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115th Congress    }                                  {        Report
                        HOUSE OF REPRESENTATIVES
 2d Session       }                                  {        115-867

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



 
  VETERANS-SPECIFIC EDUCATION FOR TOMORROW'S HEALTH PROFESSIONALS ACT

                                _______
                                

 July 24, 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. 2787]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 2787) to establish in the Department of Veterans 
Affairs a pilot program instituting a clinical observation 
program for pre-med students preparing to attend medical 
school, 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.........................................................     4
Subcommittee Consideration.......................................     5
Committee Consideration..........................................     5
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.............................     6
Committee Cost Estimate..........................................     6
Congressional Budget Office Estimate.............................     6
Federal Mandates Statement.......................................     7
Advisory Committee Statement.....................................     7
Constitutional Authority Statement...............................     7
Applicability to Legislative Branch..............................     7
Statement on Duplication of Federal Programs.....................     7
Disclosure of Directed Rulemaking................................     7
Section-by-Section Analysis of the Legislation...................     8
Changes in Existing Law Made by the Bill as Reported.............     8

    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-Specific Education for 
Tomorrow's Health Professionals Act'' or the ``Vet HP Act''.

SEC. 2. SENSE OF CONGRESS REGARDING DEPARTMENT OF VETERANS AFFAIRS 
                    PILOT PROGRAM FOR CLINICAL OBSERVATION BY 
                    UNDERGRADUATE STUDENTS.

  It is the sense of Congress that the pilot program described in 
section 3(a) should be designed to----
          (1) increase the awareness, knowledge, and empathy of future 
        health professionals toward the health conditions common to 
        veterans;
          (2) increase the diversity of the recruitment pool of future 
        physicians of the Department; and
          (3) expand clinical observation opportunities for all 
        students by encouraging students of all backgrounds to consider 
        a career in the health professions.

SEC. 3. DEPARTMENT OF VETERANS AFFAIRS PILOT PROGRAM FOR CLINICAL 
                    OBSERVATION BY UNDERGRADUATE STUDENTS.

  (a) Establishment.--The Secretary of Veterans Affairs shall carry out 
a pilot program for a one-year period, beginning not later than August 
15, 2021, to provide certain students described in subsection (d) a 
clinical observation experience at medical centers of the Department of 
Veterans Affairs.
  (b) Medical Center Selection.--The Secretary shall carry out the 
pilot program under this section at not fewer than five medical centers 
of the Department. In selecting such medical centers, the Secretary 
shall ensure regional diversity among such selected medical centers.
  (c) Clinical Observation Sessions.----
          (1) Frequency and duration.--In carrying out the pilot 
        program, the Secretary shall----
                  (A) provide at least one and not more than three 
                clinical observation sessions at each medical center 
                selected during each calendar year;
                  (B) ensure that each clinical observation session----
                          (i) lasts between four and six months; and
                          (ii) to the extent practicable, begins and 
                        ends concurrently with one or more academic 
                        terms of an institution of higher education (as 
                        defined in section 101 of the Higher Education 
                        Act of 1965 (20 U.S.C. 1001)); and
                  (C) ensure that the clinical observation sessions 
                provided at a medical center have minimal overlap.
          (2) Sessions.--The Secretary shall ensure that the pilot 
        program consists of clinical observation sessions as follows:
                  (A) Each session shall allow for not fewer than five 
                students nor greater than 15 students to participate in 
                the session.
                  (B) Each session shall consist of not fewer than 20 
                observational hours nor greater than 40 observational 
                hours.
                  (C) A majority of the observational hours shall be 
                spent observing a health professional. The other 
                observational hours shall be spent in a manner that 
                ensures a robust, well rounded experience that exposes 
                the students to a variety of aspects of medical care 
                and health care administration.
                  (D) Each session shall provide a diverse clinical 
                observation experience.
  (d) Students.----
          (1) Selection.--The Secretary shall select to participate in 
        the pilot program under subsection (a) students who are----
                  (A) nationals of the United States;
                  (B) enrolled in an accredited program of study at an 
                institution of higher education; and
                  (C) referred by their institution of higher education 
                following an internal application process.
          (2) Priority.--In making such selection, the Secretary shall 
        give priority to each of the following five categories of 
        students:
                  (A) Students who, at the time of the completion of 
                their secondary education, resided in a health 
                professional shortage area (as defined in section 332 
                of the Public Health Service Act (42 U.S.C. 254e)).
                  (B) First generation college students (as defined in 
                section 402A(h)(3) of the Higher Education Act of 1965 
                (20 U.S.C. 1067q(a))).
                  (C) Students who have been referred by minority-
                serving institutions (as defined in section 371(a) of 
                the Higher Education Act of 1965 (20 U.S.C. 1067q(a))).
                  (D) Veterans (as defined in section 101 of title 38, 
                United States Code).
                  (E) Students who indicate an intention to specialize 
                in a health professional occupation identified by the 
                Inspector General of the Department under section 7412 
                of title 38, United States Code, as having a staffing 
                shortage.
          (3) Assignment to medical centers.--The Secretary shall 
        assign students selected under paragraph (1) to medical centers 
        selected under subsection (b) without regard for whether such 
        medical centers have staffing shortages in any health 
        professional occupation pursuant to section 7412 of title 38, 
        United States Code.
  (e) Other Matters.--In carrying out the pilot program under this 
section, the Secretary shall----
          (1) establish a formal status to facilitate the access to 
        medical centers of the Department by student observers 
        participating in the pilot program;
          (2) establish standardized legal, privacy, and ethical 
        requirements for the student observers, including with respect 
        to----
                  (A) ensuring that no student observer provides any 
                care to patients while participating as an observer; 
                and
                  (B) ensuring the suitability of a student to 
                participate in the pilot program to ensure that the 
                student poses no risk to patients;
          (3) develop and implement a partnership strategy with 
        minority-serving institutions to encourage referrals;
          (4) create standardized procedures for student observers;
          (5) create an online information page about the pilot program 
        on the internet website of the Department;
          (6) publish on the online information page created under 
        paragraph (5) the locations of such centers, and other 
        information on the pilot program, not later than 180 days 
        before the date on which applications are required to be 
        submitted by potential student observers;
          (7) identify medical centers and specific health 
        professionals participating in the pilot program; and
          (8) notify the Committees on Veterans' Affairs of the House 
        of Representatives and the Senate of the medical centers 
        selected under subsection (c) within 30 days of selection, to 
        facilitate program awareness.
  (f) Report.--Not later than 180 days after 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 results of the pilot program, including----
          (1) the number and demographics of all applicants, those 
        accepted to participate in the pilot program, and those who 
        completed the pilot program; and
          (2) if participating institutions of higher education choose 
        to administer satisfaction surveys that assess the experience 
        of those who completed the pilot program, the results of any 
        such satisfaction surveys, provided at the discretion of the 
        institution of higher education.

                          PURPOSE AND SUMMARY

    H.R. 2787, as amended, the Veterans-Specific Education for 
Tomorrow's Medical Doctors Act (VET MD Act), would require VA 
to carry out a three-year pilot program not fewer than five VA 
medical centers to provide undergraduate students a clinical 
observation experience. Representative Marcy Kaptur of Ohio 
introduced H.R. 2787 on June 6, 2017.

                  BACKGROUND AND NEED FOR LEGISLATION

    According to testimony from the Partnership for Public 
Service in March 2016, VA's considerable recruitment and 
retention issues are worsened by an aging workforce that is 
increasingly retirement-eligible, creating concerns about the 
Department's ability to continue providing high-quality 
benefits and services to future generations of veterans.\1\ In 
2015, GAO found that 42% of VHA's overall senior leadership was 
eligible to retire and, by fiscal year 2019, one in five VA 
nurses would be eligible to retire.\2\
---------------------------------------------------------------------------
    \1\https://docs.house.gov/Committee/Calendar/
ByEvent.aspx?EventID=108430.
    \2\https://www.gao.gov/assets/690/681805.pdf.
---------------------------------------------------------------------------
    On June 21, 2018, the Government Accountability Office 
(GAO) testified at an oversight hearing of the Subcommittee on 
Health that the physician attrition rate at the Veterans Health 
Administration (VHA) is of particular concern given that the 
Health Resources and Services Administration (HRSA) anticipates 
that by 2025 the national demand for physician services will 
exceed supply.\3\ HRSA's office of Rural Health Policy Reported 
in 2017 that physician shortages were exacerbated in rural 
areas where communities struggle to attract and keep well-
trained providers.\4\ This is particularly concerning for VHA, 
with nearly one in four VA Medical Centers located in rural 
areas.
---------------------------------------------------------------------------
    \3\https://docs.house.gov/Committee/Calendar/
ByEvent.aspx?EventID=108430.
    \4\Department of Health and Human Services, Health Resources and 
Services Administration, Designated Health Professional Shortage Areas 
Statistic.
---------------------------------------------------------------------------
    H.R. 2787, as amended, seeks to provide opportunities to 
introduce future medical students to VHA. The Committee 
believes that early engagement with America's future physicians 
would help establish VA's candidacy as a future employer for 
these students. To that end, it would also serve to provide 
those future physicians familiarity with the medical conditions 
common among veterans.

                                HEARINGS

    On June 13th, 2018, the Subcommittee on Health conducted a 
legislative hearing on a number of bills including H.R. 2787, 
as amended.
    The following witnesses testified:
          The Honorable Vicky Hartzler, U.S. House of 
        Representatives, 4th District, Missouri; The Honorable 
        Marcy Kaptur, U.S. House of Representatives, 9th 
        District, Ohio; The Honorable Matt Cartwright, U.S. 
        House of Representatives, 17th District, Pennsylvania; 
        The Honorable Clay Higgins, U.S. House of 
        Representatives, 3rd District, Louisiana; The Honorable 
        Mike Bost, U.S. House of Representatives, 12th 
        District, Illinois; The Honorable Jeff Denham, U.S. 
        House of Representatives, 10th District, California; 
        The Honorable Jenniffer Gonzalez-Colon, U.S. House of 
        Representatives, Puerto Rico; The Honorable Brad 
        Wenstrup, U.S. House of Representatives, 2nd District, 
        Ohio; Roscoe Butler, Deputy Director for Health Care, 
        The American Legion; Jeremy Villanueva, Associate 
        National Legislative Director, Disabled American 
        Veterans; Kayda Keleher, Associate Director, Veterans 
        of Foreign Wars of the United States; Jessica Bonjorni, 
        Acting Assistant Deputy Under Secretary for Health for 
        Workforce Services, U.S. Department of Veterans 
        Affairs, who was accompanied by Dayna Cooper, MSN, RN, 
        Director of Home and Community-Based Programs, Veterans 
        Health Administration, U.S. Department of Veterans 
        Affairs.
    Statements for the record were submitted by:
          American Orthotic and Prosthetic Association, 
        Paralyzed Veterans of America, and Military Officers 
        Association of America.

                       SUBCOMMITTEE CONSIDERATION

    On June 27, 2018, the Subcommittee on Health met in open 
markup session, a quorum being present, and favorably forwarded 
H.R. 2787, as amended, to the Full Committee. During 
consideration of the bill, the following amendments were 
considered and agreed to by voice vote:
          An amendment in the nature of a substitute, offered 
        by Representative Takano of California, which would 
        clarify that it is the sense of Congress that the pilot 
        is intended for recruitment and educational purposes.

          An amendment offered by Representative Dunn of 
        Florida, which would make technical and clarifying 
        corrections to medical professional terminology.

                        COMMITTEE CONSIDERATION

    On July 12, 2018, the full Committee met in open markup 
session, a quorum being present, and ordered H.R. 2787, as 
amended, to be reported favorably to the House of 
Representatives by voice vote.

                            COMMITTEE VOTES

    In compliance with clause 3(b) of rule XIII of the Rules of 
the House of Representatives, there were no recorded votes 
taken on amendments or in connection with ordering H.R. 2787, 
as amended, reported to the House. A motion by Representative 
Walz of Minnesota to report H.R. 2787, 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 increase opportunities for 
recruitment of future health professionals at VHA and to 
educate future health professionals about the medical 
conditions common among veterans.

   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. 2787, 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. 
2787, 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. 2787, 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, July 18, 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. 2787, the 
Veterans-Specific Education for Tomorrow's Health Professionals 
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. 2787--Veterans-Specific Education for Tomorrow's Health 
        Professionals Act

    By August 15, 2021, H.R. 2787 would require the Department 
of Veterans Affairs (VA) to establish a one-year pilot program 
to allow undergraduate students to observe health professionals 
at the department. Under this program, VA would hold 15 
observation sessions spread across five medical facilities. 
Each session would last several months and, to the extent 
practicable, run concurrently with a normal academic term. On 
the basis of information from VA, CBO expects that the 
department would need the following staff to operate the pilot 
program:
           A nurse program manager (at an average 
        compensation of $132,000);
           An education program specialist (at an 
        average compensation of $111,000);
           A staff assistant to manage the pilot 
        program (at an average compensation of $78,000); and,
           Five site coordinators to oversee the 
        program at each location (at an average compensation of 
        $94,000).
    CBO expects that VA would need support staff prior to the 
onset of the program to select participants and at the end of 
the program to prepare a report for the Congress. On that 
basis, CBO estimates that this bill would cost of $2 million 
over the 2019-2023 period; any spending would be subject to the 
availability of appropriated funds.
    Enacting H.R. 2787 would not affect direct spending or 
revenues; therefore, pay-as-you-go procedures do not apply.
    CBO estimates that enacting H.R. 2787 would not increase 
net direct spending or on-budget deficits in any of the four 
consecutive 10-year periods beginning in 2029.
    H.R. 2787 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act.
    The CBO staff contact for this estimate is Ann E. Futrell. 
The estimate was reviewed by 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. 2787, 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. 
2787, as amended.

                 STATEMENT OF CONSTITUTIONAL AUTHORITY

    Pursuant to Article I, section 8 of the United States 
Constitution, H.R. 2787, 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. 2787, 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. 2787, 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. 2787, 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 establish the short title as 
the ``Veterans-Specific Education for Tomorrow's Medical 
Doctors (VET MD) Act.''

Section 2. Pilot program for clinical observation by pre-med students

    Section 2 of the bill would establish three-year pilot 
program at no fewer than five VA medical facilities to provide 
clinical observation experience to undergraduate students with 
the goals of improving physician recruitment and increasing 
awareness among future medical professionals of conditions 
common to veterans.

         CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

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

                                  [all]