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[From the U.S. Government Publishing Office]


111th Congress  }                                            {   Report
  1st Session   }       HOUSE OF REPRESENTATIVES             {  111-226                                                     

======================================================================
 
                DISABLED VETERANS HOME IMPROVEMENT AND 
            STRUCTURAL ALTERATION GRANT INCREASE ACT OF 2009 

                                _______
                                

 July 23, 2009.--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. 1293]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 1293) to amend title 38, United States Code, to 
provide for an increase in the amount payable by the Secretary 
of Veterans Affairs to veterans for improvements and structural 
alterations furnished as part of home health services, having 
considered the same, report favorably thereon without amendment 
and recommend that the bill do pass.









                                CONTENTS

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

                          Purpose and Summary

    H.R. 1293 was introduced by Representative Steve Buyer of 
Indiana, the Ranking Member of the Committee on Veterans' 
Affairs, on March 4, 2009. H.R. 1293, the Disabled Veterans 
Home Improvement and Structural Alteration Grant Increase Act 
of 2009, would increase the amount the U.S. Department of 
Veterans Affairs (VA) is authorized to pay under the Home 
Improvements and Structural Alterations (HISA) program from 
$4,100 to $6,800 for veterans with service-connected 
disabilities and from $1,200 to $2,000 for veterans with non-
service-connected disabilities. The increase would become 
effective in the case of a veteran who first applied for a HISA 
grant on, or after, the date of enactment. H.R. 1293 would also 
clarify that a veteran who received the maximum amount of 
reimbursement under the law before enactment would not be 
entitled to additional monetary benefits.

                  Background and Need for Legislation

    HISA grants are furnished through the Veterans Health 
Administration of the VA as part of home health services for 
the purpose of providing access to or within the home for the 
continuation of treatment for the veterans' disability. The 
benefit is paid from the Medical Services appropriation account 
and is available to both veterans with service-connected and 
non-service-connected disabilities. Typically, HISA grants are 
used for such things as widening doors; putting in handrails or 
special lighting; making kitchens, bathrooms, windows, or 
electrical outlets and switches more accessible; and, building 
ramps or improving entrance paths and driveways.
    The HISA grant is distinct from the Specially Adapted 
Housing (SAH) program and Special Home Adaptation (SHA) grants 
which are administered through the Veterans Benefits 
Administration of the VA and available to veterans with 
service-connected disabilities. A service-disabled veteran may 
receive both a HISA grant and either an SAH or SHA grant.
    The HISA program was first authorized in 1973 by Public Law 
93-82 (87 Stat. 179). The program was created out of concern 
that veterans could not be discharged from hospitals because 
their homes were not able to accommodate their disabilities. An 
amendment to clarify the projects that could receive HISA 
grants was enacted in 1976 by Public Law 94-581 (90 Stat. 
2842). The law also created a distinction between the lifetime 
grant ceiling for service-connected and non-service-connected 
veterans in the amount of $2,500 and $600, respectively.
    In 1992, Public Law 102-405 (106 Stat. 1984) increased the 
lifetime benefit limit from $2,500 to $4,100 for service-
connected veterans and from $600 to $1,200 for non-service-
connected veterans.
    The HISA grant ceiling has not been raised in 17 years, yet 
the cost of home modifications have increased over the same 
period. In addition, there is a new generation of veterans from 
Operation Enduring Freedom (OEF) and Operation Iraqi Freedom 
(OIF) returning home.
    A June 12, 2008, joint Department of Defense (DoD) and VA 
Inspectors Generals review of the care transition process for 
injured OEF/OIF servicemembers found that continuity of care 
was hindered by the inability of an injured active duty 
servicemember to obtain a HISA grant prior to discharge. 
Responding to this need, Public Law 110-289 (122 Stat. 2654), 
was enacted to allow VA to provide such grants to eligible 
servicemembers prior to their discharge from military service.
    VA is seeing an increasing number of service-connected 
veterans using the HISA grant with a marked 19.6 percent 
increase from fiscal year 2007 to fiscal year 2008. VA expects 
that the trend will continue to grow at an average increase of 
1.4 percent per year.
    Increasing the HISA grant amount would help veterans with a 
wide range of disabilities make much needed home alterations to 
use essential living areas, such as kitchens, bathrooms and 
bedrooms.
    H.R. 1293 would increase the maximum amount of the grants 
to $6,800 for service-connected veterans and $2,000 for non-
service-connected veterans. The proposed increase reflects 
three percent for each year since 1992 to account for inflation 
and would provide a reasonable amount for the type of home 
modifications intended in this title.

                                Hearings

    On June 18, 2009, the Subcommittee on Health held a 
legislative hearing on several bills introduced during the 
111th Congress, including H.R. 1293. The following witnesses 
testified: The Honorable Harry Mitchell of Arizona; The 
Honorable Phil Hare of Illinois; The Honorable Deborah L. 
Halvorson of Illinois; The Honorable Jerry McNerney of 
California; The Honorable Thomas S.P. Perriello of Virginia; 
The Honorable Harry Teague of New Mexico; and, Fred Cowell, 
Senior Health Policy Analyst, Paralyzed Veterans of America. 
Those submitting statements for the record included: The 
Honorable Steve Buyer of Indiana; The Honorable Jerry Moran of 
Kansas; Joy J. Ilem, Deputy National Legislative Director, 
Disabled American Veterans; Joseph L. Wilson, Deputy Director, 
Veterans Affairs and Rehabilitation Commission, The American 
Legion; Chris Needham, Senior Legislative Associate, Veterans 
of Foreign Wars of the United States; Bernard Edelman, Deputy 
Director for Policy and Government Affairs, Vietnam Veterans of 
America; the American Academy of Physician Assistants; the 
National Association of Veterans' Research and Education 
Foundation; the Wounded Warrior Project; Barbara Cohoon, Ph.D., 
RN, Government Relations Deputy Director, National Military 
Family Association; and, Robert A. Petzel, M.D., Acting 
Principal Deputy Under Secretary for Health, Veterans Health 
Administration, U.S. Department of Veterans Affairs.
    The VA and the Disabled American Veterans, Veterans of 
Foreign Wars, Vietnam Veterans of America, Paralyzed Veterans 
of America, and the National Military Family Association, 
testified in support of H.R. 1293

                       Subcommittee Consideration

    On July 9, 2009, the Subcommittee on Health met in open 
markup session and ordered favorably forwarded to the full 
Committee H.R. 1293 by voice vote.

                        Committee Consideration

    On July 15, 2009, the full Committee met in an open markup 
session, a quorum being present, and ordered H.R. 1293 reported 
favorably to the House of Representatives, 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. 1293 reported to the House. A motion by Mr. 
Buyer of Indiana to order H.R. 1293 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. 1293 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. 
1293 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. 1293 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, 2009.
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. 1293, the Disabled 
Veterans Home Improvement and Structural Alteration Grant 
Increase Act of 2009.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Sunita 
D'Monte.
            Sincerely,
                                              Douglas W. Elmendorf.
    Enclosure.

H.R. 1293--Disabled Veterans Home Improvement and Structural Alteration 
        Grant Increase Act of 2009

    H.R. 1293 would increase the maximum grant amounts awarded 
to certain disabled veterans. Those grants are used to improve 
access to homes and to essential sanitary facilities. CBO 
estimates that implementing the bill would cost $20 million 
over the 2010-2014 period, assuming appropriation of the 
necessary amounts. Enacting the bill would not affect direct 
spending or revenues.
    Under current law, the Department of Veterans Affairs (VA) 
may award a maximum of $4,100 to veterans with service-
connected disabilities and $1,200 to veterans with nonservice-
connected disabilities. The bill would increase those maximum 
allowable amounts to $6,800 and $2,000, respectively. Based on 
data from VA on the number and dollar amounts of grants awarded 
over the 2003-2008 period, CBO estimates that under the bill 
almost 2,000 veterans with service-connected disabilities would 
receive an additional $1,900 each year and almost 700 veterans 
with nonservice-connected disabilities would receive an 
additional $760 each year, for an annual cost of $4 million.
    H.R. 1293 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act and 
would not affect the budgets of state, local, or tribal 
governments.
    The CBO staff contact for this estimate is Sunita D'Monte. 
The 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. 1293 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. 
1293.

                   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. 1293 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. Short title

    This section cites the Act as the ``Disabled Veterans Home 
Improvement and Structural Alteration Grant Increase Act of 
2009.''

Section 2. Increase in amount available to disabled veterans for 
        improvements and structural alterations furnished as part of 
        home health services

    This section provides an increase in the amount available 
to disabled veterans for improvements and structural 
alterations furnished as part of home health services. The 
grant amount is increased from $4,100 to $6,800 for service-
connected veterans, and is increased from $1,200 to $2,000 for 
non-service-connected veterans. This provision is effective for 
veterans who apply for benefits on or after the date of the 
enactment of this Act.

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italic, existing law in which no change is 
proposed is shown in roman):

TITLE 38, UNITED STATES CODE

           *       *       *       *       *       *       *


PART II--GENERAL BENEFITS

           *       *       *       *       *       *       *


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

           *       *       *       *       *       *       *


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

           *       *       *       *       *       *       *


Sec. 1717. Home health services; invalid lifts and other devices

  (a)(1) * * *
  (2) Improvements and structural alterations may be furnished 
as part of such home health services only as necessary to 
assure the continuation of treatment for the veteran's 
disability or to provide access to the home or to essential 
lavatory and sanitary facilities. The cost of such improvements 
and structural alterations (or the amount of reimbursement 
therefor) under this subsection may not exceed--
          (A) [$4,100] $6,800 in the case of medical services 
        furnished under section 1710(a)(1) of this title, or 
        for a disability described in section 1710(a)(2)(C) of 
        this title; or
          (B) [$1,200] $2,000 in the case of medical services 
        furnished under any other provision of section 1710(a) 
        of this title.

           *       *       *       *       *       *       *