[Congressional Record Volume 148, Number 34 (Thursday, March 21, 2002)]
[Senate]
[Pages S2265-S2266]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. ROCKEFELLER:
  S. 2044. A bill to provide for further improvement of the program to 
expand and improve the provision of specialized mental health services 
to veterans; to the Committee on Veterans' Affairs.
  Mr. ROCKEFELLER. Mr. President, I am pleased to introduce legislation 
today to ensure that veterans who struggle with post-traumatic stress 
and substance use disorders continue to get the care that they need and 
deserve. This legislation would increase the funding for an already-
established grant program for specialized mental health services 
programs. In addition, the legislation would guarantee that some 
funding would go to those facilities which need it the most but, for 
whatever reason, have not sought grants.
  From its inception, the VA health care system has been challenged to 
meet the special needs of veterans, such as spinal cord injuries, the 
need for prosthetics, blindness, traumatic brain injury, homelessness, 
post-traumatic stress disorders or PTSD, and the substance abuse 
disorders that frequently accompany these other afflictions. Over the 
years, VA has developed widely commended expertise in providing 
specialized services to meet these needs. We can all be rightfully 
proud of VA's specialized programs, which provide care that is often 
unparalleled in the greater health care community.
  Unfortunately, these programs have been endangered by budget 
constraints, a shift in focus from inpatient care to outpatient 
clinics, and the introduction of a new resource allocation system. In 
1996, Congress recognized that VA's constant battle to serve more 
veterans with a limited budget made these relatively costly specialized 
services programs disproportionately vulnerable to reductions, and took 
steps to protect them. The Veteran's Health Care Eligibility Reform Act 
of 1966 required the Secretary of Veterans Affairs to maintain VA's 
capacity to treat specific special needs of disabled veterans at the 
then-current level, and to report to Congress annually on the 
maintenance of these specialized services.
  Subsequently, internal VA advisory committees, the GAO, and my own 
staff on the Committee on Veterans'

[[Page S2266]]

Affairs reported that these protections did not go far enough. Many 
specialized programs--particularly substance abuse and PTSD treatment 
programs, were closed, reduced in size, or understaffed, offering 
little or no care to veterans suffering from these seriously 
debilitating disorders which often result from combat experiences.
  VA's own annual capacity reports give evidence that these programs 
have failed to provide services to veterans at the needed levels, or to 
preserve equal access throughout the system. However, the current law's 
reliance on systemwide, rather than local or regional capacity, and 
VA's failure to issue these reports on a timely basis as mandated, 
prevent us from understanding how well these programs meet veterans' 
needs throughout the Nation.
  In December 2001, Congress strengthened protection of specialized 
services through the VA Health Care Programs Enhancement Act, which 
described how VA is to maintain capacity for these services in 
considerably more detail. However, I believe that we must continue to 
do what we can to foster innovation and to patch some of the holes in 
substance abuse and PTSD programs.
  In addition to protecting VA's capacity to treat veterans' special 
needs, Congress also designated $15 million in VA funding specifically 
to help medical families improve care for veterans with substance abuse 
disorders and PTSD. The funds for these mental health grant programs, 
mandated by the Veterans Millennium Benefits and Health Care Act of 
1999, will soon revert to a general fund.
  In order to distribute these funds, VA sought proposals from 
facilities interested in expanding and improving their substance use 
disorder and PTSD programs. VA began to release these funds a little 
more than a year ago. As of this month, only 8 of the 16 PTSD treatment 
programs awarded funding had become operational, and only a third of 
these have hired their full complement of authorized and funded staff. 
Of the substance abuse disorder programs funded through this act, 18 of 
31 have not yet hired complete staffs.
  Despite the slow start, this funding has already increased the PTSD 
and substance abuse disorder treatment programs available to veterans. 
More than 100 staff have been hired in 18 of VA's 21 service networks 
to treat substance abuse disorders. Nine new programs, in Baltimore, 
MD; Atlanta, GA; San Francisco, CA; and Dayton, OH, among others, have 
initiated or intensified opioid substitution programs for veterans who 
have not responded well to drug-free treatment regimens. Other new 
programs, such as those in Tampa, FL; Cincinnati, OH, Columbia, MO; and 
Loma Linda, CA, put special emphasis on treating veterans with more 
complex conditions that include PTSD and substance abuse. The 
additional funding has enabled VA to develop better outpatient 
substance abuse and PTSD treatment programs, outpatient dual-diagnosis 
programs, more PTSD community clinical teams, and more residential 
substance abuse disorder rehabilitation programs.
  Due to these grants, VA has made improvements; however, many VA 
medical center directors have been reluctant to hire specialized 
substance abuse or PTSD treatment staff when, in FY 2003, the funding 
for these programs will be subject to a population-based allocation 
system and may disappear from their budgets. The legislation that I 
introduce today would ensure that this funding remained ``protected'' 
for three more years, and would increase the total amount of funding 
identified specifically for treatment of substance abuse disorders and 
PTSD from $15 million to $25 million.
  Of the $25 million authorized for this program, $15 million would be 
allocated to individual medical facilities which respond to the call 
for proposals. The remaining $10 million would be provided as direct 
grants to VA treatment facilities throughout the Nation, based on 
veterans' needs as identified by VA's Mental Health Strategic Health 
Care Group and the Committee on Care of the Severely Chronically 
Mentally Ill.
  Although I am disappointed that VA has still been unable to properly 
maintain adequate levels of care for those veterans with specialized 
health care needs, I am encouraged that our actions to fund specific 
PTSD and substance abuse programs have provided a strong start.
  Congress has spoken quite clearly in the past: VA does not have the 
discretion to decide whether or not to provide adequate care for 
veterans with substance abuse and post traumatic stress disorders. I 
ask that my colleagues support this bill, which would help ensure that 
these specialized services, a critical aspect of the health care VA 
provides to veterans, are maintained at the necessary levels for the 
men and women who have served this Nation.
                                 ______