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115th Congress }                                          { REPORT
                        HOUSE OF REPRESENTATIVES
 1st Session   }                                          { 115-266

======================================================================
 
                   VETERANS' ACCESS TO CHILD CARE ACT

                                _______
                                

 July 28, 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. 95]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 95) to amend title 38, United States Code, to 
direct the Secretary of Veterans Affairs to provide child care 
assistance to veterans receiving certain medical services 
provided by the Department of Veterans Affairs, 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.........................................................     5
Subcommittee Consideration.......................................     5
Committee Consideration..........................................     6
Committee Votes..................................................     6
Committee Oversight Findings.....................................     6
Statement of General Performance Goals and Objectives............     6
New Budget Authority, Entitlement Authority, and Tax Expenditures     6
Earmarks and Tax and Tariff Benefits.............................     6
Committee Cost Estimate..........................................     6
Congressional Budget Office Estimate.............................     7
Federal Mandates Statement.......................................    10
Advisory Committee Statement.....................................    10
Constitutional Authority Statement...............................    10
Applicability to Legislative Branch..............................    11
Statement on Duplication of Federal Programs.....................    11
Disclosure of Directed Rulemaking................................    11
Section-by-Section Analysis of the Legislation...................    11
Changes in Existing Law Made by the Bill as Reported.............    12
    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' Access to Child Care Act''.

SEC. 2. CHILD CARE ASSISTANCE FOR VETERANS RECEIVING MENTAL HEALTH CARE 
                    AND OTHER INTENSIVE HEALTH CARE SERVICES PROVIDED 
                    BY THE DEPARTMENT OF VETERANS AFFAIRS.

  (a) In General.--Subchapter III of chapter 17 of title 38, United 
States Code, is amended by adding at the end the following new section:

``Sec. 1730B. Child care assistance for veterans receiving mental 
                    health care and other intensive health care 
                    services

  ``(a) In General.--The Secretary shall provide child care assistance 
to an eligible veteran for any period that the veteran--
          ``(1) receives covered health care services at a facility of 
        the Department; and
          ``(2) is required travel to and return from such facility for 
        the receipt of such health care services.
  ``(b) Child Care Assistance.--(1) Child care assistance provided 
under this section may include any of the following:
          ``(A) A stipend for the payment of child care offered by a 
        licensed child care center (either directly or through a 
        voucher program) which shall be, to the extent practicable, 
        modeled after the Department of Veterans Affairs Child Care 
        Subsidy Program established pursuant to section 590 of title 
        40.
          ``(B) Direct provision of child care at an on-site facility 
        of the Department.
          ``(C) A payment made directly to a private child care agency.
          ``(D) A collaboration with a facility or program of another 
        Federal department or agency.
          ``(E) Such other form of assistance as the Secretary 
        considers appropriate.
  ``(2) In the case that child care assistance under this section is 
provided as a stipend under paragraph (1)(A), such stipend shall cover 
the full cost of such child care.
  ``(c) Definitions.--In this section:
          ``(1) The term `eligible veteran' means a veteran who--
                  ``(A) is the primary caretaker of a child or 
                children; and
                  ``(B) is--
                          ``(i) receiving covered health care services 
                        from the Department; or
                          ``(ii) in need of covered health care 
                        services, and but for lack of child care 
                        services, would receive such covered health 
                        care services from the Department.
          ``(2) The term `covered health care services' means--
                  ``(A) regular mental health care services;
                  ``(B) intensive mental health care services; or
                  ``(C) such other intensive health care services that 
                the Secretary determines that provision of assistance 
                to the veteran to obtain child care would improve 
                access to such health care services by the veteran.''.
  (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item relating to section 
1730A the following new item:

``1730B. Child care assistance for veterans receiving mental health 
care and other intensive health care services.''.

SEC. 3. EXTENSION OF REDUCTION IN AMOUNT OF PENSION FURNISHED BY 
                    DEPARTMENT OF VETERANS AFFAIRS FOR CERTAIN VETERANS 
                    COVERED BY MEDICAID PLANS FOR SERVICES FURNISHED BY 
                    NURSING FACILITIES.

  Section 5503(d)(7) of title 38, United States Code, is amended by 
striking ``September 30, 2024'' and inserting ``September 30, 2026''.

SEC. 4. EXTENSION OF REQUIREMENT FOR COLLECTION OF FEES FOR HOUSING 
                    LOANS GUARANTEED BY SECRETARY OF VETERANS AFFAIRS.

  Section 3729(b)(2) of title 38, United States Code, is amended--
          (1) in subparagraph (A)--
                  (A) in clause (iii), by striking ``September 30, 
                2024'' and inserting ``December 31, 2024''; and
                  (B) in clause (iv), by striking ``September 30, 
                2024'' and inserting ``December 31, 2024'';
          (2) in subparagraph (B)--
                  (A) in clause (i), by striking ``September 30, 2024'' 
                and inserting ``December 31, 2024''; and
                  (B) in clause (ii), by striking ``September 30, 
                2024'' and inserting ``December 31, 2024'';
          (3) in subparagraph (C)--
                  (A) in clause (i), by striking ``September 30, 2024'' 
                and inserting ``December 31, 2024''; and
                  (B) in clause (ii), by striking ``September 30, 
                2024'' and inserting ``December 31, 2024''; and
          (4) in subparagraph (D)--
                  (A) in clause (i), by striking ``September 30, 2024'' 
                and inserting ``December 31, 2024''; and
                  (B) in clause (ii), by striking ``September 30, 
                2024'' and inserting ``December 31, 2024''.

                          Purpose and Summary

    H.R. 95, the Veterans' Access to Child Care Act, was 
introduced by Representative Julia Brownley of California, the 
Ranking Member of the Committee on Veterans' Affairs 
Subcommittee on Health, on January 3, 2017.
    H.R. 95, as amended, would authorize VA to require the 
Department of Veterans Affairs (VA) to provide child care 
assistance to an eligible veteran for any period that the 
veteran receives covered health care services at a VA facility 
and is required to travel to and return from such facility for 
the receipt of such services. H.R. 95, as amended, would also 
extend the current $90 per month limit on a VA pension paid to 
veterans residing in nursing homes when their nursing costs are 
paid through Medicaid and VA's authority to collect certain 
funding fees.

                  Background and Need for Legislation


Section 2. Child care assistance for veterans receiving mental health 
        care and other intensive health care services provided by the 
        Department of Veterans Affairs

    The lack of child care services at many VA medical 
facilities is frequently cited as a barrier to care for 
veterans, in general, and for women veterans, in particular. A 
2015 independent study mandated by the Caregivers and Veterans 
Omnibus Health Services Act of 2010 (Public Law 111-163; 124 
Stat. 1130) on the barriers to comprehensive health care 
experienced by women veterans found that 42 percent of female 
VA users considered finding childcare to attend medical 
appointments either ``somewhat hard'' or ``very hard.''\1\ 
Furthermore, 42 percent of the women veterans surveyed had 
dependents 17 years or younger living at home and 62 percent 
indicated that they would find on-site childcare at a VA 
medical center ``very helpful.''\2\
---------------------------------------------------------------------------
    \1\Study of Barriers for Women Veterans to VA Health Care. U.S. 
Department of Veterans Affairs. April 2015. https://
www.womenshealth.va.gov/docs/
Womens%20Health%20Services_Barriers%20to%20Care%20Final%20Report_April20
15.pdf.
    \2\Ibid.
---------------------------------------------------------------------------
    The Caregivers and Veterans Omnibus Health Services Act of 
2010 (Public Law 111-163; 124 Stat. 1130) also required VA to 
carry out a pilot program to assess the feasibility and 
advisability of providing child care assistance to veterans 
receiving mental health care and other intensive health care 
services. According to the most recent report on this pilot by 
VA, the pilot cost $3.5 million to administer from fiscal year 
2011 to fiscal year 2014, with costs for individual sites 
varying depending on start-up expenses like readily available 
space and volume of demand.\3\ At the time of the report's 
publication, a total of 10,423 children utilized the program 
and a majority of those children were between the ages of three 
and five years, with the next-largest age demographic being 
between the ages of one and three years.\4\ Average monthly 
utilization varied between 37 children and 250 children a 
month, with children tending to stay in child care between 60 
and 90 minutes.\5\ Based on responses to surveys administered 
as part of the pilot, 44 percent of veteran users were mothers 
or stepmothers and 32 percent were fathers or stepfathers (with 
the balance consisting of legal guardians and grandparents) and 
veterans were consistently ``completely satisfied'' with 
services received.\6\ Congress has extended the authority of VA 
to carry out this child care pilot through December 31, 2017, 
in the Department of Veterans Affairs Expiring Authorities Act 
of 2016 (P.L. 114-228; 130 Stat. 935).
---------------------------------------------------------------------------
    \3\Child Care Assistance for Eligible Veterans Accessing Health 
Care Services at Medical Facilities. U.S. Department of Veterans 
Affairs. March 2015.
    \4\Child Care Assistance for Eligible Veterans Accessing Health 
Care Services at Medical Facilities. U.S. Department of Veterans 
Affairs. March 2015.
    \5\Ibid.
    \6\Ibid.
---------------------------------------------------------------------------
    The Committee recognizes that the lack of child care is a 
barrier to care for many veterans and that the existing VA 
child care pilot program has been successful in reducing that 
barrier for many veterans. As such, section 2 of the bill would 
make the existing VA child care pilot program permanent by 
requiring VA to provide child care assistance to an eligible 
veteran for any period that the veteran receives covered health 
care services at a VA facility and is required to travel to and 
return from such facility for the receipt of such care. 
``Covered health care services'' are defined are regular mental 
health care services, intensive mental health care services, or 
such other intensive health care services as determined by VA. 
``Eligible veteran'' is defined as those who are the primary 
caretaker of a child and who are either receiving covered 
health care services from VA or who are in need of and would 
receive such services but for the lack of child care. Section 2 
of the bill would include the following among child care 
assistance that would be provided pursuant to this authority: a 
stipend for the payment of the full cost of child care offered 
by a licensed child care center to be modeled after the VA's 
Child Care Subsidy Program; direct provision of child care at 
an on-site VA facility; payment made directly to a private 
child care agency; and, collaboration with a facility or 
program of another federal department or agency.

Section 3. Extension of reduction in amount of pension furnished by 
        Department of Veterans Affairs for certain veterans covered by 
        Medicaid plans for services furnished by nursing facilities

    Section 5503 of title 38 United States Code (U.S.C.) sets 
forth the criteria under which eligibility for income-based 
pension payments and aid and attendance allowances are affected 
by domiciliary or nursing home residence. In instances where a 
veteran, or surviving spouse, has neither a spouse nor a child 
and is receiving Medicaid-covered nursing home care, the 
veteran or surviving spouse is eligible to receive no more than 
$90 per month in VA pension or death pension payments for any 
period after the end of the third full calendar month following 
the month of admission. Under current law, this authority 
expires on September 30, 2024.
    Section 3 of the bill would extend through September 20, 
2026, the current $90 per month limit on a VA pension paid to 
veterans residing in nursing homes when their nursing costs are 
paid through title XIX (Medicaid) of the Social Security Act.

Section 4. Extension of requirement for collection of fees for housing 
        loans guaranteed by Secretary of Veterans Affairs

    Under VA's home loan guaranty program, VA may guarantee a 
loan made to eligible servicemembers, veterans, reservists, and 
certain un-remarried surviving spouses for the purchase or 
refinancing of a house, condominium, or manufactured home. 
Section 3729(b)(2) of title 38, U.S.C., sets forth a loan fee 
table that lists funding fees associated with such loans. These 
funding fees are expressed as a percentage of the loan amount 
for different types of loans. Under current law, the higher 
rates will expire on September 30, 2024.
    Section 4 of the bill would extend through September 30, 
2025, VA's authority to collect certain funding fees by 
amending the fee schedule set forth in section 3729(b)(2) of 
title 38, U.S.C.

                                Hearings

    There were no full Committee hearings held on H.R. 95, as 
amended.
    On March 29, 2017, the Subcommittee on Health conducted a 
legislative hearing on a number of bills, including H.R. 95.
    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. 95 to 
be reported favorably to the Full Committee by voice vote.

                        Committee Consideration

    On July 19, 2017, the Full Committee met in open markup 
session, a quorum being present, and ordered H.R. 95, as 
amended, to be reported favorably to the House of 
Representatives by voice vote. During consideration of the 
bill, the following amendments were considered and agreed to by 
voice vote:
          An Amendment in the Nature of a Substitute to H.R. 
        918 offered by Representative Julia Brownley of 
        California, the Ranking Member of the Committee on 
        Veterans' Affairs Subcommittee on Health.

                            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. 918, as 
amended, reported to the House. A motion by Representative Tim 
Walz of Minnesota, the Ranking Member of the Committee on 
Veterans' Affairs, to report H.R. 95, 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 improve access to health care by 
authorizing VA to provide child care assistance to veterans 
receiving intensive mental or other health care services 
through the VA healthcare system.

   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. 95 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. 
95 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. 95 provided by the Director of the Congressional 
Budget Office pursuant to section 402 of the Congressional 
Budget Act of 1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                     Washington, DC, July 24, 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. 95, the Veterans' 
Access to Child Care 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,
                                             Mark P. Hadley
                                        (For Keith Hall, Director).
    Enclosure.

H.R. 95--Veterans' Access to Child Care Act

    H.R. 95 would extend the current limitation on pensions for 
certain veterans using Medicaid and increase the fees charged 
to veterans who obtain loans guaranteed by the Department of 
Veterans Affairs (VA). This bill also would require VA to 
provide assistance for child care (through subsidies, on-site 
services, or direct payments to service providers) to veterans 
receiving mental health care at a VA medical facility.
    CBO estimates that enacting the bill would decrease direct 
spending by $635 million over the 2017-2027 period. CBO also 
estimates that implementing the bill would cost $96 million 
over the 2017-2022 period, assuming appropriation of the 
necessary amounts.
    Because enacting the bill would affect direct spending, 
pay-as-you-go procedures apply. Enacting the bill would not 
affect revenues.
    CBO estimates that enacting H.R. 95 would not increase net 
direct spending or on-budget deficits in any of the four 
consecutive 10-year periods beginning in 2028.
    H.R. 95 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA) 
and would not affect the budgets of state, local, or tribal 
governments.
    Estimated cost to the Federal Government: The estimated 
budgetary effects of H.R. 95 are shown in the following table. 
The costs of this legislation fall within budget functions 700 
(veterans benefits and services) and 550 (health).

----------------------------------------------------------------------------------------------------------------
                                                          By fiscal year, in millions of dollars--
                                          ----------------------------------------------------------------------
                                             2017      2018      2019      2020      2021      2022    2017-2022
----------------------------------------------------------------------------------------------------------------
                                 INCREASES IN SPENDING SUBJECT TO APPROPRIATION
 
Estimated Authorization Level............         0        15        21        21        22        23        102
Estimated Outlays........................         0        13        20        20        21        22         96
----------------------------------------------------------------------------------------------------------------
Note: In addition to the budgetary effects shown above, enacting H.R. 95 would decrease direct spending by $635
  million over the 2017-2027 period.

    Basis of estimate: For this estimate, CBO assumes that the 
bill will be enacted near the beginning of 2018, that the 
estimated amounts will be appropriated each year, and that 
outlays will follow historical spending patterns for the 
affected programs.

Spending subject to appropriation

    Section 2 would require VA to provide child care assistance 
to veterans receiving mental health care at VA medical 
facilities. Under the bill VA could provide a stipend to 
veterans for child care based on the amounts provided to its 
employees, offer child care at its on-site facilities or at 
other federal departments, or directly pay child care agencies 
in the community.
    On the basis of information from the Census Bureau and VA, 
CBO estimates that VA would need to process about 665,000 
claims for reimbursement of child care benefits each year. 
Based on an average appointment time (including travel) of 
about three hours and an average hourly cost for child care 
services of $10, CBO estimates that the cost to process an 
average claim would be $30. In total, CBO estimates that 
implementing this bill would cost $96 million over the 2017-
2022 period.

Direct spending

    CBO estimates that enacting H.R. 95 would decrease direct 
spending by $635 billion over the 2017-2027 period.
    Pensions for Veterans in Medicaid-Approved Nursing Homes. 
Section 3 would extend for two years (from September 30, 2024, 
to September 30, 2026) the expiration date of a provision that 
sets a $90 per month limit on pensions paid to any veteran who 
has no spouse or child and who is receiving Medicaid benefits 
in a Medicaid-approved nursing home; that provision also 
applies to any surviving spouse of a veteran who is receiving 
such coverage. Using data from VA, CBO estimates that about 
13,000 veterans and 24,000 surviving spouses would be affected 
by this provision; the average monthly savings to VA would be 
about $1,900 per veteran and $1,200 per survivor. (Those 
estimates account for the effects of inflation, mortality 
rates, and growth of the affected population.) On that basis, 
CBO estimates that enacting the provision would reduce VA 
spending by $1.4 billion over the 2025-2026 period.
    Because of the reduced pensions, Medicaid would need to 
make some payments to nursing homes that would otherwise be 
paid by the veterans and surviving spouses. Those higher 
Medicaid payments would offset some of the savings from the 
reduced pensions. CBO estimates that those Medicaid costs would 
total about $846 million over the two years, resulting in a net 
reduction in direct spending of $552 million over the 2025-2026 
period, as shown in the pay-as-you-go table below.
    Loan Guarantee Fees. Under its Home Loan program, VA 
guarantees mortgages made to veterans; those guarantees enable 
veterans to get better loan terms, such as lower interest rates 
or smaller down payments. The loan guarantee provides a lender 
a payment of up to 25 percent of the outstanding loan balances 
(subject to some limitations on the original loan amounts) in 
the event that a veteran defaults on a guaranteed loan. Section 
3 would increase some of the fees that VA charges veterans for 
providing those guarantees. Those fees lower the subsidy cost 
of the guarantees by partially offsetting the costs of 
subsequent defaults.\1\
---------------------------------------------------------------------------
    \1\Under the Federal Credit Reform Act of 1990, the subsidy cost of 
a loan guarantee is the net present value of estimated payments by the 
government to cover defaults and delinquencies, interest subsidies, or 
other expenses, offset by any payments to the government, including 
origination fees, other fees, penalties, and recoveries on defaulted 
loans. Such subsidy costs are calculated by discounting those expected 
cash flows using the rate on Treasury securities of comparable 
maturity. The resulting estimated subsidy costs are recorded in the 
budget when the loans are disbursed.
---------------------------------------------------------------------------
    Under current law, the up-front fee varies on the basis of 
the size of the down payment and whether the veteran has 
previously used the loan-guarantee benefit. Borrowers who are 
members of the reserve component pay an additional fee of 0.25 
percent of the loan amount. Veterans who receive compensation 
for service-connected disabilities are exempt from paying the 
fee. The current fees that would be affected by section 5 are:
           2.15 percent of the loan amount for loans 
        with no down payment,
           1.50 percent of the loan amount for loans 
        with a 5 percent down payment, and
           0.75 percent of the loan amount for loans 
        with a 10 percent down payment.
    Those fees are scheduled to decline on October 1, 2024, to 
1.40 percent, 0.75 percent, and 0.50 percent, respectively.
    Under section 5, that scheduled fee reduction would be 
delayed by three months, until December 31, 2024. Continuing 
the fees at their current level would increase collections by 
VA, thereby lowering the subsidy cost of the loan guarantees. 
Based on data from VA, CBO estimates that enacting section 5 
would reduce direct spending by $83 million in 2025.
    Pay-As-You-Go considerations: The Statutory Pay-As-You-Go 
Act of 2010 establishes budget-reporting and enforcement 
procedures for legislation affecting direct spending or 
revenues. The net changes in outlays that are subject to those 
pay-as-you-go procedures are shown in the following table.

   CBO ESTIMATE OF PAY-AS-YOU-GO EFFECTS FOR H.R. 95, THE VETERANS' ACCESS TO CHILD CARE ACT, AS ORDERED REPORTED BY THE HOUSE COMMITTEE ON VETERANS'
                                                                AFFAIRS ON JULY 19, 2017
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                               By fiscal year, in millions of dollars--
                                             -----------------------------------------------------------------------------------------------------------
                                               2017   2018   2019   2020   2021   2022   2023   2024     2025       2026     2027   2017-2022  2017-2027
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                       NET INCREASE OR DECREASE (-) IN THE DEFICIT
 
Statutory Pay-As-You-Go Impact..............      0      0      0      0      0      0      0      0       -355       -280       0          0       -635
--------------------------------------------------------------------------------------------------------------------------------------------------------

    Increase in long-term direct spending and deficits: CBO 
estimates that enacting the legislation would not increase net 
direct spending or on-budget deficits in any of the four 
consecutive 10-year periods beginning in 2028.
    Intergovernmental and private-sector impact: H.R. 95 
contains no intergovernmental or private-sector mandates as 
defined in UMRA and would not affect the budgets of state, 
local, or tribal governments.
    Previous CB0 estimate: On July 24, 2017, CBO transmitted a 
cost estimate for H.R. 1058, the VA Provider Equity Act, as 
ordered reported by the House Committee on Veterans' Affairs on 
July 19, 2017. The language in H.R. 1058 that affects pensions 
is similar to language in H.R. 95 and the estimated savings are 
the same.
    On July 24, 2017, CBO transmitted a cost estimate for H.R. 
3262, the Grow Our Own Directive: Physician Assistant 
Employment and Education Act of 2017, as ordered reported by 
the House Committee on Veterans' Affairs on July 19, 2017. The 
language in H.R. 3262 that affects loan guarantee fees is 
similar to language in H.R. 95 and the estimated savings are 
the same.
    Estimate prepared by: Federal Costs: Child Care 
Assistance--Ann E. Futrell, Pensions--Dwayne M. Wright, Loan 
Guarantee Fees--David Newman; Impact on State, Local, and 
Tribal Governments: Jon Sperl; Impact on the Private Sector: 
Paige Piper/Bach.
    Estimate 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. 95 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. 
95.

                 Statement of Constitutional Authority

    Pursuant to Article I, section 8 of the United States 
Constitution, H.R. 95 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. 95 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, 115th Cong. (2017), 
the Committee finds that no provision of H.R. 95 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, 115th Cong. (2017), 
the Committee estimates that H.R. 95 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 a short title of H.R. 
95, as amended, as the ``Veterans' Access to Child Care Act.''

Section 2. Child care assistance for veterans receiving mental health 
        care and other intensive health care services provided by the 
        Department of Veterans Affairs

    Section 2(a) of the bill would amend subchapter III of 
chapter 17 of title 38, U.S.C., by adding the new section 
``Sec. 1730B. Child care assistance for veterans receiving 
mental health care and other intensive health care services.''
    The new subsection 1730B(a) would require the Secretary to 
provide child care assistance to an eligible veteran for any 
period that the veteran: (1) receives covered health care 
services at a VA facility; and, (2) is required to travel to 
and return from such facility for the receipt of such health 
care services.
    The new subsection 1730B(b) would stipulate that child care 
assistance provided under this section may include: a stipend 
for the payment of child care offered by a licensed child care 
center, either directly or through a voucher program, modeled 
after the Department of Veterans Affairs Child Care Subsidy 
Program established pursuant to section 590 of title 40; direct 
provision of child care at an on-site VA facility; a payment 
made directly to a private child care agency; a collaboration 
with a facility or program of another Federal department or 
agency; or, such other form of assistance the Secretary 
considers appropriate. This subsection would also require that 
in the case that child care assistance under this section is 
provided as a stipend under paragraph (1)(A), such stipend 
cover the full cost of such child care.
    The new subsection 1730B(c) would define the term 
``eligible veteran'' to mean a veteran who is the primary 
caregiver of a child or children, and is receiving covered 
health care services from VA or is in need of covered health 
care services and would receive such services but for lack of 
child care. This section would define the term ``covered health 
care services'' to mean regular mental health care services, 
intensive mental health care services, or such other intensive 
health that the Secretary determines that provision of 
assistance to the veteran to obtain child care would improve 
access to such health care services by the veteran.

Section 3. Extension of reduction in amount of pension furnished by 
        department of veterans affairs for certain veterans covered by 
        medicaid plans for services furnished by nursing facilities

    Section 3 of the bill would amend section 5503(d)(7) of 
title 38 U.S.C. by striking ``September 30, 2014'' and 
inserting ``September 30, 2026''.

Section 3. Extension of requirement for collection of fees for housing 
        loans guaranteed by secretary of veterans affairs

    Section 3 of the bill would amend section 3729(b)(2) of 
title 38, U.S.C. clause (iii) in subparagraph (A) by striking 
``September 30, 2024'' and inserting ``September 30, 2025;'' 
clause (iv) in subparagraph (A) by striking ``September 30, 
2024'' and inserting ``September 30, 2025;'' clause (i) in 
subparagraph (B) by striking ``September 30, 2024'' and 
inserting ``September 30, 2025;'' clause (ii) in subparagraph 
(B) by striking ``September 30, 2024'' and inserting 
``September 30, 2025;'' clause (i) in subparagraph (C) by 
striking ``September 30, 2024'' and inserting ``September 30, 
2025;'' clause (ii) in subparagraph (C) by striking ``September 
30, 2024'' and inserting ``September 30, 2025;'' clause (i) in 
subparagraph (D) by striking ``September 30, 2024'' and 
inserting ``September 30, 2025;'' and, clause (ii) in 
subparagraph (D) by striking ``September 30, 2024'' and 
inserting ``September 30, 2025.''

         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 (existing law 
proposed to be omitted is enclosed in black brackets, 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 III--MISCELLANEOUS PROVISIONS RELATING TO HOSPITAL AND 
           NURSING HOME CARE AND MEDICAL TREATMENT OF VETERANS

     * * * * * * *
1730B. Child care assistance for veterans receiving mental health care 
          and other intensive health care services.

           *       *       *       *       *       *       *


   SUBCHAPTER III--MISCELLANEOUS PROVISIONS RELATING TO HOSPITAL AND 
NURSING HOME CARE AND MEDICAL TREATMENT OF VETERANS

           *       *       *       *       *       *       *


Sec. 1730B. Child care assistance for veterans receiving mental health 
                    care and other intensive health care services

  (a) In General.--The Secretary shall provide child care 
assistance to an eligible veteran for any period that the 
veteran--
          (1) receives covered health care services at a 
        facility of the Department; and
          (2) is required travel to and return from such 
        facility for the receipt of such health care services.
  (b) Child Care Assistance.--(1) Child care assistance 
provided under this section may include any of the following:
          (A) A stipend for the payment of child care offered 
        by a licensed child care center (either directly or 
        through a voucher program) which shall be, to the 
        extent practicable, modeled after the Department of 
        Veterans Affairs Child Care Subsidy Program established 
        pursuant to section 590 of title 40.
          (B) Direct provision of child care at an on-site 
        facility of the Department.
          (C) A payment made directly to a private child care 
        agency.
          (D) A collaboration with a facility or program of 
        another Federal department or agency.
          (E) Such other form of assistance as the Secretary 
        considers appropriate.
  (2) In the case that child care assistance under this section 
is provided as a stipend under paragraph (1)(A), such stipend 
shall cover the full cost of such child care.
  (c) Definitions.--In this section:
          (1) The term ``eligible veteran'' means a veteran 
        who--
                  (A) is the primary caretaker of a child or 
                children; and
                  (B) is--
                          (i) receiving covered health care 
                        services from the Department; or
                          (ii) in need of covered health care 
                        services, and but for lack of child 
                        care services, would receive such 
                        covered health care services from the 
                        Department.
          (2) The term ``covered health care services'' means--
                  (A) regular mental health care services;
                  (B) intensive mental health care services; or
                  (C) such other intensive health care services 
                that the Secretary determines that provision of 
                assistance to the veteran to obtain child care 
                would improve access to such health care 
                services by the veteran.

           *       *       *       *       *       *       *


PART III--READJUSTMENT AND RELATED BENEFITS

           *       *       *       *       *       *       *


CHAPTER 37--HOUSING AND SMALL BUSINESS LOANS

           *       *       *       *       *       *       *


Sec. 3729. Loan fee

  (a) Requirement of Fee.--(1) Except as provided in subsection 
(c), a fee shall be collected from each person obtaining a 
housing loan guaranteed, insured, or made under this chapter, 
and each person assuming a loan to which section 3714 of this 
title applies. No such loan may be guaranteed, insured, made, 
or assumed until the fee payable under this section has been 
remitted to the Secretary.
  (2) The fee may be included in the loan and paid from the 
proceeds thereof.
  (b) Determination of Fee.--(1) The amount of the fee shall be 
determined from the loan fee table in paragraph (2). The fee is 
expressed as a percentage of the total amount of the loan 
guaranteed, insured, or made, or, in the case of a loan 
assumption, the unpaid principal balance of the loan on the 
date of the transfer of the property.
  (2) The loan fee table referred to in paragraph (1) is as 
follows:


                             LOAN FEE TABLE
------------------------------------------------------------------------
                   Active duty
 Type of loan        veteran            Reservist         Other obligor
------------------------------------------------------------------------
(A)(i) Initial  2.00               2.75                 NA
 loan
 described in
 section
 3710(a) to
 purchase or
 construct a
 dwelling with
 0-down, or
 any other
 initial loan
 described in
 section
 3710(a) other
 than with 5-
 down or 10-
 down (closed
 before
 January 1,
 2004)
(A)(ii)         2.20               2.40                 NA
 Initial loan
 described in
 section
 3710(a) to
 purchase or
 construct a
 dwelling with
 0-down, or
 any other
 initial loan
 described in
 section
 3710(a) other
 than with 5-
 down or 10-
 down (closed
 on or after
 January 1,
 2004, and
 before
 October 1,
 2004)
(A)(iii)        2.15               2.40                 NA
 Initial loan
 described in
 section
 3710(a) to
 purchase or
 construct a
 dwelling with
 0-down, or
 any other
 initial loan
 described in
 section
 3710(a) other
 than with 5-
 down or 10-
 down (closed
 on or after
 October 1,
 2004, and
 before
 [September
 30, 2024]
 December 31,
 2024 )
(A)(iv)         1.40               1.65                 NA
 Initial loan
 described in
 section
 3710(a) to
 purchase or
 construct a
 dwelling with
 0-down, or
 any other
 initial loan
 described in
 section
 3710(a) other
 than with 5-
 down or 10-
 down (closed
 on or after
 [September
 30, 2024]
 December 31,
 2024 )
(B)(i)          3.30               3.30                 NA
 Subsequent
 loan
 described in
 section
 3710(a) to
 purchase or
 construct a
 dwelling with
 0-down, or
 any other
 subsequent
 loan
 described in
 section
 3710(a)
 (closed
 before
 [September
 30, 2024]
 December 31,
 2024 )
(B)(ii)         1.25               1.25                 NA
 Subsequent
 loan
 described in
 section
 3710(a) to
 purchase or
 construct a
 dwelling with
 0-down, or
 any other
 subsequent
 loan
 described in
 section
 3710(a)
 (closed on or
 after
 [September
 30, 2024]
 December 31,
 2024 )
(C)(i) Loan     1.50               1.75                 NA
 described in
 section
 3710(a) to
 purchase or
 construct a
 dwelling with
 5-down
 (closed
 before
 [September
 30, 2024]
 December 31,
 2024 )
(C)(ii) Loan    0.75               1.00                 NA
 described in
 section
 3710(a) to
 purchase or
 construct a
 dwelling with
 5-down
 (closed on or
 after
 [September
 30, 2024]
 December 31,
 2024 )
(D)(i) Initial  1.25               1.50                 NA
 loan
 described in
 section
 3710(a) to
 purchase or
 construct a
 dwelling with
 10-down
 (closed
 before
 [September
 30, 2024]
 December 31,
 2024 )
(D)(ii)         0.50               0.75                 NA
 Initial loan
 described in
 section
 3710(a) to
 purchase or
 construct a
 dwelling with
 10-down
 (closed on or
 after
 [September
 30, 2024]
 December 31,
 2024 )
(E) Interest    0.50               0.50                 NA
 rate
 reduction
 refinancing
 loan
(F) Direct      1.00               1.00                 NA
 loan under
 section 3711
(G)             1.00               1.00                 NA
 Manufactured
 home loan
 under section
 3712 (other
 than an
 interest rate
 reduction
 refinancing
 loan)
(H) Loan to     1.25               1.25                 NA
 Native
 American
 veteran under
 section 3762
 (other than
 an interest
 rate
 reduction
 refinancing
 loan)
(I) Loan        0.50               0.50                 0.50
 assumption
 under section
 3714
(J) Loan under  2.25               2.25                 2.25
 section
 3733(a)
------------------------------------------------------------------------

  (3) Any reference to a section in the ``Type of loan'' column 
in the loan fee table in paragraph (2) refers to a section of 
this title.
  (4) For the purposes of paragraph (2):
          (A) The term ``active duty veteran'' means any 
        veteran eligible for the benefits of this chapter other 
        than a Reservist.
          (B) The term ``Reservist'' means a veteran described 
        in section 3701 (b)(5)(A) of this title who is eligible 
        under section 3702(a)(2)(E) of this title.
          (C) The term ``other obligor'' means a person who is 
        not a veteran, as defined in section 101 of this title 
        or other provision of this chapter.
          (D) The term ``initial loan'' means a loan to a 
        veteran guaranteed under section 3710 or made under 
        section 3711 of this title if the veteran has never 
        obtained a loan guaranteed under section 3710 or made 
        under section 3711 of this title.
          (E) The term ``subsequent loan'' means a loan to a 
        veteran, other than an interest rate reduction 
        refinancing loan, guaranteed under section 3710 or made 
        under section 3711 of this title if the veteran has 
        previously obtained a loan guaranteed under section 
        3710 or made under section 3711 of this title.
          (F) The term ``interest rate reduction refinancing 
        loan'' means a loan described in section 3710(a)(8), 
        3710(a)(9)(B)(i), 3710(a)(11), 3712(a)(1)(F), or 
        3762(h) of this title.
          (G) The term ``0-down'' means a downpayment, if any, 
        of less than 5 percent of the total purchase price or 
        construction cost of the dwelling.
          (H) The term ``5-down'' means a downpayment of at 
        least 5 percent or more, but less than 10 percent, of 
        the total purchase price or construction cost of the 
        dwelling.
          (I) The term ``10-down'' means a downpayment of 10 
        percent or more of the total purchase price or 
        construction cost of the dwelling.
  (c) Waiver of Fee.--(1) A fee may not be collected under this 
section from a veteran who is receiving compensation (or who, 
but for the receipt of retirement pay or active service pay, 
would be entitled to receive compensation) or from a surviving 
spouse of any veteran (including a person who died in the 
active military, naval, or air service) who died from a 
service-connected disability.
  (2)(A) A veteran described in subparagraph (B) shall be 
treated as receiving compensation for purposes of this 
subsection as of the date of the rating described in such 
subparagraph without regard to whether an effective date of the 
award of compensation is established as of that date.
  (B) A veteran described in this subparagraph is a veteran who 
is rated eligible to receive compensation--
          (i) as the result of a pre-discharge disability 
        examination and rating; or
          (ii) based on a pre-discharge review of existing 
        medical evidence (including service medical and 
        treatment records) that results in the issuance of a 
        memorandum rating.

           *       *       *       *       *       *       *


PART IV--GENERAL ADMINISTRATIVE PROVISIONS

           *       *       *       *       *       *       *


CHAPTER 55--MINORS, INCOMPETENTS, AND OTHER WARDS

           *       *       *       *       *       *       *


Sec. 5503. Hospitalized veterans and estates of incompetent 
                    institutionalized veterans

  (a)(1)(A) Where any veteran having neither spouse nor child 
is being furnished domiciliary care by the Department, no 
pension in excess of $90 per month shall be paid to or for the 
veteran for any period after the end of the third full calendar 
month following the month of admission for such care.
                  (B) Except as provided in subparagraph (D) of 
                this paragraph, where any veteran having 
                neither spouse nor child is being furnished 
                nursing home care by the Department, no pension 
                in excess of $90 per month shall be paid to or 
                for the veteran for any period after the end of 
                the third full calendar month following the 
                month of admission for such care. Any amount in 
                excess of $90 per month to which the veteran 
                would be entitled but for the application of 
                the preceding sentence shall be deposited in a 
                revolving fund at the Department medical 
                facility which furnished the veteran nursing 
                care, and such amount shall be available for 
                obligation without fiscal year limitation to 
                help defray operating expenses of that 
                facility.
                  (C) No pension in excess of $90 per month 
                shall be paid to or for a veteran having 
                neither spouse nor child for any period after 
                the month in which such veteran is readmitted 
                for care described in subparagraph (A) or (B) 
                of this paragraph and furnished by the 
                Department if such veteran is readmitted within 
                six months of a period of care in connection 
                with which pension was reduced pursuant to 
                subparagraph (A) or (B) of this paragraph.
                  (D) In the case of a veteran being furnished 
                nursing home care by the Department and with 
                respect to whom subparagraph (B) of this 
                paragraph requires a reduction in pension, such 
                reduction shall not be made for a period of up 
                to three additional calendar months after the 
                last day of the third month referred to in such 
                subparagraph if the Secretary determines that 
                the primary purpose for the furnishing of such 
                care during such additional period is for the 
                Department to provide such veteran with a 
                prescribed program of rehabilitation services, 
                under chapter 17 of this title, designed to 
                restore such veteran's ability to function 
                within such veteran's family and community. If 
                the Secretary determines that it is necessary, 
                after such period, for the veteran to continue 
                such program of rehabilitation services in 
                order to achieve the purposes of such program 
                and that the primary purpose of furnishing 
                nursing home care to the veteran continues to 
                be the provision of such program to the 
                veteran, the reduction in pension required by 
                subparagraph (B) of this paragraph shall not be 
                made for the number of calendar months that the 
                Secretary determines is necessary for the 
                veteran to achieve the purposes of such 
                program.
          (2) The provisions of paragraph (1) shall also apply 
        to a veteran being furnished such care who has a spouse 
        but whose pension is payable under section 1521(b) of 
        this title. In such a case, the Secretary may apportion 
        and pay to the spouse, upon an affirmative showing of 
        hardship, all or any part of the amounts in excess of 
        the amount payable to the veteran while being furnished 
        such care which would be payable to the veteran if 
        pension were payable under section 1521(c) of this 
        title.
  (b) Notwithstanding any other provision of this section or 
any other provision of law, no reduction shall be made in the 
pension of any veteran for any part of the period during which 
the veteran is furnished hospital treatment, or institutional 
or domiciliary care, for Hansen's disease, by the United States 
or any political subdivision thereof.
  (c) Where any veteran in receipt of an aid and attendance 
allowance described in subsection (r) or (t) of section 1114 of 
this title is hospitalized at Government expense, such 
allowance shall be discontinued from the first day of the 
second calendar month which begins after the date of the 
veteran's admission for such hospitalization for so long as 
such hospitalization continues. Any discontinuance required by 
administrative regulation, during hospitalization of a veteran 
by the Department, of increased pension based on need of 
regular aid and attendance or additional compensation based on 
need of regular aid and attendance as described in subsection 
(l) or (m) of section 1114 of this title, shall not be 
effective earlier than the first day of the second calendar 
month which begins after the date of the veteran's admission 
for hospitalization. In case a veteran affected by this 
subsection leaves a hospital against medical advice and is 
thereafter admitted to hospitalization within six months from 
the date of such departure, such allowance, increased pension, 
or additional compensation, as the case may be, shall be 
discontinued from the date of such readmission for so long as 
such hospitalization continues.
  (d)(1) For the purposes of this subsection--
                  (A) the term ``Medicaid plan'' means a State 
                plan for medical assistance referred to in 
                section 1902(a) of the Social Security Act (42 
                U.S.C. 1396a(a)); and
                  (B) the term ``nursing facility'' means a 
                nursing facility described in section 1919 of 
                such Act (42 U.S.C. 1396r), other than a 
                facility that is a State home with respect to 
                which the Secretary makes per diem payments for 
                nursing home care pursuant to section 1741(a) 
                of this title.
          (2) If a veteran having neither spouse nor child is 
        covered by a Medicaid plan for services furnished such 
        veteran by a nursing facility, no pension in excess of 
        $90 per month shall be paid to or for the veteran for 
        any period after the month of admission to such nursing 
        facility.
          (3) Notwithstanding any provision of title XIX of the 
        Social Security Act, the amount of the payment paid a 
        nursing facility pursuant to a Medicaid plan for 
        services furnished a veteran may not be reduced by any 
        amount of pension permitted to be paid such veteran 
        under paragraph (2) of this subsection.
          (4) A veteran is not liable to the United States for 
        any payment of pension in excess of the amount 
        permitted under this subsection that is paid to or for 
        the veteran by reason of the inability or failure of 
        the Secretary to reduce the veteran's pension under 
        this subsection unless such inability or failure is the 
        result of a willful concealment by the veteran of 
        information necessary to make a reduction in pension 
        under this subsection.
          (5)(A) The provisions of this subsection shall apply 
        with respect to a surviving spouse having no child in 
        the same manner as they apply to a veteran having 
        neither spouse nor child.
                  (B) The provisions of this subsection shall 
                apply with respect to a child entitled to 
                pension under section 1542 of this title in the 
                same manner as they apply to a veteran having 
                neither spouse nor child.
          (6) The costs of administering this subsection shall 
        be paid for from amounts available to the Department of 
        Veterans Affairs for the payment of compensation and 
        pension.
          (7) This subsection expires on [September 30, 2024] 
        September 30, 2026.

           *       *       *       *       *       *       *


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