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113th Congress  }                                            {   Report
  2d Session    }        HOUSE OF REPRESENTATIVES            {  113-598

=======================================================================
 
      VETERANS TRAUMATIC BRAIN INJURY CARE IMPROVEMENT ACT OF 2014 

                                _______
                                

 September 15, 2014.--Committed to the Committee of the Whole House on 
            the State of the Union and ordered to be printed

                                _______
                                

    Mr. Miller of Florida, from the Committee on Veterans' Affairs, 
                        submitted the following

                              R E P O R T

                        [To accompany H.R. 4276]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 4276) to extend and modify a pilot program on 
assisted living services for veterans with traumatic brain 
injury, having considered the same, report favorably thereon 
with an amendment and recommend that the bill as amended do 
pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     3
Background and Need for Legislation..............................     3
Hearings.........................................................     4
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.............................     5
Committee Cost Estimate..........................................     5
Congressional Budget Office Estimate.............................     5
Federal Mandates Statement.......................................     6
Advisory Committee Statement.....................................     6
Statement of Constitutional Authority............................     6
Applicability to Legislative Branch..............................     6
Statement on Duplication of Federal Programs.....................     6
Disclosure of Directed Rulemaking................................     6
Section-by-Section Analysis of the Legislation...................     6
Changes in Existing Law Made by the Bill, as Reported............     7
    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Veterans Traumatic Brain Injury Care 
Improvement Act of 2014''.

SEC. 2. EXTENSION AND MODIFICATION OF PILOT PROGRAM ON ASSISTED LIVING 
                    SERVICES FOR VETERANS WITH TRAUMATIC BRAIN INJURY.

  (a) Modification of Report Requirements.--Subsection (e) of section 
1705 of the National Defense Authorization Act for Fiscal Year 2008 
(Public Law 110-181; 38 U.S.C. 1710C note) is amended to read as 
follows:
  ``(e) Reports.--
          ``(1) Quarterly reports.--
                  ``(A) In general.--For each calendar quarter 
                occurring during the period beginning January 1, 2015, 
                and ending September 30, 2017, the Secretary shall 
                submit to the Committees on Veterans' Affairs of the 
                Senate and the House of Representatives a report on the 
                pilot program.
                  ``(B) Elements.--Each report submitted under 
                subparagraph (A) shall include each of the following 
                for the quarter preceding the quarter during which the 
                report is submitted the following:
                          ``(i) The number of individuals that 
                        participated in the pilot program.
                          ``(ii) The number of individuals that 
                        successfully completed the pilot program.
                          ``(iii) The degree to which pilot program 
                        participants and family members of pilot 
                        program participants were satisfied with the 
                        pilot program.
                          ``(iv) The interim findings and conclusions 
                        of the Secretary with respect to the success of 
                        the pilot program and recommendations for 
                        improvement.
          ``(2) Final report.--
                  ``(A) In general.--Not later than 60 days after the 
                completion of the pilot program, the Secretary shall 
                submit to the Committees on Veterans' Affairs of the 
                Senate and the House of Representatives a final report 
                on the pilot program.
                  ``(B) Elements.--The final report required by 
                subparagraph (A) shall include the following:
                          ``(i) A description of the pilot program.
                          ``(ii) The Secretary's assessment of the 
                        utility of the activities carried out under the 
                        pilot program in enhancing the rehabilitation, 
                        quality of life, and community reintegration of 
                        veterans with traumatic brain injury.
                          ``(iii) An evaluation of the pilot program in 
                        light of independent living programs carried 
                        out by the Secretary under title 38, United 
                        States Code, including--
                                  ``(I) whether the pilot program 
                                duplicates services provided under such 
                                independent living programs;
                                  ``(II) the ways in which the pilot 
                                program provides different services 
                                that the services provided under such 
                                independent living program;
                                  ``(III) how the pilot program could 
                                be better defined or shaped; and
                                  ``(IV) whether the pilot program 
                                should be incorporated into such 
                                independent living programs.
                          ``(iv) Such recommendations as the Secretary 
                        considers appropriate regarding improving the 
                        pilot program.''.
  (b) Definition of Community-based Brain Injury Residential 
Rehabilitative Care Services.--Such section is further amended--
          (1) in the section heading, by striking ``assisted living'' 
        and inserting ``community-based brain injury residential 
        rehabilitative care'';
          (2) in subsection (c), in the subsection heading, by striking 
        ``Assisted Living'' and inserting ``Community-Based Brain 
        Injury Residential Rehabilitative Care'';
          (3) by striking ``assisted living'' each place it appears, 
        and inserting ``community-based brain injury rehabilitative 
        care''; and
          (4) in subsection (f)(1), by striking ``and personal care'' 
        and inserting ``rehabilitation, and personal care''.
  (c) Effective Date.--The amendments made by this section shall take 
effect on the date of the enactment of this Act.

                          Purpose and Summary

    H.R. 4276, the Veterans Traumatic Brain Injury Care 
Improvement Act, was introduced by Representative Bill Cassidy 
of Louisiana on March 18, 2014. H.R. 4276, as amended, would: 
(1) require the Department of Veterans Affairs (VA), beginning 
in January 2015, to issue quarterly reports to Congress on the 
pilot program for assisted living services for veterans with 
traumatic brain injury with a final report to Congress due not 
later than 60 days after the completion of the pilot; and, (2) 
amend the definition of ``assisted living'' for purposes of the 
pilot program to encompass community-based brain injury 
residential rehabilitative care.

                  Background and Need for Legislation

    Section 1705 of Public Law (P.L.) 110-181, the National 
Defense Authorization Act for Fiscal Year 2008, required VA to: 
(1) carry out a five-year pilot program in collaboration with 
the Defense and Veterans Brain Injury Center to assess the 
effectiveness of providing assisted living services to veterans 
with Traumatic Brian Injury (TBI) to enhance rehabilitation, 
quality of life, and community integration; (2) provide special 
consideration to eligible veterans in rural areas in carrying 
out the pilot program; (3) carry out at least one part of the 
pilot program in a region of the Veterans Health Administration 
that contains a VA polytrauma center; and, (4) report to the 
Committees on Veterans' Affairs of the United States House of 
Representatives and the United States Senate on the pilot 
program.
    Section 501 of P.L. 113-146, the Veterans Access, Choice, 
and Accountability Act of 2014, extended the date of 
termination for the pilot program an additional three years, 
from October 6, 2014, to October 6, 2017.
    TBI is defined by the Defense and Veterans Brain Injury 
Center as a blow or jolt to the head that disrupts the normal 
function of the brain. TBI is increasingly prevalent in the 
veteran population and is one of the foremost combat injuries 
affecting veterans of Iraq and Afghanistan.
    Identifying and implementing innovative treatment 
techniques to aid these veterans in their recovery has been a 
long-standing Committee priority and was the impetus behind the 
authorization of the pilot program. Specialized residential 
rehabilitation care for veterans with TBI is not currently 
available to veterans through VA apart from the pilot program.
    According to information provided by VA, as of June 1, 
2014, 187 veterans across 46 different facilities in 22 states 
have been enrolled in the pilot program. Anecdotal evidence 
seems to indicate that these veterans and their families are 
satisfied with the pilot program and, importantly, veterans 
enrolled in the pilot program appear to experience functional 
gains as a result of the services they receive. In a briefing 
provided to Committee staff in July 2014, VA reported that 
interim analysis of clinical data indicates veterans enrolled 
in the pilot program have experienced significant positive 
changes in several domains, including general health, activity 
tolerance, and social activities. According to VA, these gains 
appear to develop within the first six months of participation 
in the pilot program and appear to be sustained over time. 
However, VA has yet to issue a report fully assessing the pilot 
program.
    To ensure that the Department is continually tracking 
important components of the pilot program, recognizing areas 
where additional improvements are needed, and evaluating 
whether or not the pilot program is successful and should be 
continued, H.R. 4276, as amended, would require VA to provide 
the Congressional veterans' committees with quarterly reports 
on the status of the pilot program and a final report sixty 
days after the completion of the pilot.
    H.R. 4276 would also replace the term ``assisted living'' 
with ``community-based brain injury residential rehabilitative 
care.'' Conversations with stakeholders regarding the pilot 
program over the last several months have made it clear that 
this term is more appropriate and applicable to the services 
the pilot program is providing than the term ``assisted 
living.''

                                Hearings

    H.R. 4276 was not the subject of any Subcommittee or full 
Committee hearings.

                        Committee Consideration

    On September 10, 2014, the full Committee met in an open 
markup session, a quorum being present and ordered H.R. 4276, 
as amended, 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. 4276, as amended, reported to the House. A 
motion by Ranking Member Michael H. Michaud of Maine to report 
H.R. 4276, as amended, 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. 4276, as amended, does not contain any congressional 
earmarks, limited tax benefits, or limited tariff benefits as 
defined in clause 9 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. 
4276, as amended, 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. 476, as amended, 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, September 12, 2014.
Hon. Jeff Miller,
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. 4276, the Veterans 
Traumatic Brain Injury Care Improvement Act of 2014.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Ann E. 
Futrell.
            Sincerely,
                                              Douglas W. Elmendorf.
    Enclosure.

H.R. 4276--Veterans Traumatic Brain Injury Care Improvement Act of 2014

    H.R. 4276 would require the Department of Veterans Affairs 
(VA) to submit detailed quarterly reports to the Congress 
regarding the pilot program for rehabilitative services for 
veterans with traumatic brain injury. Based on information from 
VA, CBO estimates that implementing this bill would cost $1 
million over the 2015-2019 period, assuming the availability of 
appropriated funds.
    Enacting H.R. 4276 would not affect direct spending or 
revenues; therefore, pay-as-you-go procedures do not apply.
    H.R. 4276 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 Ann E. Futrell. 
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. 4276, as amended, 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. 
4276, as amended.

                 Statement of Constitutional Authority

    Pursuant to Article I, section 8 of the United States 
Constitution, the reported bill is authorized by Congress' 
power to ``provide for the common Defense and general Welfare 
of the United States.''

                  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.

              Statement on Duplication of Federal Programs

    Pursuant to section 3(j) of H. Res. 5, 113th Cong. (2013), 
the Committee finds that no provision of H.R. 4276, as amended, 
establishes or reauthorizes a program of the Federal Government 
known to be duplicative of another Federal program, a program 
that was included in any report from the Government 
Accountability Office to Congress pursuant to section 21 of 
Public Law 111-139, or a program related to a program 
identified in the most recent Catalog of Federal Domestic 
Assistance.

                   Disclosure of Directed Rulemaking

    Pursuant to section 3(k) of H. Res. 5, 113th Cong. (2013), 
the Committee estimates that H.R. 4276, as amended, does not 
require any directed rule makings.

             Section-by-Section Analysis of the Legislation


Section 1. Short title

    Section 1 of the bill would provide the short title of H.R. 
4276, as amended, as the ``Veterans Traumatic Brain Injury Care 
Improvement Act of 2014.''

Section 2. Extension and Modification of Pilot Program on Assisted 
        Living Services for Veterans with Traumatic Brain Injury

    Section 2(a) of the bill would create a new subsection (e) 
of 1710(C) of title 38 U.S.C. Subsection (e)(1)(A) would 
require VA to submit quarterly reports on the pilot program 
beginning on January 1, 2015, and ending September 30, 2017, to 
the Committees on Veterans' Affairs of the Senate and the House 
of Representatives. Subsection (e)(1)(B) would require each 
such report to include the number of individuals that 
participated in the pilot program; the number of individuals 
that successfully completed the pilot program; the degree to 
which pilot program participants and family members were 
satisfied with the pilot program; and, interim findings and 
conclusions of the Secretary with respect to the success of the 
pilot program and recommendations for improvement. Subsection 
(e)(2)(A) would require VA to submit a final report on the 
pilot program to the Committees on Veterans' Affairs of the 
Senate and the House of Representatives not later than 60 days 
after completion of the pilot. Subsection (e)(2)(B) would 
require the final report to include a description of the pilot 
program; the Secretary's assessment of the utility of the 
activities carried out under the pilot program in enhancing the 
rehabilitation, quality of life, and community reintegration of 
veterans with TBI; an evaluation of the pilot program in light 
of independent living programs carried out by VA under title 38 
U.S., to include whether the pilot is duplicative of such 
programs, the ways in which the pilot program provides 
different services than those provided under such programs, how 
the pilot program could be better defined or shaped, and 
whether the pilot program should be incorporated into such 
programs; and, such recommendations as the Secretary considers 
appropriate regarding improving the pilot program.
    Section 2(b)(1) of the bill would amend the heading of 
section by striking ``assisted living'' and inserting 
``community-based brain injury residential rehabilitative 
care'' and by
    Section 2(b)(2) of the bill would amend the subsection 
heading by striking ``assisted living'' and inserting 
``community-based residential rehabilitative care.''
    Section 2(b)(3) of the bill would amend subsection (c) of 
1710(C) of title 38 U.S.C. by striking ``assisted living'' and 
inserting ``community-based residential rehabilitative care.''
    Section 2(b)(4) of the bill would amend subsection (f)(1) 
by striking ``and personal care'' and inserting 
``rehabilitation, and personal care.''
    Section 2(c) of the bill would set an effective date for 
the amendments made in Section 2 of the date of enactment.
    Section 2(d) of the bill would stipulate that no additional 
funds are authorized to be appropriated to carry out the bill 
and amendments shall be carried out using amounts otherwise 
available for sure purpose.

         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):

        NATIONAL DEFENSE AUTHORIZATION ACT FOR FISCAL YEAR 2008




           *       *       *       *       *       *       *
DIVISION A--DEPARTMENT OF DEFENSE AUTHORIZATIONS

           *       *       *       *       *       *       *


TITLE XVII--VETERANS MATTERS

           *       *       *       *       *       *       *


SEC. 1705. PILOT PROGRAM ON [ASSISTED LIVING] COMMUNITY-BASED BRAIN 
                    INJURY RESIDENTIAL REHABILITATIVE CARE SERVICES FOR 
                    VETERANS WITH TRAUMATIC BRAIN INJURY

  (a) Pilot Program.--Beginning not later than 90 days after 
the date of the enactment of this Act, the Secretary of 
Veterans Affairs, in collaboration with the Defense and 
Veterans Brain Injury Center of the Department of Defense, 
shall carry out a pilot program to assess the effectiveness of 
providing [assisted living] community-based brain injury 
rehabilitative care services to eligible veterans to enhance 
the rehabilitation, quality of life, and community integration 
of such veterans.

           *       *       *       *       *       *       *

  (c) Provision of [Assisted Living] Community-Based Brain 
Injury Residential Rehabilitative Care Services.--
          (1) Agreements.--In carrying out the pilot program, 
        the Secretary may enter into agreements for the 
        provision of [assisted living] community-based brain 
        injury rehabilitative care services on behalf of 
        eligible veterans with a provider participating under a 
        State plan or waiver under title XIX of the Social 
        Security Act (42 U.S.C. 1396 et seq.).
          (2) Standards.--The Secretary may not place, 
        transfer, or admit a veteran to any facility for 
        [assisted living] community-based brain injury 
        rehabilitative care services under the pilot program 
        unless the Secretary determines that the facility meets 
        such standards as the Secretary may prescribe for 
        purposes of the pilot program. Such standards shall, to 
        the extent practicable, be consistent with the 
        standards of Federal, State, and local agencies charged 
        with the responsibility of licensing or otherwise 
        regulating or inspecting such facilities.
  (d) Continuation of Case Management and Rehabilitation 
Services.--In carrying out the pilot program, the Secretary 
shall--
          (1) continue to provide each veteran who is receiving 
        [assisted living] community-based brain injury 
        rehabilitative care services under the pilot program 
        with rehabilitative services; and

           *       *       *       *       *       *       *

  [(e) Report.--
          [(1) In general.--Not later than 60 days after the 
        completion of the pilot program, the Secretary shall 
        submit to the Committees on Veterans' Affairs of the 
        Senate and House of Representatives a report on the 
        pilot program.
          [(2) Contents.--The report required by paragraph (1) 
        shall include the following:
                  [(A) A description of the pilot program.
                  [(B) An assessment of the utility of the 
                activities under the pilot program in enhancing 
                the rehabilitation, quality of life, and 
                community reintegration of veterans with 
                traumatic brain injury.
                  [(C) Such recommendations as the Secretary 
                considers appropriate regarding the extension 
                or expansion of the pilot program.]
  (e) Reports.--
          (1) Quarterly reports.--
                  (A) In general.--For each calendar quarter 
                occurring during the period beginning January 
                1, 2015, and ending September 30, 2017, the 
                Secretary shall submit to the Committees on 
                Veterans' Affairs of the Senate and the House 
                of Representatives a report on the pilot 
                program.
                  (B) Elements.--Each report submitted under 
                subparagraph (A) shall include each of the 
                following for the quarter preceding the quarter 
                during which the report is submitted the 
                following:
                          (i) The number of individuals that 
                        participated in the pilot program.
                          (ii) The number of individuals that 
                        successfully completed the pilot 
                        program.
                          (iii) The degree to which pilot 
                        program participants and family members 
                        of pilot program participants were 
                        satisfied with the pilot program.
                          (iv) The interim findings and 
                        conclusions of the Secretary with 
                        respect to the success of the pilot 
                        program and recommendations for 
                        improvement.
          (2) Final report.--
                  (A) In general.--Not later than 60 days after 
                the completion of the pilot program, the 
                Secretary shall submit to the Committees on 
                Veterans' Affairs of the Senate and the House 
                of Representatives a final report on the pilot 
                program.
                  (B) Elements.--The final report required by 
                subparagraph (A) shall include the following:
                          (i) A description of the pilot 
                        program.
                          (ii) The Secretary's assessment of 
                        the utility of the activities carried 
                        out under the pilot program in 
                        enhancing the rehabilitation, quality 
                        of life, and community reintegration of 
                        veterans with traumatic brain injury.
                          (iii) An evaluation of the pilot 
                        program in light of independent living 
                        programs carried out by the Secretary 
                        under title 38, United States Code, 
                        including--
                                  (I) whether the pilot program 
                                duplicates services provided 
                                under such independent living 
                                programs;
                                  (II) the ways in which the 
                                pilot program provides 
                                different services that the 
                                services provided under such 
                                independent living program;
                                  (III) how the pilot program 
                                could be better defined or 
                                shaped; and
                                  (IV) whether the pilot 
                                program should be incorporated 
                                into such independent living 
                                programs.
                          (iv) Such recommendations as the 
                        Secretary considers appropriate 
                        regarding improving the pilot program.
  (f) Definitions.--In this section:
          (1) The term ``[assisted living] community-based 
        brain injury rehabilitative care services'' means 
        services of a facility in providing room, board, [and 
        personal care] rehabilitation, and personal care for 
        and supervision of residents for their health, safety, 
        and welfare.

           *       *       *       *       *       *       *