[House Report 110-267]
[From the U.S. Government Publishing Office]





110th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 1st Session                                                    110-267

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



 
PROHIBITION ON COLLECTION OF COPAYMENTS FOR ALL HOSPICE CARE FURNISHED 
                   BY DEPARTMENT OF VETERANS AFFAIRS

                                _______
                                

 July 27, 2007.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

  Mr. Filner, from the Committee on Veterans' Affairs, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 2623]

      [Including cost estimate of the Congressional Budget Office]

  The Committee on Veterans' Affairs, to whom was referred the 
bill (H.R. 2623) to amend title 38, United States Code, to 
prohibit the collection of copayments for all hospice care 
furnished by the Department of Veterans Affairs, having 
considered the same, report favorably thereon with an amendment 
and recommend that the bill as amended do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     2
Background and Discussion........................................     2
Legislative History..............................................     3
Section-by-Section...............................................     3
Committee Consideration..........................................     3
Rollcall Votes...................................................     3
Application of Law to the Legislative Branch.....................     4
Statement of Oversight Findings and Recommendations of the 
  Committee......................................................     4
Statement of General Performance Goals and Objectives............     4
Constitutional Authority Statement...............................     4
Federal Advisory Committee Act...................................     4
Unfunded Mandate Statement.......................................     4
Earmark Identification...........................................     4
Committee Estimate...............................................     4
Budget Authority and Congressional Budget Office Cost Estimate...     5
Changes in Existing Law Made by the Bill as Reported.............     5
  The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. PROHIBITION ON COLLECTION OF COPAYMENTS FOR ALL HOSPICE CARE 
                    FURNISHED BY DEPARTMENT OF VETERANS AFFAIRS.

  Title 38, United States Code, is amended--
          (1) in section 1710(f)(1), by inserting ``(except if such 
        care constitutes hospice care)'' after ``nursing home care'';
          (2) in section 1710(g)(1), by inserting ``(except if such 
        services constitute hospice care)'' after ``medical services''; 
        and
          (3) in section 1710B(c)(2), by striking subparagraph (B) and 
        inserting after subparagraph (A) the following new subparagraph 
        (B):
          ``(B) to a veteran being furnished inpatient or outpatient 
        hospice care by the Department; or''.

                          Purpose and Summary

    H.R. 2623, to amend title 38, United States Code, to 
prohibit the collection of copayments for all hospice care 
furnished by the Department of Veterans Affairs, was introduced 
on June 7, 2007, by Representative Jeff Miller of Florida, the 
Ranking Member of the Subcommittee on Health. The legislation 
would enable the VA to provide hospice care to eligible 
veterans without collecting copayments.
    H.R. 2623 would:
    1. Prohibit the collection of copayments for all hospice 
care provided by the VA.

                       Background and Discussion

    Hospice and palliative care is a continuum of comfort-
oriented and supportive services provided across settings, 
including hospitals, extended care facilities, outpatient 
clinics and private residences.
    The Department of Veterans Affairs (VA) offers a complement 
of hospice and palliative care options as part of the 
comprehensive health care benefit provided to all enrolled 
veterans. In FY 2006, every VA facility offered some form of 
hospice and end-of-life care service. In comparison, according 
to a recent survey, only one-fourth of other hospitals had a 
palliative care program. The VA's Hospice and Palliative Care 
Program has transformed much of the end-of-life care provided 
or purchased by VA. In fact, 42 percent of all veterans who 
died in a VA facility received prior consultation from a 
palliative care team. Palliative care consults in VA hospitals 
more than doubled between FY 2003 and FY 2006 and surpassed 
20,000 in FY 2006. The number of veterans receiving VA-paid 
home hospice care tripled between FY 2003 and FY 2005, and 
increased another 30 percent in FY 2006, reaching an average 
daily census of 427 veterans.
    VA has reported that they track copayment amounts for 
inpatient services and outpatient services collectively rather 
than by individual services. It is, therefore, difficult to 
determine the exact amount of revenue VA has received from 
hospice care copayments. However, VA estimates a total of 
$343,542 in annual revenue: $183,180 for home hospice care, and 
$160,362 for inpatient hospice care.
    Under current law, a veteran receiving hospice care in a 
nursing home is exempt from any applicable copayments. However, 
if the hospice care is provided in any other setting, such as 
in an acute-care hospital or at home, the veteran may be 
subject to an inpatient or outpatient primary care copayment.
    VA's current policy penalizes a veteran who chooses to 
remain at home for their hospice care or who, out of medical 
necessity, receives hospice care in an acute care setting.
    H.R. 2623 would correct this inequity by exempting all 
hospice care provided through VA from copayment requirements. 
In addition, this legislation would also align VA with the 
Medicare program, which does not impose copayments for hospice 
care regardless of the setting.

                          Legislative History

    On May 9, 2007, the Subcommittee on Health held a hearing 
entitled ``The State of VA's Long-Term Care Program Present and 
Future.'' Testimony at this hearing included a discussion 
regarding the copayment requirements for veterans receiving 
hospice care.
    On June 14, 2007, the Subcommittee on Health held a 
legislative hearing on a number of bills, including H.R. 2623, 
introduced during the 110th Congress.
    On June 28, 2007, the Subcommittee on Health marked up H.R. 
2623. An Amendment in the Nature of a Substitute was offered by 
Representative Miller that was agreed to by voice vote. The 
Subcommittee ordered H.R. 2623, as amended, reported favorably 
to the full Committee.
    On July 17, 2007, the full Committee met in open markup 
session and approved a number of bills, including H.R. 2623, as 
amended. The full Committee, by voice vote, ordered H.R. 2623, 
as amended, reported favorably to the House of Representatives.

                           Section-by-Section


Section 1. Prohibition on collection of copayments for all hospice care 
        furnished by Department of Veterans Affairs

    This section would amend sections 1710(f)(1), 1710(g)(1), 
and 1710B(c)(2) of title 38, United States Code, to enable the 
Secretary to furnish hospice care to all eligible veterans 
without requiring the veteran to pay any applicable copayments.

                        Committee Consideration

    On July 17, 2007, the Committee ordered H.R. 2623, as 
amended, reported favorably to the House of Representatives by 
voice vote.

                             Rollcall Votes

    The Committee held no rollcall votes on this bill. A motion 
to order H.R. 2623, as amended, reported favorably to the House 
of Representatives was agreed to by voice vote.

              Application of Law to the Legislative Branch

    Section 102(b)(3) of Public Law 104-1 requires a 
description of the application of this bill to the legislative 
branch where the bill relates to the terms and conditions of 
employment or access to public services and accommodations. 
This bill does not relate to employment or access to public 
services and accommodations.

  Statement of Oversight Findings and Recommendations of the Committee

    In compliance with clause 3(c)(1) of rule XIII and clause 
(2)(b)(1) of rule X of the Rules of the House of 
Representatives, the Committee's oversight findings and 
recommendations are reflected in the descriptive portions of 
this report.

         Statement of General Performance Goals and Objectives

    In accordance with clause (3)(c)(4) of rule XIII of the 
Rules of the House of Representatives, the Committee's 
performance goals and objectives are reflected in the 
descriptive portions of this report.

                   Constitutional Authority Statement

    Under clause 3(d)(1) of rule XIII of the Rules of the House 
of Representatives, the Committee must include a statement 
citing the specific powers granted to Congress to enact the law 
proposed by H.R. 2623. The Committee finds that Article 1, 
Section 8 of the Constitution of the United States grants 
Congress the power to enact this law.

                     Federal Advisory Committee Act

    The Committee finds that the legislation does not establish 
or authorize the establishment of an advisory committee within 
the definition of 5 U.S.C. App., section 5(b).

                       Unfunded Mandate Statement

    Section 423 of the Congressional Budget and Impoundment 
Control Act (as amended by section 101(a)(2) of the Unfunded 
Mandate Reform Act, P.L. 104-4) requires a statement whether 
the provisions of the reported bill include unfunded mandates. 
In compliance with this requirement the Committee has received 
a letter from the Congressional Budget Office that is included 
herein.

                         Earmark Identification

    H.R. 2623, as amended, does not contain any congressional 
earmarks, limited tax benefits, or limited tariff benefits as 
defined in clause 9(d), 9(e), or 9(f) of rule XXI of the Rules 
of the House of Representatives.

                           Committee Estimate

    Clause 3(d)(2) of rule XIII of the Rules of the House of 
Representatives requires an estimate and a comparison by the 
Committee of the costs that would be incurred in carrying out 
H.R. 2623, as amended. However, clause 3(d)(3)(B) of that rule 
provides that this requirement does not apply when the 
Committee has included in its report a timely submitted cost 
estimate of the bill prepared by the Director of the 
Congressional Budget Office under section 402 of the 
Congressional Budget Act.

     Budget Authority and Congressional Budget Office Cost Estimate

                                     U.S. Congress,
                               Congressional Budget Office,
                                     Washington, DC, July 24, 2007.
Hon. Bob Filner,
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. 2623, a bill to 
amend title 38, United States Code, to prohibit the collection 
of copayments for all hospice care furnished by the Department 
of Veterans Affairs.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Michelle S. 
Patterson.
            Sincerely,
                                         Peter R. Orszag, Director.
    Enclosure.

H.R. 2623--A bill to amend title 38, United States Code, to prohibit 
        the collection of copayments for all hospice care furnished by 
        the Department of Veterans Affairs

    H.R. 2623 would prohibit the Department of Veterans Affairs 
(VA) from collecting copayments from veterans receiving hospice 
care. This would apply to care received at both inpatient and 
outpatient facilities. Depending upon where veterans get 
hospice care, copayments range from $15 per day to a maximum of 
$97 per day. Most veterans receiving this type of care from VA 
are not charged copayments--only veterans whose disabilities 
are unrelated to their military service and whose incomes are 
above a certain level are required to make copayments.
    Based on information from VA that 435 veterans made 
copayments averaging about $800 last year for hospice care, CBO 
estimates that implementing H.R. 2623 would decrease 
collections by less than $500,000 each year and by about $2 
million over the 2008-2012 period. Those collections are 
considered to be offsets to discretionary appropriations. As 
part of the annual appropriations process, the Congress gives 
VA authority to spend those collections. Therefore, if it 
wished to maintain the same level of health care services for 
veterans, the Congress would need to appropriate additional 
funds each year to make up for the loss of copayments under 
this bill. Under those circumstances, implementing H.R. 2623 
would cost about $2 million over the 2008-2012 period. Enacting 
this bill would not affect direct spending or receipts.
    H.R. 2623 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act and 
would impose no costs on state, local, or tribal governments.
    The CBO staff contact for this estimate is Michelle S. 
Patterson. This estimate was approved by Robert A. Sunshine, 
Assistant Director for Budget Analysis.

         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 italic, 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 II--HOSPITAL, NURSING HOME, OR DOMICILIARY CARE AND MEDICAL 
                               TREATMENT

Sec. 1710. Eligibility for hospital, nursing home, and domiciliary care

  (a) * * *

           *       *       *       *       *       *       *

  (f)(1) The Secretary may not furnish hospital care or nursing 
home care (except if such care constitutes hospice care) under 
this section to a veteran who is eligible for such care under 
subsection (a)(3) of this section unless the veteran agrees to 
pay to the United States the applicable amount determined under 
paragraph (2) or (4) of this subsection.

           *       *       *       *       *       *       *

  (g)(1) The Secretary may not furnish medical services (except 
if such services constitute hospice care) under subsection (a) 
of this section (including home health services under section 
1717 of this title) to a veteran who is eligible for hospital 
care under this chapter by reason of subsection (a)(3) of this 
section unless the veteran agrees to pay to the United States 
in the case of each outpatient visit the applicable amount or 
amounts established by the Secretary by regulation.

           *       *       *       *       *       *       *


Sec. 1710B. Extended care services

  (a) * * *

           *       *       *       *       *       *       *

  (c)(1) * * *
  (2) Paragraph (1) shall not apply--
          (A) * * *
          [(B) to a veteran being furnished hospice care under 
        this section; or]
          (B) to a veteran being furnished inpatient or 
        outpatient hospice care by the Department; or

           *       *       *       *       *       *       *


                                  
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