[Congressional Record (Bound Edition), Volume 154 (2008), Part 12]
[House]
[Pages 16860-16865]
[From the U.S. Government Publishing Office, www.gpo.gov]




          VETERANS' HEALTH CARE POLICY ENHANCEMENT ACT OF 2008

  Mr. FILNER. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 6445) to amend title 38, United States Code, to prohibit the 
Secretary of Veterans Affairs from collecting certain copayments from 
veterans who are catastrophically disabled, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 6445

       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' Health Care Policy 
     Enhancement Act of 2008''.

     SEC. 2. PROHIBITION ON COLLECTION OF CERTAIN COPAYMENTS FROM 
                   VETERANS WHO ARE CATASTROPHICALLY DISABLED.

       (a) Prohibition on Collection of Copayments and Other Fees 
     for Hospital or Nursing Home Care.--Section 1710 of title 38, 
     United States Code, is amended--
       (1) by redesignating subsection (h) as subsection (i); and
       (2) by inserting after subsection (g) the following new 
     subsection (h):
       ``(h) Notwithstanding any other provision of this section, 
     a veteran who is catastrophically disabled shall not be 
     required to make any payment otherwise required under 
     subsection (f) or (g) for the receipt of hospital care or 
     nursing home care under this section.''.
       (b) Effective Date.--Subsection (h) of section 1710 of 
     title 38, United States Code, as added by subsection (a), 
     shall apply with respect to hospital care or nursing home 
     care provided after the date of the enactment of this Act.

     SEC. 3. EXPANSION OF AUTHORITY OF SECRETARY OF VETERANS 
                   AFFAIRS TO PROVIDE COUNSELING FOR FAMILY 
                   MEMBERS OF VETERANS RECEIVING NONSERVICE-
                   CONNECTED TREATMENT.

       Section 1782(b) of title 38, United States Code, is amended 
     by striking ``if--'' and all that follows and inserting a 
     period.

     SEC. 4. COMPREHENSIVE POLICY ON PAIN MANAGEMENT.

       (a) Comprehensive Policy Required.--Not later than October 
     1, 2008, the Secretary of Veterans Affairs shall develop and 
     implement a comprehensive policy on the management of pain 
     experienced by veterans enrolled for health care services 
     provided by the Department of Veterans Affairs.
       (b) Scope of Policy.--The policy required by subsection (a) 
     shall cover each of the following:
       (1) The systemwide management of acute and chronic pain 
     experienced by veterans.
       (2) The standard of care for pain management to be used 
     throughout the Department.
       (3) The consistent application of pain assessments to be 
     used throughout the Department.
       (4) The assurance of prompt and appropriate pain care 
     treatment and management by the Department, systemwide, when 
     medically necessary.
       (5) The Department's program of research related to acute 
     and chronic pain suffered by veterans, including pain 
     attributable to central and peripheral nervous system damage 
     characteristic of injuries incurred in modern warfare.
       (6) The Department's program of pain care education and 
     training for health care personnel of the Department.
       (7) The Department's program of patient education for 
     veterans suffering from acute or chronic pain and their 
     families.
       (c) Updates.--The Secretary shall revise the policy 
     developed under subsection (a) on a periodic basis in 
     accordance with experience and evolving best practice 
     guidelines.

[[Page 16861]]

       (d) Consultation.--The Secretary shall develop the policy 
     developed under subsection (a), and revise such policy under 
     subsection (c), in consultation with veterans service 
     organizations and organizations with expertise in the 
     assessment, diagnosis, treatment, and management of pain.
       (e) Annual Report.--
       (1) In general.--Not later than 180 days after the date of 
     the completion and initial implementation of the policy under 
     subsection (a) and on October 1 of every fiscal year 
     thereafter through fiscal year 2018, the Secretary shall 
     submit to the Committee on Veterans' Affairs of the Senate 
     and the Committee on Veterans' Affairs of the House of 
     Representatives a report on the implementation of the policy 
     developed under subsection (a).
       (2) Contents.--The report required by paragraph (1) shall 
     include the following:
       (A) A description of the policy developed and implemented 
     under subsection (a) and any revisions to such policy under 
     subsection (c).
       (B) A description of the performance measures used to 
     determine the effectiveness of such policy in improving pain 
     care for veterans systemwide.
       (C) An assessment of the adequacy of the Department's pain 
     management services based on a survey of patients managed in 
     Department clinics.
       (D) An assessment of the Department's research programs 
     relevant to the treatment of the types of acute and chronic 
     pain suffered by veterans.
       (E) An assessment of the training provided to Department 
     health care personnel with respect to the diagnosis, 
     treatment, and management of acute and chronic pain.
       (F) An assessment of the Department's pain care-related 
     patient education programs.
       (f) Veterans Service Organization Defined.--In this 
     section, the term ``veterans service organization'' means any 
     organization recognized by the Secretary for the 
     representation of veterans under section 5902 of title 38, 
     United States Code.

     SEC. 5. ESTABLISHMENT OF CONSOLIDATED PATIENT ACCOUNTING 
                   CENTERS.

       (a) Establishment of Centers.--Chapter 17 of title 38, 
     United States Code, is amended by inserting after section 
     1729A the following:

     ``Sec. 1729B. Consolidated patient accounting centers

       ``(a) In General.--Not later than 5 years after the date of 
     enactment of this section, the Secretary of Veterans Affairs 
     shall establish not more than seven consolidated patient 
     accounting centers for conducting industry-modeled 
     regionalized billing and collection activities of the 
     Department.
       ``(b) Functions.--The centers shall carry out the following 
     functions:
       ``(1) Reengineer and integrate all business processes of 
     the revenue cycle of the Department.
       ``(2) Standardize and coordinate all activities of the 
     Department related to the revenue cycle for all health care 
     services furnished to veterans for nonservice-connected 
     medical conditions.
       ``(3) Apply commercial industry standards for measures of 
     access, timeliness, and performance metrics with respect to 
     revenue enhancement of the Department.
       ``(4) Apply other requirements with respect to such revenue 
     cycle improvement as the Secretary may specify.''.
       (b) Clerical Amendment.--The table of sections at the 
     beginning of such chapter is amended by inserting after the 
     item relating to section 1729A the following:

``1729B. Consolidated patient accounting centers.''.

     SEC. 6. SIMPLIFYING AND UPDATING NATIONAL STANDARDS TO 
                   ENCOURAGE TESTING OF THE HUMAN IMMUNODEFICIENCY 
                   VIRUS.

       Section 124 of the Veterans' Benefits and Services Act of 
     1988 (38 U.S.C. 7333 note; 102 Stat. 505) and the item 
     relating to such section in the table of contents of such Act 
     (102 Stat. 487) are repealed.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
California (Mr. Filner) and the gentleman from Kansas (Mr. Moran) each 
will control 20 minutes.
  The Chair recognizes the gentleman from California.
  Mr. FILNER. I yield myself such time as I may consume.
  We have a number of bills on the floor today, all of which will go to 
improving both the health and the benefits of our veterans, to whom we 
owe so much. The bill on the floor now comes to us from Mr. Cazayoux of 
Louisiana, one of our newest Members, but who has already taken an 
active role on the Veterans' Committee. In addition, the bill includes 
elements of bills from Mr. Doyle of Pennsylvania, Mr. Walz from 
Minnesota, Mr. Buyer from Indiana, and Mr. Hare from Illinois, and 
addresses a number of policies in the VA which directly affect our 
Nation's veterans.
  Within the care the VA gives, there is a small population of veterans 
who suffer from nonservice-connected but catastrophically disabling 
injuries. These veterans are stuck in an extreme paradox. They have 
injuries so severe that it prevents them from maintaining employment 
and causes them to utilize many more health services than other 
veterans. Yet, because of the nonservice-connected nature of their 
injuries, they are forced to bare the burden of copayments, which many 
of them are ill-equipped to pay. This bill will eliminate the injustice 
by prohibiting the VA from collecting copayments from this particularly 
vulnerable population of veterans.
  The bill also addresses VA's ability to provide counseling, training, 
or mental health services to family members of veterans who are seeking 
treatment for nonservice-connected disabilities. Currently, VA is 
unable to provide these essential family support services unless the 
veteran is an inpatient and these services are needed for his or her 
discharge.
  The policy is out of date and is a remnant from the days when the VA 
was primarily an inpatient system. This bill removes those restrictive 
requirements and will allow the VA to provide those services to 
families in need. This is particularly important for our newest 
generation of veterans, many of whom are struggling with PTSD and 
depression.
  Section 4 of this bill addresses an issue that many veterans face on 
a daily basis. It is a battle against chronic and acute pain. The pain 
lingers long after the physical wounds of war have healed and affects 
the quality of life of many veterans. Although the VA has worked on a 
national pain management strategy, its implementation remains uneven 
across our system. This bill will require the VA to develop and 
implement a systemwide policy on pain management. We thank Mr. Walz 
from Minnesota for bringing this to us.
  The VA is also currently authorized to collect third-party payments 
from veterans' insurance companies, but due to ineffective procedures, 
over a billion dollars go uncollected annually. This is money the VA 
can reuse for providing medical services to veterans. To address this 
issue, the VA began a demonstration project of a Consolidated Patient 
Accounting Center in 2005, and has some success in improving revenue 
collections. In Section 5 of this bill, we require the VA to establish 
no more than seven other CPACs, (Consolidated Pain Accounting Centers) 
to enable it to improve its billing performance.
  This service, Mr. Speaker, has been outsourced for the last 5 or 6 
years on a sole-source contract. I would urge the VA right now, on the 
floor, I am urging them in letters and, if necessary, legislation, to 
open that bidding process to a wider variety of contractors, many of 
whom have systems to save almost a billion and a half dollars per year, 
that is not collected for the VA. That money would go directly back to 
the services of our veterans.
  The VA is also the largest provider of HIV/AIDS care in the United 
States, but its policies regarding HIV testing are based on best 
practices that date back to the 1980s. The CDC revised their HIV 
testing guidance in 2006. It now recommends that HIV testing be a part 
of routine clinical care and that separate written consent for HIV 
screening should no longer be required.
  Section 6 of the bill brings the VA care in this area up to current 
standards of practice and provides VA the flexibility to update their 
screening standards in the future without congressional intervention.
  Every provision of this bill, we believe, will improve the quality of 
health care of our veterans. It comes to us on a unanimous basis from 
the Committee on Veterans' Affairs. I urge my colleagues to support it.
  I would reserve the balance of my time.
  Mr. MORAN of Kansas. I rise in support of H.R. 6445, as amended, the 
Veterans' Health Care Policy Enhancement Act of 2008, a bill that 
amends title 38 to the United States Code to prohibit the Secretary of 
Veterans Affairs from collecting certain copayments from veterans who 
are catastrophically disabled, and a number of other purposes. H.R. 
6445 includes the text of four other bills introduced by Members, both 
Republican and Democrat, and all provisions have bipartisan support.

[[Page 16862]]

  Section 2 of the bill would ensure that veterans who have been 
determined to be catastrophically disabled from nonservice-connected 
would not be required to pay any copayment for their inpatient, 
outpatient, and long-term care needs. These veterans, because of their 
very complex medical needs, depend heavily upon the VA for their health 
care.
  There are currently about 25,000 seriously disabled veterans who 
would benefit from this provision, and I thank our new colleague, the 
gentleman from Louisiana, Representative Cazayoux, for introducing this 
bill.
  Section 3 of the bill would eliminate an outdated statutory 
requirement that a veteran being treated for a nonservice-connected 
condition be hospitalized in order for the VA to provide counseling 
services to the family members. In today's delivery of health care, 
this makes no sense. We must ensure that all families, regardless of 
the nature of the veteran's condition, are eligible for needed and 
valuable support services that will aid in the treatment of that 
veteran patient. I want to thank my friend and colleague from the 
committee, the gentleman from Illinois (Mr. Hare) for bringing this 
provision forward.
  Section 4 of the bill would require the VA to maintain current pain 
management policy and ensure that the policy is both effective and 
implemented in a consistent manner throughout the VA health care 
delivery system. The VA has long recognized the importance of providing 
early and appropriate care for management of pain.
  In 1998, the VA developed a strategy of ``Pain Assessment, the Fifth 
Vital Sign,'' which established procedures for pain assessment, 
treatment, and outcomes at all VA clinical settings. The VA further 
enhanced its efforts in 2003, and issued a new directive establishing 
the National Pain Management Strategy. This legislation would support 
those VA efforts. I thank the gentleman, Mr. Walz, for introducing this 
measure to ensure the VA maintains a national standard to reduce the 
suffering of our veterans experiencing acute and chronic pain 
associated with a wide range of illnesses.
  Section 5 of the bill would improve effectiveness of the VA's process 
for securing reimbursements from third-party insurance companies. This 
measure was introduced by our ranking member, the gentleman from 
Indiana (Mr. Buyer). Mr. Buyer has long been at the forefront of this 
issue. Every dollar that goes uncollected is one less additional dollar 
that can be used to enhance the care of our veterans.
  The Government Accounting Office has consistently reported the VA's 
processes and procedures for billing and collecting third-party 
payments are ineffective and limit the revenue received from those 
third-party payers. However, in the latest GAO report, June of 2008, 
the GAO found that the Mid-Atlantic Consolidated Patient Accounting 
Center, CPAC, achieved better billing performances and reduced billing 
time, leading to improved collections. The GAO also noted the VA may be 
leaving over $1.4 billion in uncollected care.
  In 2005, the VA created the Mid-Atlantic CPAC in Asheville, North 
Carolina, to maximize its collections by using a private sector model 
tailored to VA billing and collection needs. Last Congress, we directed 
the VA to establish a Revenue Demonstration Project to improve its 
collections and develop a systemwide model to improve its performance. 
In fiscal year 2007, CPAC achieved 110 percent of its expected 
collections, a $20.3 million increase from its performance in the 
previous fiscal year.
  Approximately $12 million for the fiscal year 2007 in additional 
collections was generated as a result of the Revenue Improvement 
Demonstration Project. Expanding this project will continue to improve 
the VA's collections. Mr. Buyer's measure would require VA to establish 
no more than seven CPACs within 5 years, modeled after the successful 
Asheville, North Carolina project.
  Improving collections is a win-win for our Nation's veterans, and I 
want to commend the ranking member for his continued work in this 
regard.
  Finally, Section 6 of the bill would repeal outdated statutory 
language that requires the VA to provide separate written informed 
consent for HIV testing, as well as pre-and post-test counseling. Since 
the requirements were codified almost 20 years ago, there is a better 
understanding of HIV and its transmission.
  The administration in its FY 2009 budget proposal requested this 
change in law so that veteran patients receive the same standard of HIV 
care that is recommended by the Centers for Disease Control and 
Prevention.
  Ensuring veterans receive the best care possible requires effective 
use of VA authorities and resources for the provision of that medical 
care. I urge my colleagues to support the Veterans' Health Care Policy 
Enhancement Act.
  I now reserve the balance of my time.
  Mr. FILNER. Mr. Speaker, I would yield 3 minutes to a new Member from 
Illinois, but has been very aggressive, coming from the district which 
give us Lane Evans, former ranking member of the Veterans' Committee, 
and has been a leader in the search for better mental health care for 
our veterans.
  Mr. HARE. Thank you, Mr. Chairman. I thank you for those kind words.
  Mr. Speaker, I rise today in strong support of H.R. 6445, to prohibit 
the collection of certain copayments from veterans who are 
catastrophically disabled. I want to commend Representative Don 
Cazayoux of Louisiana for introducing this measure. This bill also 
includes legislation that I authored, H.R. 6439, the Mental Health for 
Heroes' Families Act.
  Current law allows the VA to provide support services to immediate 
family members of veterans being treated for service-connected 
conditions. However, with respect to other veterans, the VA may only 
provide the services when they are initiated during a period of 
hospitalization, greatly limiting veterans and their families' access 
to care.
  While not changing the rule that such services must be deemed 
necessary for the veteran's treatment, my bill simply repeals the 
precondition that a veteran must be hospitalized before initiating 
family services.
  The VA has begun to transform the delivery of mental health care from 
an inpatient-based model to an outpatient model, which has improved 
efficiency and increased veterans' access to care. However, as a 
result, some families have become ineligible for support services 
simply because their loved one's care was provided on an outpatient 
basis. As long as family support services are necessary in connection 
with the veteran's treatment, it should be irrelevant whether the 
disability under treatment is service-connected or provided in a 
hospital.
  This bill would make a meaningful difference in the lives of millions 
of men and women, and I am pleased it is being considered as part of 
H.R. 6445. I urge all of my colleagues to support Mr. Cazayoux's 
legislation to ensure that our veterans and their families receive the 
care and support they need.
  Once again, I want to thank the chairman of our committee, Chairman 
Filner, and Ranking Member Buyer.
  Mr. MORAN of Kansas. Mr. Speaker, I reserve the balance of my time.
  Mr. FILNER. I yield 3 minutes to the gentleman from Minnesota (Mr. 
Walz), the highest ranking enlisted Member ever elected to the United 
States Congress, Command Sergeant Major Walz, who I am tempted to say 
gave us part of this legislation on pain. You've been a great pain, Mr. 
Walz, but we love you on our committee.

                              {time}  1700

  Mr. WALZ of Minnesota. Thank you to the chairman, the gentleman from 
California (Mr. Filner) and thank you to Ranking Member Moran who is 
here today.
  I rise in strong support of H.R. 6445, but I rise proudly amongst 
this committee of what the American people I think would be proud to 
know, this is one committee where both Republican and Democrats are 
here for a single purpose, and that is to serve our veterans in the 
best way possible. So I thank the ranking member and the chairman for 
doing exactly that.

[[Page 16863]]

  I rise to speak on the portion of this bill that I introduced as the 
Veterans Pain Care Act of 2008. I was moved to introduce this bill 
after listening to countless stories, as many Members have, of problems 
of chronic and acute pain among our veterans.
  The single largest cause of disability claims among veterans is acute 
pain. It erodes the quality of life, it makes work very difficult, and 
it does not allow our veterans to get back to the point in their life 
where their quality of life is as high as it possibly could be.
  This bill requires the Secretary of the VA to develop and implement a 
comprehensive policy of pain management for veterans who are enrolled 
in the VA health care system, and more importantly, or equally 
important, is to carry out a program of research, training and 
education on chronic pain.
  By directing the VA to update its pain management policies and in 
light of experience, research and evolving practices, this bill will 
lay a foundation for ongoing improvements in pain care management for 
our veterans. In that way, we can work to fulfill what I believe is an 
absolute moral obligation to care for these veterans with the most 
innovative, best practices and pain management possible.
  This bill has broad support from a large number of pain care 
organizations that include patients, providers and numerous veterans 
service organizations. I thank all of them for their indispensable 
support and hard work in moving this bipartisan piece of legislation.
  I would also like to express deep appreciation for the Veterans' 
Affairs Committee staff on both the majority side and the minority side 
for working out this piece of legislation. It truly is a compromise. It 
truly is a piece of legislation, the entire bill, H.R. 6445, that 
transcends politics and gets at the heart of what the public wants us 
to do, come together as Americans to pass good legislation that 
prioritizes this Nation's veterans at the top and cares for them in a 
fiscally responsible manner that allows them to return to their daily 
lives after they have served us. It is the very least our country can 
do, and I am proud to be associated with it.
  Mr. MORAN of Kansas. Mr. Speaker, I yield back the balance of my 
time.


                             General Leave

  Mr. FILNER. Mr. Speaker, I ask unanimous consent that all Members may 
have 5 legislative days in which to revise and extend their remarks and 
include extraneous material on H.R. 6445, as amended.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from California?
  There was no objection.
  Mr. FILNER. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, the next bill on our agenda was supposed to be a bill by 
Mr. Moran, who is managing the bills today. Due to some bureaucratic 
delays, we have not been able to put that bill on the floor, but I 
assure the gentleman from Kansas that we will. He has been a leader in 
rural health care to veterans. It is a problem that faces many of us 
all over the country, and we will address these issues that you have 
raised.
  I will yield to the gentleman from Kansas.
  Mr. MORAN of Kansas. I appreciate the gentleman from California's 
comments. I appreciate him yielding me time. I am delighted to hear 
what he has to say. This is an important piece of legislation that 
affects many veterans across the country and has the strong support of 
many Members of Congress. I know we are working to see if we can get it 
on the suspension calendar tomorrow. I appreciate the gentleman's 
comments and assurances.
  Mr. DOYLE. Mr. Speaker, I rise today in support of H.R. 6445, which 
will provide important relief to veterans who are catastrophically 
disabled.
  I would like to mention that this bill also contains legislation that 
I originally introduced as a freestanding bill--H.R. 6114, the 
Simplifying and Updating National Standards to Encourage Testing of the 
Human Immunodeficiency Virus Act of 2008--or the SUNSET Act. I 
introduced this legislation several months ago to modernize the HIV 
testing policies of the U.S. Department of Veterans Affairs.
  The current HIV testing policies used by the VA were mandated in the 
Veterans Benefits and Services Act of 1988. These policies are now 20 
years old, and they fail to reflect everything we've learned about HIV 
testing and treatment over the last two decades.
  Twenty years ago, it took a long time for patients and health care 
providers to get the results of HIV tests. Today, safe non-invasive 
tests are available that can provide reliable results in only 20 
minutes. Moreover, under the current testing policies, half of all HIV-
positive veterans in the VA health care system don't get diagnosed 
until they've already suffered significant damage to their immune 
systems. Many of these veterans are already receiving health care 
services through the VA--diagnosing these veterans earlier would enable 
the VA to provide them with medical care that could extend their life 
expectancy and improve their quality of life.
  Consequently, I believe that the VA should adopt a more modern policy 
on HIV/AIDS testing, including the testing of all incoming patients for 
HIV/AIDS unless a patient specifically opts out.
  The VA wants to adopt such policies--while maintaining its counseling 
and data privacy policies--but since the VA's HIV testing policies are 
mandated by law, Congress must enact a new law to change them. That's 
why I introduced the Simplifying and Updating National Standards to 
Encourage Testing of the Human Immunodeficiency Virus Act of 2008.
  This legislation would simply repeal the section of the 1988 law that 
set out the HIV testing policy the VA must use. This would allow the VA 
to adopt up-to-date policies that would improve the health care 
provided to veterans with HIV/AIDS.
  I want to thank my friends and former colleagues on the Veterans 
Committee, Chairman Filner and Chairman Michaud, for supporting the 
SUNSET Act and moving it expeditiously through the Committee. I'm also 
grateful to my friend Representative Cazayoux for his eagerness to 
include this provision in his bill. H.R. 6445 deserves our 
consideration and swift enactment into law with or without the SUNSET 
Act, but this bill, which includes the SUNSET Act as well, will do even 
more to help some of our most afflicted veterans.
  I urge my colleagues to support this important legislation.
  Mr. CAZAYOUX. Mr. Speaker, I rise today in support of H.R. 6445. I'd 
like to thank the members of the Veterans' Affairs committee--
especially Chairman Filner, Ranking Member Buyer, Subcommittee Chairman 
Michaud, and Ranking Member Miller--for not only supporting my 
legislation, but also for adding provisions that go even further in 
improving health care for our veterans.
  My original legislation prohibits the VA from collecting co-payments 
for hospital and nursing home care from veterans who are 
catastrophically disabled. This provision aims to ease the burden on 
veterans who have a permanent, severely disabling injury, disorder, or 
disease that compromises their ability to carry out the activities of 
daily living. Currently, those veterans must make co-payments for non-
service related injuries at VA facilities. This includes veterans who 
suffer with, among other things, spinal cord injuries, stroke, diseases 
such as Parkinson's and ALS, and multiple amputees.
  As you could imagine, these disabled veterans are oftentimes some of 
the poorest of the poor and cannot afford adequate health care, much 
less the enormous cost that these burdens place on them and their 
families. This bill hopes to change that and make a positive impact on 
the 25,000 veterans with catastrophic disability that receive care 
through VA.
  H.R. 6445 incorporates other meaningful provisions authored by some 
of my colleagues on the committee. It contains a provision that expands 
the authority of the Secretary of Veterans Affairs to provide 
counseling for families of veterans receiving non-connected treatment. 
It directs the VA to develop and implement a comprehensive policy on 
the management of pain experienced by veterans receiving VA care. It 
improves billing and accounting procedures at the Veterans 
Administration by regionalizing the process. Finally, this legislation 
makes it easier for veterans to get HIV testing if they choose.
  Mr. Speaker, we have no greater duty as Members of Congress than to 
take care of those who have sacrificed life and limb in service to 
their country. We need to instill faith in the public that when we ask 
you to serve we will take care of you when you return.
  This often repeated quote from George Washington still rings true 
today: ``The willingness with which our young people are likely to 
serve in any war, no matter how justified, shall be directly 
proportional to how they perceive the Veterans of earlier wars were 
treated and appreciated by their nation.'' This legislation helps us 
fulfill this most sacred duty.

[[Page 16864]]

  I again thank my colleagues for their excellent contributions to this 
legislation, and I ask my colleagues in the House to pass this bill 
without delay.
  Mr. MICHAUD. Mr. Speaker, I rise today in support of H.R. 6445, the 
Veterans Health Care Policy Enhancement Act. I would like to thank Mr. 
Cazayoux for this progressive piece of legislation, and Representatives 
Doyle, Walz, Buyer and Hare for their significant contributions. Thank 
you also Chairman Filner and Ranking Member Buyer for your support of 
this measure. Finally, I would like to acknowledge the great effort of 
the House Veterans' Affairs Committee staff in compiling this bill and 
achieving it's strong bi-partisan nature.
  Over the past few decades, VA has transformed the way it delivers 
care to our veterans. This transformation has significantly increased 
their efficiency, increased veterans' access to care, and aligned the 
VA with the health care industry at large.
  Unfortunately, certain policies that are relics of the previous era 
of health care delivery remain. This bill will modernize VA policies 
regarding copayments for nonservice-connected, catastrophically 
disabled, Category Group 4 veterans; pain care; counseling services for 
family members; and HIV testing. Additionally, this legislation 
enhances the VA's ability to collect third party payments.
  Currently, there are approximately 25,000 non-service connected 
catastrophically disabled veterans enrolled in Priority Group 4. These 
veterans have a permanent, severely disabling injury, disorder, or 
disease that compromises their ability to carry out many activities of 
daily living.
  The very nature and severity of their disabilities precludes them 
from employment. Yet current VA policy requires these veterans to pay 
copayments for their care.
  Section 2 of this bill prohibits VA from collecting copayments from 
these vulnerable veterans.
  Another legacy policy of the VA states that families of veterans 
being treated for non-service connected disabilities are only eligible 
for family support services, such as counseling, training or mental 
health services, if they are necessary for the veteran's treatment and 
they are initiated during the veteran's hospitalization and they are 
essential for the discharge of the veteran from the hospital.
  Since the VA has transformed to a predominantly outpatient-based 
system, this policy is no longer effective.
  Section 3 of this bill removes these restrictions on the provision of 
family support services. This is essential for our newest generation of 
veterans and their families.
  Veterans suffer from acute and chronic pain in proportions far 
exceeding the general population. In fact, pain is the leading cause of 
disability among veterans.
  To address the issue, the VA developed a ``National Pain Management 
Strategy'' and issued a directive to make pain management a national 
priority. However, this directive expired May 31, 2008 and reports from 
the field suggest that implementation has been far from consistent.
  Section 4 of this bill mandates that the VA develop and implement a 
comprehensive policy on the management of pain experienced by veterans. 
It requires the VA to develop the policy in consultation with veterans 
service organizations and other 7137 organizations with expertise in 
the assessment, diagnosis, treatment, and management of pain.
  Current law authorizes the VA to bill veterans' insurance companies 
(third-party collections) for non-service connected care provided to 
veterans enrolled in the VA health care system. A June 2008 report from 
the Government Accountability Office (GAO) estimated that $1.2 to $1.4 
billion dollars go uncollected annually by VA due to improper coding, 
delays in billing, and collections follow-up.
  In 2005, VA created the Mid-Atlantic Consolidated Patient Accounting 
Center (CPAC) in Asheville, North Carolina which has been tremendously 
successful.
  Section 5 of this bill would require the VA establish no more than 
seven other CPACs to help maximize its collections by using industry 
best-practices to improve timely and accurate billing and enhance 
collections.
  The VA is the largest, single provider of HIV/AIDS care in the United 
States with over 22,800 patients with HIV/AIDS. In 1988, Congress 
passed legislation that required the VA obtain a veteran's written 
informed consent before being tested for HIV. This was based on the 
best practice in 1988.
  However, since then our knowledge of HIV/AIDS has increased 
significantly and treatments have advanced significantly. As a result, 
in 2006, the CDC revised their recommendations regarding diagnostic HIV 
testing. CDC now recommends HIV testing be a part of routine clinical 
care and recommends that separate written consent for HIV screening 
should no longer be required.
  Section 6 of this bill brings VA HIV/AIDS care up to current 
standards of practice.
  All the provisions in this bill are intended to enhance current VA 
policies to bring them into the 21st century.
  The improvements in these policies will have a direct and positive 
impact on improving the quality of healthcare our veterans receive.
  I urge my colleagues to support H.R. 6445.
  Mr. BUYER. Mr. Speaker, I rise in support of H.R. 6445, as amended, 
the Veterans Health Care Policy Enhancement Act of 2008, to amend title 
38, United States Code, to make a number of improvements to Department 
of Veterans Affairs health care policies.
  H.R. 6445 is a bipartisan bill that includes provisions from four 
veterans' health care bills that were introduced by members from both 
sides of the aisle. I thank our new colleague on the Committee, Don 
Cazayoux, for introducing this bill.
  H.R. 6445 would exempt veterans, who have non-service connected 
catastrophic injuries, from co-payment requirements for treatment at VA 
facilities. Such veterans require extensive medical care and many have 
limited financial means. The bill would also require the VA to 
implement a comprehensive policy on the management of pain experienced 
by veterans, encourage HIV testing for veterans, and expand the VA's 
authority to provide counseling for family members of veterans 
receiving non-service-connected treatment.
  I am pleased that this bill also includes the text of H.R. 6366, the 
Veterans Revenue Enhancement Act of 2008. I, along with Mike Michaud, 
Jeff Miller and Henry Brown, introduced this bipartisan legislation to 
help VA better manage third-party collections, and provide additional 
fiscal responsibility for the department.
  The provision would require VA to establish seven Consolidated 
Patient Accounting Centers (CPACs) modeled after the successful 
demonstration project in Asheville, NC. The concept of the Consolidated 
Patient Accounting Center, also known as CPAC, was included as a 
demonstration project in the Conference Report (House Report 109-95 and 
Conference Report 109-305) in 2005 accompanying H.R. 2528, requiring 
the Department of Veterans Affairs (VA) to initiate a revenue 
improvement demonstration project within 60 days after enactment of the 
bill (Public Law 109-114). The VA followed the recommendations in the 
report, and created the Mid-Atlantic Consolidated Patient Accounting 
Center demonstration project located in Asheville, North Carolina.
  The Asheville project proved to be very successful in enhancing 
revenue by more than $12.5 million in fiscal year 2007 and $6.5 million 
so far in fiscal year 2008. Building on this success, would enable VA 
to secure hundreds of millions of dollars that currently go 
uncollected. These funds could be used to further improve veterans' 
health care.
  I urge my colleagues to support the Veterans' Health Care Policy 
Enhancement Act of 2008.
  Mr. PAUL. Mr. Speaker, I rise in support of this legislation, which 
will bar the collection of co-payments from veterans for hospital and 
nursing home care if the veteran is considered catastrophically 
disabled. I strongly advocate a noninterventionist foreign policy that 
would result in far fewer wars and, thankfully, far fewer 
catastrophically disabled veterans. But I also strongly believe that we 
must take care of those veterans who have been so severely wounded or 
otherwise disabled. Too often those who are most vocal in support of 
foreign military action are most silent when it comes time to take care 
of those who have paid a very high price for these actions. This 
legislation will provide at least a little relief to the most seriously 
injured veterans.
  I am concerned, however, that this bill incorporates language from 
H.R. 6114, which rescinds a current law requirement that the VA obtain 
a signed consent form from a veteran before conducting an HIV test. We 
have seen veterans punished severely for attempting to avoid the 
required but controversial myriad of inoculations they are required to 
receive. Now we see that they will have less control over what medical 
tests to which they might be subjected. I am concerned over this loss 
of control over one's healthcare decisions among those who voluntarily 
join the military, and I urge the adoption of a more flexible policy. I 
would also urge my colleagues and the American people to contemplate 
this deprivation of medical and privacy rights on a massive scale 
should we ever reinstate the draft. I believe taking care of veterans 
should include both providing promised benefits and protecting their 
privacy rights.
  Mr. FILNER. Mr. Speaker, I urge my colleagues to support the bill 
before us,

[[Page 16865]]

H.R. 6445, as amended, and yield back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from California (Mr. Filner) that the House suspend the rules 
and pass the bill, H.R. 6445, as amended.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds 
being in the affirmative, the ayes have it.
  Mr. MORAN of Kansas. Mr. Speaker, I object to the vote on the ground 
that a quorum is not present and make the point of order that a quorum 
is not present.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX and the 
Chair's prior announcement, further proceedings on this motion will be 
postponed.
  The point of no quorum is considered withdrawn.

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