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115th Congress    }                                     {      Report
                        HOUSE OF REPRESENTATIVES
 2d Session       }                                     {     115-683

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



 
            MILITARY SEXUAL ASSAULT VICTIMS EMPOWERMENT ACT

                                _______
                                

  May 18, 2018.--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. 3642]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 3642) to direct the Secretary of Veterans 
Affairs to carry out a pilot program to improve the access to 
private health care for veterans who are survivors of military 
sexual trauma, 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..............................     4
Hearings.........................................................     5
Subcommittee Consideration.......................................     6
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.............................     7
Committee Cost Estimate..........................................     7
Congressional Budget Office Estimate.............................     7
Federal Mandates Statement.......................................     8
Advisory Committee Statement.....................................     8
Constitutional Authority Statement...............................     9
Applicability to Legislative Branch..............................     9
Statement on Duplication of Federal Programs.....................     9
Disclosure of Directed Rulemaking................................     9
Section-by-Section Analysis of the Legislation...................     9
Changes in Existing Law Made by the Bill as Reported.............    11
    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 ``Military Sexual Assault Victims 
Empowerment Act'' or the ``Military SAVE Act''.

SEC. 2. PILOT PROGRAM FOR PRIVATE HEALTH CARE FOR VETERANS WHO ARE 
                    SURVIVORS OF MILITARY SEXUAL TRAUMA.

  (a) Establishment.--The Secretary of Veterans Affairs shall carry out 
a pilot program to furnish hospital care and medical services to 
eligible veterans through non-Department health care providers to treat 
injuries or illnesses which, in the judgment of a professional employed 
by the Department, resulted from a physical assault of a sexual nature, 
battery of a sexual nature, or sexual harassment which occurred while 
the veteran was serving on active duty, active duty for training, or 
inactive duty training.
  (b) Duration.--The Secretary shall carry out the pilot program under 
subsection (a) for a three-year period. If at the completion of the 
pilot program an eligible veteran is receiving hospital care and 
medical services from a non-Department health care provider under the 
pilot program, the Secretary may approve, on a case-by-case basis, the 
continuation of such hospital care and medical services from that non-
Department health care provider until the completion of the episode of 
care.
  (c) Eligible Veterans.--A veteran is eligible to participate in the 
pilot program under subsection (a) if the veteran--
          (1) is eligible to receive counseling and appropriate care 
        and services under section 1720D of title 38, United States 
        Code; and
          (2) resides in a site selected under subsection (d).
  (d) Sites.--
          (1) Selection.--The Secretary shall select not more than five 
        sites in which to carry out the pilot program under subsection 
        (a). Each site shall meet each of the following criteria:
                  (A) Except as provided by paragraph (2), the site 
                consists of a city with a population between 200,000 
                and 500,000, as determined by the Bureau of the Census 
                as of the first day of the pilot program.
                  (B) The site is in a State in which the National 
                Violence Against Women Prevention Research Center or 
                the Centers for Disease Control and Prevention, or 
                both, has determined the rate of sexual assault to be a 
                substantial problem.
                  (C) The site is in a State that, as of the first day 
                of the pilot program, has a weighted percentage of 
                reported rape of not less than 20 percent but not more 
                than 30 percent of sexual assault cases, in accordance 
                with the finding of the Centers for Disease Control and 
                Prevention contained in the ```Lifetime Prevalence of 
                Sexual Violence by any Perpetrator'' (NISVS 2010).
          (2) Rural site.--Not fewer than one site selected under 
        paragraph (1) shall be rural, as determined by the Secretary.
  (e) Participation.--
          (1) Election.--Subject to paragraph (2), an eligible veteran 
        may elect to participate in the pilot program under subsection 
        (a). Such election shall not affect the ability of the veteran 
        to receive health care furnished by Department providers.
          (2) Number.--Not more than 75 veterans may participate in the 
        pilot program under subsection (a) at each site selected under 
        subsection (d).
          (3) Choice of non-department health care providers.--An 
        eligible veteran who participates in the pilot program under 
        subsection (a) may freely choose from which non-Department 
        health care provider the veteran receives hospital care or 
        medical services under the pilot program, except that the 
        Secretary shall--
                  (A) ensure that each such non-Department health care 
                provider maintains at least the same or similar 
                credentials and licenses as those credentials and 
                licenses that are required of health care providers of 
                the Department, as determined by the Secretary for the 
                purposes of this section; and
                  (B) make a reasonable effort to ensure that such non-
                Department health care provider is familiar with the 
                conditions and concerns that affect members of the 
                Armed Forces and veterans and is trained in evidence-
                based psychotherapy
          (4) Provision of information.--The Secretary shall--
                  (A) notify eligible veterans of the ability to make 
                an election under paragraph (1); and
                  (B) provide to such veterans educational referral 
                materials, including through pamphlets and internet 
                websites, on the non-Department providers in the sites 
                selected under subsection (d).
  (f) Authorization and Monitoring of Care.--In accordance with 
subsection (e), the Secretary shall ensure that the Department of 
Veterans Affairs authorizes and monitors the hospital care and medical 
services furnished under the pilot program for appropriateness and 
necessity. In authorizing and monitoring such care, the Secretary 
shall--
          (1) treat a non-Department health care provider that 
        furnishes to such a veteran hospital care or medical services 
        under the pilot program as an authorized recipient of records 
        of such veteran for purposes of section 7332(b) of title 38, 
        United States Code; and
          (2) ensure that such non-Department health care provider 
        transmits to the Department such records as the Secretary 
        determines appropriate.
  (g) Payments.--
          (1) Current providers.--If a non-Department health care 
        provider has entered into a contract, agreement, or other 
        arrangement with the Secretary pursuant to another provision of 
        law to furnish hospital care or medical services to veterans, 
        the Secretary shall pay the health care provider for hospital 
        care or medical services furnished under this section using the 
        same rates and payment schedules as provided for in such 
        contract, agreement, or other arrangement.
          (2) New providers.--If a non-Department health care provider 
        has not entered into a contract, agreement, or other 
        arrangement with the Secretary pursuant to another provision of 
        law to furnish hospital care or medical services to veterans, 
        the Secretary shall pay the health care provider for hospital 
        care or medical services furnished under this section using the 
        same rates and payment schedule as if such care and services 
        was furnished pursuant to section 1703 of title 38, United 
        States Code.
          (3) New contracts and agreements.--The Secretary shall take 
        reasonable efforts to enter into a contract, agreement, or 
        other arrangement with a non-Department health care provider 
        described in subsection (a) to ensure that future care and 
        services authorized by the Secretary and furnished by the 
        provider are subject to such a contract, agreement, or other 
        arrangement
  (h) Surveys.--The Secretary shall conduct a survey of a sample of 
eligible veterans to assess the hospital care and medical services 
furnished to such veterans either pursuant to this section or section 
1720D of title 38, United States Code, as the case may be.
  (i) Report.--Not later than 60 days before the completion of the 
pilot program under subsection (a), the Secretary shall submit to the 
Committees on Veterans' Affairs of the House of Representatives and the 
Senate a report on the pilot program. The report shall include the 
following:
          (1) The results of the pilot program, including, to the 
        extent possible, an assessment of the health outcomes of 
        veterans who participated in the pilot program.
          (2) The recommendation of the Secretary with respect to 
        extending or making permanent the pilot program.
  (j) Definitions.--In this section:
          (1) The term ``non-Department health care provider'' means an 
        entity specified in section 101(a)(1)(B) of section 101 of the 
        Veterans Access, Choice, and Accountability Act of 2015 (Public 
        Law 113-146; 38 U.S.C. 1701) or any other health care provider 
        that has entered into a contract, agreement, or other 
        arrangement with the Secretary pursuant to another provision of 
        law to furnish hospital care or medical services to veterans.
          (2) The term ``sexual harassment'' has the meaning given that 
        term in section 1720D of title 38, United States Code.
          (3) The term ``State'' has the meaning given that term in 
        section 101(20) of title 38, United States Code.

                          Purpose and Summary

    H.R. 3642, as amended, the ``Military Sexual Assault 
Victims Empowerment Act'' or the ``Military SAVE Act'' would 
require the Department of Veterans Affairs (VA) to carry out a 
pilot program to furnish care in the community to veterans who 
have experienced military sexual trauma (MST). Representative 
Andy Barr of Kentucky introduced H.R. 3642 on August 4, 2017.

                  Background and Need for Legislation

    Section 1720D of title 38 United States Code (U.S.C.) 
requires VA to provide counseling, care, and services to 
veterans who are experiencing ``psychological trauma, which in 
the judgment of a mental health professional employed by the 
Department, resulted from a physical assault of a sexual 
nature, battery of a sexual nature, or sexual harassment which 
occurred while the veteran was serving on active duty or active 
duty for training.'' Such trauma is commonly referred to as 
MST. Diagnoses that are commonly associated with MST include 
posttraumatic stress disorder, depression, other mood 
disorders, and substance use disorder.\1\
---------------------------------------------------------------------------
    \1\Military Sexual Trauma. Veterans Health Administration Office of 
Mental Health Care. https://www.mentalhealth.va.gov/docs/
mst_general_factsheet.pdf. Accessed April 26, 2018.
---------------------------------------------------------------------------
    In fiscal year (FY) 2017, the Veterans Health 
Administration (VHA)--which manages and oversees the VA 
healthcare system--provided MST-related outpatient care to 
142,750 veterans.\2\ In addition, the Readjustment Counseling 
Service--which manages and oversee VA's Vet Center program--
provided MST-related care to 11,892 veterans in FY 2017. 
According to VA, ``[c]onsistent with previous years, the total 
number of veterans who received MST-related care and the total 
number of encounters provided [by VA for MST] has increased 
relative to FY 2016,'' and, ``[i]n fact, the total number of 
veterans who received MST-related care and the total number of 
encounters [provided by VA for MST] has increased every year 
since VA Office of Mental Health and Suicide Prevention's 
National MST Support Team began monitoring them.''\3\
---------------------------------------------------------------------------
    \2\``Department of Veterans Affairs Annual Report on Training and 
Certification for Health Care Providers on Care for Veterans and Active 
Duty Servicemembers who Experienced Military Sexual Trauma for Fiscal 
Year 2017,'' January 17, 2018.
    \3\Ibid.
---------------------------------------------------------------------------
    VHA Directive 2010-033 provides VA policy for MST 
programming and states that MST-related care must be provided 
in a setting that is therapeutically appropriate and takes into 
account the circumstances that resulted in the need for such 
care.\4\ It also states that care in the community is available 
for veterans who have experienced MST when it is clinically 
inadvisable to provide such care in a VA facility, when VA 
facilities are geographically inaccessible, or when VA 
facilities are unable to provide care in a timely manner.\5\ 
However, testimony before the Committee from MST survivors and 
other stakeholders in recent years has called into question 
VA's ability to adequately meet veterans' MST-related needs and 
to refer veterans to community providers for MST-related care 
when it is requested by the veteran.\6\\7\ This testimony is 
particularly concerning given the growing need within VA's 
patient population for MST-related care.
---------------------------------------------------------------------------
    \4\VHA Directive 2010-033, ``Military Sexual Trauma (MST) 
Programming,'' July 14, 2010.
    \5\Ibid.
    \6\United States Cong. House Committee on Veterans' Affairs. 
``Legislative Hearing'' October 24, 2017. 115th Cong. 1st sess. 
Washington: GPO, 2017 (statement of the Honorable Andy Barr, U.S. House 
of Representatives, 6th District, Kentucky).
    \7\United States Cong. House Committee on Veterans' Affairs 
Subcommittee on Health. ``Legislative Hearing'' November 17, 2015. 
114th Cong. 1st sess. Washington: GPO, 2015 (statement of Susan 
Moseley).
---------------------------------------------------------------------------
    Section 2 of the bill would create a three-year pilot 
program to furnish care in the community to veterans who have 
experienced MST. VA would select up to five sites to 
participate in the pilot program. Up to 75 veterans per site 
would be eligible to participate in the pilot program and these 
veterans would be able to select a community provider of their 
choice to receive MST-related care from. Community providers 
participating in the pilot program who have entered into a 
contract, agreement, or other arrangement with VA would be 
reimbursed pursuant to such contract, agreement, or other 
arrangement. However, community providers participating in the 
pilot program who have not entered into a contract, agreement, 
or other arrangement with VA would be reimbursed using the same 
rates or payment schedule as if such care were provided 
pursuant to VA's authority to provide care in the community in 
section 1703 of title 38 U.S.C. and VA would be required to 
make a reasonable effort to ensure that future care or services 
provided by that community provider is pursuant to a contract, 
agreement, or other arrangement. VA would further be 
responsible for: notifying eligible veterans of the pilot 
program and providing them with relevant educational materials; 
ensuring that community providers participating in the pilot 
program are appropriately licensed, credentialed, trained, and 
culturally competent; for authorizing and monitoring the care 
that veterans receive under the pilot program to include 
ensuring medical documentation return from community providers; 
and reporting to the Committees on Veterans' Affairs of the 
House of Representatives and the Senate with the results of the 
pilot program and a recommendation with respect to extending or 
making it permanent. In addition, VA would be required to 
conduct a survey of a sample of eligible veterans to assess the 
provision of MST-related counseling, care, or services through 
VA or pursuant to the pilot program.

                                HEARINGS

    On October 24, 2017, the full Committee conducted a 
legislative hearing on a number of bills including H.R. 3642.
    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. 3642.

                        COMMITTEE CONSIDERATION

    On May 8, 2018, the full Committee met in open markup 
session, a quorum being present, and ordered H.R. 3642, as 
amended, to be reported favorably to the House of 
Representatives by voice vote. During consideration of the 
bill, the following amendment was considered and agreed to by 
voice vote:
          An amendment in the nature of a substitute offered by 
        Representative Bruce Poliquin of Maine.

                            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. 3642, 
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. 3642, as amended, favorably 
to the House of Representatives was adopted by voice vote.

                      COMMITTEE OVERSIGHT FINDINGS

    In compliance with clause 3(c)(1) of rule XIII and clause 
(2)(b)(1) of rule X of the Rules of the House of 
Representatives, the Committee's oversight findings and 
recommendations are reflected in the descriptive portions of 
this report.

         STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

    In accordance with clause 3(c)(4) of rule XIII of the Rules 
of the House of Representatives, the Committee's performance 
goals and objectives are to create a pilot program to provide 
MST-related care to veterans in the community.

   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. 3642, as amended, does not contain any Congressional 
earmarks, limited tax benefits, or limited tariff benefits as 
defined in clause 9 of rule XXI of the Rules of the House of 
Representatives.

                        COMMITTEE COST ESTIMATE

    The Committee adopts as its own the cost estimate on H.R. 
3642, as amended, prepared by the Director of the Congressional 
Budget Office pursuant to section 402 of the Congressional 
Budget Act of 1974.

               CONGRESSIONAL BUDGET OFFICE COST ESTIMATE

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
for H.R. 3642, as amended, 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, May 9, 2018.
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. 3642, the Military 
Sexual Assault Victims Empowerment Act.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Ann E. 
Futrell.
            Sincerely,
                                                Keith Hall,
                                                          Director.
    Enclosure.

H.R. 3642--Military Sexual Assault Victims Empowerment Act

    Summary: H.R. 3642 would require the Department of Veterans 
Affairs (VA) to conduct a three-year pilot program to provide 
treatment at non-VA medical facilities to veterans who have 
experienced medical sexual trauma (MST). CBO estimates that 
implementing the bill would cost $6 million over the 2019-2023 
period, assuming appropriation of the necessary amounts.
    Enacting the bill would not affect direct spending or 
revenues; therefore, pay-as-you-go procedures do not apply.
    CBO estimates that enacting H.R. 3642 would not increase 
net direct spending or on-budget deficits in any of the four 
consecutive 10-year periods beginning in 2029.
    H.R. 3642 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA).
    Estimated cost to the Federal Government: The estimated 
budgetary effect of H.R. 3642 is shown in the following table. 
The costs of the legislation fall within budget function 700 
(veterans benefits and services).

----------------------------------------------------------------------------------------------------------------
                                                            By fiscal year, in millions of dollars--
                                               -----------------------------------------------------------------
                                                  2018     2019     2020     2021     2022     2023   2019--2023
----------------------------------------------------------------------------------------------------------------
                                 INCREASES IN SPENDING SUBJECT TO APPROPRIATION
Estimated Authorization Level.................        0        1        1        2        1        1          6
Estimated Outlays.............................        0        1        1        2        1        1          6
----------------------------------------------------------------------------------------------------------------
* = less than $500,000.

    Basis of estimate: For this estimate, CBO assumes that H.R. 
3642 will be enacted at the beginning of fiscal year 2019 and 
that the estimated amounts will be appropriated each year. 
Estimated outlays are based on historical spending patterns for 
similar programs.
    The bill would require VA to implement a three-year pilot 
program to treat MST patients at non-VA medical facilities. 
After completion of the pilot program, VA would be authorized 
to continue to provide such care to participants through the 
remainder of their treatment. The pilot program would operate 
in not more than five locations in the VA health care system 
and would include no more than 75 participants at each 
location, or a total of 375 participants.
    On the basis of information from VA on the costs and 
duration of treatment for MST patients, CBO estimates an 
average annual cost of $5,700 per patient over a three-year 
treatment period. CBO expects that VA would allow patients 
whose treatment was ongoing at the end of the pilot to complete 
that treatment in the private sector. Implementing this bill, 
therefore, would cost $6 million over the 2019-2023 period, 
assuming appropriation of the necessary amounts, CBO estimates.
    Pay-As-You-Go considerations: None.
    Increase in long-term direct spending and deficits: CBO 
estimates that enacting H.R. 3642 would not increase net direct 
spending or on-budget deficits in any of the four consecutive 
10-year periods beginning in 2029.
    Mandates: H.R. 3642 contains no intergovernmental or 
private-sector mandates as defined in UMRA.
    Estimate prepared by: Federal Costs: Ann E. Futrell; 
Mandates: Andrew Laughlin.
    Estimate reviewed by: Sarah Jennings, Chief, Defense and 
International Affairs Cost Estimates Unit; Leo Lex, Deputy 
Assistant Director for Budget Analysis.

                       FEDERAL MANDATES STATEMENT

    The Committee adopts as its own the estimate of Federal 
mandates regarding H.R. 3642, as amended, prepared by the 
Director of the Congressional Budget Office pursuant to section 
423 of the Unfunded Mandates Reform Act.

                      ADVISORY COMMITTEE STATEMENT

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act would be created by H.R. 
3642, as amended.

                 STATEMENT OF CONSTITUTIONAL AUTHORITY

    Pursuant to Article I, section 8 of the United States 
Constitution, H.R. 3642, 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. 3642, 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 clause 3(c)(5) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that no provision 
of H.R. 3642, 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. 3642, 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. 3642, as amended, as the ``Military Sexual Assault Victims 
Empowerment Act'' or the ``Military SAVE Act''.

Section 2. Pilot program for private health care for veterans who are 
        survivors of military sexual trauma

    Section 2(a) of the bill would require VA to carry out a 
pilot program to furnish hospital care and medical services to 
eligible veterans through community providers to treat injuries 
or illnesses which, in the judgement of a VA professional, 
resulted from a physical assault of a sexual nature, battery of 
a sexual nature, or sexual harassment which occurred while the 
veteran was serving on active duty, active duty for training, 
or inactive duty for training.
    Section 2(b) of the bill would require VA to carry out the 
pilot program for a three year period and authorize VA, at the 
completion of the pilot program, to approve, on a case-by-case 
basis, the continuation of hospital care or medical services 
from a community provider until the completion of the episode 
of care.
    Section 2(c) of the bill would define a veteran who is 
eligible to participate in the pilot program as a veteran who 
is eligible to receive counseling and appropriate care and 
services under section 1720D of title 38 U.S.C. and resides in 
a site selected under section 2(d) of the bill.
    Section 2(d) of the bill would require VA to select not 
more than five pilot sites in which to carry out the pilot 
program under section 2(a) of the bill and require each site 
to: consist of a city with a population between 200,000 and 
500,000 as determined by the Bureau of Census as of the first 
day of the pilot program (except that at least one pilot site 
would be required to be in a rural area as determined by VA); 
be a site within a State in which the National Violence Against 
Women Prevention Research Center or the Centers for Disease 
Control and Prevention, or both, has determined the rate of 
sexual assault to be a substantial problem; and be a site 
within a State that, as of the first day of the pilot program, 
has a weighted percentage of reported rape of not less than 20 
percent but not more than 30 percent of sexual assault cases in 
accordance with the finding of the Centers for Disease Control 
and Prevention contained in the ``Lifetime Prevalence of Sexual 
Violence by any Perpetrator (NISVS 2010).
    Section 2(e) of the bill would authorize up to 75 eligible 
veterans per site to elect to participate in the pilot program 
under section 2(a) of the bill and require that such an 
election does not affect the ability of such veteran to receive 
health care from VA providers. Section 2(e) of the bill would 
also authorize an eligible veteran who participates in the 
pilot program under section 2(a) of the bill to freely choose 
which community provider the veteran receives hospital care or 
medical services from under the pilot program. Section 2(e) 
would further require VA: to ensure that each community 
provider who participates in the pilot program maintains at 
least the same or similar credentials and licenses as those 
required by VA providers, as determined by VA; to make a 
reasonable effort to ensure that such community provider is 
familiar with the conditions and concerns that affect members 
of the Armed Forces and veterans and is trained in evidence-
based psychotherapy; to notify eligible veterans of their 
ability to elect to participate in the pilot program; and to 
provide eligible veterans with educational materials regarding 
community providers participating in the pilot program, 
including through pamphlets and internet websites.
    Section 2(f) of the bill would require VA to authorize and 
monitor the hospital care and medical services furnished to 
eligible veterans under the pilot program for appropriateness 
and necessity and to treat each community provider 
participating in the pilot program as an authorized recipient 
of records for the purposes of section 7332(b) of title 38 
U.S.C. and to ensure that such community providers transmit to 
VA such records as VA determines appropriate.
    Section 2(g) of the bill would require VA to reimburse 
community providers participating in the pilot program at the 
same rates and payment schedules as provided for in such 
contract, agreement, or other arrangement. Section 2(g) of the 
bill would also require VA to reimburse community providers 
participating in the pilot program who VA has not entered into 
a contract, agreement, or other arrangement with using the same 
rates and payment schedules as if such care and services was 
furnished pursuant to section 1703 of title 38 U.S.C. and to 
take reasonable efforts to ensure that future care and services 
authorized by VA and furnished by such providers are subject to 
a contract, agreement, or other arrangement.
    Section 2(h) of the bill would require VA to conduct a 
survey of a sample of eligible veterans to assess the hospital 
care and medical services furnished to veterans either pursuant 
to section 2 of the bill or to section 1720D of title 38 U.S.C.
    Section 2(i) of the bill would require VA to submit a 
report to the Committees on Veterans' Affairs of the House of 
Representatives and the Senate not later than 60 days before 
the completion of the pilot program established under section 
2(a) of the bill on the pilot program and to include the 
results of the pilot program--including, to the extent 
possible, an assessment of the health outcomes of veterans who 
participated in the pilot program--and VA's recommendation with 
respect to extending or making the pilot program permanent.
    Section 2(j) of the bill would define: the term ``non-
Department health care provider'' as an entity specified in 
section 101(a)(1)(B) of section 101 of the Veterans Access, 
Choice, and Accountability Act of 2015 (Public Law 113-146; 38 
U.S.C. 1701) or any other health care provider that has entered 
into a contract, agreement, or other arrangement with VA 
pursuant to another provision of law to furnish hospital care 
or medical services to veterans; the term ``sexual harassment'' 
as the meaning given that term in section 1720D of title 38 
U.S.C.; and the term ``State'' as the meaning given that term 
in section 101(20) of title 38 U.S.C.

         CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

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

                                  [all]