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114th Congress    }                                     {       Report
                        HOUSE OF REPRESENTATIVES
 2d Session       }                                     {      114-817

======================================================================



 
                       NO HERO LEFT UNTREATED ACT

                                _______
                                

 November 14, 2016.--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. 5600]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 5600) to direct the Secretary of Veterans 
Affairs to carry out a pilot program to provide access to 
magnetic EEG/EKG-guided resonance therapy technology to 
veterans, 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..............................................     2
Background and Need for Legislation..............................     2
Hearings.........................................................     4
Subcommittee Consideration.......................................     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.............................     4
Committee Cost Estimate..........................................     5
Congressional Budget Office Estimate.............................     5
Federal Mandates Statement.......................................     6
Advisory Committee Statement.....................................     6
Constitutional Authority Statement...............................     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

                               AMENDMENT

    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 ``No Hero Left Untreated Act''.

SEC. 2. FINDINGS.

  Congress finds the following:
          (1) Magnetic EEG/EKG-guided Resonance Therapy technology (in 
        this section referred to as ``MeRT technology'') has 
        successfully treated more than 400 veterans with post-traumatic 
        stress disorder, traumatic brain injury, military sexual 
        trauma, chronic pain, and opiate addiction.
          (2) Recent clinical trials and randomized, placebo-
        controlled, double-blind studies have produced promising 
        measurable outcomes in the evolution of MeRT technology.
          (3) These outcomes have resulted in escalating demand from 
        returning warriors and veterans who are seeking access to this 
        treatment.
          (4) Congress recognizes the importance of initiating 
        innovative pilot programs that demonstrate the use and 
        effectiveness of new treatment options for post-traumatic 
        stress disorder, traumatic brain injury, military sexual 
        trauma, chronic pain, and opiate addiction.

SEC. 3. MAGNETIC EEG/EKG-GUIDED RESONANCE THERAPY TECHNOLOGY PILOT 
                    PROGRAM.

  (a) Pilot Program.--The Secretary of Veterans Affairs shall carry out 
a pilot program to provide access to magnetic EEG/EKG-guided resonance 
therapy technology (commonly referred to as ``MeRT technology'') to 
treat larger populations of veterans suffering from post-traumatic 
stress disorder, traumatic brain injury, military sexual trauma, 
chronic pain, or opiate addiction.
  (b) Locations.--The Secretary shall carry out the pilot program under 
subsection (a) at not more than two facilities of the Department of 
Veteran Affairs.
  (c) Participants.--In carrying out the pilot program under subsection 
(a), the Secretary may not provide access to magnetic EEG/EKG-guided 
resonance therapy technology to more than 50 veterans.
  (d) Duration.--The Secretary shall carry out the pilot program under 
subsection (a) for a one-year period.
  (e) Report.--Not later than 90 days after the date of the termination 
of the pilot program under subsection (a), the Secretary shall submit 
to the Committees on Veterans' Affairs of the House of Representatives 
and the Senate a report on the pilot program.
  (f) No Authorization of Appropriations.--No additional funds are 
authorized to be appropriated to carry out the requirements of this 
section. Such requirements shall be carried out using amounts otherwise 
authorized.

                          PURPOSE AND SUMMARY

    H.R. 5600, the ``No Hero Left Untreated Act,'' was 
introduced by Representative Stephen Knight of California on 
June 28, 2016. H.R. 5600, as amended, would require the 
Department of Veterans Affairs (VA) to carry out a one-year 
pilot program at no more than two VA medical facilities to 
provide access to magnetic electroencephalogram/
electrocardiogram-guided resonance therapy (MeRT) technology to 
veterans with post-traumatic stress disorder (PTSD), traumatic 
brain injury (TBI), military sexual trauma (MST), chronic pain, 
or opiate addiction.

                  BACKGROUND AND NEED FOR LEGISLATION

Section 3. Magnetic EEG/EKG-Guided Resonance Therapy

    According to a 2016 VA report entitled, Suicide Among 
Veterans and Other Americans 2001-2014, the rate of mental 
health conditions or substance use disorders among Veterans 
Health Administration (VHA) patients has been increasing 
throughout the 21st century, rising from about twenty-seven 
percent in 2001 to over forty percent in 2014.\1\ At the same 
time, the number of prescriptions for opioids written by VA 
providers has increased 259%.\2\ Even more troubling, the 
report also found a high rate of suicide among veterans, with 
approximately 20 veteran suicides per day.\3\ Given these 
alarming statistics--which have occurred alongside significant 
increases in VA's mental health budget and programming--the 
Committee believes that there is a demonstrated need to explore 
new and innovative treatments for veterans with mental health 
conditions or chronic pain.
---------------------------------------------------------------------------
    \1\Suicide Among Veterans and Other Americans 2001-2014. http://
www.mentalhealth.va.gov/docs/2016suicidedatareport.pdf
    \2\The Center for Investigative Reporting, ``VA's Opiate Overload 
Feeds Veterans' Addictions, Overdose Deaths,'' Sep. 28, 2013, http://
cironline.org/reports/vas-opiate-overload-feeds-veterans-addictions-
overdose-deaths-5261
    \3\Ibid.
---------------------------------------------------------------------------
    MeRT technology is one such promising treatment. MeRT uses 
quantitative electroencephalogram (EEG)/ electrocardiogram 
(EKG) technology to identify dysfunctional areas of the brain 
in patients suffering from mental health conditions and then 
repeatedly applying magnetic stimulation to help restore proper 
brain function in those areas. MeRT technology has been 
approved by the Food and Drug Administration to treat 
depression, and has been successfully used off-label to treat 
conditions like PTSD and TBI. A 2015 study found that, after 
two weeks of MeRT treatment, participating veterans experienced 
an average 47.4 percent reduction in symptom severity. After 
four weeks of MeRT treatment, veteran participants reported an 
average reduction in symptom severity of 64 percent.\4\ No 
adverse events, including worsening of patients' symptoms, were 
reported during studies.\5\ MeRT treatment is currently 
provided through the Brain Treatment Center (BTC). With 
locations in Washington State, California, and abroad, BTC has 
successfully treated over four hundred veteran patients with 
MeRT to-date. However, the Committee believes that more 
veterans should have access to MeRT treatment given the 
promising results that the treatment has produced thus far. The 
Committee believes that providing veterans with access to this 
technology is no different than providing veterans with 
patented medications.
---------------------------------------------------------------------------
    \4\Taghva, Alexander, M.D., et al. Biometrics-Guided Magnetic E-
Resonance Therapy (MeRT) in Post-Traumatic Stress Disorder: A 
Randomized, Double-Blind, Sham Controlled Trial.N.p., Nov. 2015. 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4727473/.
    \5\Taghva, Alexander, M.D., et al. Biometrics-Guided Magnetic E-
Resonance Therapy (MeRT) in Post-Traumatic Stress Disorder.
---------------------------------------------------------------------------
    As such, Section 3 of the bill would require VA to carry 
out a one-year pilot program at not more than two VA medical 
facilities to provide access to MeRT treatment for up to fifty 
veterans with PTSD, TBI, MST, chronic pain, or opiate addiction 
and to submit a report on the pilot program to the Committees 
on Veterans' Affairs of the House of Representatives and the 
Senate 90 days after the pilot's termination. The Committee 
believes that such a pilot program and the ensuing report would 
provide valuable information on the effectiveness of MeRT and 
similar technologies for veteran patients and potentially open 
the door to similar innovative treatments within the VA health 
care system. Section 3 of the bill would also stipulate that no 
additional funds are authorized to be appropriated to carry out 
the requirements of this Act.

                                HEARINGS

    There were no Full Committee or Subcommittee hearings held 
on H.R. 5600, as amended.

                       SUBCOMMITTEE CONSIDERATION

    There was no Subcommittee markup of H.R. 5600, as amended.

                        COMMITTEE CONSIDERATION

    On September 21, 2016, the Full Committee met in open 
markup session, a quorum being present, and ordered H.R. 5600, 
as amended, reported favorably to the House of Representatives 
by voice vote. During consideration of H.R. 5600, the following 
amendment was considered and agreed to by voice vote:
          An amendment in the nature of a substitute offered by 
        Representative Jackie Walorski of Indiana.

                            COMMITTEE VOTES

    In compliance with clause 3(b) of rule XIII of the Rules of 
the House of Representatives, there were no recorded votes 
taken on amendments or in connection with ordering H.R. 5600, 
as amended, reported to the House. A motion by Representative 
Mark Takano of California to report H.R. 5600, 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 to create a pilot program to increase 
access to MeRT treatment for veterans with PTSD, TBI, MST, 
chronic pain, or opiate addiction.

   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. 5600, 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. 
5600, 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. 5600, 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, October 13, 2016.
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. 5600, the No Hero 
Left Untreated Act.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Ann E. 
Futrell.
            Sincerely,
                                                        Keith Hall.
    Enclosure.

H.R. 5600--No Hero Left Untreated Act

    H.R. 5600 would require the Department of Veterans Affairs 
(VA) to establish a one-year pilot program to treat a limited 
number of veterans with post-traumatic stress disorder, 
traumatic brain injury, military sexual trauma, chronic pain, 
or opiate addiction by using Magnetic eResonance Therapy 
technology (MeRT technology). The bill also would require VA to 
report to the Congress on the results of that pilot program. 
MeRT technology is a customized neurological treatment that 
uses magnetic pulses to stimulate brain tissue. The Brain 
Treatment Center (BTC) in Southern California developed the 
MeRT technology and has proprietary rights to the treatment. 
Over the 2012-2015 period, the center has treated more than 400 
veterans at four locations in the state of California and the 
state of Washington.
    Under this proposal, VA would be required to carry out the 
one-year pilot program with no more than 50 veterans in one or 
two medical facilities. Because the technologuy is proprietary, 
we expect that VA would contract with BTC to provide MeRT 
technology to those veterans. On the basis of information from 
BTC, CBO expects the average patient at VA would undergo an 
initial assessment at a cost of $1,000 and at least 20 MeRT 
sessions over a 30-day period at a cost of $22,000.
    On that basis, CBO estimates that implementing this bill 
would cost $1 million over the 2017-2021 period; that spending 
would be subject to the availability of appropriated funds.
    Enacting the legislation would not affect direct spending 
or revenues; therefore, pay-as-you-go procedures do not apply. 
CBO estimates that enacting H.R. 5600 would not increase net 
direct spending or on-budget deficits in any of the four 
consecutive 10-year periods beginning in 2027.
    H.R. 5600 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 H. Samuel Papenfuss, Deputy 
Assistant Director for Budget Analysis.

                       FEDERAL MANDATES STATEMENT

    The Committee adopts as its own the estimate of Federal 
mandates regarding H.R. 5600, 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. 
5600, as amended.

                 STATEMENT OF CONSTITUTIONAL AUTHORITY

    Pursuant to Article I, section 8 of the United States 
Constitution, H.R. 5600, as amended, 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 H.R. 5600, as amended, 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(g) of H. Res. 5, 114th Cong. (2015), 
the Committee finds that no provision of H.R. 5600, 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(i) of H. Res. 5, 114th Cong. (2015), 
the Committee estimates that H.R. 5600, as amended, contains no 
directed rule making that would require the Secretary to 
prescribe regulations.

             SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Short title

    Section 1 of the bill would provide the short title for 
H.R. 5600, as amended, as the ``No Hero Left Untreated Act.''

Section 2. Findings.

    Section 2 of the bill states the following findings: (1) 
the MeRT technology has successfully treated more than 400 
veterans with PTSD, TBI, MST, chronic pain, and opiate 
addiction; (2) that recent clinical trials and randomized, 
placebo-controlled, double-blind studies have produced 
promising measurable outcomes in the evolution of MeRT 
technology; (3) that these outcomes have resulted in escalating 
demand from returning servicemembers and veterans who are 
seeking access to this treatment; and (4) that Congress 
recognizes the importance of initiating innovative pilot 
programs that demonstrate the use and effectiveness of new 
treatment options for post-traumatic stress disorder, traumatic 
brain injury, military sexual trauma, chronic pain, and opiate 
addiction.

Section 3. Magnetic EEG/EKG-Guided Resonance Therapy

    Section 3(a) of the bill would require the Secretary to 
carry out a pilot program to provide access to MeRT technology 
to treat veterans with PTSD, TBI, MST, chronic pain, or opiate 
addiction.
    Section 3(b) of the bill would require the pilot program 
established by section 2(a) of the bill be carried out at not 
more than two VA facilities.
    Section 3(c) of the bill would prohibit the Secretary from 
providing access to MeRT technology to more than 50 veterans 
during the pilot program.
    Section 3(d) of the bill would set a duration of one year 
for the pilot program established by section 2(a).
    Section 3(e) of the bill would require the Secretary to 
submit a report to the House and Senate Committees on Veterans' 
Affairs on the pilot program established by Section 2(a) of the 
bill by not later than 90 days after the date of the 
termination of the pilot.
    Section 3(f) of the bill would stipulate that no additional 
funds are authorized to be appropriated to carry out the 
requirements of Section 2 of the bill, and the requirements of 
Section 2 of the bill are required to be carried out using 
amounts otherwise authorized.

         CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

    If enacted, this bill would make no changes in existing 
law.

                                  [all]