in military testing conducted by the Department
of Defense Deseret Test Center. The VA requested this authority
be made permanent.
EXTENSION OF EXPIRING COLLECTIONS AUTHORITIES
Public Law 101-508, the ``Omnibus Budget Reconciliation Act
of 1990,'' required certain non-service connected veterans with
higher incomes to pay a per diem copayment when they receive VA
hospital care and allows VA to collect from a service-connected
patient's insurance company for the cost of care provided for
any non-service-connected disability. The VA requested this
authority be made permanent. This legislation would extend this
authority until 2009.
EXPANSION AND EXTENSION OF AUTHORITY FOR PROGRAM OR REFERRAL AND
COUNSELING SERVICES FOR AT RISK VETERANS TRANSITIONING FROM CERTAIN
INSTITUTIONS
This legislation would expand and extend the counseling
services for at-risk veterans programs from six to at least 12
locations throughout the Veterans Health Administration.
Significant numbers of incarcerated veterans are at risk for
homelessness, substance abuse, mental illness, and chronic
illness and infectious disease upon release. These veterans
often need multiple services, including medical services,
psychiatric care, substance abuse treatment, transitional
housing, vocational/employment assistance, and veterans'
benefits services.
PERMANENT AUTHORITY FOR DOMICILIARY SERVICES FOR HOMELESS VETERANS AND
ENHANCEMENT OF CAPACITY OF DOMICILIARY SERVICES FOR HOMELESS VETERANS
AND ENHANCEMENT OF CAPACITY OF DOMICILIARY CARE PROGRAMS FOR FEMALE
VETERANS
By 2010, it is projected that there will be 1.8 million
women veterans. Today's female servicemember is much more
likely to be exposed to combat or combat-like conditions than
her predecessors in past conflicts. Women veterans now
represent nearly four percent of the homeless veteran
population as opposed to three percent five years ago. VA's
domiciliary care programs are essential in assisting veterans
and providing needed services to help them recover and become
productive citizens again. This legislation enhances the
capacity of domiciliary care programs for female veterans.
FINANCIAL ASSISTANCE FOR SUPOPRTIVE SERVICES FOR VERY LOW-INCOME
VETERAN FAMILIES IN PERMANENT HOUSING
The U.S. Census Bureau estimates that 1.5 million of our
nation's veterans live in poverty, including 702,000 veterans
with disabilities and 404,000 veterans in households with
children. Of the 1.5 million poor veterans 634,000 live in
extreme poverty. These veterans face insecurity in housing as
well as health and vocational challenges. Gaining access to
supportive services has also proven to be difficult. This
contributes to their inability to sustain housing and maintain
independence for more costly public institutional care and
support. This legislation would authorize the Secretary to
provide financial assistance to nonprofit organizations and
consumer cooperatives to provide and coordinate the provision
of supportive services that address the needs of very low-
income veterans occupying permanent housing. Veterans
transitioning from homelessness to permanent housing, poor
disabled and older veterans requiring supportive services in
home based settings, and poor veterans in rural areas with
distance barriers to centrally located services would benefit
from this legislation.
EXPANSION OF ELIGIBILITY FOR DENTAL CARE
VA can provide dental services to eligible homeless
veterans as long as they have been receiving care for a period
of 60 consecutive days in a domiciliary, therapeutic residence,
community residential care coordinated by VA, or a setting for
which the VA provides funds to a grant and per diem provider.
Dental care includes treatment necessary for the veterans to
gain or regain employment, and alleviate pain for moderate,
severe, or severe and complicated gingival and periodontal
pathology.
The VA believes that the 60-day requirement serves as an
incentive to keep the veteran in the rehabilitation program the
veteran is in so they can receive the full range of services
offered by VA. The Committee believes there are other
incentives the VA offers to homeless veterans that would keep
them in such a program including food, shelter and safety. This
legislation would reduce the number of days that a homeless
veteran would have to wait to receive dental treatment from 60
days to 30 days.
TECHNICAL AMENDMENTS
This section makes several technical amendments to title
38, United States Code.
Legislative History
On April 18, 2007, the Subcommittee on Health held a
hearing entitled ``Access to VA Health Care: How Easy is it for
Veterans: Addressing the Gaps.''
On June 14, 2007, the Subcommittee on Health held a
legislative hearing on a number of bills introduced by 110th
Congress, including two Discussion Drafts of legislation
concerning mental health and homeless veterans' issues.
H.R. 2874, as amended, contains provisions from H.R. 2005,
introduced by Representative John Salazar of Texas; H.R. 2689,
introduced by Representative Ciro Rodriguez of Texas; and, H.R.
2378, introduced by Representative Stephanie Herseth Sandlin of
South Dakota.
On June 28, 2007, the Subcommittee on Health marked up H.R.
2874. The markup was recessed and on July 11, 2007, the
Subcommittee on Health continued the markup. Chairman Michaud
introduced an Amendment in the Nature of a Substitute to H.R.
2874 which was agreed to by the Subcommittee by voice vote.
Ranking Member Miller ordered it reported favorably to the
Committee.
On July 17, 2007, the full Committee met in open markup
session and approved a number of bills, including H.R. 2874, as
amended. The Committee, by voice vote, ordered H.R. 2874, as
amended, reported favorably to the House of Representatives.
Section-By-Section
Section 1. Short title
This section would provide the short title of H.R. 2874 as
the ``Veterans' Health Care Improvement Act of 2007.''
Section 2. Grants for support of therapeutic readjustment programs for
veterans
This section would create a new section in Subchapter II of
chapter 5 of title 38, United States Code. New section 521A
would authorize the VA to make grants to qualifying nonprofit
entities to conduct workshop programs that have been shown to
assist in therapeutic readjustment and rehabilitation of
participants. VA would determine, through an application
process, what entities are most qualified to receive the grant.
VA would be required to submit to the House and Senate
Committees on Veterans' Affairs, a detailed report on the
number and amount of grants made during the previous fiscal
year, the total number of veterans participating in workshop
programs, and a description of the programs and the therapeutic
benefits to veterans who participate.
Section 3. Transportation grants for rural veterans service
organizations
This section would create a new section under subchapter I
of chapter 17 of title 38, United States Code. New section 1709
would authorize VA to establish a grant program to provide
innovative transportation options to veterans living in rural
areas. Grants may be awarded to State veterans' service
agencies, veterans' service organizations, and nonprofits to
help veterans living in rural areas travel to VA medical
centers. The Secretary would be required to prescribe
regulations for evaluating grant applications and administering
the program.
Section 4. Permanent treatment authority for participants in Department
of Defense chemical and biological testing conducted by Deseret
Test Center (including Project Shipboard hazard and Defense)
This section would make permanent VA's authority to treat
participants in the Department of Defense (DOD) chemical
biological testing conducted by Deseret Test Center (including
SHAD)
Section 5. Extension of expiring collections authorities
This section extends the expiring collection authorities
from 2007 to 2009 for health care copayments and medical care
cost recovery.
Section 6. Readjustment and mental health services for Operation
Enduring Freedom and Operation Iraqi Freedom veterans
This section would create a new section 1712C that would
authorize the Secretary to carry out programs to provide peer
outreach services, peer support services, and readjustment and
mental health services to OEF/OIF veterans. The VA would
contract with community mental health centers in areas not
adequately served by VA. These contracts should employ
veterans, use telehealth services, participate in training
programs, and comply with protocols subscribed to by VA. The
centers would be required to submit a report to the Secretary
on an annual basis that details the number of veterans served,
diagnosed, and courses of treatment provided to veterans. Also
included in the report would be demographic information and
clinical summary information, as the Secretary may require, on
each veteran. The VA would contract with a nonprofit mental
health organization to train veterans to provide peer outreach
and peer support services. VA would be required to conduct a
training program for clinicians to ensure that each are able to
provide the services that utilize best practices and
technologies.
Section 7. Expansion and extension of authority for program of referral
and counseling services for at-risk veterans transitioning from
certain institutions
This section would expand and extend the counseling
services for at-risk veterans programs to at least 12 locations
until September 30, 2011.
Section 8. Permanent authority for domiciliary services for homeless
veterans and enhancement of capacity of domiciliary services
for homeless veterans and enhancement of capacity of
domiciliary care programs for female veterans
This section would require the VA to ensure that VA
domiciliary programs are adequate in capacity and safety to
meet the needs of women veterans.
Section 9. Financial assistance for supportive services for very low-
income veterans families in permanent housing
This section would create a new section 2044 that would
authorize VA to provide financial assistance to eligible
entities to provide supportive services for very low-income
veteran families residing in permanent housing. VA may give
preference to an entity that provides or coordinates supportive
services for very low-income veteran families who are
transitioning from homelessness to permanent housing. Eligible
entities would apply to VA for financial assistance and VA
would be required to ensure that assistance is equitably
distributed across geographic regions, including rural
communities and tribal lands. VA would also provide training
and technical assistance to eligible entities that provide
supportive services to very low-income veterans. To carry out
this section, $25,000,000 would be authorized to be
appropriated each fiscal year.
Section 10. Expansion of eligibility for dental care
This section would amend section 2062(b) of title 38,
United States Code to allow homeless veterans to become
eligible for dental care after 30 consecutive days of receiving
treatment rather than 60 consecutive days.
Committee Consideration
On July 17, 2007, the Committee ordered H.R. 2874, as
amended, reported favorably to the House of Representatives by
voice vote.
Rollcall Votes
The Committee held no rollcall votes on this bill. A motion
to order H.R. 2874, as amended, reported favorably to the House
of Representatives was agreed to by voice vote.
Application of Law to the Legislative Branch
Section 102(b)(3) of Public Law 104-1 requires a
description of the application of this bill to the legislative
branch where the bill relates to the terms and conditions
ofemployment or access to public services and accommodations. This bill
does not relate to employment or access to public services and
accommodations.
Statement of Oversight Findings and Recommendations of the Committee
In compliance with clause 3(c)(1) of rule XIII and clause
2(b)(1) of rule X of the Rules of the House of Representatives,
the Committee's oversight findings and recommendations are
reflected in the descriptive portions of this report.
Statement of General Performance Goals and Objectives
In accordance with clause 3(c)(4) of rule XIII of the Rules
of the House of Representatives, the Committee's performance
goals and objectives are reflected in the descriptive portions
of this report.
Constitutional Authority Statement
Under clause 3(d)(1) of rule XIII of the Rules of the House
of Representatives, the Committee must include a statement
citing the specific powers granted to Congress to enact the law
proposed by H.R. 2874. Article 1, Section 8 of the Constitution
of the United States grants Congress the power to enact this
law.
Federal Advisory Committee Act
The Committee finds that the legislation does not establish
or authorize the establishment of an advisory committee within
the definition of 5 U.S.C. App., section 5(b).
Unfunded Mandate Statement
Section 423 of the Congressional Budget and Impoundment
Control Act (as amended by section 101(a)(2) of the Unfunded
Mandate Reform Act, P.L. 104-4) requires a statement whether
the 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. 2874, as amended, does not contain any congressional
earmarks, limited tax benefits, or limited tariff benefits as
defined in clause 9(d), 9(e), or 9(f) of rule XXI of the Rules
of the House of Representatives.
Committee Estimate
Clause 3(d)(2) of rule XIII of the Rules of the House of
Representatives requires an estimate and a comparison by the
Committee of the costs that would be incurred in carrying out
H.R. 2874, as amended. However, clause 3(d)(3)(B) of that rule
provides that this requirement does not apply when the
Committee has included in its report a timely submitted cost
estimate of the bill prepared by the Director of the
Congressional Budget Office under section 402 of the
Congressional Budget Act.
Budget Authority and Congressional Budget Office Cost Estimate
U.S. Congress,
Congressional Budget Office,
Washington, DC, July 27, 2007.
Hon. Bob Filner,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 2874, the
Veterans' Health Care Improvement Act of 2007.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Michelle S.
Patterson.
Sincerely,
Peter R. Orszag, Director.
Enclosure.
H.R. 2874--Veterans' Health Care Improvement Act of 2007
Summary: H.R. 2874 contains provisions that would both
increase and decrease spending for veterans' health care. The
bill would expand certain health care benefits available for
veterans and would create new programs to help low-income
veterans and veterans in rural areas. H.R. 2874 also would
extend for two years the authority of the Department of
Veterans Affairs (VA) to collect certain payments for medical
care.
The bill also would require VA to implement a new program
to provide readjustment counseling and mental health care
services to recent veterans. CBO does not have sufficient
information about how VA might implement this requirement to
estimate the cost. CBO estimates that the net effect of
implementing the remainder of H.R. 2874 would be to reduce
costs for veterans' health care by $22 million in 2008 and to
increase costs by $199 million over the 2008-2012 period,
assuming the availability of appropriated funds. Enacting the
bill would not affect direct spending or revenues.
H.R. 2874 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA);
any costs to state, local, or tribal governments would be
incurred voluntarily.
Estimated cost to the Federal Government: The estimated
budgetary impact of H.R. 2874 is shown in Table 1. The costs of
this legislation fall within budget function 700 (veterans
benefits and services).
TABLE 1.--ESTIMATED BUDGETARY IMPACT OF H.R. 2847a
------------------------------------------------------------------------
By fiscal year, in millions of
dollars--
------------------------------------
2008 2009 2010 2011 2012
------------------------------------------------------------------------
CHANGES IN SPENDING SUBJECT TO APPROPRIATION
Estimated Authorization Level...... 42 43 43 43 38
Estimated Outlays.................. -22 33 100 46 42
------------------------------------------------------------------------
aThis table does not include the costs for implementing section 6 of
H.R. 2874, which CBO cannot estimate at this time.
Basis of estimate: For this estimate, CBO assumes that the
legislation will be enacted near the start of fiscal year 2008,
that the estimated amounts will be appropriated each year, and
that outlays will follow historical spending patterns for the
VA medical services program.
Offsetting collections
VA has a number of authorities that allow it to bill third-
party insurance for care given to veterans, and to collect a
variety of fees and copayments from veterans. Two specific
authorities will expire at the end of fiscal year 2007. Those
expiring authorities allow VA to collect a $10 daily payment
for hospital stays from certain veterans and to bill insurance
companies for care given to veterans who have a disability
related to their service, but who are being treated for a
nonservice-related condition. Based on information from VA, CBO
estimates that the department will collect about $525 million
in 2007 as a result of those two expiring authorities.
Section 5 would allow VA to continue collecting those
monies for another two years--until September 30, 2009. All VA
collections are currently deposited into the Medical Care
Collections Fund (MCCF). Amounts deposited to the MCCF are
considered to be offsets to discretionary appropriations and
spending from the MCCF is subject to annual appropriation
action. Accounting for inflation and increased usage, CBO
estimates that implementing this provision would increase--
relative to current law--offsetting collections deposited to
the MCCF by $582 million in 2008 and about $1.2 billion over
the 2008-2009 period.
TABLE 2.--COMPONENTS OF THE ESTIMATED CHANGES IN SPENDING SUBJECT TO
APPROPRIATION UNDER H.R. 2847a
------------------------------------------------------------------------
By fiscal year, in millions of
dollars--
-----------------------------------
2008 2009 2010 2011 2012
------------------------------------------------------------------------
Offsetting Collections:
Estimated Authorization Level... 0 0 0 0 0
Estimated Outlays............... -58 -9 57 3 1
Help for Very-Low Income Veterans:
Authorization Level............. 25 25 25 25 25
Estimated Outlays............... 23 25 25 25 25
Dental Benefits for Homeless
Veterans:
Estimated Authorization Level... 7 7 7 7 8
Estimated Outlays............... 6 7 7 7 8
Transportation Grants:
Authorization Level............. 3 3 3 3 3
Estimated Outlays............... 3 3 3 3 3
Veterans Released from Prison:
Estimated Authorization Level... 4 4 4 4 0
Estimated Outlays............... 1 3 4 4 3
Therapeutic Readjustment Grants:
Authorization Level............. 2 2 2 2 0
Estimated Outlays............... 2 2 2 2 0
Chemical and Biological Testing
Participants:
Estimated Authorization Level... 1 2 2 2 2
Estimated Outlays............... 1 2 2 2 2
Total Changes:a
Estimated Authorization 42 43 43 43 38
Level......................
Estimated Outlays........... -22 33 100 46 42
------------------------------------------------------------------------
aThis table does not include the cost of implementing section 6 of H.R.
2874, which CBO cannot estimate at this time.
Subject to annual appropriation action, VA can spend the
money in the MCCF to provide medical care for veterans. CBO
estimates that implementing section 5 would increase
discretionary spending on medical care for veterans by $523
million in 2008 and $1.1 billion over the 2008-2012 period,
assuming appropriation of the collected amounts. Because CBO
assumes that VA will spend the collections, the estimated
budget authority for collections and spending offset each other
exactly, while the outlays lag behind spending. This results in
outlay savings in the first two years and costs in later years.
Therefore, CBO estimates that the net budgetary impact of
implementing H.R. 2874 would be a reduction in discretionary
outlays of $58 million in 2008 and $6 million over the 2008-
2012 period.
Help for very-low income veterans
Section 9 would authorize the appropriation of $25 million
a year to provide financial assistance to qualified nonprofit
organizations and consumer cooperatives that provide supportive
services to very-low income veterans who live in permanent
housing, with preference given to those entities that help
veterans make a transition from homelessness to permanent
housing. Very-low income veterans would be defined as those
having an income that is less than half of the median income
for the area in which the veteran lives. The authorized funding
would support a wide array of services, including outreach,
health care, counseling, transportation, assistance with daily
living, and assistance in obtaining veterans benefits and other
public benefits, among others. CBO estimates that implementing
this section would cost $23 million in 2008 and $123 million
over the 2008-2012 period.
Dental benefits for homeless veterans
Section 10 would expand a benefit program that provides
dental care to certain veterans. Under current law, veterans
who have received 60 consecutive days of care through a VA
program that provides rehabilitation and treatment for homeless
veterans may receive dental care to alleviate pain, as part of
treatment for a more severe periodontal disease, or to aid in
getting a job. Section 10 would decrease the required number of
days of care to 30, allowing homeless veterans who are
receiving shorter-term treatment, such as for substance abuse,
to receive the dental benefit.
In late 2006, VA implemented a Homeless Veterans Dental
Initiative to address the concern that homeless veterans were
not able to get appointments for dental care because priority
is given to veterans returning from overseas deployments. In
2008, VA plans to use $10 million for this purpose. VA reports
that, to date, about 4,500 veterans have received treatment
under this program and that an additional 2,500 veterans would
be eligible for the benefit under H.R. 2874. At an average cost
of about $2,500 per veteran in 2007, and adjusting for medical
inflation, CBO estimates that implementing this provision would
increase the cost of this program by $6 million in 2008 and $35
million over the 2008-2012 period.
Transportation grants
Section 3 would authorize the appropriation of $3 million
each year from 2008 through 2012 to provide grants to
organizations that would assist veterans in rural areas to
travel to VA medical facilities. Eligible entities would
include state veterans agencies and nonprofit organizations.
CBO estimates that implementing this section would cost $3
million in 2008 and $15 million over the 2008-2012 period.
Veterans released from prison
VA is currently working with the Department of Labor (DOL)
on a demonstration program to provide counseling and referrals
to veterans leaving penal institutions who are at risk of
becoming homeless. VA hires case managers to oversee the
program while DOL administers the grants to nonprofit
organizations that provide the counseling and referrals. Under
current law, the program is being conducted at six sites and
will expire on September 30, 2007. Section 7 would double the
number of program sites and extend the authority through fiscal
year 2011. CBO estimates that, in total, implementing this
provision would cost about $1 million in 2008 and $15 million
over the 2008-2011 period.
Based on information from VA that six case managers would
be needed to oversee the 12 sites at an average cost of $80,000
per person, CBO estimates that such additional staff would cost
VA less than $500,000 in 2008 and $2 million over the 2008-2011
period.
Under this program, DOL issued grants totaling over $1.6
million in 2007 through nonprofit organizations to provide
counseling and referral services to almost 1,000 veterans
leaving penal institutions. CBO estimates that increasing the
size of the program would increase costs for such grants by
less than $500,000 in 2008 and by $13 million over the 2008-
2011 period.
Therapeutic readjustment grants
Section 2 would authorize the appropriation of $2 million
in each year from 2008 through 2011 to be given as grants to
nonprofit organizations that would provide therapeutic
readjustment and rehabilitation programs to veterans who served
in areas of combat after November 11, 1998. All grantees must
show that their programs assist in the readjustment and
rehabilitation of participants. CBO estimates that implementing
this section would cost $2 million in 2008 and $8 million over
the 2008-2011 period.
Chemical and biological testing participants
From 1962 to 1973, the Department of Defense conducted
certain tests to determine the vulnerability of personnel,
buildings, and ships to various biological and chemical
threats. Veterans who were exposed to agents used in those
tests are eligible to receive free health care from VA, though
copayments are required for treatment for diseases or injuries
that are obviously not related to military service. The
authority to provide this benefit expires on December 31, 2007.
Section 4 would make this authority permanent.
Based on data provided by VA that about 300 such veterans
are receiving health care from the agency at an average cost of
$5,800 in 2007, CBO estimates that implementing this section
would cost $1 million in 2008 and $9 million over the 2008-2012
period.
Mental health care and readjustment counseling
Section 6 would require VA to implement a new program to
provide readjustment counseling and mental health care to
veterans who have served in combat operations since November
11, 1998, and left active-duty service after September 11,
2001. The program would include peer outreach and support
services. In areas of the country where the Secretary
determines there is inadequate coverage by VA medical
facilities, the department would be required to contract with
community mental health centers to provide these services. VA
would be required to provide training to clinicians in those
centers to ensure that the services provided are appropriate
for veterans of Operation Iraqi Freedom and Operation Enduring
Freedom. In addition, VA would be required to contract with
nonprofit organizations to train combat veterans to provide
peer outreach and support services.
VA has not yet determined how it would implement the
requirements of this section. According to VA, it currently has
over 200 contracts with private-sector agencies to provide
readjustment counseling to veterans, primarily in rural areas.
However, other than ensuring that the agency is qualified to
provide counseling, VA does not provide additional assistance
to ensure that the services provided are appropriate for
veterans who served in Iraq and Afghanistan. VA conducts
training programs for veterans to provide peer outreach, but it
does this with its own resources and not through contracts with
nonprofit organizations. Because VA is not yet able to specify
how its current programs would change under the requirements of
this provision, CBO cannot estimate the costs of implementing
section 6. Depending on how VA decides to implement those
requirements, costs could range from a negligible amount to
several million dollars a year.
Intergovernmental and private-sector impact: H.R. 2874
contains no intergovernmental or private-sector mandates as
defined in URMA. Programs authorized in the bill would benefit
state, local, and tribal governments that provide
transportation or housing assistance to veterans. Any costs
they might incur to comply with reporting requirements of the
programs would be incurred voluntarily.
Estimate prepared by: Federal Costs: Michelle S. Patterson;
Impact on State, Local, and Tribal Governments: Lisa Ramirez-
Branum; Impact on the Private Sector: Victoria Liu.
Estimate approved by: Peter H. Fontaine, Deputy Assistant
Director for Budget Analysis.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italic, existing law in which no change is
proposed is shown in roman):
TITLE 38, UNITED STATES CODE
PART I--GENERAL PROVISIONS
* * * * * * *
CHAPTER 5--AUTHORITY AND DUTIES OF THE SECRETARY
Sec.
SUBCHAPTER I--GENERAL AUTHORITIES
501. Rules and regulations.
* * * * * * *
SUBCHAPTER II--SPECIFIED FUNCTIONS
521. Assistance to certain rehabilitation activities.
521A. Assistance to therapeutic readjustment programs.
* * * * * * *
SUBCHAPTER II--SPECIFIED FUNCTIONS
* * * * * * *
Sec. 521A. Assistance to therapeutic readjustment programs
(a) Grant Program.--The Secretary of Veterans Affairs may
make grants to qualified entities described in subsection (b)
to conduct workshop programs that have been shown to assist in
the therapeutic readjustment and rehabilitation of participants
to assist in the therapeutic readjustment of covered veterans.
(b) Qualified Entities.--In order to qualify for grant
assistance under subsection (a), a private nonprofit entity
must have, as determined by the Secretary, experience and
expertise in offering programs to assist in the therapeutic
readjustment of participants and that such programs will likely
assist covered veterans.
(c) Amount of Grant; Use of Funds.--A grant under this
section shall not exceed $100,000 for any calendar year and
shall be used by the recipient exclusively for the benefit of
covered veterans.
(d) Application.--An application for a grant under this
section shall include details regarding the extent and nature
of the proposed program, the therapeutic readjustment and
rehabilitation benefits expected to be achieved by
participants, and any other information the Secretary
determines may be necessary to assist the Secretary in ensuring
that covered veterans receive therapeutic readjustment and
rehabilitation benefits.
(e) Covered Veterans.--For the purposes of this subsection, a
``covered veteran'' is a veteran who served on active duty in a
theater of combat operations (as determined by the Secretary in
consultation with the Secretary of Defense) during a period of
war after the Persian Gulf War, or in combat against a hostile
force during a period of hostilities (as defined in section
1712A(a)(2)(B) of this title) after November 11, 1998, and who
is discharged or released from active military, naval, or air
service on or after September 11, 2001.
(f) Reports.--Not later than 60 days after the last day of a
fiscal year, the Secretary shall submit to the Committees on
Veterans' Affairs of the Senate and House of Representatives a
report detailing the number and amount of grants made under
this section during the previous fiscal year, the total number
of covered veterans participating in workshop programs funded
by such grants, a description of the programs, and the
therapeutic benefits to covered veterans of participation in
the various programs funded.
(g) Authorization of Appropriations.--There is authorized to
be appropriated for each of fiscal years 2008 through 2011
$2,000,000 to carry out this section.
(h) Termination.--The authority of the Secretary to make a
grant under subsection (a) shall terminate on September 30,
2011.
* * * * * * *
PART II--GENERAL BENEFITS
* * * * * * *
CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE
Sec.
SUBCHAPTER I--GENERAL
1701. Definitions.
* * * * * * *
1709. Grants for provision of transportation to Department medical
facilities for veterans in remote rural areas.
SUBCHAPTER II--HOSPITAL, NURSING HOME, OR DOMICILIARY CARE AND MEDICAL
TREATMENT
1710. Eligibility for hospital, nursing home, and domiciliary care.
* * * * * * *
1712C. Provision of readjustment counseling and mental health services
for covered veterans.
* * * * * * *
SUBCHAPTER I--GENERAL
* * * * * * *
Sec. 1708. Temporary lodging
(a) * * *
* * * * * * *
(d) The Secretary may establish charges for providing lodging
under this section. The proceeds from such charges shall be
credited to the [medical care account] medical services account
and shall be available until expended for the purposes of
providing such lodging.
* * * * * * *
Sec. 1709. Grants for provision of transportation to Department medical
facilities for veterans in remote rural areas
(a) Grants Authorized.--(1) The Secretary shall establish a
grant program to provide innovative transportation options to
veterans in remote rural areas.
(2) Grants awarded under this section may be used by State
veterans' service agencies, veterans service organizations, and
private nonprofit entities to assist veterans in remote rural
areas to travel to Department medical facilities.
(3) The amount of a grant under this section may not exceed
$50,000.
(4) The recipient of a grant under this section shall not be
required to provide matching funds as a condition for receiving
such grant.
(b) Regulations.--The Secretary shall prescribe regulations
for--
(1) evaluating grant applications under this section;
and
(2) otherwise administering the program established
by this section.
(c) Authorization of Appropriations.--There is authorized to
be appropriated $3,000,000 for each of fiscal years 2008
through 2012 to carry out this section.
SUBCHAPTER II--HOSPITAL, NURSING HOME, OR DOMICILIARY CARE AND MEDICAL
TREATMENT
Sec. 1710. Eligibility for hospital, nursing home, and domiciliary care
(a) * * *
* * * * * * *
(e)(1) * * *
* * * * * * *
(3) Hospital care, medical services, and nursing home care
may not be provided under or by virtue of subsection
(a)(2)(F)--
(A) * * *
(B) in the case of care for a veteran
described in paragraph (1)(C), after December
31, 2002; and
(C) in the case of care for a veteran
described in paragraph (1)(D), after a period
of 2 years beginning on the date of the
veteran's discharge or release from active
military, naval, or air service[; and].
[(D) in the case of care for a veteran
described in paragraph (1)(E), after December
31, 2007.]
* * * * * * *
(f)(1) * * *
(2) A veteran who is furnished hospital care or nursing home
care under this section and who is required under paragraph (1)
of this subsection to agree to pay an amount to the United
States in order to be furnished such care shall be liable to
the United States for an amount equal to--
(A) * * *
(B) before September 30, [2007] 2009, an
amount equal to $10 for every day the veteran
receives hospital care and $5 for every day the
veteran receives nursing home care.
* * * * * * *
Sec. 1712A. Eligibility for readjustment counseling and related mental
health services
(a) * * *
* * * * * * *
[(d)] (c) The Under Secretary for Health may provide for such
training of professional, paraprofessional, and lay personnel
as is necessary to carry out this section effectively, and, in
carrying out this section, may utilize the services of
paraprofessionals, individuals who are volunteers working
without compensation, and individuals who are veteran-students
(as described in section 3485 of this title) in initial intake
and screening activities.
[(e)] (d)(1) * * *
* * * * * * *
[(f)] (e) The Secretary, in cooperation with the Secretary of
Defense, shall take such action as the Secretary considers
appropriate to notify veterans who may be eligible for
assistance under this section of such potential eligibility.
[(g)(1)(A) Except as provided in subparagraph (C) of this
paragraph, the Secretary may close or relocate a center in
existence on January 1, 1988, only as described in the national
plan required by paragraph (3) of this subsection (or in a
revision to such plan under paragraph (4) of this subsection in
which the closure or relocation of that center is proposed).
[(B) A closure or relocation of a center which is proposed in
such national plan may be carried out only after the end of the
120-day period beginning on the date on which the national plan
is submitted. A closure or relocation of a center not proposed
in such plan may be carried out only after the end of the 60-
day period beginning on the date the Secretary submits a
revision to such plan in which the closure or relocation of
that center is proposed.
[(C) The Secretary may relocate a center in existence on
January 1, 1988, without regard to the national plan (including
any revision to such plan) if such relocation is to a new
location away from a Department general health-care facility
when such relocation is necessitated by circumstances beyond
the control of the Department. Such a relocation may be carried
out only after the end of the 30-day period beginning on the
date on which the Secretary notifies the Committees on
Veterans' Affairs of the Senate and the House of
Representatives of the proposed relocation, of the
circumstances making it necessary, and of the reason for the
selection of the new site for the center.
[(2)(A) Not later than April 1, 1988, the Secretary shall
submit to the Committees on Veterans' Affairs of the Senate and
House of Representatives a report on the Secretary's evaluation
of the effectiveness in helping to meet the readjustment needs
of veterans who served on active duty during the Vietnam era of
the readjustment counseling and mental health services provided
pursuant to this section (and of outreach efforts with respect
to such counseling and services). Such report shall give
particular attention, in light of the results of the study
required by section 102 of the Veterans' Health Care Amendments
of 1983 (Public Law 98-160), to the provision of such
counseling and services to veterans with post-traumatic stress
disorder and to the diagnosis and treatment of such disorder.
[(B) The report required by subparagraph (A) of this
paragraph shall include--
[(i) the opinion of the Secretary with
respect to (I) the extent to which the
readjustment needs of veterans who served on
active duty during the Vietnam era remain
unmet, and (II) the extent to which the
provision of readjustment counseling services
under this section in centers is needed to meet
such needs; and
[(ii) in light of the opinion submitted
pursuant to clause (i) of this subparagraph,
such recommendations for amendments to this
subsection and for other legislative and
administrative action as the Secretary
considers appropriate.
[(3)(A) The Secretary, after considering the recommendations
of the Under Secretary for Health, shall submit to such
committees a report setting forth a national plan for all
centers in existence on January 1, 1988. Such national plan
shall set forth the Secretary's proposals as to each such
center for a period (to be determined by the Secretary) of not
less than 12 months beginning on the date of the submission of
the report. The plan shall include, as to each center, whether
the Secretary proposes to relocate the center to a general
Department facility, relocate the center to a new location away
from a general Department facility, expand the center in the
same location, or close the center. The plan shall also set
forth any proposal of the Secretary to open additional centers.
[(B) The plan shall include the Secretary's evaluation as to
how, in light of each of the criteria described in subparagraph
(C) of this paragraph, the proposal set forth in the plan for
each center covered by the plan would ensure the continued
availability and effective furnishing of readjustment
counseling services to eligible veterans needing such services
in the geographic area served by that center.
[(C) The Secretary shall make the evaluation described in
subparagraph (B) of this paragraph with respect to any center
in light of the following:
[(i) The distribution of Vietnam-era veterans
in the geographic area served by the center and
the relationships between the location of such
center and the general Department facility and
such distribution.
[(ii) The distance between the center and the
general Department facility.
[(iii) The availability of other entities
(such as State, local, or private outreach
facilities) which provide assistance to
Vietnam-era veterans in the area served by the
center.
[(iv) The availability of transportation to,
and parking at, the center and the general
Department facility.
[(v) The availability, cost, and suitability
of the space at the general Department
facility.
[(vi) The overall cost impact of the proposed
closure or relocation, including a comparison
of the recurring nonpersonnel costs of
providing readjustment counseling to the same
estimated number of veterans at the center and
the general Department facility.
[(vii) The workload trends over the two
previous fiscal years, and projected over the
next fiscal year (or longer), at the center.
[(viii) Such other factors as the Secretary
determines to be relevant to making the
evaluation described in subparagraph (B) of
this paragraph.
[(D) For the purposes of this paragraph, the term ``general
Department facility'' means a Department facility which is not
a center and at which readjustment counseling would be
furnished in a particular geographic area upon the closure or
relocation of a center.
[(4) After submitting the plan required by paragraph (3) of
this subsection, the Secretary may submit to the committees a
revision to such plan in order to modify the proposal set forth
in the plan as to any center. Any such revision shall include,
with respect to each center addressed in the revision, a
description of the Secretary's evaluation of the matters
specified in paragraphs (3)(B) and (3)(C) of this subsection.
[(5) For purposes of determining a period of time under
paragraph (1)(B) of this subsection, if the national plan (or a
revision to the national plan) is submitted to the committees
during the 121-day period beginning 60 days before and ending
60 days after the final day of a session of the Congress, it
shall be deemed to have been submitted on the sixty-first day
after the final day of such session.]
[(i)] (f) For the purposes of this section:
(1) The term ``center'' means a facility [(including
a Resource Center designated under subsection (h)(3)(A)
of this section)] which is operated by the Department
for the provision of services under this section and
which (A) is situated apart from Department general
health-care facilities, or (B) was so situated but has
been relocated to a Department general health-care
facility.
* * * * * * *
Sec. 1712C. Provision of readjustment counseling and mental health
services for covered veterans
(a) Program Required.--The Secretary shall carry out a
program to provide peer outreach services, peer support
services, and readjustment and mental health services to
covered veterans.
(b) Contracts with Community Mental Health Centers.--In
carrying out the program required by subsection (a), the
Secretary shall contract with community mental health centers
and other qualified entities to provide the services referred
to in that paragraph in areas the Secretary determines are not
adequately served by health care facilities of the Department.
Such contracts shall require each community health center or
other entity--
(1) to the extent practicable, to employ covered
veterans trained under subsection (c);
(2) to the extent practicable, to use telehealth
services for the provision of such services;
(3) to participate in the training program under
subsection (d);
(4) to comply with applicable protocols of the
Department before incurring any liability on behalf of
the Department for the provision of such the services;
(5) to submit annual reports to the Secretary
containing, with respect to the program required by
subsection (a) and for the last full calendar year
ending before the submission of such report--
(A) the number of veterans served, veterans
diagnosed, and courses of treatment provided to
veterans as part of the program required by
subsection (a); and
(B) demographic information for such
services, diagnoses, and courses of treatment;
(6) to provide to the Secretary such clinical summary
information as the Secretary may require for each
veteran for whom the center or entity provides mental
health services under the contract; and
(7) to meet such other requirements as the Secretary
may require.
(c) Training Program for Veterans.--In carrying out the
program required by subsection (a), the Secretary shall
contract with a nonprofit mental health organization to carry
out a program to train covered veterans to provide peer
outreach and peer support services.
(d) Training Program for Clinicians.--The Secretary shall
conduct a training program for clinicians of community mental
health centers or other entities that have entered into
contracts with the Secretary under subsection (b) to ensure
that such clinicians are able to provide the services required
by subsection (a) in a manner that--
(1) recognizes factors that are unique to the
experience of veterans who served on active duty in
Operation Iraqi Freedom or Operation Enduring Freedom
(including the combat and military training experiences
of such veterans); and
(2) utilizes best practices and technologies.
(e) Covered Veterans.--For the purposes of this subsection, a
``covered veteran'' is a veteran who served on active duty in a
theater of combat operations (as determined by the Secretary in
consultation with the Secretary of Defense) during a period of
war after the Persian Gulf War, or in combat against a hostile
force during a period of hostilities (as defined in
section1712A(a)(2)(B) of this title) after November 11, 1998,
and who is discharged or released from active military, naval,
or air service on or after September 11, 2001.
* * * * * * *
SUBCHAPTER III--MISCELLANEOUS PROVISIONS RELATING TO HOSPITAL AND
NURSING HOME CARE AND MEDICAL TREATMENT OF VETERANS
* * * * * * *
Sec. 1729. Recovery by the United States of the cost of certain care
and services
(a)(1) * * *
(2) Paragraph (1) of this subsection applies to a non-
service-connected disability--
(A) * * *
* * * * * * *
(E) for which care and services are furnished before
October 1, [2007] 2009, under this chapter to a veteran
who--
(i) * * *
* * * * * * *
CHAPTER 20--BENEFITS FOR HOMELESS VETERANS
SUBCHAPTER I--PURPOSE; DEFINITIONS; ADMINISTRATIVE MATTERS
Sec.
2001. Purpose.
* * * * * * *
SUBCHAPTER III--TRAINING AND OUTREACH
* * * * * * *
2023. Referral and counseling services: veterans at risk of
homelessness who are transitioning from certain institutions.
* * * * * * *
SUBCHAPTER V--HOUSING ASSISTANCE
* * * * * * *
2044. Financial assistance for supportive services for very low-income
veteran families residing in permanent housing.
* * * * * * *
SUBCHAPTER III--TRAINING AND OUTREACH
* * * * * * *
Sec. 2022. Coordination of outreach services for veterans at risk of
homelessness
(a) * * *
* * * * * * *
(f) Reports.--(1) * * *
(2) Not later than December 31, 2005, the Secretary shall
submit to the committees referred to in paragraph (1) an
interim report on outreach activities carried out by the
Secretary with respect to homeless veterans. The report shall
include the following:
(A) * * *
* * * * * * *
(C) A description of the implementation and
operation of the [demonstration] program under
section 2023 of this title.
* * * * * * *
[Sec. 2023. Demonstration program of referral and counseling for
veterans transitioning from certain institutions
who are at risk for homelessness]
Sec. 2023. Referral and counseling services: veterans at risk of
homelessness who are transitioning from certain
institutions
(a) Program Authority.--The Secretary and the Secretary of
Labor (hereinafter in this section referred to as the
``Secretaries'') shall carry out [a demonstration program for
the purpose of determining the costs and benefits of providing]
a program to provide referral and counseling services to
eligible veterans with respect to benefits and services
available to such veterans under this title and under State
law.
(b) Location of [Demonstration] Program.--The [demonstration]
program shall be carried out [in at least six locations] in at
least 12 locations. One location shall be a penal institution
under the jurisdiction of the Bureau of Prisons.
(c) Scope of Program.--(1) To the extent practicable, the
[demonstration] program shall provide both referral and
counseling services, and in the case of counseling services,
shall include counseling with respect to job training and
placement (including job readiness), housing, health care, and
other benefits to assist the eligible veteran in the transition
from institutional living.
* * * * * * *
(d) Duration.--The authority of the Secretaries to provide
referral and counseling services under the demonstration
program [shall cease on September 30, 2007.] shall cease on
September 30, 2011.
* * * * * * *
SUBCHAPTER V--HOUSING ASSISTANCE
* * * * * * *
Sec. 2043. Domiciliary care programs
(a) * * *
[(b) Authorization of Appropriations.--There are authorized
to be appropriated to the Secretary $5,000,000 for each of
fiscal years 2003 and 2004 to establish the programs referred
to in subsection (a).]
(b) Enhancement of Capacity of Domiciliary Care Programs for
Female Veterans.--The Secretary shall take appropriate actions
to ensure that the domiciliary care programs of the Department
are adequate, with respect to capacity and safety, to meet the
needs of veterans who are women.
Sec. 2044. Financial assistance for supportive services for very low-
income veteran families residing in permanent
housing
(a) Distribution of Financial Assistance.--
(1) The Secretary shall provide financial assistance
to eligible entities approved under this section to
provide and coordinate the provision of the supportive
services for very low-income veteran families residing
in permanent housing.
(2)(A) Financial assistance under this section shall
consist of payments for each such family for which an
approved eligible entity provides or coordinates the
provision of supportive services.
(B) The Secretary shall establish a formula for
determining the rate of payments provided to a very
low-income veteran family receiving supportive services
under this section. The rate shall be adjusted not less
than once annually to reflect changes in the cost of
living. In calculating the payment formula under this
subparagraph, the Secretary may consider geographic
cost of living variances, family size, and the cost of
services provided.
(3) In providing financial assistance under paragraph
(1), the Secretary shall give preference to an entity
that provides or coordinates the provision of
supportive services for very low-income veteran
families who are transitioning from homelessness to
permanent housing.
(4) The Secretary shall ensure that, to the extent
practicable, financial assistance under this subsection
is equitably distributed across geographic regions,
including rural communities and tribal lands.
(5) Each entity receiving financial assistance under
this section to provide supportive services to a very
low-income veteran family shall notify the family that
such services are being paid for, in whole or in part,
by the Department.
(6) The Secretary may require an entity receiving
financial assistance under this section to submit a
report to the Secretary describing the supportive
services provided with such financial assistance.
(b) Application for Financial Assistance.--
(1) An eligible entity seeking financial assistance
under subsection (a) shall submit to the Secretary an
application in such form, in such manner, and
containing such commitments and information as the
Secretary determines to be necessary.
(2) An application submitted under paragraph (1)
shall contain--
(A) a description of the supportive services
proposed to be provided by the eligible entity;
(B) a description of the types of very low-
income veteran families proposed to be provided
such services;
(C) an estimate of the number of very low-
income veteran families proposed to be provided
such services;
(D) evidence of the experience of the
eligible entity in providing supportive
services to very low-income veteran families;
and
(E) a description of the managerial capacity
of the eligible entity to--
(i) coordinate the provision of
supportive services with the provision
of permanent housing, by the eligible
entity or by other organizations;
(ii) continuously assess the needs of
very low-income veteran families for
supportive services;
(iii) coordinate the provision of
supportive services with the services
of the Department;
(iv) tailor supportive services to
the needs of very low-income veteran
families; and
(v) continuously seek new sources of
assistance to ensure the long-term
provision of supportive services to
very low-income veteran families.
(3) The Secretary shall establish criteria for the
selection of eligible entities to receive financial
assistance under this section.
(c) Technical Assistance.--
(1) The Secretary shall provide training and
technical assistance to eligible entities that receive
financial assistance under this section with respect to
the planning, development, and provision of supportive
services to very low-income veteran families occupying
permanent housing.
(2) The Secretary may provide the training described
in paragraph (1) directly or through grants or
contracts with appropriate public or nonprofit private
entities.
(d) Authorization of Appropriations.--There is authorized to
be appropriated, for each fiscal year, $25,000,000, to carry
out this section, of which not more than $750,000 for each
fiscal year may be used to provide technical assistance under
subsection (c).
(e) Definitions.--For the purposes of this section:
(1) The term ``very low-income veteran family'' means
a veteran family whose income does not exceed 50
percent of the median income for the area, as
determined by the Secretary in accordance with this
paragraph, except that--
(A) the Secretary shall make appropriate
adjustments to the income requirement under
subparagraph (A) based on family size; and
(B) the Secretary may establish an income
ceiling higher or lower than 50 percent of the
median income for an area if the Secretary
determines that such variations are necessary
because the area has unusually high or low
construction costs, fair market rents (as
determined under section 8 of the United States
Housing Act of 1937 (42 U.S.C. 1437f)), or
family incomes.
(C) the Secretary shall establish criteria
for determining the need for specific
supportive services (as defined by paragraph
(8)) of individual very low income veteran
families occupying permanent housing.
(2) The term ``veteran family'' includes a veteran
who is a single person and a family in which the head
of household or the spouse of the head of household is
a veteran.
(3) The term ``consumer cooperative'' has the meaning
given such term in section 202 of the Housing Act of
1959 (12 U.S.C. 1701q).
(4) The term ``eligible entity'' means--
(A) a private nonprofit organization; or
(B) a consumer cooperative.
(5) The term ``homeless'' has the meaning given the
term in section 103 of the McKinney-Vento Homeless
Assistance Act (42 U.S.C. 11302).
(6) The term ``permanent housing'' means community-
based housing without a designated length of stay.
(7) The term ``private nonprofit organization''
means--
(A) any incorporated private institution or
foundation--
(i) no part of the net earnings of
which inures to the benefit of any
member, founder, contributor, or
individual;
(ii) which has a governing board that
is responsible for the operation of the
supportive services provided under this
section; and
(iii) which is approved by the
Secretary as to financial
responsibility;
(B) a for-profit limited partnership, the
sole general partner of which is an
organization meeting the requirements of
clauses (i), (ii), and (iii) of subparagraph
(A);
(C) a corporation wholly owned and controlled
by an organization meeting the requirements of
clauses (i), (ii), and (iii) of subparagraph
(A); and
(D) a tribally designated housing entity (as
defined in section 4 of the Native American
Housing Assistance and Self-Determination Act
of 1996 (25 U.S.C. 4103)).
(8) The term ``supportive services'' means the
following:
(A) Services provided by an eligible entity
or subcontractors that address the needs of
very low-income veteran families occupying
permanent housing, including--
(i) outreach services;
(ii) health care services, including
diagnosis, treatment, and counseling
for mental health and substance abuse
disorders and for post-traumatic stress
disorder, if such services are not
readily available through the
Department of Veterans Affairs medical
center serving the geographic area in
which the veteran family is housed;
(iii) habilitation and rehabilitation
services;
(iv) case management services;
(v) daily living services;
(vi) personal financial planning;
(vii) transportation services;
(viii) vocational counseling;
(ix) employment and training;
(x) educational services;
(xi) assistance in obtaining veterans
benefits and other public benefits,
including health care provided by the
Department;
(xii) assistance in obtaining income
support;
(xiii) assistance in obtaining health
insurance;
(xiv) fiduciary and representative
payee services;
(xv) legal services to assist the
veteran family with reconsiderations or
appeals of veterans and public benefit
claim denials and to resolve
outstanding warrants that interfere
with the family's ability to obtain or
retain housing or supportive services;
(xvi) child care;
(xvii) housing counseling;
(xviii) other services necessary for
maintaining independent living; and
(xix) coordination of services
described in this paragraph.
(B) Services provided by an eligible entity
or subcontractors, including services described
in clauses (i) through (xix) of subparagraph
(A), that are delivered to very low-income
veteran families who are homeless and who are
scheduled to become residents of permanent
housing within 90 days of the date on which the
service is provided pending the location or
development of housing suitable for permanent
housing.
(C) Services provided by an eligible entity
or subcontractors, including services described
in clauses (i) through (xix) of subparagraph
(A), for very low-income veteran families who
have voluntarily chosen to seek other housing
after a period of tenancy in permanent housing,
that are provided, for a period of 90 days
beginning on the date on which such a family
exits permanent housing or until such a family
commences receipt of other housing services
adequate to meet the needs of the family, but
only to the extent that services under this
paragraph are designed to support such a family
in the choice to transition into housing that
is responsive to the individual needs and
preferences of the family.
* * * * * * *
SUBCHAPTER VII--OTHER PROVISIONS
* * * * * * *
Sec. 2062. Dental care
(a) * * *
(b) Eligible Veterans.--Subsection (a) applies to a veteran--
(1) who is enrolled for care under section 1705(a) of
this title; and
(2) who, for a period of [60 consecutive days] 30
consecutive days, is receiving care (directly or by
contract) in any of the following settings:
(A) * * *
* * * * * * *
(3) For purposes of paragraph (2), in determining
whether a veteran has received treatment for a period
of [60 consecutive days] 30 consecutive days, the
Secretary may disregard breaks in the continuity of
treatment for which the veteran is not responsible.
* * * * * * *
Sec. 2065. Annual report on assistance to homeless veterans
(a) * * *
(b) General Contents of Report.--Each report under subsection
(a) shall include the following:
(1) * * *
* * * * * * *
(3) The Secretary's evaluation of the effectiveness
of the programs of the Department in providing
assistance to homeless veterans, including--
(A) * * *
* * * * * * *
(C) contract care programs for alcohol and
drug-dependence or use disabilities[)].
* * * * * * *
PART III--READJUSTMENT AND RELATED BENEFITS
* * * * * * *
CHAPTER 36--ADMINISTRATION OF EDUCATIONAL BENEFITS
SUBCHAPTER I--STATE APPROVING AGENCIES
Sec.
3670. Scope of approval.
* * * * * * *
SUBCHAPTER II--MISCELLANEOUS PROVISIONS
* * * * * * *
[3684A. Procedures relating to computer matching programs.]
3684A. Procedures relating to computer matching program.
* * * * * * *
SUBCHAPTER II--MISCELLANEOUS PROVISIONS
* * * * * * *
Sec. 3684. Reports by veterans, eligible persons, and institutions;
reporting fee
(a)(1) Except as provided in paragraph (2) of this
subsection, the veteran or eligible person and the educational
institution offering a course in which such veteran or eligible
person is enrolled under chapter 31, [34,,] 34, 35, or 36 of
this title shall, without delay, report to the Secretary, in
the form prescribed by the Secretary, such enrollment and any
interruption or termination of the education of each such
veteran or eligible person. The date of such interruption or
termination will be the last date of pursuit, or, in the case
of correspondence training, the last date a lesson was serviced
by a school.
* * * * * * *
CHAPTER 41--JOB COUNSELING, TRAINING, AND PLACEMENT SERVICE FOR
VETERANS
* * * * * * *
Sec. 4110. Advisory Committee on Veterans Employment, Training, and
Employer Outreach
(a) * * *
* * * * * * *
(c)(1) The Secretary of Labor shall appoint at least 12, but
no more than [15] 16, individuals to serve as members of the
advisory committee as follows:
(A) * * *
* * * * * * *
PART IV--GENERAL ADMINISTRATIVE PROVISIONS
* * * * * * *
CHAPTER 51--CLAIMS, EFFECTIVE DATES, AND PAYMENTS
SUBCHAPTER I--CLAIMS
Sec.
5100. Definition of ``claimant''.
* * * * * * *
[5121. Payment of certain accrued benefits upon death of beneficiary.]
5121. Payment of certain accrued benefits upon death of a beneficiary.
* * * * * * *
PART V--BOARDS, ADMINISTRATIONS, AND SERVICES
* * * * * * *
CHAPTER 73--VETERANS HEALTH ADMINISTRATION-ORGANIZATION AND FUNCTIONS
* * * * * * *
SUBCHAPTER II--GENERAL AUTHORITY AND ADMINISTRATION
* * * * * * *
Sec. 7314. Geriatric research, education, and clinical centers
(a) * * *
* * * * * * *
(f) There are authorized to be appropriated such sums as may
be necessary for the support of the research and education
activities of the centers established pursuant to subsection
(a). The Under Secretary for Health shall allocate to such
centers from other funds appropriated generally for the
Department [medical care account] medical services account and
medical and prosthetics research account, as appropriate, such
amounts as the Under Secretary for Health determines
appropriate.
* * * * * * *
Sec. 7320. Centers for mental illness research, education, and clinical
activities
(a) * * *
* * * * * * *
(j)(1) * * *
(2) In addition to funds appropriated for a fiscal year
pursuant to the authorization of appropriations in paragraph
(1), the Under Secretary for Health shall allocate to such
centers from other funds appropriated for that fiscal year
generally for the Department of Veterans Affairs [medical care
account] medical services account and the Department of
Veterans Affairs medical and prosthetics research account such
amounts as the Under Secretary for Health determines
appropriate to carry out the purposes of this section.
* * * * * * *
Sec. 7325. Medical emergency preparedness centers
(a) * * *
* * * * * * *
(i) Funding.--(1) * * *
(2) In addition to funds appropriated for a fiscal year
specifically for the activities of the centers pursuant to
paragraph (1), the Under Secretary for Health shall allocate to
such centers from other funds appropriated for that fiscal year
generally for the Department [medical care account] medical
services account and the Department medical and prosthetics
research account such amounts as the Under Secretary determines
appropriate to carry out the purposes of this section. Any
determination by the Under Secretary under the preceding
sentence shall be made in consultation with the Assistant
Secretary with responsibility for operations, preparedness,
security, and law enforcement functions.
* * * * * * *
Sec. 7328. Medical preparedness centers
(a) * * *
* * * * * * *
(i) Funding.--(1) * * *
(2) In addition to any amounts appropriated for a fiscal year
specifically for the activities of the centers pursuant to
paragraph (1), the Under Secretary for Health shall allocate to
the centers from other funds appropriated for that fiscal year
generally for the Department [medical care account] medical
services account and the Department medical and prosthetic
research account such amounts as the Under Secretary determines
necessary in order to carry out the purposes of this section.
* * * * * * *
CHAPTER 74--VETERANS HEALTH ADMINISTRATION - PERSONNEL
* * * * * * *
SUBCHAPTER IV--PAY FOR NURSES AND OTHER HEALTH-CARE PERSONNEL
* * * * * * *
Sec. 7458. Recruitment and retention bonus pay
(a) * * *
(b)(1) * * *
(2) In the case of an agreement for employment on less than a
full-time basis, the amount of bonus pay shall be [pro rated]
pro-rated accordingly.
* * * * * * *
PART VI--ACQUISITION AND DISPOSITION OF PROPERTY
* * * * * * *
CHAPTER 81--ACQUISITION AND OPERATION OF HOSPITAL AND DOMICILIARY
FACILITIES; PROCUREMENT AND SUPPLY; ENHANCED-USE LEASES OF REAL
PROPERTY
SUBCHAPTER I--ACQUISITION AND OPERATION OF MEDICAL FACILITIES
* * * * * * *
Sec. 8117. Emergency preparedness
(a) Readiness of Department Medical Centers.--(1) The
Secretary shall take appropriate actions to provide for the
readiness of Department medical centers to protect the patients
and staff of such centers from a public health emergency (as
defined in section 2801 of the Public Health Service Act) or
otherwise to respond to [such such] such an emergency so as to
enable such centers to fulfill their obligations as part of the
Federal response to such emergencies.
* * * * * * *
