[House Report 108-198]
[From the U.S. Government Publishing Office]



108th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 1st Session                                                    108-198

======================================================================



 
              VETERANS HEALTH CARE IMPROVEMENT ACT OF 2003

                                _______
                                

 July 10, 2003.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

   Mr. Smith of New Jersey, from the Committee on Veterans' Affairs, 
                        submitted the following

                              R E P O R T

                        [To accompany H.R. 2357]

      [Including cost estimate of the Congressional Budget Office]

  The Committee on Veterans' Affairs, to whom was referred the 
bill (H.R. 2357) to amend title 38, United States Code, to 
establish standards of access to care for veterans seeking 
health care from the Department of Veterans Affairs, and for 
other purposes, having considered the same, reports favorably 
thereon with amendments and recommends that the bill as amended 
do pass.

  The amendments are as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Veterans Health Care Improvement Act 
of 2003''.

SEC. 2. APPOINTMENT OF CHIROPRACTORS IN THE VETERANS HEALTH 
                    ADMINISTRATION.

  (a) Appointments.--Section 7401 of title 38, United States Code, is 
amended--
          (1) by inserting ``and chiropractic care'' in the matter 
        preceding paragraph (1) after ``medical care''; and
          (2) by inserting ``chiropractors,'' in paragraph (1) after 
        ``podiatrists,''.
  (b) Qualifications of Appointees.--Section 7402(b) of such title is 
amended--
          (1) by redesignating paragraph (10) as paragraph (11); and
          (2) by inserting after paragraph (9) the following new 
        paragraph (10):
  ``(10) Chiropractor.--To be eligible to be appointed to a 
chiropractor position, a person must--
          ``(A) hold the degree of doctor of chiropractic, or its 
        equivalent, from a college of chiropractic approved by the 
        Secretary; and
          ``(B) be licensed to practice chiropractic in a State.''.
  (c) Period of Appointments and Promotions.--Section 7403(a)(2) of 
such title is amended by adding at the end the following new 
subparagraph:
          ``(H) Chiropractors.''.
  (d) Grades and Pay Scales.--Section 7404(b)(1) of such title is 
amended by striking the third center heading in the table and inserting 
the following:

    ``CLINICAL PODIATRIST, CHIROPRACTOR, AND OPTOMETRIST SCHEDULE''.

  (e) Temporary and Part-Time Appointments.--Section 7405(a) of such 
title is amended--
          (1) by adding at the end of paragraph (1) the following new 
        subparagraph:
                  ``(E) Chiropractors.''; and
          (2) by adding at the end of paragraph (2) the following new 
        subparagraph:
                  ``(D) Chiropractors.''.
  (f) Residencies and Internships.--Section 7406(c) of such title is 
amended--
          (1) in paragraph (1)--
                  (A) by inserting ``and chiropractic'' after 
                ``medical'' the first place it appears; and
                  (B) by inserting ``or chiropractic'' after 
                ``medical'' the second place it appears;
          (2) in paragraph (2)(B), by inserting ``or chiropractic'' 
        after ``medical'' the first place it appears; and
          (3) in paragraph (3)(A), by inserting ``or chiropractic'' 
        after ``medical''.
  (g) Malpractice and Negligence Protection.--Section 7316(a) of such 
title is amended--
          (1) in paragraph (1), by inserting ``or chiropractic'' after 
        ``medical'' each place it appears; and
          (2) in paragraph (2)--
                  (A) by inserting ``or chiropractic'' after 
                ``medical'' the first place it appears; and
                  (B) by inserting ``chiropractor,'' after 
                ``podiatrist,''.
  (h) Treatment as Scarce Medical Specialists for Contracting 
Purposes.--Section 7409(a) of such title is amended by inserting 
``chiropractors,'' in the second sentence after ``optometrists,''.
  (i) Reimbursement of Continuing Professional Education Expenses.--
Section 7411 of such title is amended by striking ``or dentist'' and 
inserting ``, dentist, or chiropractic''.
  (j) Collective Bargaining Exemption.--Section 7421(b) of such title 
is amended by adding at the end the following new paragraph:
          ``(8) Chiropractors.''.
  (k) Effective Date.--The amendments made by this section shall take 
effect at the end of the 180-day period beginning on the date of the 
enactment of this Act.

SEC. 3. ELIGIBILITY FOR DEPARTMENT OF VETERANS AFFAIRS HEALTH CARE OF 
                    CERTAIN FILIPINO WORLD WAR II VETERANS RESIDING IN 
                    THE UNITED STATES.

  (a) Eligibility.--The text of section 1734 of title 38, United States 
Code, is amended to read as follows:
  ``(a) The Secretary shall furnish hospital and nursing home care and 
medical services to any individual described in subsection (b) in the 
same manner, and subject to the same terms and conditions, as apply to 
the furnishing of such care and services to individuals who are 
veterans as defined in section 101(2) of this title. Any disability of 
an individual described in subsection (b) that is a service-connected 
disability for purposes of this subchapter (as provided for under 
section 1735(2) of this title) shall be considered to be a service-
connected disability for purposes of furnishing care and services under 
the preceding sentence.
  ``(b) Subsection (a) applies to any individual who is a Commonwealth 
Army veteran or new Philippine Scout and who--
          ``(1) is residing in the United States; and
          ``(2) is a citizen of the United States or an alien lawfully 
        admitted to the United States for permanent residence.''.
  (b) Limitation.--(1) The amendment made by subsection (a) shall take 
effect on the date on which the Secretary of Veterans Affairs submits 
to the Committees on Veterans' Affairs of the Senate and House of 
Representatives and publishes in the Federal Register a certification 
described in paragraph (2).
  (2) A certification referred to in paragraph (1) is a certification 
that sufficient resources are available for the fiscal year during 
which the certification is submitted to carry out section 1734 of title 
38, United States Code, as amended by such amendment, during that 
fiscal year at each significantly affected health care facility of the 
Department of Veterans Affairs.
  (3) For purposes of paragraph (2), the term ``significantly affected 
health care facility'' means a health care facility at which, as 
determined by the Secretary, it is reasonably foreseeable that the 
implementation of the provisions of section 1734 of title 38, United 
States Code, as amended by subsection (a), will result in a significant 
increase in the use of health care resources due to the number of 
veterans described in subsection (b) of that section who are considered 
to be likely to seek hospital or nursing home care or medical services, 
as authorized by subsection (a) of that section, at that facility.

  Amend the title so as to read:

      A bill to amend title 38, United States Code, to provide 
for the appointment of chiropractors in the Veterans Health 
Administration of the Department of Veterans Affairs and to 
provide eligibility for Department of Veterans Affairs health 
care for certain Filipino World War II veterans residing in the 
United States.

                              Introduction

    The reported bill reflects the Committee's consideration of 
several bills introduced during the 108th Congress, including 
H.R. 2357, H.R. 2414, and H.R. 2352. On June 5, 2003, Honorable 
Ginny Brown-Waite, Honorable Christopher H. Smith, and 
Honorable Jeff Miller introduced H.R. 2357, to amend title 38, 
United States Code, to establish standards of access to care 
for veterans seeking health care from the Department of 
Veterans Affairs, and for other purposes. On June 10, 2003, 
Honorable Jerry Moran, Honorable Christopher H. Smith, 
Honorable Lane Evans, Honorable Bob Filner, and Honorable Luis 
V. Gutierrez introduced H.R. 2414, to amend title 38, United 
States Code, to provide for the appointment of chiropractors in 
the Veterans Health Administration of the Department of 
Veterans Affairs, and for other purposes. On June 5, 2003, 
Honorable Rob Simmons, Honorable Bob Filner, Honorable Ciro D. 
Rodriguez, Honorable Lane Evans, Honorable Randy ``Duke'' 
Cunningham, Honorable Neil Abercrombie, Honorable Dana 
Rohrabacher, Honorable Susan A. Davis, Honorable Darrell E. 
Issa, and Honorable Christopher H. Smith introduced H.R. 2352, 
to amend title 38, United States Code, to provide eligibility 
for Department of Veterans Affairs health care for certain 
Filipino World War II veterans residing in the United States.
    On June 13, 2002, the Subcommittee on Health held a hearing 
on the health care of Filipino World War II veterans within the 
Department of Veterans Affairs. Witnesses who appeared before 
the subcommittee included His Excellency Albert Del Rosario, 
Ambassador to the United States, Embassy of the Philippines; 
Honorable Anthony J. Principi, Secretary, Department of 
Veterans Affairs, accompanied by Mr. John H. Thompson, Deputy 
General Counsel; Honorable Daniel K. Inouye, United States 
Senator for the State of Hawaii; Honorable Benjamin Gilman, 
Member of Congress from the State of New York; Honorable Randy 
``Duke'' Cunningham, Member of Congress from the State of 
California; Honorable Dana Rohrabacher, Member of Congress from 
the State of California; Honorable Patsy T. Mink, Member of 
Congress from the State of Hawaii; Honorable Juanita Millender-
McDonald, Member of Congress from the State of California; 
Honorable Robert A. Underwood, Member of Congress from the 
Territory of Guam; Mr. Lou Diamond Phillips, actor and Filipino 
Veterans Activist, Los Angeles, California; Mr. Fritz Friedman, 
Chair, Assembly for Justice, Los Angeles, California; Mr. Resty 
Supnet, President, Filipino World War II Veterans Foundation of 
San Diego County, accompanied by Mr. Romy Monteyro; Mr. Patrick 
Ganio, President, American Coalition for Filipino Veterans; Ms. 
Susan Espiritu Maquindang, Executive Director, Filipino-
American Service Group; Ms. Lourdes Santos Tancinco, President, 
San Francisco Veterans Equity Center; Ms. Joy J. Ilem, 
Assistant National Legislative Director, Disabled American 
Veterans; Mr. Richard Weidman, Director of Government 
Relations, Vietnam Veterans of America; and Mr. James Fischl, 
Director of National Veterans Affairs and Rehabilitation 
Commission, The American Legion. Written testimonies were 
received from Honorable Barbara Boxer, United States Senator 
from the State of California; Honorable Barbara Lee, Member of 
Congress from the State of California; Honorable Nancy Pelosi, 
Member of Congress from the State of California; Honorable 
Maxine Waters, Member of Congress from the State of California; 
General Tagumpay Nanadiego, Former Special Presidential 
Representative, Embassy of the Philippines; Ms. Wendy Lawrence, 
Associate Director, National Legislative Service, Veterans of 
Foreign Wars; and Mr. Richard Jones, National Legislative 
Director, AMVETS.
    On June 24, 2003, the Subcommittee on Health met and 
unanimously ordered H.R. 2357, as amended, reported favorably 
to the full Committee.
    On June 26, 2003, the full Committee met and ordered H.R. 
2357, as amended, reported favorably to the House by voice 
vote.

                      Summary of the Reported Bill

    H.R. 2357, as amended, would:

    1.  LAuthorize the Secretary of Veterans Affairs to appoint 
chiropractors to the Veterans Health Administration under title 
38, United States Code.

    2.  LRequire chiropractors to meet the following criteria 
for Department appointment: hold a degree of doctor of 
chiropractic or its equivalent from a college of chiropractic 
approved by the Secretary and be licensed to practice 
chiropractic in a State.

    3.  LRequire chiropractors to be placed under the same 
grades and pay scale as certain other health care providers.

    4.  LAuthorize the Secretary to appoint chiropractors on a 
full-time, part-time, temporary or without-compensation basis, 
as well as on a fee basis.

    5.  LAuthorize the Secretary to appoint chiropractors to 
intern or residency positions.

    6.  LProvide chiropractors protection against malpractice 
and negligence liability.

    7.  LPermit the Secretary to enter into contracts with non-
VA institutions should chiropractic services be unavailable.

    8.  LRequire the Secretary to reimburse any full-time board 
certified chiropractor for expenses incurred, up to $1,000 a 
year, for continuing professional education.

    9.  LRequire chiropractors to observe VA's prescribed 
hours, conditions of employment, and leaves of absence for 
clinical professionals.

    10. LAuthorize VA to provide hospital and nursing home care 
and medical services to certain Filipino World War II veterans 
of the Philippines Commonwealth Army and former Philippines 
``New Scout'' veterans who permanently reside in the United 
States, in the same manner as provided to U.S. veterans.

    11. LProvide that this health care authority for Filipino 
WWII veterans would not take effect until the Secretary issues 
a certification to Congress and a notice to the public that 
resources are sufficient at those VA facilities where the 
majority of Filipino veterans are authorized to receive care.

                       Background and Discussion

    Chiropractic Services.--The Committee's previously 
expressed concerns continue regarding veterans who are enrolled 
in VA's health care system and who are unable to receive 
chiropractic care. VA has resisted authorizing this type of 
specialty care. The Committee has found that chiropractic care 
is an effective therapy in a number of instances, and can be 
less costly than other medical approaches to low back pain, 
back spasm, and other maladies of the spinal region, including 
health problems caused by the aging process and physical 
exertion.

    Section 303 of Public Law 106-117, the Veterans Millennium 
Health Care and Benefits Act, requires the Under Secretary for 
Health to establish a defined policy regarding the role of 
chiropractic care for veterans enrolled in the Veterans Health 
Administration (VHA). Almost a year after enactment of that 
measure, the Under Secretary published VHA Directive 2000-014, 
establishing what the Department deemed to be a responsive 
policy on VA chiropractic care. However, the Committee found 
the policy to be unacceptable. It did not improve veterans' 
access to chiropractic care in VHA.
    As a result, Congress enacted section 204 of the Department 
of Veterans Affairs Health Care Programs Enhancement Act of 
2001 (Public Law 107-135). This Act requires the Secretary to 
create a program to provide chiropractic care and services for 
veterans who are enrolled in VA's health care system, and 
specifies that each of VA's 21 geographic service areas 
establish at least one chiropractic care program. This law also 
requires establishment of a chiropractic advisory committee 
within the Department, and charges the Committee to provide 
assistance to the Secretary in the development and 
implementation of the chiropractic health program the law 
authorizes, including recommendations on scope of practice, 
qualifications, privileging and credentialing matters, among 
other factors that might influence the employment of 
chiropractors and the deployment of a new nationwide VA 
chiropractic program.
    While some progress has been made because of the presence 
of the advisory committee, the Department has contended that 
formal organizational, qualification, and classification 
studies are needed due to VA's lack of a specified employment 
authority in title 38 of the United States Code to authorize 
the appointment of VA chiropractors. The Committee believes 
that VA already possesses authority for these employment 
matters within the parameters of title 38, United States Code. 
VA studies could consume years of work, would be a waste of 
money and may be used to effectively block direct employment of 
chiropractors.
    The Committee bill would address the issue of authority for 
VA to appoint chiropractors in VHA so that those veterans who 
are in need of chiropractic care may receive it in VA 
facilities by VA-appointed chiropractors. This bill would allow 
doctors of chiropractic to work alongside other health care 
providers already practicing within VA's health care system. 
The Committee believes that this can be accomplished by 
establishing a fair compensation schedule comparable to those 
used to set salaries for other categories of health care 
providers already authorized in title 38, United States Code. 
Chiropractors would be added to the authorization of 
compensation for physicians, dentists, podiatrists, and 
optometrists.
    Currently, VA patients who desire to use the services of a 
chiropractor may only obtain such services on a fee or contract 
basis, causing administrative expenses and inconveniencing 
eligible veterans. This bill would permit the Secretary to 
appoint chiropractors on a full-time, part-time, or 
intermittent basis, as interns or residents, similar to its 
authority for appointment of medical practitioners. Also, the 
Secretary would be required to ensure that chiropractors were 
placed appropriately within the system to work with other 
health care practitioners.

    Health Care Benefits for Filipino WWII Veterans in the 
U.S.--The Filipino soldiers of World War II served side-by-side 
with forces from the United States, exhibiting great courage at 
the epic battles of Bataan and Corregidor and contributing to 
the successful outcome of the war. After the Philippines became 
independent, Congress passed the Rescission Act of 1946, 
reducing or eliminating many of the veterans' benefits Filipino 
veterans had been eligible for based on service in the 
Commonwealth Army. Today, almost 60 years later, 60,000 World 
War II Filipino veterans are alive and continue to seek 
restoration of these benefits.

    On June 13, 2002, (107th Congress), the Subcommittee on 
Health held a hearing to consider the provision of health care 
to certain Filipino World War II veterans by the Department of 
Veterans Affairs. His Excellency Albert Del Rosario, Ambassador 
to the United States, Embassy of the Philippines, was among the 
distinguished witnesses who appeared before the Subcommittee in 
support of expanding access to VA health care for World War II 
Filipino veterans.
    On July 22, 2002, H.R. 3645, the Veterans Health Care and 
Procurement Improvement Act of 2002, passed the House. Section 
5 of that measure contained a provision to provide certain 
Filipino veterans of World War II who now live in the United 
States health care benefits on the same basis as if they were 
veterans of the U.S. armed services. The Senate, however, did 
not act on the legislation prior to adjournment of the 107th 
Congress.
    The reported bill is similar to section 5 of H.R. 3645; it 
would provide health care benefits to approximately 14,000 
Commonwealth Army and New Philippines Scout veterans who are 
permanent and legal residents of the United States. In 
addition, the bill would require the Secretary to issue a 
certification and a public notice attesting that sufficient 
resources are available at those Department facilities where 
the majority of these veterans would receive their care. The 
Administration supports this provision. See ``Additional Views 
from Administration'', p. 10. The Congressional Budget Office 
estimates that the proposal would cost about $61 million over 
the 2004-2008 period.

                      Section-By-Section Analysis

    Section 1 of the bill would provide that this Act may be 
cited as the ``Veterans Health Care Improvement Act of 2003''.

    Section 2(a) of the bill would amend section 7401 of title 
38, United States Code, to include ``chiropractic care'' and 
``chiropractors'' so the Secretary may appoint such personnel 
as necessary for the chiropractic care of veterans.

    Section 2(b) of the bill would amend section 7402(b) of 
title 38, United States Code, to add eligibility requirements 
for a doctor of chiropractic to be appointed to VA; the 
requirements would be (1) a degree of doctor of chiropractic, 
or its equivalent, from a college of chiropractic approved by 
the Secretary; and (2) the individual must be licensed to 
practice chiropractic in a State.

    Section 2(c) of the bill would amend section 7403(a)(2) of 
title 38, United States Code, to allow chiropractors, along 
with other health care professionals, to be appointed to VA if 
their qualifications meet VA's hiring criteria.

    Section 2(d) of the bill would amend section 7404(b)(1) of 
title 38, United States Code, to include chiropractors in the 
prescribed pay grades along with certain other health care 
professionals.

    Section 2(e) of the bill would amend Section 7405(a) of 
title 38, United States Code, to (1) allow chiropractors to be 
employed on a temporary, full-time, part-time, or without 
compensation basis, and (2) allow chiropractors to be employed 
on a fee basis.

    Section 2(f) of the bill would amend section 7406(c) of 
title 38, United States Code, so that (1) VA may contract with 
a designated administrative agency to place qualified persons 
from chiropractic schools or chiropractic installations in 
intern or residency positions in VA; (2) VA may pay a stipend 
to a designated administrative agency for those chiropractors 
in intern or residency positions; (3) the acceptance of 
stipends by the designated agency shall be in lieu of and 
constitute a waiver of any payment of stipends or employee 
benefits to which such chiropractors in intern or residency 
positions at VA may be entitled to under the provisions of 
title 38, United States Code, or title 5, United States Code; 
and (4) the designated administrative agency employing 
chiropractors in intern or residency positions makes all 
appropriate tax deductions and maintains all appropriate 
records pertinent to such deductions and maintains leave 
accrual records for such individuals.

    Section 2(g) of the bill would amend section 7316(a) of 
title 38, United States Code, to include chiropractors among 
those VA medical care employees covered by federal malpractice 
and negligence protections.

    Section 2(h) of the bill would amend section 7409(a) of 
title 38, United States Code, so that the Secretary may enter 
into contracts with non-Department institutions to supply 
scarce chiropractic specialist services at VA facilities.

    Section 2(i) of the bill would expand the group of health 
care professionals listed in section 7411 of title 38, United 
States Code, to allow VA chiropractors to be reimbursed up to 
$1,000 a year for continuing professional education.

    Section 2(j) of the bill would amend section 7421(b) of 
title 38, United States Code, so that chiropractors would be 
required to follow the hours, conditions of employment, and 
leaves of absence regulations the Secretary prescribes.

    Section 2(k) of the bill would require the amendments made 
by this section to take effect at the end of the 180-day period 
beginning on the date of the enactment of this Act.

    Section 3(a) of the bill would amend section 1734 of title 
38, United States Code, to authorize the Secretary to furnish 
hospital and nursing home care and medical services to any 
individual who is a Commonwealth Army veteran or new Philippine 
Scout who is residing in the United States and who is a citizen 
of the United States or who is an alien lawfully admitted to 
the United States for permanent residence. Such care and 
services would be subject to the same terms and conditions as 
they apply to individuals who are veterans as defined in 
section 101(2) of title 38, United States Code. Service-
connected disabilities for purposes of this subchapter (as 
provided for under section 1735(2) of title 38, United States 
Code), would be considered to be a service-connected disability 
for purposes of furnishing such care and services.

    Section 3(b) of the bill would provide that the amendment 
made by subsection 3(a) shall take effect on the date on which 
the Secretary submits to the Committees on Veterans' Affairs of 
the Senate and House of Representatives, and publishes in the 
Federal Register a certification that sufficient resources are 
available to carry out the purpose of section 3 of the bill for 
the fiscal year during which the certification is submitted and 
at those facilities where the majority of these veterans would 
receive their care and services.

                    Performance Goals and Objectives

    The Department of Veterans Affairs' performance goals and 
objectives are established in annual performance plans and are 
subject to the Committee's regular oversight and evaluation by 
the U.S. General Accounting Office. VA also publishes a 
performance and accountability report for each fiscal year.

              Statement of the Views of the Administration

      Health Care Benefits for Filipino WWII Veterans in the U.S.

 Testimony of Honorable Anthony J. Principi, Secretary, Department of 
  Veterans Affairs, Health Subcommittee Hearing on the health care of 
   Filipino World War II veterans within the Department of Veterans 
                                Affairs

                             June 13, 2002

    Before I address the subject of today's hearing, let me first 
reiterate what has been said concerning last November's meeting between 
President Bush and President Arroyo of the Philippines. In 
commemorating the 50th anniversary of the signing of the U.S. 
Philippine Mutual Defense Treaty, they reaffirmed the strength and 
warmth of bilateral relations and agreed that the alliance of the 
United States and the Philippines remains vital to both nations, 
particularly in the wake of the September 11 attacks. Their meeting was 
characterized by sincerity and candor and heralded a new era of 
comprehensive cooperation and friendship between the United States and 
the Philippines. President Bush also agreed to review the services and 
benefits that the United States provides for Filipino veterans, and 
that review has already yielded results.
    Mr. Chairman, I am second to none in my admiration of the 
sacrifices made by Filipinos during World War II. These brave soldiers 
were called on to defend the Philippine people against superior forces, 
and, in the face of what should have been a devastating loss, they 
performed magnificently. The world is indebted to Filipino veterans for 
their contribution to the Allied victory in World War II.
    The Department of Veterans Affairs (VA) has long recognized the 
unique status and contributions of Filipino veterans. During World War 
II, the Philippine Islands was a U.S. territory, and its troops fought 
under U.S. command. There has been no other similar arrangement in 
recent American history. The special circumstances of Filipino veterans 
have also been recognized in law. Soon after World War II, legislation 
was enacted making disabled Filipino veterans and their survivors 
eligible for compensation at the rate of one Philippine peso for each 
dollar of compensation authorized. A later change authorized 
compensation at half the rate paid to U.S. veterans and survivors. In 
late 2000, Congress increased the rate of compensation for certain 
Filipino veterans and expanded access to health care and burial 
services.
    Specifically with regard to health care, prior to October 27, 2000, 
the law authorized VA to provide care in the Manila Outpatient Clinic 
only for the service-connected conditions of U.S. veterans. The term 
``U.S. veterans'' includes members of the Old Philippine Scouts. With 
enactment of Public Law 106-377 in October of 2000, Congress authorized 
VA to begin providing care in the clinic for the non-service-connected 
conditions of those same U.S. veterans. Filipino veterans, however, 
including Commonwealth Army veterans and New Philippine Scouts, are not 
eligible for VA health care in the Philippines. The Philippine 
Government provides health care to eligible Filipino veterans.
    The law regarding care of Filipino veterans residing in the United 
States also changed. Prior to the enactment of Public Law 106-377, VA 
was authorized to provide care in the United States only for the 
service-connected conditions of Commonwealth Army veterans, members of 
recognized guerilla groups, and New Philippine Scouts. Public Law 106-
377 authorized VA to begin providing hospital care, nursing home care, 
and medical services to veterans of the Commonwealth Army and 
recognized guerilla forces that have service-connected disabilities on 
the same basis as U.S. veterans. In short the change allowed these 
veterans to seek care for their non-service-connected conditions. The 
change in law did not expand eligibility for New Philippine Scout 
veterans. They continue to be eligible for care in the United States 
only on a discretionary basis (within the limits of VA resources) and 
only for service-connected disabilities.
          * * * * * * *
    Mr. Chairman, VA continues to work with the White House to explore 
opportunities to enhance our assistance to Filipino veterans. Section 
1731 of Title 38 authorizes the President to assist the Republic of the 
Philippines in fulfilling its responsibilities in providing medical 
care and treatment for Commonwealth Army veterans and new Philippine 
Scouts. I am working to utilize this authority to provide grants of 
equipment, as well as assistance in installation and maintenance of the 
equipment, to the Philippine government to improve care at the Veterans 
Memorial Medical Center in Manila. I anticipate the equipment grants 
would be for $500,000 per year.
    Mr. Chairman, we look forward to working with Congress to provide 
appropriate benefits and services for this deserving group of 
individuals. I personally support the proposal to include former 
members of the New Philippine Scouts in the ranks of Filipino veterans 
who are eligible for burial benefits. I believe enactment of 
legislation to provide for those benefits is possible if the number of 
beneficiaries, and hence the cost of enactment, is so small that 
enactment would not trigger the PAYGO requirements of the Omnibus 
Budget Reconciliation Act of 1990.
                  ADDITIONAL VIEWS FROM ADMINISTRATION

    In a letter dated May 12, 2003, Secretary Principi 
transmitted a draft bill, ``To amend title 38, United States 
Code, to improve benefits for Filipino veterans of World War II 
and survivors off such veterans, and for other purposes'' to 
the Speaker of the House, Honorable J. Dennis Hastert. The 
proposed legislation would extend health care and certain other 
benefits to certain Filipino veterans residing legally in the 
United States. Secretary Principi stated:

    Currently, both Commonwealth Army veterans and new Philippine 
Scouts are eligible for treatment of service-connected disabilities 
within the limits of Department facilities. However, Commonwealth Army 
veterans are also eligible for treatment of non service-connected 
disabilities in the same manner as a veteran, if they are in receipt of 
certain compensation and reside legally in the United States. The 
proposal would extend to new Philippine Scouts who reside legally in 
the United States the same eligibility for medical care and services of 
non-service connected disabilities that currently exists for 
Commonwealth Army veterans, while eliminating the receipt-of-
compensation requirement for these veterans and scouts. It would also 
apply the facilities-resources limitation to all care furnished under 
this section.

               Congressional Budget Office Cost Estimate

    The following letter was received from the Congressional 
Budget Office concerning the cost of the reported bill:

                                     U.S. Congress,
                               Congressional Budget Office,
                                      Washington, DC, June 30, 2003
Hon. Christopher H. Smith
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC

    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 2357, the Veterans 
Health Care Improvement Act of 2003.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Sam 
Papenfuss, who can be reached at 226-2840.

            Sincerely,
                                       Douglas Holtz-Eakin,
                                                           Director
    Enclosure.

               Congressional Budget Office Cost Estimate

        H.R. 2357, Veterans Health Care Improvement Act of 2003

As ordered reported by the House Committee on Veterans' Affairs on June 
                                26, 2003

Summary
    H.R. 2357 would provide new health care benefits to certain 
Filipino veterans and make it easier for the Department of 
Veterans Affairs (VA) to hire certain health care workers. The 
bill would modify the eligibility criteria to allow a greater 
number of Filipino veterans living in the United States to 
receive health care from VA. H.R. 2357 also would make it 
easier for VA to hire chiropractors by specifically listing 
chiropractors as medical professionals that VA could hire. In 
addition, the bill would grant VA the authority to treat 
chiropractors like other medical professionals with regard to 
malpractice and negligence, reimbursement of certain education 
expenses, and collective bargaining.
    CBO estimates that implementing the bill would cost $7 
million in 2004 and $61 million over the 2004-2008 period, 
assuming appropriation of the estimated amounts.
    H.R. 2357 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA) 
and would not affect the budgets of state, local, or tribal 
governments.
Estimated cost to the federal government
    The estimated budgetary impact of H.R. 2357 is shown in the 
following table. This estimate assumes the legislation will be 
enacted by the end of fiscal year 2003, that the necessary 
funds for implementing the bill will be provided for each year, 
and that outlays will follow historical spending patterns for 
existing or similar programs. The costs of this legislation 
fall within budget function 700 (veterans benefits and 
services).






                                                                   By Fiscal Year, in Millions of Dollars
                                                           -----------------------------------------------------
                                                              2003     2004     2005     2006     2007     2008
----------------------------------------------------------------------------------------------------------------
Spending Under Current Law for Veterans' Medical Care
  Estimated Authorization Level 1.........................   25,279   26,153   26,987   27,890   28,824   29,452
  Estimated Outlays.......................................   25,677   26,179   26,783   27,655   28,583   29,271

Proposed Changes
  Estimated Authorization Level...........................        0        8       16       14       13       12
  Estimated Outlays.......................................        0        7       15       14       13       12

Spending Under H.R. 2357 for Veterans' Medical Care
  Estimated Authorization Level...........................   25,279   26,161   27,003   27,904   28,837   29,464
  Estimated Outlays.......................................   25,677   26,186   26,798   27,669   28,596   29,283
----------------------------------------------------------------------------------------------------------------
1 The 2003 level is the estimated net amount appropriated for that year. No full-year appropriation has yet been
  provided for fiscal year 2004. The current-law amounts for the 2004-2008 period assume that appropriations
  remain at the 2003 level with adjustments for anticipated inflation.




    Health Care for Filipino Veterans. Under current law, only 
certain Filipino veterans who served during World War II are 
eligible for health care benefits from VA. Under section 2 of 
the bill, any individual who is a veteran of the Philippine 
Commonwealth Army or a former New Philippine Scout living 
legally in the United States would be eligible for VA health 
care benefits provided by VA. Using information from VA, CBO 
estimates that in 2004 about 9,500 Filipino veterans would 
qualify for this new benefit and that they would be classified 
as Category 5 veterans, based on income and other factors. 
Based on average enrollment and use rates for Category 5 
veterans, CBO estimates that about 35 percent of these veterans 
would use VA health care benefits in 2004 at an estimated cost 
of $5,100 per person. After adjusting for mortality, CBO 
expects that the number of eligible Filipino veterans using VA 
health care benefits would grow to 2,900 in 2005 as more of 
these veterans become aware of the benefit, and then gradually 
decline to about 1,900 by 2008. Accordingly, CBO estimates that 
implementing this section would cost $7 million in 2004 and $61 
million over the 2004-2008 period, assuming appropriation of 
the estimated amounts.

    Chiropractors. Under current law, VA is required to make 
chiropractic care available to veterans at least one site in 
each of VA's 21 geographic service areas. Section 1 would make 
it easier for VA to appoint and hire chiropractors by 
specifying that they be treated as other medical professionals 
like podiatrists and optometrists. Based on information from 
VA, CBO does not expect that implementing this provision would 
increase the level of spending for chiropractic care that VA 
would provide beyond what VA is already required to provide 
under the current law. Thus, the primary effect would be to 
facilitate the establishment of chiropractic care that VA is 
already undertaking.

Intergovernmental and private-sector impact
    H.R. 2357 contains no intergovernmental or private-sector 
mandates as defined in UMRA and would not affect the budgets of 
state, local, or tribal governments.
Estimate prepared by:
    Federal Costs: Sam Papenfuss (226-2840)
    Impact on State, Local, and Tribal Governments: David 
Conway and Gregory Waring (225-3220)
    Impact on the Private Sector: Allison Percy (226-2900)
Estimate approved by:
    Paul R. Cullinan
    Chief for Human Resources Cost Estimates Unit, Budget 
Analysis Division

                     Statement of Federal Mandates

    The preceding Congressional Budget Office cost estimate 
states that the bill contains no intergovernmental or private 
sector mandates as defined in the Unfunded Mandates Reform Act.

                 Statement of Constitutional Authority

    Pursuant to Article I, section 8 of the United States 
Constitution, the reported bill is authorized by Congress' 
power to ``provide for the common Defense and general Welfare 
of the United States.''

         Changes in Existing Law Made by the Bill, as Reported

    In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italics, existing law in which no change 
is proposed is shown in roman):

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italics, existing law in which no change 
is proposed is shown in roman):

                      TITLE 38, UNITED STATES CODE



           *       *       *       *       *       *       *
PART II--GENERAL BENEFITS

           *       *       *       *       *       *       *


CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE

           *       *       *       *       *       *       *


SUBCHAPTER IV--HOSPITAL CARE AND MEDICAL TREATMENT FOR VETERANS IN THE 
REPUBLIC OF THE PHILIPPINES

           *       *       *       *       *       *       *


Sec. 1734. Hospital and nursing home care and medical services in the 
                    United States

  [(a) The Secretary, within the limits of Department 
facilities, may furnish hospital and nursing home care and 
medical services to Commonwealth Army veterans and new 
Philippine Scouts for the treatment of the service-connected 
disabilities of such veterans and scouts.
  [(b) An individual who is in receipt of benefits under 
subchapter II or IV of chapter 11 of this title paid by reason 
of service described in section 107(a) of this title who is 
residing in the United States and who is a citizen of, or an 
alien lawfully admitted for permanent residence in, the United 
States shall be eligible for hospital and nursing home care and 
medical services in the same manner as a veteran, and the 
disease or disability for which such benefits are paid shall be 
considered to be a service-connected disability for purposes of 
this chapter.]
  (a) The Secretary shall furnish hospital and nursing home 
care and medical services to any individual described in 
subsection (b) in the same manner, and subject to the same 
terms and conditions, as apply to the furnishing of such care 
and services to individuals who are veterans as defined in 
section 101(2) of this title. Any disability of an individual 
described in subsection (b) that is a service-connected 
disability for purposes of this subchapter (as provided for 
under section 1735(2) of this title) shall be considered to be 
a service-connected disability for purposes of furnishing care 
and services under the preceding sentence.
  (b) Subsection (a) applies to any individual who is a 
Commonwealth Army veteran or new Philippine Scout and who--
          (1) is residing in the United States; and
          (2) is a citizen of the United States or an alien 
        lawfully admitted to the United States for permanent 
        residence.

           *       *       *       *       *       *       *


PART V--BOARDS, ADMINISTRATIONS, AND SERVICES

           *       *       *       *       *       *       *


CHAPTER 73--VETERANS HEALTH ADMINISTRATION--ORGANIZATION AND FUNCTIONS

           *       *       *       *       *       *       *


SUBCHAPTER II--GENERAL AUTHORITY AND ADMINISTRATION

           *       *       *       *       *       *       *


Sec. 7316. Malpractice and negligence suits: defense by United States

  (a)(1) The remedy--
          (A) against the United States provided by sections 
        1346(b) and 2672 of title 28, or
          (B) through proceedings for compensation or other 
        benefits from the United States as provided by any 
        other law, where the availability of such benefits 
        precludes a remedy under section 1346(b) or 2672 of 
        title 28,

for damages for personal injury, including death, allegedly 
arising from malpractice or negligence of a medical or 
chiropractic care employee of the Administration in furnishing 
medical or chiropractic care or treatment while in the exercise 
of that employee's duties in or for the Administration shall be 
exclusive of any other civil action or proceeding by reason of 
the same subject matter against the medical or chiropractic 
care employee (or employee's estate) whose act or omission gave 
rise to such claim.
  (2) For purposes of paragraph (1), the term ``medical or 
chiropractic care employee of the Administration'' means a 
physician, dentist, podiatrist, chiropractor, optometrist, 
nurse, physician assistant, expanded-function dental auxiliary, 
pharmacist, or paramedical (such as medical and dental 
technicians, nursing assistants, and therapists), or other 
supporting personnel.

           *       *       *       *       *       *       *


              CHAPTER 74--VETERANS HEALTH ADMINISTRATION--
PERSONNEL

           *       *       *       *       *       *       *


                       SUBCHAPTER I--APPOINTMENTS

Sec. 7401. Appointments in Veterans Health Administration

  There may be appointed by the Secretary such personnel as the 
Secretary may find necessary for the medical care and 
chiropractic care of veterans (in addition to those in the 
Office of the Under Secretary for Health appointed under 
section 7306 of this title), as follows:
          (1) Physicians, dentists, podiatrists, chiropractors, 
        optometrists, registered nurses, physician assistants, 
        and expanded-function dental auxiliaries.

           *       *       *       *       *       *       *


Sec. 7402. Qualifications of appointees

  (a) * * *
  (b)(1) * * *

           *       *       *       *       *       *       *

  (10) Chiropractor.--To be eligible to be appointed to a 
chiropractor position, a person must--
          (A) hold the degree of doctor of chiropractic, or its 
        equivalent, from a college of chiropractic approved by 
        the Secretary; and
          (B) be licensed to practice chiropractic in a State.
  [(10)] (11) Other Health-Care Positions.--To be appointed as 
a physician assistant, expanded-function dental auxiliary, 
certified or registered respiratory therapist, licensed 
physical therapist, licensed practical or vocational nurse, 
occupational therapist, dietitian, microbiologist, chemist, 
biostatistician, medical technologist, dental technologist, or 
other position, a person must have such medical, dental, 
scientific, or technical qualifications as the Secretary shall 
prescribe.

           *       *       *       *       *       *       *


Sec. 7403. Period of appointments; promotions

  (a)(1) * * *
  (2) This section applies to the following persons appointed 
under this chapter:
          (A) * * *

           *       *       *       *       *       *       *

          (H) Chiropractors.

           *       *       *       *       *       *       *


Sec. 7404. Grades and pay scales

  (a) * * *
  (b)(1) The grades for positions provided for in paragraph (1) 
of section 7401 of this title shall be as follows. The annual 
ranges of rates of basic pay for those grades shall be 
prescribed from time to time by Executive order as authorized 
by chapter 53 of title 5 or as otherwise authorized by law:

                     physician and dentist schedule

  Director grade.

           *       *       *       *       *       *       *


             [clinical podiatrist and optometrist schedule]

      clinical podiatrist, chiropractor, and optometrist schedule

  Chief grade.

           *       *       *       *       *       *       *


Sec. 7405. Temporary full-time appointments, part-time appointments, 
                    and without-compensation appointments

  (a) The Secretary, upon the recommendation of the Under 
Secretary for Health, may employ, without regard to civil 
service or classification laws, rules, or regulations, 
personnel as follows:
          (1) On a temporary full-time basis, part-time basis, 
        or without compensation basis, persons in the following 
        positions:
                  (A) * * *

           *       *       *       *       *       *       *

                  (E) Chiropractors.
          (2) On a fee basis, persons in the following 
        positions:
                  (A) * * *

           *       *       *       *       *       *       *

                  (D) Chiropractors.

           *       *       *       *       *       *       *


Sec. 7406. Residencies and internships

  (a) * * *

           *       *       *       *       *       *       *

  (c)(1) In order to carry out more efficiently the provisions 
of subsection (a)(1), the Secretary may contract with one or 
more hospitals, medical and chiropractic schools, or medical or 
chiropractic installations having hospital facilities and 
participating with the Department in the training of interns or 
residents to provide, by the designation of one such 
institution to serve as a central administrative agency, for 
the central administration--
          (A) * * *

           *       *       *       *       *       *       *

  (2) The Secretary may pay to such designated agency, without 
regard to any other law or regulation governing the expenditure 
of Government moneys either in advance or in arrears, an amount 
to cover the cost for the period such intern or resident serves 
in a Department facility furnishing hospital care or medical 
services of--
          (A) * * *
          (B) hospitalization, medical or chiropractic care, 
        and life insurance and any other employee benefits as 
        are agreed upon by the participating institutions for 
        the period that such intern or resident serves in a 
        Department facility furnishing hospital care or medical 
        services;

           *       *       *       *       *       *       *

  (3)(A) Any amounts paid by the Secretary to such central 
administrative agency to cover the cost of hospitalization, 
medical or chiropractic care, or life insurance or other 
employee benefits shall be in lieu of any benefits of like 
nature to which such intern or resident may be entitled under 
the provisions of title 5, and the acceptance of stipends and 
employee benefits from the designated central administrative 
agency shall constitute a waiver by the recipient of any claim 
such recipient might have to any payment of stipends or 
employee benefits to which such recipient may be entitled under 
this title or title 5.

           *       *       *       *       *       *       *


Sec. 7409. Contracts for scarce medical specialist services

  (a) The Secretary may enter into contracts with institutions 
and persons described in subsection (b) to provide scarce 
medical specialist services at Department facilities. Such 
services may include the services of physicians, dentists, 
podiatrists, optometrists, chiropractors, nurses, physician 
assistants, expanded-function dental auxiliaries, technicians, 
and other medical support personnel.

           *       *       *       *       *       *       *


Sec. 7411. Full-time board-certified physicians and dentists: 
                    reimbursement of continuing professional education 
                    expenses

  The Secretary shall reimburse any full-time board-certified 
physician [or dentist], dentist, or chiropractic appointed 
under section 7401(1) of this title for expenses incurred, up 
to $1,000 per year, for continuing professional education.

           *       *       *       *       *       *       *


   SUBCHAPTER II--COLLECTIVE BARGAINING AND PERSONNEL ADMINISTRATION

Sec. 7421. Personnel administration: in general

  (a) * * *
  (b) Subsection (a) refers to the following positions:
          (1) * * *

           *       *       *       *       *       *       *

          (8) Chiropractors.

           *       *       *       *       *       *       *


                                
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