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110th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 2d Session                                                     110-773
======================================================================
 
TO AMEND TITLE 38, UNITED STATES CODE, TO ESTABLISH AN OMBUDSMAN WITHIN 
                   THE DEPARTMENT OF VETERANS AFFAIRS

                                _______
                                

 July 24, 2008.--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. 2192]

      [Including cost estimate of the Congressional Budget Office]

  The Committee on Veterans' Affairs, to whom was referred the 
bill (H.R. 2192) to amend title 38, United States Code, to 
establish an Ombudsman within the Department of Veterans 
Affairs, having considered the same, report favorably thereon 
with an amendment and recommend that the bill as amended do 
pass.

                                CONTENTS

                                                                   Page
Amendment........................................................     2
Purpose and Summary..............................................     3
Background and Need for Legislation..............................     3
Hearings.........................................................     4
Subcommittee Consideration.......................................     4
Committee Consideration..........................................     5
Committee Votes..................................................     5
Committee Oversight Findings.....................................     5
Statement of General Performance Goals and Objectives............     5
New Budget Authority, Entitlement Authority, and Tax Expenditures     5
Earmarks and Tax and Tariff Benefits.............................     5
Committee Cost Estimate..........................................     5
Congressional Budget Office Estimate.............................     6
Federal Mandates Statement.......................................     6
Advisory Committee Statement.....................................     7
Constitutional Authority Statement...............................     7
Applicability to Legislative Branch..............................     7
Section-by-Section Analysis of the Legislation...................     7
Changes in Existing Law Made by the Bill, as Reported............     7

                               Amendment

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

SECTION 1. ESTABLISHMENT OF OFFICE OF THE OMBUDSMAN IN VETERANS HEALTH 
                    ADMINISTRATION.

  (a) Office of the Ombudsman.--
          (1) Establishment.--Subchapter I of chapter 73 of title 38, 
        United States Code, is amended by adding at the end the 
        following new section:

``Sec. 7309. Office of the Ombudsman

  ``(a) Office; Directors.--There is established in the Veterans Health 
Administration an Office of the Ombudsman (in this section referred to 
as the `Office'). The Office shall be headed by a Director appointed by 
the Secretary. The Director shall report directly to the Secretary.
  ``(b) Duties of Office.--The Office shall--
          ``(1) be responsible for ensuring--
                  ``(A) all matters referred to the Office are handled 
                in a confidential manner; and
                  ``(B) any action taken by the Administration with 
                respect to such a matter does not negatively affect the 
                ability of any veteran to receive health care or 
                benefits under a law administered by the Secretary; and
          ``(2) serve as a last resort for complaints and issues that 
        cannot be resolved at a local or regional level in the 
        Administration.
  ``(c) Duties of Director.--The Director shall--
          ``(1) be responsible for overseeing the efforts of patient 
        advocates in the Administration;
          ``(2) develop and make available to local offices of the 
        Administration tools for monitoring the work of such patient 
        advocates and standards to evaluate the work of such patient 
        advocates;
          ``(3) determine trends, in terms of numbers, topics, and 
        facility locations, in patient issues and complaints;
          ``(4) participate in such national quality conferences of the 
        Administration as the Under Secretary for Health may designate;
          ``(5) help coordinate assistance for veterans who need 
        assistance from the Administration in more than one region of 
        the Administration; and
          ``(6) maintain a public Web site with links to contact 
        information for each patient advocate at each medical center of 
        the Department.
  ``(d) Regional Administrators.--The Director shall appoint three 
regional administrators to support facilities of the Administration and 
veterans integrated service networks in their patient advocacy work, to 
identify best practices for patient advocacy work and inform such 
facilities and networks of such best practices, and to receive and 
refer to the board established under subsection (e) appeals from 
veterans in their respective regions who are not satisfied with the 
efforts of their local medical center of the Department and veteran 
integrated service network.
  ``(e) Board.--The Director shall establish a board composed of the 
Director and the three regional administrators appointed under 
subsection (d) to hear appeals referred to the board by a regional 
administrator under subsection (d) and issue a letter explaining the 
board's decision regarding such appeal and outlining possible steps for 
resolving issues raised in such appeal.
  ``(f) Limitation on Statutory Construction.--Nothing in this section 
shall be construed as affecting the authority and responsibility of 
coordinators of patient advocates for severely injured veterans of 
Operation of Enduring Freedom and severely injured veterans of 
Operation Iraqi Freedom.''.
          (2) Clerical amendment.--The table of sections at the 
        beginning of such chapter is amended by inserting after the 
        item relating to section 7308 the following new item:

``7309. Office of the Ombudsman.''.

  (b) Deadline for Designation of Ombudsman.--Not later than 180 days 
after the date of the enactment of this Act, the Secretary of Veterans 
Affairs shall designate an individual to serve as the Ombudsman of the 
Veterans Health Administration under section 7309 of title 38, United 
States Code, as added by subsection (a).

                          Purpose and Summary

    H.R. 2192 was introduced by Representative Paul W. Hodes of 
New Hampshire on May 7, 2007. The purpose of H.R. 2192 is to 
establish an Office of the Ombudsman within the Department of 
Veterans Affairs (VA). H.R. 2192, as amended, would establish 
an Office of the Ombudsman within the Veterans Health 
Administration (VHA) and a Director responsible for overseeing 
the efforts of the patient advocates and resolving patient 
issues and complaints that cannot be resolved at the local or 
regional level.
    The bill would require that the Office of the Ombudsman 
ensure all matters referred to the office are handled in a 
confidential matter; develop tools for monitoring and 
establishing performance standards for the work of the patient 
advocates; track trends in patient issues and complaints; 
participate in VA's national quality conferences; and, maintain 
a public website with contact information for each patient 
advocate.
    The bill would require the Director to appoint three 
regional administrators to support the work of the Office, and 
establish a Board comprised of the Director and the three 
regional administrators to hear appeals from veterans who are 
unsatisfied with the efforts of their local facility and issue 
a decision regarding such appeal and outlining possible steps 
to resolve the complaint.

                  Background and Need for Legislation

    Over 30,000 servicemembers have been wounded in Operations 
Enduring Freedom and Iraqi Freedom (OEF/OIF). Due to improved 
battlefield medicine, those who might have died in past 
conflicts are now surviving, many with multiple serious 
injuries such as amputations, traumatic brain injury (TBI), and 
post-traumatic stress disorder (PTSD). These injuries often 
require long-term health care from the VA beyond the 
servicemember's discharge.
    In 2007, reports from the Independent Review Group, the 
President's Task Force on Returning Global War on Terror 
Heroes, and the President's Commission on Care for America's 
Returning Wounded Warriors all highlighted the need to improve 
case management for servicemembers and veterans in the military 
health system and in the VA.
    VA instituted a number of initiatives in response to these 
reports to support veteran patients and their families. These 
measures include appointing patient advocates in every medical 
center, OEF/OIF Coordinators, and Transition Patient Advocates 
for those seriously injured in combat.
    The joint Federal Recovery Coordinator Program (FRCP) was 
also established to cut across bureaucratic lines and assist 
seriously wounded and ill servicemembers. The FRCP is designed 
to be the single point of contact to identify needed services 
for seriously wounded and ill servicemembers, veterans and 
their families. However, the scope of the FRCP is very limited. 
As of June 1, 2008, there were eight recovery coordinators 
working with 80 patients.
    Veterans who do not have access to FRCP must attempt to 
navigate the complex system using a number of resources 
including medical center patient advocates, benefit counselors, 
OEF/OIF Coordinators, Transition Patient Advocates and Vet 
Center counselors. Outside of the VA, many veterans also rely 
on veteran service organizations to provide guidance and 
counseling.
    H.R. 2192, as amended, would create the Office of the 
Ombudsman (Office) within the VHA to oversee patient advocacy 
work and coordinate assistance for veterans. The Office would 
be required to identify trends across the system regarding 
patient issues and complaints that would allow improvements to 
VA's policies, practices and procedures. The Office would also 
serve as the arbiter of last resort for complaints and issues 
that cannot be resolved at local or regional levels.
    The creation of an Office of the Ombudsman would not affect 
the authority and responsibility of the Federal Recovery 
Coordinators.

                                Hearings

    On June 14, 2007, the Subcommittee on Health held a 
legislative hearing on a number of bills introduced in the 
110th Congress, including H.R. 2192. The following witnesses 
testified: The Honorable Stephanie Herseth Sandlin of South 
Dakota; The Honorable Ciro D. Rodriguez of Texas; The Honorable 
James P. Moran of Virginia; The Honorable Diane E. Watson of 
California; The Honorable Silvestre Reyes of Texas; The 
Honorable John T. Salazar of Colorado; The Honorable Jeff 
Miller of Florida; The Honorable Paul W. Hodes of New 
Hampshire; The Honorable Nita M. Lowey; Ms. Shannon Middleton, 
Deputy Director for Health for Veterans Affairs and 
Rehabilitation Commission, The American Legion; Mr. Kimo S. 
Hollingsworth, Legislative Director, American Veterans 
(AMVETS); Mr. Adrian Atizado, Assistant National Legislative 
Director, Disabled American Veterans; Mr. Carl Blake, National 
Legislative Director, Paralyzed Veterans of America; Mr. Dennis 
M. Cullinan, Director, National Legislative Service, Veterans 
of Foreign Wars of the United States; Mr. Barry Hagge, National 
Secretary, Vietnam Veterans of America; The Honorable Michael 
J. Kussman, M.D., Under Secretary for Health, Veterans Health 
Administration, U.S. Department of Veterans Affairs accompanied 
by Walter A. Hall, Assistant General Counsel, U.S. Department 
of Veterans Affairs. Those submitting statements for the record 
included: Mr. Andy Behrman, Chair of the Rural Health Policy 
Board, National Rural Health Association; and, Ms. Ruth 
Cooperrider, President of the United States Ombudsman 
Association, and Deputy Ombudsman, State of Iowa--Office of 
Citizens' Aide/Ombudsman.

                       Subcommittee Consideration

    On June 5, 2008, the Subcommittee on Health met in open 
markup session and ordered favorably forwarded to the full 
Committee H.R. 2192, as amended, by voice vote. During 
consideration of the bill the following amendment was 
considered: An amendment in the nature of a substitute by Mr. 
Michaud of Maine to require the Secretary to designate an 
Ombudsman Director in the VA for each administration of the 
Department and appoint a regional ombudsman for the VHA and VBA 
within each of the six regions established, was agreed to by 
voice vote.

                        Committee Consideration

    On July 16, 2008, the full Committee met in open markup 
session, a quorum being present, and ordered H.R. 2192, as 
amended, favorably reported to the House of Representatives, by 
voice vote. During consideration of the bill the following 
amendment was considered:
    An amendment in the nature of a substitute by Mr. Michaud 
of Maine to require the Secretary to establish an Office of the 
Ombudsman in the Veterans Health Administration headed by a 
Director appointed by the Secretary, was agreed to by voice 
vote.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list the record votes 
on the motion to report the legislation and amendments thereto. 
There were no record votes taken on amendments or in connection 
with ordering H.R. 2192 reported to the House. A motion by Mr. 
Buyer of Indiana to order H.R. 2192, as amended, reported 
favorably to the House of Representatives was agreed to by 
voice vote.

                      Committee Oversight Findings

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

         Statement of General Performance Goals and Objectives

    In accordance with clause 3(c)(4) of rule XIII of the Rules 
of the House of Representatives, the Committee's performance 
goals and objectives are reflected in the descriptive portions 
of this report.

   New Budget authority, Entitlement Authority, and Tax Expenditures

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

                  Earmarks and Tax and Tariff Benefits

    H.R. 2192 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 Cost Estimate

    The Committee adopts as its own the cost estimate on H.R. 
2192 prepared by the Director of the Congressional Budget 
Office pursuant to section 402 of the Congressional Budget Act 
of 1974.

               Congressional Budget Office Cost Estimate

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
for H.R. 2192 provided by the Congressional Budget Office 
pursuant to section 402 of the Congressional Budget Act of 
1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                     Washington, DC, July 22, 2008.
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. 2192, a bill to 
amend title 38, United States Code, to establish an Ombudsman 
within the Department of Veterans Affairs.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Sunita 
D'Monte.
            Sincerely,
                                         Robert A. Sunshine
                                   (For Peter R. Orszag, Director).
    Enclosure.

H.R. 2192--A bill to amend title 38, United States Code, to establish 
        an Ombudsman within the Department of Veterans Affairs

    H.R. 2192 would establish an Office of, the Ombudsman at 
the Veterans Health Administration (VHA). The bill would 
require VHA to appoint a director to report directly to the 
Secretary of the Department of Veterans Affairs (VA). The 
director would be required to appoint three regional 
administrators to support patient advocacy and resolve appeals 
from patients at VHA facilities.
    Based on information from VA, CBO estimates that under the 
bill VA would require four additional employees at an annual 
cost between $500,000 and $600,000. Assuming that the estimated 
amounts are appropriated and outlays follow historical spending 
patterns, CBO estimates that implementing the bill would cost 
$3 million over the 2009-2013 period. Enacting the bill would 
not affect direct spending or revenues.
    H.R. 2192 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act and 
would impose no costs on state, local, or tribal governments.
    The CBO staff contact for this estimate is Sunita D'Monte. 
This estimate was approved by Theresa Gullo, Deputy Assistant 
Director for Budget Analysis.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates regarding H.R. 2192 prepared by the Director of the 
Congressional Budget Office pursuant to section 423 of the 
Unfunded Mandates Reform Act.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act would be created by H.R. 
2192.

                   Constitutional Authority Statement

    Pursuant to clause 3(d)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that the 
Constitutional authority for H.R. 2192 is provided by Article 
I, section 8 of the Constitution of the United States.

                  Applicability to Legislative Branch

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

             Section-by-Section Analysis of the Legislation


Section 1. Establishment of Office of the Ombudsman in Veterans Health 
        Administration

    This section would amend title 38, United States Code, by 
inserting a new section 7309. Section 7309 would establish an 
Office of the Ombudsman within the VHA. The Office would be led 
by a Director, designated by the Secretary within 180 days of 
enactment, and would serve six principal duties: (1) oversee 
the efforts of patient advocates within the VA; (2) develop 
tools that local VA offices may use to monitor and evaluate 
patient advocates; (3) determine numerical, topical, and 
location trends in patient issues and complaints; (4) 
participate in national quality conferences of the VA at the 
designation of the Under Secretary for Health; (5) help 
veterans seeking VA assistance in more than one VA region; (6) 
establish and maintain a Web site providing contact information 
for each patient advocate at each VA medical center.
    This section would also establish a board consisting of the 
Director of the Office of Ombudsman and three regional 
administrators appointed by the Director. This board would hear 
appeals from veterans unhappy with the performance of their 
local medical center and veteran integrated service network 
(VISN) and respond to each appeal with a letter explaining the 
decision of the board and outlining steps towards resolving the 
issue. In addition, the three regional administrators would 
support patient advocacy work by VA medical centers and VISNs 
and identify and disseminate best practices for patient 
advocacy work.

         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 (new matter is 
printed in italic and existing law in which no change is 
proposed is shown in roman):

TITLE 38, UNITED STATES CODE

           *       *       *       *       *       *       *



PART V--BOARDS, ADMINISTRATIONS, AND SERVICES

           *       *       *       *       *       *       *



 CHAPTER 73--VETERANS HEALTH ADMINISTRATION-ORGANIZATION AND FUNCTIONS


                       SUBCHAPTER I--ORGANIZATION

Sec.
7301.  Functions of Veterans Health Administration: in general.
     * * * * * * *
7309.  Office of the Ombudsman.

           *       *       *       *       *       *       *


SUBCHAPTER I--ORGANIZATION

           *       *       *       *       *       *       *


Sec. 7309. Office of the Ombudsman

  (a) Office; Directors.--There is established in the Veterans 
Health Administration an Office of the Ombudsman (in this 
section referred to as the ``Office''). The Office shall be 
headed by a Director appointed by the Secretary. The Director 
shall report directly to the Secretary.
  (b) Duties of Office.--The Office shall--
          (1) be responsible for ensuring--
                  (A) all matters referred to the Office are 
                handled in a confidential manner; and
                  (B) any action taken by the Administration 
                with respect to such a matter does not 
                negatively affect the ability of any veteran to 
                receive health care or benefits under a law 
                administered by the Secretary; and
          (2) serve as a last resort for complaints and issues 
        that cannot be resolved at a local or regional level in 
        the Administration.
  (c) Duties of Director.--The Director shall--
          (1) be responsible for overseeing the efforts of 
        patient advocates in the Administration;
          (2) develop and make available to local offices of 
        the Administration tools for monitoring the work of 
        such patient advocates and standards to evaluate the 
        work of such patient advocates;
          (3) determine trends, in terms of numbers, topics, 
        and facility locations, in patient issues and 
        complaints;
          (4) participate in such national quality conferences 
        of the Administration as the Under Secretary for Health 
        may designate;
          (5) help coordinate assistance for veterans who need 
        assistance from the Administration in more than one 
        region of the Administration; and
          (6) maintain a public Web site with links to contact 
        information for each patient advocate at each medical 
        center of the Department.
  (d) Regional Administrators.--The Director shall appoint 
three regional administrators to support facilities of the 
Administration and veterans integrated service networks in 
their patient advocacy work, to identify best practices for 
patient advocacy work and inform such facilities and networks 
of such best practices, and to receive and refer to the board 
established under subsection (e) appeals from veterans in their 
respective regions who are not satisfied with the efforts of 
their local medical center of the Department and veteran 
integrated service network.
  (e) Board.--The Director shall establish a board composed of 
the Director and the three regional administrators appointed 
under subsection (d) to hear appeals referred to the board by a 
regional administrator under subsection (d) and issue a letter 
explaining the board's decision regarding such appeal and 
outlining possible steps for resolving issues raised in such 
appeal.
  (f) Limitation on Statutory Construction.--Nothing in this 
section shall be construed as affecting the authority and 
responsibility of coordinators of patient advocates for 
severely injured veterans of Operation of Enduring Freedom and 
severely injured veterans of Operation Iraqi Freedom.

           *       *       *       *       *       *       *