[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2792 Introduced in House (IH)]
107th CONGRESS
1st Session
H. R. 2792
To amend title 38, United States Code, to authorize the Secretary of
Veterans Affairs to make service dogs available to disabled veterans
and to make various other improvements in health care benefits provided
by the Department of Veterans Affairs, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
August 2, 2001
Mr. Moran of Kansas (for himself, Mr. Smith of New Jersey, and Mr.
Simmons) introduced the following bill; which was referred to the
Committee on Veterans' Affairs
_______________________________________________________________________
A BILL
To amend title 38, United States Code, to authorize the Secretary of
Veterans Affairs to make service dogs available to disabled veterans
and to make various other improvements in health care benefits provided
by the Department of Veterans Affairs, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Disabled Veterans Service Dog and
Health Care Improvement Act of 2001''.
SEC. 2. AUTHORIZATION FOR SECRETARY OF VETERANS AFFAIRS TO PROVIDE
SERVICE DOGS FOR DISABLED VETERANS.
(a) Authority.--Section 1714 of title 38, United States Code, is
amended--
(1) in subsection (b)--
(A) by striking ``seeing-eye or'' the first place
it appears;
(B) by striking ``who are entitled to disability
compensation'' and inserting ``who are enrolled under
section 1705 of this title'';
(C) by striking ``, and may pay'' and all that
follows through ``such seeing-eye or guide dogs''; and
(D) by striking ``handicap'' and inserting
``disability''; and
(2) by adding at the end the following new subsections:
``(c) The Secretary may provide--
``(1) service dogs trained for the aid of the hearing
impaired to veterans who are hearing impaired and are enrolled
under section 1705 of this title; and
``(2) service dogs trained for the aid of persons with
spinal cord injury or dysfunction or other chronic impairment
that substantially limits mobility to veterans with such
injury, dysfunction, or impairment who are enrolled under
section 1705 of this title.
``(d) In the case of a veteran provided a dog under subsection (b)
or (c), the Secretary may pay travel and incidental expenses for that
veteran under the terms and conditions set forth in section 111 of this
title to and from the veteran's home for expenses incurred in becoming
adjusted to the dog.''.
(b) Clerical Amendments.--
(1) The heading for such section is amended to read as
follows:
``Sec. 1714. Fitting and training in use of prosthetic appliances;
guide dogs; service dogs''.
(2) The item relating to such section in the table of
sections at the beginning of chapter 17 of such title is
amended to read as follows:
``1714. Fitting and training in use of prosthetic appliances; guide
dogs; service dogs.''.
SEC. 3. MAINTENANCE OF CAPACITY FOR SPECIALIZED TREATMENT AND
REHABILITATIVE NEEDS OF DISABLED VETERANS.
(a) Maintenance of Capacity on a Service-Network Basis.--Paragraph
(1) of section 1706(b) of title 38, United States Code, is amended--
(1) in the first sentence, by inserting ``(and each
geographic service area of the Veterans Health
Administration)'' after ``ensure that the Department'';
(2) in clause (B), by inserting ``(and each geographic
service area of the Veterans Health Administration)'' after
``overall capacity of the Department''; and
(3) by inserting after the first sentence the following new
sentence: ``The capacity of the Department (and each geographic
service area of the Veterans Health Administration) to provide
for the specialized treatment and rehabilitative needs of
disabled veterans (including veterans with spinal cord
dysfunction, blindness, amputations, and mental illness) within
distinct programs or facilities shall be measured by the annual
amount (adjusted for inflation) expended for care of such
veterans in dedicated programs which provide such specialized
treatment and rehabilitative services through specialized
staff.''.
(b) Extension of Annual Report Requirement.--Paragraph (2) of such
section is amended by striking ``April 1, 1999, April 1, 2000, and
April 1, 2001'' and inserting ``April 1 of each year through 2004''.
SEC. 4. THRESHOLD FOR VETERANS HEALTH CARE ELIGIBILITY MEANS TEST TO
REFLECT LOCALITY COST-OF-LIVING VARIATIONS.
(a) Revised Threshold.--Subsection (b) of section 1722 is amended
to read as follows:
``(b) For purposes of subsection (a)(3), the income threshold
applicable to a veteran is the greater of the following:
``(1) For any calendar year after 2000--
``(A) in the case of a veteran with no dependents,
$23,688, as adjusted pursuant to subsection (c); or
``(B) in the case of a veteran with one or more
dependents, $28,429, as so adjusted, plus $1,586, as so
adjusted, for each dependent in excess of one.
``(2) The amount in effect under the HUD Low Income Index
that is applicable in the area in which the veteran resides.''.
(b) HUD Low Income Index.--Subsection (b) of such section is
further amended by adding at the end the following new paragraph:
``(3) For purposes of paragraph (1)(B), the term `HUD Low Income
Index' means the family income ceiling amounts determined by the
Secretary of Housing and Urban Development under section 3(b)(2) of the
United States Housing Act of 1937 (42 U.S.C. 1437a(b)(2)) for purposes
of the determination of `low-income families' under that section.''.
(c) Conforming Amendments.--Such section is further amended--
(1) in subsection (b)(2), by striking ``December 31, 1990''
and inserting ``December 31, 2001''; and
(2) in subsection (c), by striking ``subsection (b)'' and
inserting ``subsection (b)(1)''.
(d) Effective Date.--The amendments made by this section shall take
effect on April 1, 2002.
SEC. 5. PILOT PROGRAM FOR COORDINATION OF AMBULATORY COMMUNITY HOSPITAL
CARE.
(a) In General.--Chapter 17 of title 38, United States Code, is
amended by inserting after section 1725 the following new section:
``Sec. 1725A. Coordination of hospital benefits: pilot program
``(a) Pilot Program.--Subject to the availability of funds
specified in subsection (g), the Secretary shall carry out a pilot
program in not more than four geographic areas of the United States to
improve access to, and coordination of, inpatient care of eligible
veterans. Under the pilot program, the Secretary, subject to subsection
(b), shall pay certain costs described in subsection (b) for which an
eligible veteran would otherwise be personally liable. The authority to
carry out the pilot program shall expire on September 30, 2006.
``(b) Payment of Costs.--In carrying out the program described in
subsection (a), the Secretary may pay the costs authorized under this
section for hospital care and medical services furnished on an
inpatient basis in a non-Department hospital to an eligible veteran
participating in the program. Such payment may cover the costs for
applicable plan deductibles and coinsurance and the reasonable costs of
such inpatient care and medical services not covered by any applicable
health-care plan of the veteran, but only to the extent such care and
services are of the kind authorized under this chapter. The Secretary
shall limit the care and services for which payment may be made under
the program to general medical and surgical services and shall require
that such services may be provided only upon preauthorization by the
Secretary.
``(c) Eligible Veterans.--(1) A veteran described in paragraph (1)
or (2) of section 1710(a) of this title is eligible to participate in
the pilot program if the veteran--
``(A) is enrolled to receive medical services from an
outpatient clinic operated by the Secretary which is (i) within
reasonable proximity to the principal residence of the veteran,
and (ii) located within the geographic area in which the
Secretary is carrying out the program described in subsection
(a);
``(B) has received care under this chapter within the 24-
month period preceding the veteran's application for enrollment
in the pilot program;
``(C) as determined by the Secretary before the
hospitalization of the veteran (i) requires such hospital care
and services for a non-service-connected condition, and (ii)
could not receive such services from a clinic operated by the
Secretary; and
``(D) elects to receive such care under a health-care plan
(other than under this title) under which the veteran is
entitled to receive such care.
``(2) Nothing in this section shall be construed to reduce the
authority of the Secretary to contract with non-Department facilities
for care of a service-connected disability of a veteran.
``(3) Notwithstanding subparagraph (D) of paragraph (1), the
Secretary shall ensure that not less than 15 percent of the veterans
participating in the program are veterans who do not have a health-care
plan.
``(d) Case Management.--As part of the program under this section,
the Secretary shall, through provision of case-management, coordinate
the care being furnished directly by the Secretary and care furnished
under the program in non-Department hospitals to veterans participating
in the program.
``(e) Designation of Participating Sites.--(1) In designating
geographic areas in which to establish the program under subsection
(a), the Secretary shall ensure that--
``(A) the areas designated are geographically dispersed;
``(B) at least 70 percent of the veterans who reside in a
designated area reside at least two hours driving distance from
the closest medical center operated by the Secretary which
provides medical and surgical hospital care; and
``(C) the establishment of the program in any such area
would not result in jeopardizing the critical mass of patients
needed to maintain a Department medical center that serves that
area.
``(2) Notwithstanding paragraph (1)(B), the Secretary may designate
for participation in the program at least one area which is in
proximity to a Department medical center which, as a result of a change
in mission of that center, does not provide hospital care.
``(f) Reports.--(1) Not later than September 30, 2003, the
Secretary shall submit to the Committees on Veterans' Affairs of the
Senate and House of Representatives a report on the experience in
implementing the pilot program under subsection (a).
``(2) Not later than September 30, 2005, the Secretary shall submit
to those committees a report on the experience in operating the pilot
program during the first two full fiscal years during which the pilot
program is conducted. That report shall include--
``(A) a comparison of the costs incurred by the Secretary
under the program and the cost experience for the calendar year
preceding establishment of the program at each site at which
the program is operated;
``(B) an assessment of the satisfaction of the participants
in the program; and
``(C) an analysis of the effect of the program on access
and quality of care for veterans.
``(g) Funding Limitations.--(1) The total amount expended for the
pilot program in any fiscal year (including amounts for administrative
costs) may not exceed $50,000,000.
``(2) Any expenditure of funds for the pilot program shall be made
from amounts in the Medical Care Collections Fund attributable to
collections under section 1729 of this title. No funds may be expended
to support the purposes of this section from any other funds available
to the Secretary for the delivery of health care services to veterans,
including funds appropriated or otherwise available for the care and
treatment of veterans who require specialized care and resources.
``(h) Health-Care Plan Defined.--For purposes of this section, the
term `health-care plan' has the meaning given that term in section
1725(f)(3) of this title.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item relating to section
1725 the following new item:
``1725A. Coordination of hospital benefits: pilot program.''.
SEC. 6. PILOT PROGRAM FOR CONTRACT HOSPITALIZATION AND FEE BASIS
AMBULATORY CARE.
(a) Establishment of Program.--The Secretary of Veterans Affairs
shall conduct a pilot program under which veterans receiving fee basis
and contract hospitalization under sections 1703 and 1728 of title 38,
United States Code, in selected service areas of the Veterans Health
Administration shall be provided such hospitalization through a
contractor that is a managed care coordinator. The program shall be
conducted during the three-year period beginning on July 1, 2002.
(b) Sites for Program.--The Secretary shall conduct the pilot
program in not less than four geographic service areas of the Veterans
Health Administration that are selected by the Secretary for
participation in the program from among such service areas that are
located in areas that the Secretary determines exhibit mature managed
care markets. Under the program, to the extent practicable all fee
basis and contract hospitalization provided by the Secretary in a
selected geographic service area shall be provided through a managed
care coordinator contractor.
(c) Selection of Contractor.--The Secretary shall select a
contractor for the pilot program not later than six months after the
date of the enactment of this Act. The contractor shall be an
experienced managed care coordinator with an in-place network of
credentialed providers.
(d) Automatic Enrollment.--Each veteran who is enrolled under
section 1705 of title 38, United States Code, who resides in a
geographic service area selected for participation in the pilot
program, and who as of the commencement of the pilot program is
authorized use of non-VA care services through fee basis programs of
the Department, or who is eligible for contract hospitalization under
section 1703 or 1728 of title 38, United States Code, shall be
automatically enrolled for participation in the pilot program. Each
such veteran shall be provided a directory of credentialed health care
providers from which to choose when approved by the Secretary to
receive non-VA care or to use in health emergencies in the case of
contract hospitalization.
(e) Program Features.--As part of the program, the Secretary shall
provide for the following:
(1) Use of commercial-industry standards (or in their
absence, Department standards) for access, timeliness, patient
satisfaction measures, and utilization management.
(2) Assignment of a primary care manager at each department
medical center participating in the program.
(3) Establishment by the contractor of a toll-free
telephone system staffed by registered nurses to provide advice
and health care referral information to veterans enrolled in
the pilot program on a 24-hour a day, seven-day a week basis.
(4) Establishment by the contractor of a veterans service
telephone line for the provision of information on eligibility,
enrollment, and provider locations.
(5) Concurrent review.
(6) Demand management.
(7) Disease management.
(8) Health and wellness programs.
(f) Primary Care Manager Functions.--Each primary care manager
provided for pursuant to subsection (e)(2) shall have responsibility
for the coordination and case management of each veteran enrolled under
section 1705 of title 38, United States Code, through that medical
center who is enrolled in the pilot program pursuant to subsection (d),
to ensure that such veterans receive the appropriate care, and that the
veteran is brought back into the VA system for followup whenever
possible and appropriate.
(g) Reports.--(1) Not later than October 1, 2003, the Secretary
shall submit to Congress a report on the operation of the pilot program
through June 30, 2003. That report shall include the Secretary's
assessment of--
(A) the adequacy of the managed care networks;
(B) patient satisfaction surveys completed by veterans
participating in the program;
(C) cost savings to the Department as a result of care
provided through the program; and
(D) proposed uses for savings if the pilot program were
implemented on a permanent basis throughout the Department for
the management of non-VA care.
(2) Not later than October 1, 2004, the Secretary shall submit a
report to Congress on the program through June 30, 2004. The Secretary
shall include in that report the matters specified in paragraph (1) and
the Secretary's recommendation for implementing on a nationwide basis
the management system tested in the pilot program.
(h) GAO Review.--Not later than June 30, 2005, the Comptroller
General of the United States shall conduct a review of the pilot
program and shall provide to Congress the Comptroller General's
findings and recommendations concerning the program.
(i) Non-VA Care Defined.--For purposes of this section, the term
``non-VA care'' means care provided in a facility other than a facility
of the Veterans Health Administration or by a health care provider who
is not an employee of the Veterans Health Administration.
SEC. 7. RECODIFICATION OF BEREAVEMENT COUNSELING AUTHORITY AND CERTAIN
OTHER HEALTH-RELATED AUTHORITIES.
(a) Statutory Reorganization.--Subchapter I of chapter 17 of title
38, United States Code, is amended--
(1) in section 1701(6)--
(A) by striking subparagraph (B) and the sentence
following that subparagraph;
(B) by striking ``services--'' in the matter
preceding subparagraph (A) and inserting ``services,
the following:''; and
(C) by striking subparagraph (A) and inserting the
following:
``(A) Surgical services.
``(B) Dental services and appliances as described in
sections 1710 and 1712 of this title.
``(C) Optometric and podiatric services.
``(D) Preventive health services.
``(E) In the case of a person otherwise receiving care or
services under this chapter--
``(i) wheelchairs, artificial limbs, trusses, and
similar appliances;
``(ii) special clothing made necessary by the
wearing of prosthetic appliances; and
``(iii) such other supplies or services as the
Secretary determines to be reasonable and necessary.
``(F) Travel and incidental expenses pursuant to section
111 of this title.''; and
(2) in section 1707--
(A) by inserting ``(a)'' at the beginning of the
text of the section; and
(B) by adding at the end the following:
``(b) The Secretary may furnish sensori-neural aids only in
accordance with guidelines prescribed by the Secretary.''.
(b) Consolidation of Provisions Relating to Persons Other Than
Veterans.--Such chapter is further amended by adding at the end the
following new subchapter:
``SUBCHAPTER VIII--HEALTH CARE OF PERSONS OTHER THAN VETERANS
``Sec. 1782. Counseling, training, and mental health services for
immediate family members
``(a) Counseling for Family Members of Veterans Receiving Service-
Connected Treatment.--In the case of a veteran who is receiving
treatment for a service-connected disability pursuant to paragraph (1)
or (2) of section 1710(a) of this title, the Secretary shall provide to
individuals described in subsection (c) such consultation, professional
counseling, training, and mental health services as are necessary in
connection with that treatment.
``(b) Counseling for Family Members of Veterans Receiving Non-
Service-Connected Treatment.--In the case of a veteran who is eligible
to receive treatment for a non-service-connected disability under the
conditions described in paragraph (1), (2), or (3) of section 1710(a)
of this title, the Secretary may, in the discretion of the Secretary,
provide to individuals described in subsection (c) such consultation,
professional counseling, training, and mental health services as are
necessary in connection with that treatment if--
``(1) those services were initiated during the veteran's
hospitalization; and
``(2) the continued provision of those services on an
outpatient basis is essential to permit the discharge of the
veteran from the hospital.
``(c) Eligible Individuals.--Individuals who may be provided
services under this subsection are--
``(1) the members of the immediate family or the legal
guardian of a veteran; or
``(2) the individual in whose household such veteran
certifies an intention to live.
``(d) Travel and Transportation Authorized.--Services provided
under subsections (a) and (b) may include, under the terms and
conditions set forth in section 111 of this title, travel and
incidental expenses of individuals described in subsection (c) in the
case of--
``(1) a veteran who is receiving care for a service-
connected disability; and
``(2) a dependent or survivor receiving care under the last
sentence of section 1783(b) of this title.
``Sec. 1783. Bereavement counseling
``(a) Deaths of Veterans.--In the case of an individual who was a
recipient of services under section 1782 of this title at the time of
the death of the veteran, the Secretary may provide bereavement
counseling to that individual in the case of a death--
``(1) that was unexpected; or
``(2) that occurred while the veteran was participating in
a hospice program (or a similar program) conducted by the
Secretary.
``(b) Deaths In Active Service.--The Secretary may provide
bereavement counseling to an individual who is a member of the
immediate family of a member of the Armed Forces who dies in the active
military, naval, or air service in the line of duty and under
circumstances not due to the person's own misconduct.
``(c) Bereavement Counseling Defined.--For purposes of this
section, the term `bereavement counseling' means such counseling
services, for a limited period, as the Secretary determines to be
reasonable and necessary to assist an individual with the emotional and
psychological stress accompanying the death of another individual.
``Sec. 1784. Humanitarian care
``The Secretary may furnish hospital care or medical services as a
humanitarian service in emergency cases, but the Secretary shall charge
for such care and services at rates prescribed by the Secretary.''.
(c) Transfer of CHAMPVA Section.--Section 1713 of such title is--
(1) transferred to subchapter VIII of chapter 17 of such
title, as added by subsection (b), and inserted after the
subchapter heading;
(2) redesignated as section 1781; and
(3) amended by adding at the end of subsection (b) the
following new sentence: ``A dependent or survivor receiving
care under the preceding sentence shall be eligible for the
same medical services as a veteran, including services under
sections 1782 and 1783 of this title.''.
(d) Repeal of Recodified Authority.--Section 1711 of such title is
amended by striking subsection (b).
(e) Cross Reference Amendments.--Such title is further amended as
follows:
(1) Section 103(d)(5)(B) is amended by striking ``1713''
and inserting ``1781''.
(2) Sections 1701(5) is amended by striking ``1713(b)'' in
subparagraphs (B) and (C)(i) and inserting ``1781(b)''.
(3) Section 1712A(b) is amended--
(A) in the last sentence of paragraph (1), by
striking ``section 1711(b)'' and inserting ``section
1784''; and
(A) in paragraph (2), by striking ``section
1701(6)(B)'' and inserting ``sections 1782 and 1783''.
(4) Section 1729(f) is amended by striking ``section
1711(b)'' and inserting ``section 1784''.
(5) Section 1729A(b) is amended--
(A) by redesignating paragraph (7) as paragraph
(8); and
(B) by inserting after paragraph (6) the following
new paragraph (7):
``(7) Section 1784 of this title.''.
(6) Section 8111(g) is amended--
(A) in paragraph (4), by inserting ``services under
sections 1782 and 1783 of this title'' after ``of this
title,''; and
(B) in paragraph (5), by striking ``section 1711(b)
or 1713'' and inserting ``section 1782, 1783, or
1784''.
(7) Section 8111A(a)(2) is amended by inserting ``, and the
term `medical services' includes services under sections 1782
and 1783 of this title'' before the period at the end.
(8) Section 8152(3) is amended by inserting ``services
under sections 1782 and 1783 of this title'' after ``of this
title),''.
(9) Sections 8502(b), 8520(a), and 8521 are amended by
striking ``the last sentence of section 1713(b)'' and inserting
``the penultimate sentence of section 1781(b)''.
(f) Clerical Amendments.--
(1) The table of sections at the beginning of such chapter
is amended--
(A) by striking the item relating to section 1707
and inserting the following:
``1707. Limitations.'';
(B) by striking the item relating to section 1713;
and
(C) by adding at the end the following:
``subchapter viii--health care of persons other than veterans
``1781. Medical care for survivors and dependents of certain veterans.
``1782. Counseling, training, and mental health services for immediate
family members.
``1783. Bereavement counseling.
``1784. Humanitarian care.''.
(2) The heading for section 1707 is amended to read as
follows:
``Sec. 1707. Limitations''.
SEC. 8. EXTENSION OF EXPIRING COLLECTIONS AUTHORITIES.
Sections 1710(f)(2)(B) and 1729(a)(2)(E) of title 38, United States
Code, are each amended by striking ``September 30, 2002'' and inserting
``September 30, 2007''.
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