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116th Congress } { Report
HOUSE OF REPRESENTATIVES
1st Session } { 116-71
======================================================================
WHOLE VETERAN ACT
_______
May 17, 2019.--Committed to the Committee on the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Takano, from the Committee on Veterans' Affairs,
submitted the following
R E P O R T
[To accompany H.R. 2359]
The Committee on Veterans' Affairs, to whom was referred
the bill (H.R. 2359) to direct the Secretary of Veterans
Affairs to submit to Congress a report on the Department of
Veterans Affairs advancing of whole health transformation,
having considered the same, report favorably thereon with an
amendment and recommend that the bill as amended do pass.
CONTENTS
Page
Amendment........................................................ 1
Purpose and Summary.............................................. 2
Background and Need for Legislation.............................. 2
Hearings......................................................... 4
Subcommittee Consideration....................................... 4
Committee Consideration.......................................... 5
Committee Votes.................................................. 5
Committee Oversight Findings..................................... 5
Congressional Budget Office Estimate; Committee Cost Estimate;
and New Budget Authority....................................... 5
Statement of General Performance Goals and Objectives............ 6
Earmarks and Tax and Tariff Benefits............................. 6
Federal Mandates Statement....................................... 6
Advisory Committee Statement..................................... 6
Constitutional Authority Statement............................... 6
Applicability to Legislative Branch.............................. 6
Statement on Duplication of Federal Programs..................... 6
Section-by-Section Analysis of the Legislation................... 6
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 ``Whole Veteran Act''.
SEC. 2. REPORT ON DEPARTMENT OF VETERANS AFFAIRS ADVANCING OF WHOLE
HEALTH TRANSFORMATION.
(a) Report.--Not later than 180 days after the date of the enactment
of this Act, the Secretary of Veterans Affairs shall submit to Congress
a report on the implementation of the Department of Veterans Affairs
memorandum dated February 1, 2019, on the subject of Advancing Whole
Health Transformation Across Veterans Health Administration.
(b) Matters Included.--The report under subsection (a) shall include
the following:
(1) An analysis of the accessibility and availability of each
of the following services at medical facilities of the
Department of Veterans Affairs (including community based
outpatient clinics, vet centers, and community living centers):
(A) Massage.
(B) Chiropractic services.
(C) Whole health clinician services.
(D) Whole health coaching.
(E) Acupuncture.
(F) Healing touch.
(G) Whole health group services.
(H) Guided imagery.
(I) Meditation.
(J) Hypnosis.
(K) Yoga.
(L) Tai chi or Qi gong.
(M) Equine assisted therapy.
(N) Any other service the Secretary determines
appropriate.
(2) An assessment of the health outcomes derived from the
services specified in paragraph (1).
(3) An assessment of the resources required to expand such
services to the entire Veterans Health Administration.
(4) A plan to provide the services referred to in paragraph
(1) to veterans who reside in a geographic area where no
community-based outpatient clinic, medical center, Vet Center,
or community living center is located.
PURPOSE AND SUMMARY
H.R. 2359, as amended, would require the Secretary of the
Department of Veterans Affairs (VA) to submit to Congress a
report on the implementation of the February 1, 2019 Whole
Health Transformation Memorandum. The report would include an
analysis of the accessibility and availability of relevant
services with respect to the implementation of such memorandum,
an assessment of health outcomes, and an assessment of
resources necessary to expand Whole Health to the VHA
enterprise. It would also require VA to produce a plan on the
delivery of VA Whole Health elements to veterans living in
areas without access to VA facilities.
Representative Conor Lamb of Pennsylvania introduced H.R.
2359 on April 25, 2019.
BACKGROUND AND NEED FOR LEGISLATION
America's healthcare systems are grappling with redesigning
delivery of care to meet healthcare needs in this country.
Social isolation, economic inequality, and prohibitive health
care costs have led to increased use of complementary and
alternative medicine (CAM), or complementary and integrative
health (CIH), such as health coaching, chiropractic services,
acupuncture, yoga, meditation, and equine therapy. The Veterans
Health Administration (VHA) is one of the first to take steps
to create a system focused on maintaining health, rather than a
system designed to only treat disease. This redesign will
appropriately accommodate the veteran population and their
unique needs while empowering veterans to control their health
and wellbeing.
In 2000, the White House Commission on Complementary and
Alternative Medicine Policy (WHCCAMP) submitted a report to the
President that included public policy recommendations to
maximize the benefits of CIH for Americans.\1\ The report
called on VA to assist in the implementation of its
recommendations. In 2005, the Institute of Medicine (IOM) (now
the National Academy of Medicine) suggested (1) health care
should strive to be both comprehensive and evidence-based; and
(2) conventional medical treatments and CIH should be held to
the same standards for validating clinical effectiveness.\2\ A
report from VHA's Healthcare Analysis and Information Group,
titled ``FY 2015 VHA Complementary & Integrative Health
Services (formerly CAM)'' demonstrated the CIH practices in
greatest use within VHA were acupuncture, animal assisted
therapy, biofeedback, guided imagery, hypnosis, meditation,
music therapy, progressive muscle relaxation, stress management
and relaxation therapy, and yoga.\3\ VA recognizes these
practices help in developing a patient's personalized and
patient-centric treatment plan.
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\1\VHA Directive 1137, Provision of Complementary and Integrative
Health (CIH), May 18, 2017, 2c
\2\VHA Directive 1137, Provision of Complementary and Integrative
Health (CIH), May 18, 2017, 2e
\3\VHA Directive 1137, Provision of Complementary and Integrative
Health (CIH), May 18, 2017, 2h
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The Office of Patient Centered Care and Cultural
Transformation (OPCC&CT) was established in January 2011. The
OPCC&CT works with
``VHA leadership and other program offices to
transform the system of health care from the
traditional medical model to a whole health system of
care, which is personalized, proactive, and patient
driven. The mission of OPCC & CT is to catalyze and
sustain cultural transformation in healthcare for and
with Veterans. Its stated vision is to transform from a
problem-based disease care system to a patient centered
health care system.''\4\
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\4\VHA Directive 1137, Provision of Complementary and Integrative
Health (CIH), May 18, 2017, 2j
In 2017, VHA launched the Whole Health Transformation
Program at 18 flagship sites, with positive early outcomes.
According to a February 2019 memo, ``Advancing Whole Health
Transformation Across Veterans Health Administration,'' VHA
plans to expand the full program to an additional 18 sites by
summer 2019, though 140 medical centers have elements of the
program.
As VA struggles to prevent the tragic reality of 20 veteran
suicides per day, programs that provide the means for social
connection and wellness services are crucial.\5\ The pace,
efficacy, and reach of the Whole Health program are not known
to Congress. Thus, by requiring the delivery of a report on the
subject of ``Advancing Whole Health Transformation Across
Veterans Health Administration,'' with analysis of
accessibility of critical services, Congress can better inform
its efforts to ensure veterans are treated as whole people, and
not episodes of care. This is particularly true for socially
isolated veterans and veterans living far from a VA facility.
As such, Congress must understand how VA has rolled out the
initial expansion, the outcomes, and the resources needed to
continue the program.
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\5\VA National Suicide Data Report 2005-2016, Office of Mental
Health and Suicide Prevention, U.S. Department of Veterans Affairs,
September 2018.
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HEARINGS
For the purposes of section 103(i) of H.Res. 6 of the 116th
Congress--(1) the following hearings were used to develop or
consider H.R. 2359.
On April 29, 2019, the Committee on Veterans' Affairs
conducted an oversight hearing titled, ``Tragic Trends: Suicide
Prevention Among Veterans''' to explore actions the Department
of Veterans Affairs and the House Committee on Veterans'
Affairs could take to combat the epidemic of suicide within the
veteran population.
The following witnesses testified:
Shelli Avenevoli PhD, the Deputy Director of the
National Institute of Mental Health within the National
Institute of Health; Richard McKeon PhD, MPH, the Chief
of the Suicide Prevention Branch within the Substance
Abuse and Mental Health Services Administration; and
Richard Stone M.D., the Executive-in-Charge of the
Veterans Health Administration within the U.S.
Department of Veterans Affairs, who was accompanied by
Keita Franklin LCSW, PhD, the National Director of
Suicide Prevention of the Office of Mental Health and
Suicide Prevention within the U.S. Department of
Veterans Affairs.
Statements for the record were received by American
Veterans, Disabled American Veterans, Iraq and Afghanistan
Veterans of America, The American Legion, Vietnam Veterans of
America, Wounded Warrior Project, Center for Disease Control,
Veterans of Foreign Wars, and The Independence Fund.
On April 30, 2019, the Subcommittee on Health conducted a
legislative hearing on several bills including H.R. 2359.
The following witnesses testified:
The Honorable Earl Blumenauer, U.S. House of
Representatives; The Honorable J. Louis Correa, U.S.
House of Representatives; The Honorable Conor Lamb,
U.S. House of Representatives; The Honorable Max Rose,
U.S. House of Representatives; Keita Franklin LCSW,
PhD, the National Director of Suicide Prevention of the
Office of Mental Health and Suicide Prevention within
the U.S. Department of Veterans Affairs, who was
accompanied by Tracy Gaudet M.D., the Director of the
Office of Patient Centered Care within the U.S.
Department of Veterans Affairs and Larry Mole PharmD,
the Chief Consultant on Population Health of the U.S.
Department of Veterans Affairs; Stephanie Mullen,
Research Director for Iraq and Afghanistan Veterans of
America; Carlos Fuentes, the Director of the National
Legislative Service within Veterans of Foreign Wars;
and Joy Ilem, the National Legislative Director for
Disabled American Veterans.
No statements for the record were received.
SUBCOMMITTEE CONSIDERATION
H.R. 2359 was not considered before the Subcommittee.
COMMITTEE CONSIDERATION
On May 8, 2019, the Committee on Veterans' Affairs met in
an open markup session, a quorum being present, and reported
H.R. 2359, as amended, 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 offered by
Representative Mark Takano of California that would require the
Secretary of the Department of Veterans Affairs to submit to
Congress a report on the implementation of the February 1, 2019
Whole Health Transformation Memorandum. The report would
include an analysis of the accessibility and availability of
relevant services with respect to the implementation of such
memorandum, an assessment of health outcomes, and an assessment
of resources necessary to expand Whole Health to the VHA
enterprise.
An amendment to the amendment in the nature of substitute
offered by Representative Gregorio Sablan that would require VA
to submit a plan to provide the components of Whole Health to
veterans without access to a VA facility, including a medical
facility, community-based outpatient center, or Vet Center.
An amendment to the amendment in the nature of a substitute
offered by Representative Andy Barr of Kentucky that would
ensure VA considers the availability of equine therapy as part
of its assessment.
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. 2359,
as amended, reported to the House. A motion by Ranking Member
David P. Roe of Tennessee to report H.R. 2359, 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.
CONGRESSIONAL BUDGET OFFICE ESTIMATE; COMMITTEE COST ESTIMATE; AND NEW
BUDGET AUTHORITY
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 the 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.
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 expand access to high quality
mental healthcare and related resources to curb the prevalence
of suicide among veterans, servicemembers, Reservists, and
members of the Coast Guard and National Guard.
EARMARKS AND TAX AND TARIFF BENEFITS
H.R. 2359, 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.
FEDERAL MANDATES STATEMENT
The Committee adopts as its own the estimate of Federal
mandates regarding H.R. 2359, 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.
2359, as amended.
CONSTITUTIONAL AUTHORITY STATEMENT
Pursuant to Article I, section 8 of the United States
Constitution, H.R. 2359, 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. 2359, 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. 2359, 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.
SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION
Section 1. Short title
Section 1 of the bill establishes the short title of the
measure as the ``Whole Veteran Act.''
Section 2. Report on Department of Veterans Affairs Advancing of Whole
Health Transformation
Section 2 of the bill requires, not later than 180 days
after the date of enactment of this Act, the Secretary of
Veterans Affairs submit to Congress a report on the
implementation of the Whole Health Transformation as outlined
in the Department of Veterans Affairs memorandum dated February
1, 2019. The report shall include analysis on the accessibility
and availability of massage, chiropractic services, whole
health clinician services, whole health coaching, acupuncture,
healing touch, whole health group services, guided imagery,
meditation, hypnosis, yoga, Tai chi or Qi gong, equine therapy,
and any other service the Secretary determines appropriate. The
report will also include an assessment of the health outcomes
from these services and an assessment of the resources required
to expand such services to the entire VHA. Additionally,
section 2 would require VA to submit a plan to the Committees
on Veterans Affairs of the Senate and House of Representatives
to provide the components of Whole Health to veterans without
access to a VA facility such as a medical facility, community-
based outpatient center, or Vet Center.
[all]
