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115th Congress   }                                      {       Report
                        HOUSE OF REPRESENTATIVES
 1st Session     }                                      {      115-393

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



 
                VETERANS TRANSPLANT COVERAGE ACT OF 2017

                                _______
                                

November 7, 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. 1133]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 1133) to amend title 38, United States Code, to 
authorize the Secretary of Veterans Affairs to provide for an 
operation on a live donor for purposes of conducting a 
transplant procedure for a veteran, and for other purposes, 
having considered the same, report favorably thereon with an 
amendment and recommend that the bill as amended do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     2
Background and Need for Legislation..............................     2
Hearings.........................................................     4
Subcommittee Consideration.......................................     4
Committee Consideration..........................................     4
Committee Votes..................................................     5
Committee Oversight Findings.....................................     5
Statement of General Performance Goals and Objectives............     5
New Budget Authority, Entitlement Authority, and Tax Expenditures     5
Earmarks and Tax and Tariff Benefits.............................     5
Committee Cost Estimate..........................................     5
Budget Authority and Congressional Budget Office Cost Estimate...     6
Federal Mandates Statement.......................................     6
Advisory Committee Statement.....................................     6
Statement of Constitutional Authority............................     6
Applicability to Legislative Branch..............................     6
Statement on Duplication of Federal Programs.....................     6
Disclosure of Directed Rulemaking................................     7
Section-by-Section Analysis of the Legislation...................     7
Changes in Existing Law Made by the Bill, as Reported............     7

    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Veterans Transplant Coverage Act of 
2017''.

SEC. 2. AUTHORIZATION TO PROVIDE FOR OPERATIONS ON LIVE DONORS FOR 
                    PURPOSES OF CONDUCTING TRANSPLANT PROCEDURES FOR 
                    VETERANS.

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

``Sec. 1788. Transplant procedures with live donors and related 
                    services

  ``(a) In General.--In a case in which a veteran is eligible for a 
transplant procedure from the Department, the Secretary may provide for 
an operation on a live donor to carry out such procedure for such 
veteran, notwithstanding that the live donor may not be eligible for 
health care from the Department.
  ``(b) Other Services.--Subject to the availability of appropriations 
for such purpose, the Secretary shall furnish to a live donor any care 
or services before and after conducting the transplant procedure under 
subsection (a) that may be required in connection with such procedure.
  ``(c) Use of Department or Non-Department Facilities.--The Secretary 
may provide for the operation described in subsection (a) on a live 
donor and furnish to the live donor the care and services described in 
subsection (b) at a facility of the Department or at a non-Department 
facility pursuant to an agreement entered into by the Secretary under 
section 1703 or 8153 of this title, section 101 of the Veterans Access, 
Choice, and Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 
1701 note), or any other authority of the Secretary to furnish care at 
non-Department facilities. The live donor shall be deemed to be an 
individual eligible for hospital care and medical services at a non-
Department facility pursuant to such an agreement solely for the 
purposes of receiving such operation, care, and services at the non-
Department facility.''.
  (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 17 of such title is amended by inserting after the item 
relating to section 1787 the following new item:

``1788. Transplant procedures with live donors and related services.''.

                          Purpose and Summary

    H.R. 1133, as amended, the ``Veterans Transplant Coverage 
Act of 2017,'' would authorize the Department of Veterans 
Affairs (VA) to provide for any care or services a live donor 
may require to carry out a transplant procedure--in either a VA 
medical facility or a medical facility in the community--for an 
eligible veteran notwithstanding that the live donor may not be 
eligible for VA health care. Representative John Carter of 
Texas introduced H.R. 1133 on February 16, 2017.

                  Background and Need for Legislation

    VA has offered solid organ transplant services for eligible 
veteran patients since 1962 and bone marrow transplant services 
for eligible veteran patients since 1982.\1\ Through VA's 
National Transplant Program, VA provides transplants primarily 
through 13 VA transplant centers located in: Palo Alto, 
California; Portland, Oregon; Seattle, Washington; Houston, 
Texas; San Antonio, Texas; Salt Lake City, Utah; Iowa City, 
Iowa; Madison, Wisconsin; Birmingham, Alabama; Nashville, 
Tennessee; West Roxbury, Massachusetts; Bronx, New York; 
Pittsburgh, Pennsylvania; and Richmond, Virginia.\2\
---------------------------------------------------------------------------
    \1\VA National Transplant Program. https://www.va.gov/health/
services/transplant/ Accessed October 30, 2017.
    \2\Ibid.
---------------------------------------------------------------------------
    The Veterans Access, Choice, and Accountability Act of 2014 
(Public Law 113-146; 128 STAT. 1754) created the Choice program 
to increase access to care in the community for veteran 
patients unable to receive care at VA medical facilities due to 
long waiting times for VA appointments or lengthy travel 
distances to VA medical facilities. Since the implementation of 
the Choice program, the Committee has heard an increasing 
number of complaints about the VA transplant program from 
veterans who are concerned about the lengthy travel required 
for many veterans to reach a VA transplant center and barriers 
to receiving transplant care in the community. For example, in 
2016, Charles Nelson--a 100 percent service-connected veteran 
from Leander, Texas--attempted to receive a kidney transplant 
through the VA health care system.\3\ Mr. Nelson's non-veteran 
son, Austin, was willing and able to serve as Mr. Nelson's live 
donor.\4\ Rather than travel to VA transplant centers in 
Nashville, Tennessee, or Portland, Oregon, to receive his 
kidney transplant, Mr. Nelson asked VA to authorize him to 
receive his transplant at the University Hospital in San 
Antonio via the Choice program.\5\\6\ Though his request was 
approved by local VA officials in Texas, VA Central Office in 
Washington, D.C. denied Mr. Nelson's request to receive his 
transplant through the Choice program, arguing that because 
Austin was not a veteran VA would be unable to use Choice funds 
to cover the costs of his care.\7\ Though Choice is just one of 
several care in the community programs that VA could have used 
to cover the costs of Mr. Nelson's transplant at the University 
Hospital in San Antonio, Mr. Nelson eventually received his 
transplant at that facility using his Medicare benefits, 
private donations, and personal savings to cover the cost of 
his care.\8\
---------------------------------------------------------------------------
    \3\United States Cong. House Committee on Veterans' Affairs. 
Legislative Hearing. October 24, 2017. 115th Cong. 1st sess. 
Washington: GPO, 2017 (statement for the record Representative John 
Carter).
    \4\Ibid.
    \5\Ibid.
    \6\Fox 7, ``Leander Veteran Fighting for VA to Pay for Kidney 
Transplant,'' May 24, 2016, http://www.fox7austin.com/news/local-news/
disabled-leander-veteran-fighting-to-get-va-to-pay-for-kidney-
transplant.
    \7\United States Cong. House Committee on Veterans' Affairs. 
Legislative Hearing. October 24, 2017. 115th Cong. 1st sess. 
Washington: GPO, 2017 (statement for the record Representative John 
Carter).
    \8\Ibid.
---------------------------------------------------------------------------
    On June 29, 2016, the Journal of the American Medical 
Association published an article which found that greater 
distance from a VA Transplant Center was associated with a 
lower likelihood of receiving a transplant and a greater 
likelihood of death among certain veteran transplant 
patients.\9\ Given the article's findings the Committee 
believes that veterans residing far from VA transplant centers 
should be given the option of receiving their transplant from 
transplant centers in the community closer to the veteran's 
place of residence. The Committee also believes that, wherever 
possible, VA should remove barriers to transplant care in the 
community for veteran patients. Consistent with those goals, 
section 2 of the bill would authorize VA to provide for any 
care or services a live donor may require to carry out a 
transplant procedure in either a VA transplant center or 
medical facility or VA community care facility for an eligible 
veteran notwithstanding that the live donor may not be eligible 
for VA health care.
---------------------------------------------------------------------------
    \9\Journal of the American Medical Association, ``Association of 
Distance from a Transplant Center with Access to Waitlist Placement, 
Receipt of Liver Transplantation, and Survival Among U.S. Veterans, 
June 29, 2016, https://www.ncbi.nlm.nih.gov/pubmed/24668105.
---------------------------------------------------------------------------

                                Hearings

    There were no Subcommittee hearings held on H.R. 1133.
    On October 24, 2017, the full Committee conducted a 
legislative hearing on a number of bills including H.R. 1133.
    The following witnesses testified:
          The Honorable Jim Banks, U.S. House of 
        Representatives, 3rd District, Indiana; The Honorable 
        Mike Gallagher, U.S. House of Representatives, 8th 
        District, Wisconsin; The Honorable John R. Carter, U.S. 
        House of Representatives, 31st District, Texas; The 
        Honorable Glenn Thompson, U.S. House of 
        Representatives, 5th District, Pennsylvania; The 
        Honorable Neal P. Dunn, U.S. House of Representatives, 
        2nd District, Florida; The Honorable Andy Barr, U.S. 
        House of Representatives, 6th District, Kentucky; The 
        Honorable David J. Shulkin, M.D., Secretary, U.S. 
        Department of Veterans Affairs, who was accompanied by 
        Carolyn Clancy M.D., the Executive in Charge of the 
        Veterans Health Administration, and Laurie Zephyrin 
        M.D., MPH, MBA, the Acting Deputy Under Secretary for 
        Health for Community Care for the Veterans Health 
        Administration; Adrian M. Atizado, Deputy National 
        Legislative Director, Disabled American Veterans; 
        Roscoe G. Butler, Deputy Director for Health Care, 
        Veterans Affairs and Rehabilitation Division, The 
        American Legion; and, Kayda Keleher, Associate 
        Director, National Legislative Service, Veterans of 
        Foreign Wars of the United States.
    Statements for the record were submitted by:
          American Federation of Government Employees, AFL-CIO; 
        American Health Care Association; American Medical 
        Association; AMVETS; Concerned Veterans of America; 
        Fleet Reserve Association; Got Your 6; Health IT Now; 
        Iraq and Afghanistan Veterans of America; Military 
        Officers Association of America; Military Order of the 
        Purple Heart; National Alliance on Mental Illness; 
        National Guard Association of the United States; Nurses 
        Organization of Veterans Affairs/Association of VA 
        Psychologist Leaders/Association of VA Social Workers/
        Veterans Healthcare Action Campaign; Paralyzed Veterans 
        of America; Reserve Officers Association; University of 
        Pittsburgh; Vietnam Veterans of America; the Wounded 
        Warrior Project; The American Congress of Obstetrics 
        and Gynecologists; the University of California, 
        Riverside School of Medicine; the American Society of 
        Transplant Surgeons; and, the National Indian Health 
        Board.

                       Subcommittee Consideration

    There was no Subcommittee consideration of H.R. 1133, as 
amended.

                        Committee Consideration

    On November 2, 2017, the full Committee met in open markup 
session, a quorum being present, and ordered H.R. 1133, 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. 
        1133 offered by Representative Brad Wenstrup of Ohio.

                            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. 1133, 
as amended, reported to the House. A motion by Representative 
Tim Walz of Minnesota, Ranking Member of the Committee on 
Veterans' Affairs, to report H.R. 1133, 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 the provision of transplant 
care to veteran patients by authorizing VA to provide for any 
care or services a live donor may require to carry out a 
transplant procedure in either a VA or VA community care 
facility for an eligible veteran notwithstanding that the live 
donor may not be eligible for VA health care.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    With respect to the requirement with respect to clause 
3(c)(2) of rule XIII of the Rules of the House of 
Representatives, the Committee has requested but not received 
from the Director of the Congressional Budget Office an 
estimate of new budget authority, entitlement authority, or tax 
expenditures or revenues.

                  Earmarks and Tax and Tariff Benefits

    H.R. 1133, as amended, does not contain any Congressional 
earmarks, limited tax benefits, or limited tariff benefits as 
defined in clause 9 of rule XXI of the Rules of the House of 
Representatives.

                        Committee Cost Estimate

    Clause 3(d)(2) of rule XIII of the Rules of the House of 
Representatives requires an estimate and a comparison by the 
Committee of the costs that would be incurred in carrying out 
this bill. However, clause 3(d)(3)(B) of that Rule provides 
that this requirement does not apply when the Committee has 
included in its report a timely submitted cost estimate of the 
bill prepared by the Director of the Congressional Budget 
Office under section 402 of the Congressional Budget Act of 
1974. The Committee has requested but not received a cost 
estimate for this bill from the Director of the Congressional 
Budget Office. The Committee believes, according to a 
preliminary score from the Congressional Budget Office, that 
enactment of H.R. 1133, as amended, could have significant 
discretionary costs in the tens of millions of dollars over a 5 
year period.

     Budget Authority and Congressional Budget Office Cost Estimate

    With respect to the requirements of clause 3(c)(2) of rule 
XIII of the Rules of the House of Representatives and section 
308(a) of the Congressional Budget Act of 1974 and with respect 
to requirements of clause (3)(c)(3) of rule XIII of the Rules 
of the House of Representatives and section 402 of the 
Congressional Budget Act of 1974, the Committee has requested 
but not received a cost estimate for this bill from the 
Director of Congressional Budget Office. The Committee has 
requested but not received from the Director of the 
Congressional Budget Office a statement as to whether this bill 
contains any new budget authority, spending authority, credit 
authority, or an increase or decrease in revenues or tax 
expenditures.

                       Federal Mandates Statement

    With respect to the requirements of Section 423 of the 
Congressional Budget and Impoundment Control Act (as amended by 
Section 101(a)(2) of the Unfunded Mandate Reform Act, P.L. 104-
4), the Committee has requested but not received from the 
Director of the Congressional Budget Office a statement as to 
whether the provisions of the reported bill include unfunded 
mandates.

                      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. 
1133, as amended.

                 Statement of Constitutional Authority

    Pursuant to Article I, section 8 of the United States 
Constitution, H.R. 1133, as amended, is authorized by Congress' 
power to ``provide for the common Defense and general Welfare 
of the United States.''

                  Applicability to Legislative Branch

    The Committee finds that H.R. 1133, as amended, does not 
relate to the terms and conditions of employment or access to 
public services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

              Statement on Duplication of Federal Programs

    Pursuant to section 3(g) of H. Res. 5, 115th Cong. (2017), 
the Committee finds that no provision of H.R. 1133, as amended, 
establishes or reauthorizes a program of the Federal Government 
known to be duplicative of another Federal program, a program 
that was included in any report from the Government 
Accountability Office to Congress pursuant to section 21 of 
Public Law 111-139, or a program related to a program 
identified in the most recent Catalog of Federal Domestic 
Assistance.

                   Disclosure of Directed Rulemaking

    Pursuant to section 3(i) of H. Res. 5, 115th Cong. (2017), 
the Committee estimates that H.R. 1133, as amended, 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. 1133, as amended, as the ``Veterans Transplant Coverage 
Act of 2017''.

Section 2. Authorization to provide for operations on live donors for 
        purposes on conducting transplant procedures for veterans

    Section 2(a) of the bill would amend subchapter VIII of 
chapter 17 of title 38 U.S.C. by adding at the end the 
following new section: ``Sec. 1788. Transplant procedures with 
live donors and related services.'' The new section 1788 (a) 
would authorize VA, in the case in which a veteran is eligible 
for a transplant procedure from VA, to provide for an operation 
on a live donor to carry out the transplant procedure for the 
eligible veteran notwithstanding that the live donor may not be 
eligible for health care from VA. The new section 1788 (b) 
would require VA, subject to the availability of appropriations 
for such purpose, to furnish to a live donor any care or 
services before or after conducting the transplant procedure 
under section 1788(a) that may be required in connection with 
such procedure. The new section 1788(c) would authorize VA to 
provide for the operation described in section 1788(a) on a 
live donor and furnish to the live donor the care and services 
described in section 1788(b) pursuant to an agreement entered 
into by VA under section 1703 or 8153 of title 38 U.S.C., 
section 101 of the Veterans Access, Choice, and Accountability 
Act of 2014 (Public Law 113-146; 38 U.S.C. 1701 note), or any 
other authority to provide to furnish care at non-VA 
facilities. The new section 1788(c) would also require the live 
donor to be deemed an individual eligible for hospital care and 
medical services at a non-VA facility pursuant to such an 
agreement solely for the purposes of receiving such operation, 
care, and services at a non-VA facility.
    Section 2(b) of the bill would amend the table of sections 
at the beginning of chapter 17 of title 38 U.S.C. by inserting 
after the item relating to section 1787 the following new item: 
1788. Transplant procedures with live donors and related 
services.''.

         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.
     * * * * * * *
1788. Transplant procedures with live donors and related services.

           *       *       *       *       *       *       *


SUBCHAPTER VIII--HEALTH CARE OF PERSONS OTHER THAN VETERANS

           *       *       *       *       *       *       *


Sec. 1788. Transplant procedures with live donors and related services

  (a) In General.--In a case in which a veteran is eligible for 
a transplant procedure from the Department, the Secretary may 
provide for an operation on a live donor to carry out such 
procedure for such veteran, notwithstanding that the live donor 
may not be eligible for health care from the Department.
  (b) Other Services.--Subject to the availability of 
appropriations for such purpose, the Secretary shall furnish to 
a live donor any care or services before and after conducting 
the transplant procedure under subsection (a) that may be 
required in connection with such procedure.
  (c) Use of Department or Non-Department Facilities.--The 
Secretary may provide for the operation described in subsection 
(a) on a live donor and furnish to the live donor the care and 
services described in subsection (b) at a facility of the 
Department or at a non-Department facility pursuant to an 
agreement entered into by the Secretary under section 1703 or 
8153 of this title, section 101 of the Veterans Access, Choice, 
and Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 
1701 note), or any other authority of the Secretary to furnish 
care at non-Department facilities. The live donor shall be 
deemed to be an individual eligible for hospital care and 
medical services at a non-Department facility pursuant to such 
an agreement solely for the purposes of receiving such 
operation, care, and services at the non-Department facility.

           *       *       *       *       *       *       *


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