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115th Congress    }                                    {        Report
                        HOUSE OF REPRESENTATIVES
 1st Session      }                                    {       115-148

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



 
  TO AMEND TITLE 38, UNITED STATES CODE, TO IMPROVE THE PROVISION OF 
              ADULT DAY HEALTH CARE SERVICES FOR VETERANS

                                _______
                                

  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. 1005]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 1005) to amend title 38, United States Code, to 
improve the provision of adult day health care services for 
veterans, 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..........................................     3
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
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

    H.R. 1005 was introduced by Representative Lee Zeldin of 
New York on February 13, 2017.
    H.R. 1005 would direct the Department of Veterans Affairs 
(VA) to enter into an agreement or a contract with state 
veterans homes (SVHs) to pay for adult day health care (ADHC) 
for a veteran eligible for, but not receiving, nursing home 
care.

                  Background and Need for Legislation


Section 1. Provision of adult day health care services for veterans

    In 2017, approximately 9.8 million veterans--or, 46 percent 
of the total veteran population--will be 65 years of age or 
older.\1\ Congress has long recognized the need to ensure 
appropriate and affordable geriatric and long-term care is 
available to aging veterans through the VA healthcare system. 
Accordingly, the Veterans Benefits, Health Care, and 
Information Technology Act of 2006 (P.L. 109-416, 120 Stat. 
3403) required VA to cover the cost of nursing home care in a 
SVH for any veteran in need of such care due to a service-
connected disability or with a service-connected disability 
rated 70 percent or more. However, there is an increasing 
demand for VA to offer geriatric and long-term care programs 
for veterans in non-institutional settings that would allow 
aging veterans to receive the services and support they need to 
remain in their homes.
---------------------------------------------------------------------------
    \1\United States Cong. House Committee on Veterans Affairs. U.S. 
Department of Veterans Affairs Budget Request for Fiscal Year 2017. 
February 10, 2016. 114th Cong. 2nd sess. Washington: GPO, 2016 
(statement The Honorable Robert A. McDonald, Secretary, U.S. Department 
of Veterans Affairs)
---------------------------------------------------------------------------
    ADHC programs--a popular alternative to nursing home care--
provide veterans in need of supportive services with 
companionship, peer support, recreation, and certain health 
care services.\2\ According to the Disabled American Veterans--
a proponent of increasing access to ADHC programs for 
veterans--ADHC programs are, designed to promote socialization 
[and] stimulation, and to maximize independence while enhancing 
quality of life as well as providing comprehensive medical, 
nursing, and personal care services for veterans.\3\ ADHC 
programs also provide valuable respite opportunities for 
caregivers. Despite these benefits, veterans currently face 
barriers accessing ADHC programs due to cost, meaning some 
veterans who would prefer ADHC choose instead to receive VA-
paid nursing home care.\4\ In testimony before the Subcommittee 
on Health on March 29, 2017, the National Association of State 
Veterans Homes claimed that, there are a number of State Homes 
across the country interested in providing medical model ADHC 
services; however the current basic ADHC per diem [paid to the 
SVH by VA] is not nearly sufficient for most State Homes to be 
cover the costs of this program.\5\ As a result, only three 
SVHs out of 153 SVHs nationwide provide ADHC programs. Those 
SVHs that provide ADHC programs are located in Stony Brook, New 
York; Minneapolis, Minnesota; and, Hilo, Hawaii. The Committee 
is supportive of increasing access to ADHC for veterans and 
recognizes that such access could allow veterans who would 
otherwise qualify for more costly VA-paid nursing home care the 
ability to stay at home longer.
---------------------------------------------------------------------------
    \2\U.S. Department of Veterans Affairs. Geriatrics and Extended 
Care, Adult Day Health Care, https://www.va.gov/geriatrics/guide/
longtermcare/Adult_Day_Health_Care.asp. Accessed May 11, 2017.
    \3\United States Cong. House. Committee on Veterans Affairs 
Subcommittee on Health. Legislative Hearing. March 29, 2017. 115th 
Cong. 1st sess. Washington: GPO, 2016 (statement from Shurhonda Y. 
Love, Assistant National Legislative Director, Disabled American 
Veterans)
    \4\United States Cong. House Committee on Veterans Affairs 
Subcommittee on Health. Legislative Hearing. March 29, 2017. 115th 
Cong. 1st sess. Washington: GPO, 2016 (statement for the record from 
the National Association of State Veterans Homes)
    \5\Ibid.
---------------------------------------------------------------------------
    Section 1 of the bill would require VA to enter into an 
agreement or a contract with SVHs to pay for ADHC for a veteran 
eligible for, but not receiving, nursing home care and 
stipulates that payment under each agreement or contract must 
equal 65 percent of the payment that VA would otherwise pay to 
the SVH if the veteran were receiving nursing home care.

                                Hearings

    There were no full Committee hearings held on H.R. 1005.
    On March 29, 2017, the Subcommittee on Health conducted a 
legislative hearing on a number of bills including H.R. 1005.
    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. 1005 
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. 1005 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. 
1005 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. 1005 
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 Committees 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 Committees performance 
goals and objectives are to increase the provision of ADHC 
programs through SVHs.

   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. 1005 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. 
1005 prepared by 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. 1005 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. 1005, a bill to 
amend title 38, United States Code, to improve the provision of 
adult day health care services for veterans.
    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. 1005--A bill to amend title 38, United States Code, to improve the 
        provision of adult day health care services for veterans

    H.R. 1005 would require the Department of Veterans Affairs 
(VA) to enter into provider agreements or contracts with State 
Veterans Homes (SVHs) to provide adult day health care (ADHC) 
to veterans with severe service-connected disabilities (SCD) at 
rates above VA's current per-diem rates; per-diem rates cover 
not more than half of the cost of the care. SVHs are facilities 
operated by state governments that offer nursing home care, 
domiciliary care, or ADHC primarily to veterans and receive 
some of their funding from the federal government. Under the 
bill, VA would pay for ADHC at a higher rate equal to 65 
percent of the prevailing rate for nursing home care in that 
region.
    Under current law, VA is required to comply with the 
Federal Acquisition Regulation (FAR) for agreements and 
contracts with SVHs. The FAR is an extensive and complex set of 
rules governing the federal government's purchasing processes. 
VA has been unable to secure agreements or contracts with any 
SVH because of the contractual requirements under the FAR 
(mostly related to reporting, compensation, and fringe 
benefits). As a result, VA would face challenges in entering 
into agreements or contracts under the bill and CBO expects 
that VA would continue to pay the SVHs at the current per-diem 
rate. Therefore, CBO estimates that implementing the bill would 
have no budgetary effects.
    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. 1005 would not increase net 
direct spending or on-budget deficits in any of the four 
consecutive 10-year periods beginning in 2028.
    H.R. 1005 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. 1005 prepared by 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. 
1005.

                 Statement of Constitutional Authority

    Pursuant to Article I, section 8 of the United States 
Constitution, H.R. 1005 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. 1005 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 of 1995.

              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. 1005 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. 1005 contains no directed 
rulemaking that would require the Secretary to prescribe 
regulations.

             Section-by-Section Analysis of the Legislation


Section 1. Provision of adult day health care services for veterans

    Section 1(a) of the bill would amend section 1745 of title 
38 U.S.C. by adding at the end a new subsection (d) that would:
    (1) require the Secretary of Veterans Affairs to enter into 
an agreement under section 1720(c)(1) of this title or a 
contract with each State home for payment for adult day health 
care provided to a veteran who is eligible for but not 
receiving nursing home care;
    (2) stipulate that payment under each agreement or contract 
between the Secretary of Veterans Affairs and a State home is 
required to be made at a rate equal to 65 percent of the 
payment that the Secretary would pay pursuant to subsection 
(a)(2) if a veteran received nursing home care under subsection 
(a) rather than under paragraph (1) of this subsection; and,
    (3) stipulate that payment by the Secretary of Veterans 
Affairs under paragraph (1) to a State home for adult day 
health care provided to a veteran described in that paragraph 
constitutes payment in full to the State home for such care 
furnished to that veteran. Section 1(a) of the bill would amend 
section 1745 of title 38 U.S.C. by adding at the end a new 
subsection (d) that would:
    Section 1(a) of the bill would also amend section 1745 of 
title 38 U.S.C. in the heading by inserting, adult day health 
care, after home care.
    Section 1(b) of the bill would amend the table of sections 
at the beginning of chapter 17 of title 38 U.S.C. by striking 
the item relating to section 1745 and inserting the following 
new item: 1745. Nursing home care, adult day health care, and 
medications for veterans with service-connected 
disabilities.''.

         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):

         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 II--GENERAL BENEFITS

           *       *       *       *       *       *       *


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


                          SUBCHAPTER I--GENERAL

Sec.
1701. Definitions.
     * * * * * * *

                  SUBCHAPTER V--PAYMENTS TO STATE HOMES

     * * * * * * *
[1745. Nursing home care and medications for veterans with service-
          connected disabilities.]
1745. Nursing home care, adult day health care, and medications for 
          veterans with service-connected disabilities.

           *       *       *       *       *       *       *


SUBCHAPTER V--PAYMENTS TO STATE HOMES

           *       *       *       *       *       *       *



Sec. 1745. Nursing home care, adult day health care, and medications 
                    for veterans with service-connected disabilities

  (a)(1) The Secretary shall enter into a contract (or 
agreement under section 1720(c)(1) of this title) with each 
State home for payment by the Secretary for nursing home care 
provided in the home, in any case in which such care is 
provided to any veteran as follows:
          (A) Any veteran in need of such care for a service-
        connected disability.
          (B) Any veteran who--
                  (i) has a service-connected disability rated 
                at 70 percent or more; and
                  (ii) is in need of such care.
  (2) Payment under each contract (or agreement) between the 
Secretary and a State home under paragraph (1) shall be based 
on a methodology, developed by the Secretary in consultation 
with the State home, to adequately reimburse the State home for 
the care provided by the State home under the contract (or 
agreement).
  (3) Payment by the Secretary under paragraph (1) to a State 
home for nursing home care provided to a veteran described in 
that paragraph constitutes payment in full to the State home 
for such care furnished to that veteran.
  (b) The Secretary shall furnish such drugs and medicines as 
may be ordered on prescription of a duly licensed physician as 
specific therapy in the treatment of illness or injury to any 
veteran as follows:
          (1) Any veteran who--
                  (A) is not being provided nursing home care 
                for which payment is payable under subsection 
                (a); and
                  (B) is in need of such drugs and medicines 
                for a service-connected disability.
          (2) Any veteran who--
                  (A) has a service-connected disability rated 
                at 50 percent or more;
                  (B) is not being provided nursing home care 
                for which payment is payable under subsection 
                (a); and
                  (C) is in need of such drugs and medicines.
  (c) Any State home that requests payment or reimbursement for 
services provided to a veteran under this section shall provide 
to the Secretary such information as the Secretary considers 
necessary to identify each individual veteran eligible for 
payment under such section.
  (d)(1) The Secretary shall enter into an agreement under 
section 1720(c)(1) of this title or a contract with each State 
home for payment by the Secretary for adult day health care 
provided to a veteran who is eligible for, but does not 
receive, nursing home care pursuant to subsection (a).
  (2) Payment under each agreement or contract between the 
Secretary and a State home under paragraph (1) for each veteran 
who receives care under such paragraph shall be made at a rate 
that is equal to 65 percent of the payment that the Secretary 
would pay to the State home pursuant to subsection (a)(2) if 
the veteran received nursing home care under subsection (a) 
rather than under paragraph (1) of this subsection.
  (3) Payment by the Secretary under paragraph (1) to a State 
home for adult day health care provided to a veteran described 
in that paragraph constitutes payment in full to the State home 
for such care furnished to that veteran.

           *       *       *       *       *       *       *


                                  [all]