[Congressional Record Volume 149, Number 163 (Tuesday, November 11, 2003)]
[Senate]
[Pages S14454-S14455]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. CORZINE:
  S. 1847. A bill to amend title 38, United States Code, to establish a 
comprehensive program for testing and treatment of veterans for 
Hepatitis C virus; to the Committee on Veterans' Affairs.
  Mr. CORZINE. Mr. President, I rise today on Veterans Day to introduce 
the Veterans Comprehensive Hepatitis C Health Care Act. This bill would 
fundamentally change the way the Department of Veterans Affairs is 
addressing the growing Hepatitis C epidemic, and would create a 
national standard for testing and treating veterans with the virus.
  Hepatitis C is a disease of the liver caused by contact with the 
Hepatitis C virus. It is primarily spread by contact with infected 
blood. The CDC estimates that 1.8 percent of the population is infected 
with the Hepatitis C virus, and that number is much higher among 
veterans. Vietnam-era veterans are considered to be at greater risk 
because many were exposed to Hepatitis C-infected blood as a result of 
combat-related surgical care during the Vietnam War. In fact, data from 
the Veterans Administration suggests that as many as 18 percent of all 
veterans and 64 percent of Vietnam veterans are infected with the 
Hepatitis C Virus (HCV). For many of those infected, Hepatitis C can 
lead to liver failure, transplants, liver cancer, and death.
  And yet, most veterans who have Hepatitis C don't even know it--and 
often do not get treatment until it's too late. Despite recent advances 
in treating Hepatitis C, the VA still lacks a comprehensive, 
consistent, uniform approach to testing and treating veterans for the 
virus. Only a fraction of the 3.5 million veterans enrolled nationally 
with the VA Health Care System have been tested to date. Part of the 
problem stems from a lack of qualified, full-time medical personnel to 
administer and analyze the tests. Most of the 172 VA hospitals in this 
country have only one doctor, working a half day a week, to conduct and 
analyze all the tests. At this rate, it will take years to test the 
entire enrolled population--years that many of these veterans may not 
have.
  To address this growing problem, I am introducing the Veterans 
Comprehensive Hepatitis C Health Care Act. This legislation will 
improve access to Hepatitis C testing and treatment for all veterans, 
ensure that the VA spends all allocated Hepatitis C funds on testing 
and treatment, and sets new, national policies for Hepatitis C care. 
Congressman Rodney Frelinghuysen from New Jersey has introduced 
companion legislation in the House of Representatives.
  The bill would improve testing and treatment for veterans by 
requiring annual screening tests for Vietnam-era veterans enrolled in 
the VA system, and providing annual tests, upon request, to other 
veterans enrolled in the VA system. Further, it would require the VA to 
treat any enrolled veteran who tests positive for the Hepatitis C 
virus, regardless of service-connected disability status or priority 
group categorization. The VA would be required to provide at least one 
dedicated health care professional--a doctor and a nurse--at each VA 
Hospital for testing and treatment of this disease.
  This bill would also increase the amount of money dedicated to 
Hepatitis C testing and treatment, and would make sure these funds are 
spent where they are needed most. Beginning in FY04, Hepatitis C 
funding would be shifted to the Specific Purpose account under the 
Veterans Health Administration, and would be dedicated solely for the 
purpose of paying for the costs associated with treating veterans with 
the Hepatitis C virus. The bill would allocate these funds to the 22 
Veterans Integrated Service Networks (VISN) based on each VISN's 
Hepatitis C incidence rate, or the number of veterans infected with the 
virus.
  In addition, this bill will end the confusing patchwork of policies 
governing the care of veterans with Hepatitis C throughout the nation. 
This legislation directs the VA to develop and implement a 
standardized, national Hepatitis C policy for its testing protocol, 
treatment options and education and notification efforts. The bill 
further directs the VA to develop an outreach program to notify 
veterans who have

[[Page S14455]]

not been tested for the Hepatitis C virus of the need for such testing 
and the availability of such testing through the VA. And finally, this 
legislation would establish Hepatitis C Centers of Excellence in 
geographic areas with high incidence of Hepatitis C infection.
  As I've said, many veterans do not even realize that they may be 
infected with the Hepatitis C virus, and the VA is doing little to 
encourage them to get the critical testing they need. The VA currently 
lacks a comprehensive national strategy for combating this deadly 
disease. With the passage of the Veterans Comprehensive Hepatitis C 
Health Care Act, veterans will finally be provided with the access to 
testing and treatment that they have more than earned and deserve. 
Additionally, the Federal Government will actually save money in the 
long run by testing and treating this infection early on. The 
alternative is much more costly treatment of end-stage liver disease 
and the associated complications, or other disorders.
  The VA has known about the problem of Hepatitis C among veterans 
since 1992, but they have not acted. We must address this critical 
issue for the brave men and women who have placed their lives in danger 
to protect the United States. I urge my colleagues to join me in 
supporting this crucial legislation.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1847

       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 ``Veterans Comprehensive 
     Hepatitis C Health Care Act''.

     SEC. 2. COMPREHENSIVE HEPATITIS C HEALTH CARE TESTING AND 
                   TREATMENT PROGRAM FOR VETERANS.

       (a) In General.--Chapter 17 of title 38, United States 
     Code, is amended by inserting after section 1720E the 
     following new section:

     ``Sec. 1720F. Hepatitis C testing and treatment

       ``(a) Initial Testing.--(1) During the one-year period 
     beginning on the date of the enactment of the Veterans 
     Comprehensive Hepatitis C Health Care Act, the Secretary 
     shall provide a blood test for the Hepatitis C virus to--
       ``(A) each veteran who served in the active military, 
     naval, or air service during the Vietnam era or who is 
     considered to be `at risk,' and is enrolled to receive care 
     under section 1710 of this title who requests the test or is 
     otherwise receiving a physical examination or any care or 
     treatment from the Secretary; and
       ``(B) to any other veteran who requests the test.
       ``(2) After the end of the period referred to in paragraph 
     (1), the Secretary shall provide a blood test for the 
     Hepatitis C virus to any veteran who requests the test.
       ``(b) Followup Testing and Treatment.--In the case of any 
     veteran who tests positive for the Hepatitis C virus, the 
     Secretary--
       ``(1) shall provide such followup tests as are considered 
     medically appropriate; and
       ``(2) shall provide appropriate treatment for that veteran 
     in accordance with the national protocol for the treatment of 
     Hepatitis C.
       ``(c) Status of Care.--(1) Treatment shall be provided 
     under subsection (b) without regard to whether the Hepatitis 
     C virus is determined to be service-connected and without 
     regard to priority group categorization of the veteran. No 
     copayment may be charged for treatment under subsection (b), 
     and no third-party reimbursement may be sought or accepted, 
     under section 1729 of this title or any other provision of 
     law, for testing or treatment under subsection (a) or (b).
       ``(2) Paragraph (1) shall cease to be in effect upon the 
     effective date of a determination by the Secretary or by 
     Congress that the occurrence of the Hepatitis C virus in 
     specified veterans shall be presumed to be service-connected.
       ``(d) Staffing.--(1) The Secretary shall require that each 
     Department medical center employ at least one full-time 
     gastroenterologist, hepatologist, or other qualified 
     physician to provide tests and treatment for the Hepatitis C 
     virus under this section.
       ``(2) The Secretary shall, to the extent practicable, 
     ensure that each Department medical center has at least one 
     staff member assigned to work, in coordination with Hepatitis 
     C medical personnel, to coordinate treatment options for 
     Hepatitis C patients and provide information and counseling 
     for those patients and their families. Such a staff member 
     should preferably be trained in psychology or psychiatry or 
     be a social worker.
       ``(3) In order to improve treatment provided to veterans 
     with the Hepatitis C virus, the Secretary shall provide 
     increased training options to Department health care 
     personnel.''.
       (b) Clerical Amendment.--The table of sections at the 
     beginning of such chapter is amended by inserting after the 
     item relating to section 1720E the following new item:

``1720F. Hepatitis C testing and treatment.''.

     SEC. 3. FUNDING FOR HEPATITIS C PROGRAMS OF THE DEPARTMENT OF 
                   VETERANS AFFAIRS.

       (a) Program Account.--Beginning with fiscal year 2004, 
     amounts appropriated for the Department of Veterans Affairs 
     for Hepatitis C detection and treatment shall be provided, 
     within the ``Medical Care'' account, through the ``Specific 
     Purpose'' subaccount, rather than the ``VERA'' subaccount.
       (b) Allocation of Funds to VISNs.--In allocating funds 
     appropriated for the Department of Veterans Affairs for the 
     ``Medical Care'' account to the Veterans Integrated Service 
     Networks, the Secretary of Veterans Affairs shall allocate 
     funds for detection and treatment of the Hepatitis C virus 
     based upon incidence rates of that virus among veterans 
     (rather than based upon the overall population of veterans) 
     in each such network.
       (c) Limitation on Use of Funds.--Amounts appropriated for 
     the Department of Veterans Affairs for Hepatitis C detection 
     and treatment through the ``Specific Purpose'' subaccount may 
     not be used for any other purpose.

     SEC. 4. NATIONAL POLICY.

       (a) Standardized Nationwide Policy.--The Secretary of 
     Veterans Affairs shall develop and implement a standardized 
     policy to be applied throughout the Department of Veterans 
     Affairs health care system with respect to the Hepatitis C 
     virus. The policy shall include the testing protocol for the 
     Hepatitis C virus, treatment options, education and 
     notification efforts, and establishment of a specific 
     Hepatitis C diagnosis code for measurement and treatment 
     purposes.
       (b) Outreach.--The Secretary shall, on an annual basis, 
     take appropriate actions to notify veterans who have not been 
     tested for the Hepatitis C virus of the need for such testing 
     and the availability of such testing from the Department of 
     Veterans Affairs.

     SEC. 5. HEPATITIS C CENTERS OF EXCELLENCE.

       (a) Establishment.--The Secretary of Veterans Affairs shall 
     establish at least one, and not more than three, additional 
     Hepatitis C centers of excellence or additional sites at 
     which activities of Hepatitis C centers of excellence are 
     carried out. Each such additional center or site shall be 
     established at a Department of Veterans Affairs medical 
     center in one of the five geographic service areas (known as 
     a Veterans Integrated Service Network) with the highest case 
     rate of Hepatitis C in fiscal year 1999.
       (b) Funding.--Funding for the centers or sites established 
     under subsection (a) shall be provided from amounts available 
     to the Central Office of the Department of Veterans Affairs 
     and shall be in addition to amounts allocated for Hepatitis C 
     pursuant to section 3.
                                 ______