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115th Congress    }                                    {        Report
                        HOUSE OF REPRESENTATIVES
 1st Session      }                                    {       115-147

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



 
                       NO HERO LEFT UNTREATED ACT

                                _______
                                

  May 23, 2017.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

    Mr. Roe of Tennessee, from the Committee on Veterans' Affairs, 
                        submitted the following

                              R E P O R T

                        [To accompany H.R. 1162]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 1162) to direct the Secretary of Veterans 
Affairs to carry out a pilot program to provide access to 
magnetic EEG/EKG-guided resonance therapy to veterans, having 
considered the same, reports favorably thereon without 
amendment and recommends that the bill do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     2
Background and Need for Legislation..............................     2
Hearings Subcommittee............................................     3
Consideration....................................................     3
Committee Consideration..........................................     3
Committee Votes..................................................     4
Committee Correspondence.........................................     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...............................     5
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

                          PURPOSE AND SUMMARY

    Representative Stephen Knight of California introduced H.R. 
1162, the No Hero Left Untreated Act, on February 16, 2017. 
H.R. 1162 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 electroencephalogram/
electrocardiogram-guided magnetic resonance therapy (MRT) 
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

    A 2016 VA report titled, Suicide Among Veterans and Other 
Americans 2001-2014, found that the rate of mental health 
conditions or substance use disorders among Veterans Health 
Administration (VHA) patients has been steadily increasing 
throughout the 21st century, rising from about twenty-seven 
percent in 2001 to over forty percent in 2014.\1\ During the 
same time, the number of prescriptions for opioids written by 
VA providers has increased 259 percent.\2\ The same 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 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.
---------------------------------------------------------------------------
    Magnetic Resonant Therapy (MRT) is one such promising 
treatment. MRT 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. MRT 
technology has been approved by the Food and Drug 
Administration to treat depression, and has been successfully 
used to treat conditions like PTSD and TBI. A 2015 study found 
that, after two weeks of MRT treatment, participating veterans 
experienced an average 47.4 percent reduction in symptom 
severity. After four weeks of MRT 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\ The 
Committee believes that more veterans should have access to MRT 
treatment given the promising results that the treatment has 
produced thus far.
---------------------------------------------------------------------------
    \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.
---------------------------------------------------------------------------
    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 MRT 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 MRT 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 hearings held on H.R. 1162.
    On March 29, 2017, the Subcommittee on Health conducted a 
legislative hearing on a number of bills including H.R. 1162.
    The following witnesses testified:
          The Honorable David. P. Roe M.D. of Tennessee; The 
        Honorable Jackie Walorski of Indiana; The Honorable 
        Doug Collins of Georgia; The Honorable Mike Coffman of 
        Colorado; The Honorable Stephen Knight of California; 
        The Honorable Ann M. Kuster of New Hampshire; Jennifer 
        S. Lee, M.D., the Deputy Under Secretary for Health for 
        Policy and Services for the Veterans Health 
        Administration of the U.S. Department of Veterans 
        Affairs who was accompanied by Susan Blauert, the Chief 
        Counsel for the Health Care Law Group of the Office of 
        the General Counsel for the U.S. Department of Veterans 
        Affairs; Kayda Keleher, Legislative Associate for the 
        National Legislative Service of the Veterans of Foreign 
        Wars of the United States; Shurhonda Y. Love, the 
        Assistant National Legislative Director for the 
        Disabled American Veterans; and, Sarah S. Dean, the 
        Associate Legislative Director for the Paralyzed 
        Veterans of America.
    Statements for the record were submitted by:
          The Honorable Lee Zeldin of New York; The American 
        Legion; the National Association of State Veteran 
        Homes; Swords to Plowshares; and, the Wounded Warrior 
        Project.

                       SUBCOMMITTEE CONSIDERATION

    On April 6, 2017, the Subcommittee on Health met in an open 
markup session, a quorum being present, and ordered H.R. 1162 
to be reported favorably to the Full Committee by voice vote.

                        COMMITTEE CONSIDERATION

    On May 17, 2017, the Full Committee met in open markup 
session, a quorum being present, and ordered H.R. 1162 to be 
reported favorably to the House of Representatives by voice 
vote. A motion by Representative Tim Walz of Minnesota, Ranking 
Member of the Committee on Veterans' Affairs, to report H.R. 
1162 favorably to the House of Representatives was agreed to by 
voice vote.

                            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. 1162 
reported to the House.

                      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 MRT 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. 1162 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. 
1162 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. 1162 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, May 22, 2017.
Hon. Phil Roe, M.D.,
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. 1162, 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. 1162--No Hero Left Untreated Act

    H.R. 1162 would require the Department of Veterans Affairs 
(VA) to establish a one-year pilot program to use Magnetic 
eResonance Therapy technology (MeRT technology) to treat 
veterans with post-traumatic stress disorder, traumatic brain 
injury, military sexual trauma, chronic pain, and opiate 
addiction. MeRT technology, a neurological treatment, was 
pioneered by the Brain Treatment Center (BTC) in Southern 
California, which holds proprietary rights in the treatment. 
Over the past two years, the center has treated more than 400 
veterans at four locations in California and Washington.
    Under the bill, VA would carry out the one-year pilot 
program with no more than 50 veterans in up to two medical 
facilities. We anticipate that VA would contract with BTC to 
offer the MeRT technology to 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 one-month span at a cost of 
$22,000. In total, CBO estimates that implementing this bill 
would cost $1 million over the 2018-2022 period; that spending 
would be subject to the availability of appropriations.
    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. 1162 would not increase net 
direct spending or on-budget deficits in any of the four 
consecutive 10-year periods beginning in 2028.
    H.R. 1162 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. 1162 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. 
1162.

                 STATEMENT OF CONSTITUTIONAL AUTHORITY

    Pursuant to Article I, section 8 of the United States 
Constitution, H.R. 1162 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. 1162 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. 1162 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. 1162 contains no directed 
rulemaking 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. 1162, as the No Hero Left Untreated Act.

Section 2. Findings

    Section 2 of the bill states the following findings: (1) 
the MRT 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 MRT 
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 MRT 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 MRT 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]