[House Report 110-268]
[From the U.S. Government Publishing Office]





110th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 1st Session                                                    110-268

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



 
             VETERANS' HEALTH CARE IMPROVEMENT ACT OF 2007

                                _______
                                

 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. 2874]

      [Including cost estimate of the Congressional Budget Office]

  The Committee on Veterans' Affairs, to whom was referred the 
bill (H.R. 2874) to amend title 38, United States Code, to make 
certain improvements in the provision of health care to 
veterans, and for other purposes, having considered the same, 
report favorably thereon with an amendment and recommend that 
the bill as amended do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     7
Background and Discussion........................................     9
Legislative History..............................................    12
Section-by-Section...............................................    13
Committee Consideration..........................................    15
Rollcall Votes...................................................    15
Application of Law to the Legislative Branch.....................    15
Statement of Oversight Findings and Recommendations of the 
  Committee......................................................    15
Statement of General Performance Goals and Objectives............    15
Constitutional Authority Statement...............................    15
Federal Advisory Committee Act...................................    15
Unfunded Mandate Statement.......................................    15
Earmark Identification...........................................    16
Committee Estimate...............................................    16
Budget Authority and Congressional Budget Office Cost Estimate...    16
Changes in Existing Law Made by the Bill as Reported.............    21

    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

  (a) Short Title.--This Act may be cited as the ``Veterans' Health 
Care Improvement Act of 2007''.
  (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Grants for support of therapeutic readjustment programs for 
veterans.
Sec. 3. Transportation grants for rural veterans service organizations.
Sec. 4. Permanent treatment authority for participants in Department of 
Defense chemical and biological testing conducted by Deseret Test 
Center (including Project Shipboard Hazard and Defense).
Sec. 5. Extension of expiring collections authorities.
Sec. 6. Readjustment and mental health services for Operation Enduring 
Freedom and Operation Iraqi Freedom Veterans.
Sec. 7. Expansion and extension of authority for program of referral 
and counseling services for at-risk veterans transitioning from certain 
institutions.
Sec. 8. Permanent authority for domiciliary services for homeless 
veterans and enhancement of capacity of domiciliary care programs for 
female veterans.
Sec. 9. Financial assistance for supportive services for very low-
income veteran families in permanent housing.
Sec. 10. Expansion of eligibility for dental care.
Sec. 11. Technical amendments.

SEC. 2. GRANTS FOR SUPPORT OF THERAPEUTIC READJUSTMENT PROGRAMS FOR 
                    VETERANS.

  (a) Grant Program.--Subchapter II of chapter 5 of title 38, United 
States Code, is amended by inserting after section 521 the following 
new section:

``Sec. 521A. Assistance to therapeutic readjustment programs

  ``(a) Grant Program.--The Secretary of Veterans Affairs may make 
grants to qualified entities described in subsection (b) to conduct 
workshop programs that have been shown to assist in the therapeutic 
readjustment and rehabilitation of participants to assist in the 
therapeutic readjustment of covered veterans.
  ``(b) Qualified Entities.--In order to qualify for grant assistance 
under subsection (a), a private nonprofit entity must have, as 
determined by the Secretary, experience and expertise in offering 
programs to assist in the therapeutic readjustment of participants and 
that such programs will likely assist covered veterans.
  ``(c) Amount of Grant; Use of Funds.--A grant under this section 
shall not exceed $100,000 for any calendar year and shall be used by 
the recipient exclusively for the benefit of covered veterans.
  ``(d) Application.--An application for a grant under this section 
shall include details regarding the extent and nature of the proposed 
program, the therapeutic readjustment and rehabilitation benefits 
expected to be achieved by participants, and any other information the 
Secretary determines may be necessary to assist the Secretary in 
ensuring that covered veterans receive therapeutic readjustment and 
rehabilitation benefits.
  ``(e) Covered Veterans.--For the purposes of this subsection, a 
`covered veteran' is a veteran who served on active duty in a theater 
of combat operations (as determined by the Secretary in consultation 
with the Secretary of Defense) during a period of war after the Persian 
Gulf War, or in combat against a hostile force during a period of 
hostilities (as defined in section 1712A(a)(2)(B) of this title) after 
November 11, 1998, and who is discharged or released from active 
military, naval, or air service on or after September 11, 2001.
  ``(f) Reports.--Not later than 60 days after the last day of a fiscal 
year, the Secretary shall submit to the Committees on Veterans' Affairs 
of the Senate and House of Representatives a report detailing the 
number and amount of grants made under this section during the previous 
fiscal year, the total number of covered veterans participating in 
workshop programs funded by such grants, a description of the programs, 
and the therapeutic benefits to covered veterans of participation in 
the various programs funded.
  ``(g) Authorization of Appropriations.--There is authorized to be 
appropriated for each of fiscal years 2008 through 2011 $2,000,000 to 
carry out this section.
  ``(h) Termination.--The authority of the Secretary to make a grant 
under subsection (a) shall terminate on September 30, 2011.''.
  (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item relating to section 
521 the following new item:

``521A. Assistance to therapeutic readjustment programs.''.

SEC. 3. TRANSPORTATION GRANTS FOR RURAL VETERANS SERVICE ORGANIZATIONS.

  (a) Grant Program.--Subchapter I of chapter 17 of title 38, United 
States Code, is amended by adding at the end the following new section:

``Sec. 1709. Grants for provision of transportation to Department 
                    medical facilities for veterans in remote rural 
                    areas

  ``(a) Grants Authorized.--(1) The Secretary shall establish a grant 
program to provide innovative transportation options to veterans in 
remote rural areas.
  ``(2) Grants awarded under this section may be used by State 
veterans' service agencies, veterans service organizations, and private 
nonprofit entities to assist veterans in remote rural areas to travel 
to Department medical facilities.
  ``(3) The amount of a grant under this section may not exceed 
$50,000.
  ``(4) The recipient of a grant under this section shall not be 
required to provide matching funds as a condition for receiving such 
grant.
  ``(b) Regulations.--The Secretary shall prescribe regulations for--
          ``(1) evaluating grant applications under this section; and
          ``(2) otherwise administering the program established by this 
        section.
  ``(c) Authorization of Appropriations.--There is authorized to be 
appropriated $3,000,000 for each of fiscal years 2008 through 2012 to 
carry out this section.''.
  (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item relating to section 
1708 the following new item:

``1709. Grants for provision of transportation to Department medical 
facilities for veterans in remote rural areas.''.

SEC. 4. PERMANENT TREATMENT AUTHORITY FOR PARTICIPANTS IN DEPARTMENT OF 
                    DEFENSE CHEMICAL AND BIOLOGICAL TESTING CONDUCTED 
                    BY DESERET TEST CENTER (INCLUDING PROJECT SHIPBOARD 
                    HAZARD AND DEFENSE).

  Section 1710(e)(3) of title 38, United States Code, is amended--
          (1) in subparagraph (B), by inserting ``and'' after the 
        semicolon;
          (2) in subparagraph (C), by striking ``; and'' and inserting 
        a period; and
          (3) by striking subparagraph (D).

SEC. 5. EXTENSION OF EXPIRING COLLECTIONS AUTHORITIES.

  (a) Health Care Copayments.--Section 1710(f)(2)(B) is amended by 
striking ``2007'' and inserting ``2009''.
  (b) Medical Care Cost Recovery.--Section 1729(a)(2)(E) is amended by 
striking ``2007'' and inserting ``2009''.

SEC. 6. READJUSTMENT AND MENTAL HEALTH SERVICES FOR COVERED VETERANS.

  (a) Provision of Readjustment Counseling and Mental Health 
Services.--Subchapter II of chapter 17 of title 38, United States Code, 
is amended by inserting after section 1712B the following new section:

``Sec. 1712C. Provision of readjustment counseling and mental health 
                    services for covered veterans

  ``(a) Program Required.--The Secretary shall carry out a program to 
provide peer outreach services, peer support services, and readjustment 
and mental health services to covered veterans.
  ``(b) Contracts With Community Mental Health Centers.--In carrying 
out the program required by subsection (a), the Secretary shall 
contract with community mental health centers and other qualified 
entities to provide the services referred to in that paragraph in areas 
the Secretary determines are not adequately served by health care 
facilities of the Department. Such contracts shall require each 
community health center or other entity--
          ``(1) to the extent practicable, to employ covered veterans 
        trained under subsection (c);
          ``(2) to the extent practicable, to use telehealth services 
        for the provision of such services;
          ``(3) to participate in the training program under subsection 
        (d);
          ``(4) to comply with applicable protocols of the Department 
        before incurring any liability on behalf of the Department for 
        the provision of such the services;
          ``(5) to submit annual reports to the Secretary containing, 
        with respect to the program required by subsection (a) and for 
        the last full calendar year ending before the submission of 
        such report--
                  ``(A) the number of veterans served, veterans 
                diagnosed, and courses of treatment provided to 
                veterans as part of the program required by subsection 
                (a); and
                  ``(B) demographic information for such services, 
                diagnoses, and courses of treatment;
          ``(6) to provide to the Secretary such clinical summary 
        information as the Secretary may require for each veteran for 
        whom the center or entity provides mental health services under 
        the contract; and
          ``(7) to meet such other requirements as the Secretary may 
        require.
  ``(c) Training Program for Veterans.--In carrying out the program 
required by subsection (a), the Secretary shall contract with a 
nonprofit mental health organization to carry out a program to train 
covered veterans to provide peer outreach and peer support services.
  ``(d) Training Program for Clinicians.--The Secretary shall conduct a 
training program for clinicians of community mental health centers or 
other entities that have entered into contracts with the Secretary 
under subsection (b) to ensure that such clinicians are able to provide 
the services required by subsection (a) in a manner that--
          ``(1) recognizes factors that are unique to the experience of 
        veterans who served on active duty in Operation Iraqi Freedom 
        or Operation Enduring Freedom (including the combat and 
        military training experiences of such veterans); and
          ``(2) utilizes best practices and technologies.
  ``(e) Covered Veterans.--For the purposes of this subsection, a 
`covered veteran' is a veteran who served on active duty in a theater 
of combat operations (as determined by the Secretary in consultation 
with the Secretary of Defense) during a period of war after the Persian 
Gulf War, or in combat against a hostile force during a period of 
hostilities (as defined in section1712A(a)(2)(B) of this title) after 
November 11, 1998, and who is discharged or released from active 
military, naval, or air service on or after September 11, 2001''.
  (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item relating to section 
1712B the following new item:

``1712C. Provision of readjustment counseling and mental health 
services for covered veterans.''.

SEC. 7. EXPANSION AND EXTENSION OF AUTHORITY FOR PROGRAM OF REFERRAL 
                    AND COUNSELING SERVICES FOR AT-RISK VETERANS 
                    TRANSITIONING FROM CERTAIN INSTITUTIONS.

  (a) Program Authority.--Subsection (a) of section 2023 of title 38, 
United States Code, is amended by striking ``a demonstration program 
for the purpose of determining the costs and benefits of providing'' 
and inserting ``a program to provide''.
  (b) Scope of Program.--Subsection (b) of such section is amended--
          (1) by striking ``Demonstration'' in the subsection heading;
          (2) by striking ``demonstration''; and
          (3) by striking ``in at least six locations'' and inserting 
        ``in at least 12 locations''.
  (c) Extension of Authority.--Subsection (d) of such section is 
amended by striking ``shall cease'' and all that follows and inserting 
``shall cease on September 30, 2011.''.
  (d) Conforming Amendments.--
          (1) Scope of program.--Subsection (c)(1) of such section is 
        amended by striking ``demonstration''.
          (2) Section heading.--The heading of such section is amended 
        to read as follows:

``Sec. 2023. Referral and counseling services: veterans at risk of 
                    homelessness who are transitioning from certain 
                    institutions''.

          (3) Other conforming amendment.--Section 2022(f)(2)(C) of 
        such title is amended by striking ``demonstration''.
  (e) Clerical Amendment.--The table of sections at the beginning of 
chapter 20 of such title is amended by striking the item relating to 
section 2023 and inserting the following new item:

``2023. Referral and counseling services: veterans at risk of 
homelessness who are transitioning from certain institutions.''.

SEC. 8. PERMANENT AUTHORITY FOR DOMICILIARY SERVICES FOR HOMELESS 
                    VETERANS AND ENHANCEMENT OF CAPACITY OF DOMICILIARY 
                    CARE PROGRAMS FOR FEMALE VETERANS.

  Subsection (b) of section 2043 of title 38, United States Code, is 
amended to read as follows:
  ``(b) Enhancement of Capacity of Domiciliary Care Programs for Female 
Veterans.--The Secretary shall take appropriate actions to ensure that 
the domiciliary care programs of the Department are adequate, with 
respect to capacity and safety, to meet the needs of veterans who are 
women.''.

SEC. 9. FINANCIAL ASSISTANCE FOR SUPPORTIVE SERVICES FOR VERY LOW-
                    INCOME VETERAN FAMILIES IN PERMANENT HOUSING.

  (a) Purpose.--The purpose of this section is to facilitate the 
provision of supportive services for very low-income veteran families 
in permanent housing.
  (b) Authorization of Financial Assistance.--
          (1) In general.--Subchapter V of chapter 20 of title 38, 
        United States Code, is amended by adding at the end the 
        following new section:

``Sec. 2044. Financial assistance for supportive services for very low-
                    income veteran families residing in permanent 
                    housing

  ``(a) Distribution of Financial Assistance.--
          ``(1) The Secretary shall provide financial assistance to 
        eligible entities approved under this section to provide and 
        coordinate the provision of the supportive services for very 
        low-income veteran families residing in permanent housing.
          ``(2)(A) Financial assistance under this section shall 
        consist of payments for each such family for which an approved 
        eligible entity provides or coordinates the provision of 
        supportive services.
          ``(B) The Secretary shall establish a formula for determining 
        the rate of payments provided to a very low-income veteran 
        family receiving supportive services under this section. The 
        rate shall be adjusted not less than once annually to reflect 
        changes in the cost of living. In calculating the payment 
        formula under this subparagraph, the Secretary may consider 
        geographic cost of living variances, family size, and the cost 
        of services provided.
          ``(3) In providing financial assistance under paragraph (1), 
        the Secretary shall give preference to an entity that provides 
        or coordinates the provision of supportive services for very 
        low-income veteran families who are transitioning from 
        homelessness to permanent housing.
          ``(4) The Secretary shall ensure that, to the extent 
        practicable, financial assistance under this subsection is 
        equitably distributed across geographic regions, including 
        rural communities and tribal lands.
          ``(5) Each entity receiving financial assistance under this 
        section to provide supportive services to a very low-income 
        veteran family shall notify the family that such services are 
        being paid for, in whole or in part, by the Department.
          ``(6) The Secretary may require an entity receiving financial 
        assistance under this section to submit a report to the 
        Secretary describing the supportive services provided with such 
        financial assistance.
  ``(b) Application for Financial Assistance.--
          ``(1) An eligible entity seeking financial assistance under 
        subsection (a) shall submit to the Secretary an application in 
        such form, in such manner, and containing such commitments and 
        information as the Secretary determines to be necessary.
          ``(2) An application submitted under paragraph (1) shall 
        contain--
                  ``(A) a description of the supportive services 
                proposed to be provided by the eligible entity;
                  ``(B) a description of the types of very low-income 
                veteran families proposed to be provided such services;
                  ``(C) an estimate of the number of very low-income 
                veteran families proposed to be provided such services;
                  ``(D) evidence of the experience of the eligible 
                entity in providing supportive services to very low-
                income veteran families; and
                  ``(E) a description of the managerial capacity of the 
                eligible entity to--
                          ``(i) coordinate the provision of supportive 
                        services with the provision of permanent 
                        housing, by the eligible entity or by other 
                        organizations;
                          ``(ii) continuously assess the needs of very 
                        low-income veteran families for supportive 
                        services;
                          ``(iii) coordinate the provision of 
                        supportive services with the services of the 
                        Department;
                          ``(iv) tailor supportive services to the 
                        needs of very low-income veteran families; and
                          ``(v) continuously seek new sources of 
                        assistance to ensure the long-term provision of 
                        supportive services to very low-income veteran 
                        families.
          ``(3) The Secretary shall establish criteria for the 
        selection of eligible entities to receive financial assistance 
        under this section.
  ``(c) Technical Assistance.--
          ``(1) The Secretary shall provide training and technical 
        assistance to eligible entities that receive financial 
        assistance under this section with respect to the planning, 
        development, and provision of supportive services to very low-
        income veteran families occupying permanent housing.
          ``(2) The Secretary may provide the training described in 
        paragraph (1) directly or through grants or contracts with 
        appropriate public or nonprofit private entities.
  ``(d) Authorization of Appropriations.--There is authorized to be 
appropriated, for each fiscal year, $25,000,000, to carry out this 
section, of which not more than $750,000 for each fiscal year may be 
used to provide technical assistance under subsection (c).
  ``(e) Definitions.--For the purposes of this section:
          ``(1) The term `very low-income veteran family' means a 
        veteran family whose income does not exceed 50 percent of the 
        median income for the area, as determined by the Secretary in 
        accordance with this paragraph, except that--
                  ``(A) the Secretary shall make appropriate 
                adjustments to the income requirement under 
                subparagraph (A) based on family size; and
                  ``(B) the Secretary may establish an income ceiling 
                higher or lower than 50 percent of the median income 
                for an area if the Secretary determines that such 
                variations are necessary because the area has unusually 
                high or low construction costs, fair market rents (as 
                determined under section 8 of the United States Housing 
                Act of 1937 (42 U.S.C. 1437f)), or family incomes.
                  ``(C) the Secretary shall establish criteria for 
                determining the need for specific supportive services 
                (as defined by paragraph (8)) of individual very low 
                income veteran families occupying permanent housing.
          ``(2) The term `veteran family' includes a veteran who is a 
        single person and a family in which the head of household or 
        the spouse of the head of household is a veteran.
          ``(3) The term `consumer cooperative' has the meaning given 
        such term in section 202 of the Housing Act of 1959 (12 U.S.C. 
        1701q).
          ``(4) The term `eligible entity' means--
                  ``(A) a private nonprofit organization; or
                  ``(B) a consumer cooperative.
          ``(5) The term `homeless' has the meaning given the term in 
        section 103 of the McKinney-Vento Homeless Assistance Act (42 
        U.S.C. 11302).
          ``(6) The term `permanent housing' means community-based 
        housing without a designated length of stay.
          ``(7) The term `private nonprofit organization' means--
                  ``(A) any incorporated private institution or 
                foundation--
                          ``(i) no part of the net earnings of which 
                        inures to the benefit of any member, founder, 
                        contributor, or individual;
                          ``(ii) which has a governing board that is 
                        responsible for the operation of the supportive 
                        services provided under this section; and
                          ``(iii) which is approved by the Secretary as 
                        to financial responsibility;
                  ``(B) a for-profit limited partnership, the sole 
                general partner of which is an organization meeting the 
                requirements of clauses (i), (ii), and (iii) of 
                subparagraph (A);
                  ``(C) a corporation wholly owned and controlled by an 
                organization meeting the requirements of clauses (i), 
                (ii), and (iii) of subparagraph (A); and
                  ``(D) a tribally designated housing entity (as 
                defined in section 4 of the Native American Housing 
                Assistance and Self-Determination Act of 1996 (25 
                U.S.C. 4103)).
          ``(8) The term `supportive services' means the following:
                  ``(A) Services provided by an eligible entity or 
                subcontractors that address the needs of very low-
                income veteran families occupying permanent housing, 
                including--
                          ``(i) outreach services;
                          ``(ii) health care services, including 
                        diagnosis, treatment, and counseling for mental 
                        health and substance abuse disorders and for 
                        post-traumatic stress disorder, if such 
                        services are not readily available through the 
                        Department of Veterans Affairs medical center 
                        serving the geographic area in which the 
                        veteran family is housed;
                          ``(iii) habilitation and rehabilitation 
                        services;
                          ``(iv) case management services;
                          ``(v) daily living services;
                          ``(vi) personal financial planning;
                          ``(vii) transportation services;
                          ``(viii) vocational counseling;
                          ``(ix) employment and training;
                          ``(x) educational services;
                          ``(xi) assistance in obtaining veterans 
                        benefits and other public benefits, including 
                        health care provided by the Department;
                          ``(xii) assistance in obtaining income 
                        support;
                          ``(xiii) assistance in obtaining health 
                        insurance;
                          ``(xiv) fiduciary and representative payee 
                        services;
                          ``(xv) legal services to assist the veteran 
                        family with reconsiderations or appeals of 
                        veterans and public benefit claim denials and 
                        to resolve outstanding warrants that interfere 
                        with the family's ability to obtain or retain 
                        housing or supportive services;
                          ``(xvi) child care;
                          ``(xvii) housing counseling;
                          ``(xviii) other services necessary for 
                        maintaining independent living; and
                          ``(xix) coordination of services described in 
                        this paragraph.
                  ``(B) Services provided by an eligible entity or 
                subcontractors, including services described in clauses 
                (i) through (xix) of subparagraph (A), that are 
                delivered to very low-income veteran families who are 
                homeless and who are scheduled to become residents of 
                permanent housing within 90 days of the date on which 
                the service is provided pending the location or 
                development of housing suitable for permanent housing.
                  ``(C) Services provided by an eligible entity or 
                subcontractors, including services described in clauses 
                (i) through (xix) of subparagraph (A), for very low-
                income veteran families who have voluntarily chosen to 
                seek other housing after a period of tenancy in 
                permanent housing, that are provided, for a period of 
                90 days beginning on the date on which such a family 
                exits permanent housing or until such a family 
                commences receipt of other housing services adequate to 
                meet the needs of the family, but only to the extent 
                that services under this paragraph are designed to 
                support such a family in the choice to transition into 
                housing that is responsive to the individual needs and 
                preferences of the family.''.
          (2) Clerical amendment.--The table of sections at the 
        beginning of such chapter is amended by inserting after the 
        item relating to section 2043 the following new item:

``2044. Financial assistance for supportive services for very low-
income veteran families residing in permanent housing.''.

SEC. 10. EXPANSION OF ELIGIBILITY FOR DENTAL CARE.

  Section 2062(b) of title 38, United States Code, is amended by 
striking ``60 consecutive days'' both places it appears and inserting 
``30 consecutive days''.

SEC. 11. TECHNICAL AMENDMENTS.

  Title 38, United States Code, is amended--
          (1) in each of sections 1708(d), 7314(f), 7320(j)(2), 
        7325(i)(2), and 7328(i)(2), by striking ``medical care 
        account'' and inserting ``medical services account'';
          (2) in section 1712A--
                  (A) by striking subsection (g);
                  (B) by redesignating subsections (d), (e), (f), and 
                (i) as subsections (c) through (f), respectively; and
                  (C) in subsection (f)(1), as so redesignated, by 
                striking ``(including a Resource Center designated 
                under subsection (h)(3)(A) of this section)'';
          (3) in section 2065(b)(3)(C), by striking ``)'';
          (4) in the table of sections at the beginning of chapter 36, 
        by striking the item relating to section 3684A and inserting 
        the following new item:

``3684A. Procedures relating to computer matching program.'';

          (5) in section 3684(a)(1), by striking ``34,,'' and inserting 
        ``34,'';
          (6) in section 4110(c)(1), by striking ``15'' and inserting 
        ``16'';
          (7) in the table of sections at the beginning of chapter 51, 
        by striking the item relating to section 5121 and inserting the 
        following new item:

``5121. Payment of certain accrued benefits upon death of a 
beneficiary.'';

          (8) in section 7458(b)(2), by striking ``pro rated'' and 
        inserting ``pro-rated''; and
          (9) in section 8117(a)(1), by striking ``such such'' and 
        inserting ``such''.

                          Purpose and Summary

    H.R. 2874, the ``Veterans Health Care Improvement Act of 
2007,'' was introduced on June 27, 2007, by Representative 
Michael H. Michaud of Maine, the Chairman of the Subcommittee 
on Health. The legislation would make certain improvements in 
the ability of the Department of Veterans Affairs (VA) to 
provide treatment and care to veterans suffering from mental 
health issues as well as veterans who are homeless. This bill 
would further assist low-income veteran families living in 
permanent housing.
    H.R. 2874 would:
    1. Authorize VA to establish a grant program for nonprofit 
entities to conduct workshops to assist in the therapeutic 
readjustment and rehabilitation of Operation Enduring Freedom 
or Operation Iraqi Freedom (OEF/OIF) veterans. VA would 
determine that a nonprofit entity has the experience and 
expertise to conduct such programs and require the grants be 
used exclusively for the benefit of veterans. VA would submit a 
report to the House and Senate Veterans' Affairs Committees 
detailing the number of grants made each fiscal year, and the 
total number of veterans participating in workshop programs 
funded by the grants. The amount of the grants would be limited 
to $100,000 for each calendar year and there would be $2 
million authorized each fiscal year to carry out the program. 
Authority for the grant program would terminate on September 
20, 2011.
    2. Require VA to establish a grant program for rural 
veterans service organizations, State veterans' service 
agencies, and nonprofits to provide innovative transportation 
options to veterans in remote rural areas to travel to VA 
medical facilities. Limit grants to $50,000 and authorize 
appropriations of $3 million for each fiscal year from 2008 to 
2012 to carry out the program.
    3. Make permanent VA's authority to provide veterans who 
participated in a test conducted by the Department of Defense 
Deseret Test Center from 1962 through 1973 higher priority for 
hospital care, medical services and nursing home care without 
requirement for proof of service-connection.
    4. Extend through September 30, 2009, VA's authority to 
require certain non-service connected veterans to pay a $10 per 
diem co-payment when they receive VA hospital care.
    5. Extend through October 1, 2009, VA's authority to bill a 
service-connected patient's third-party insurance carrier for 
the cost of care VA provides the veteran for any non-service-
connected disability.
    6. Require VA to provide for readjustment counseling and 
mental health services for OEF/OIF veterans through programs 
which would provide peer outreach services, peer support 
services, and readjustment and mental health services. Such 
services would include contracting with community mental health 
centers in areas not adequately served by VA and contracting 
with nonprofit mental health organizations to train OEF/OIF 
veterans in outreach and peer support. Directs VA to conduct 
training programs for clinicians that have contracts with VA to 
provide such services.
    7. Expand the counseling services for at-risk veterans 
transitioning from certain institutions to at least 12 
locations and extends authority for programs to September 30, 
2011.
    8. Require the Secretary to ensure that VA domiciliary 
programs are adequate in capacity and safety to meet the needs 
of women veterans.
    9. Require VA to provide financial assistance to eligible 
entities to provide supportive services for very low-income 
veteran families residing in permanent housing.
    10. Modify the requirement for a homeless veteran to be 
eligible for dental care by reducing, from 60 to 30, the number 
of consecutive days a homeless veteran must participate in a 
VA-sponsored rehabilitation program.
    11. Make technical amendments to title 38, United States 
Code.

                       Background and Discussion

    The Mental Health Assessment Team IV Report (MHAT IV) is 
the fourth in a series of studies since 2003 to assess the 
mental health and well-being of the deployed forces serving in 
Iraq.
    The MHAT IV central findings included:
     The level of combat is the main determinant of a 
Soldier's or Marine's mental health status.
     Multiple deployers reported higher acute stress 
than first-time deployers. Deployment length was related to 
higher rates of mental health problems and marital problems.
     Although demographic differences exist between the 
deployed OIF Soldiers and the Army population, 2003-2006 OIF 
suicide rates are higher than the average Army rate, 16.1 vs. 
11.6 Soldier suicides per year per 100,000.
     There is no standardized joint reporting system 
for monitoring mental health status and suicide surveillance of 
service members in a combat/deployed environment.
    The mental health and well-being of the newest generation 
of veterans is a leading cause of concern for VA. VA reported 
in the April 2007 quarterly Analysis of VA Health Care 
Utilization Among US Southwest Asian War Veterans, Operation 
Enduring Freedom, Operation Iraqi Freedom, that of those 
Southwest Asian War veterans that have separated, 33 percent 
have sought VA health care since FY 2002. Additionally, mental 
disorders rank second for frequency of possible diagnoses among 
recent OEF/OIF veterans, at a rate of 36.6 percent, it is 
second only to diseases of the musculoskeletal system at 43.4 
percent. VA reports that of the 83,889 patients that have 
received a diagnosis of a possible mental disorder, Post-
traumatic Stress Disorder (PTSD) is the number one health 
concern with 39,243 veterans receiving at least a provisional 
diagnosis. Nondependent abuse of drugs and depressive disorders 
are number two andthree. Early intervention and early treatment 
are essential to the successful treatment of PTSD.
    The composition of the combat forces in OEF/OIF is unique 
from previous conflicts. There is a heavy reliance on the 
National Guard and Reserve forces. Though only 19 percent of 
the nation lives in rural America, 44 percent of military 
recruits come from rural areas and nearly one-third of those 
who have been killed in Iraq are from small towns and 
communities across the nation. Another very important aspect of 
OEF/OIF is the prevalence of repeated deployments.
    VA's primary challenge in serving veterans who reside in 
rural areas is to effectively address access to quality care in 
areas where veteran populations are dispersed over a large 
geographical area.
    H.R. 2874 would authorize VA to establish a new grant 
program to conduct therapeutic workshops that would allow the 
veteran to express thoughts and feelings through such programs 
as art, writing and music. Additionally, to address the 
readjustment counseling and mental health concerns of veterans 
who live in rural areas or areas where VA does not have 
adequate readjustment counseling and mental health services 
available, this legislation would require VA to contract with 
mental health centers and nonprofit mental health organizations 
to provide peer-to-peer counseling and outreach training. It 
further requires VA to train mental health clinicians to VA 
standards in order to maintain the highest quality of care 
provided to veterans.
    This legislation also begins to address the difficult task 
of providing access to health care in rural areas by 
authorizing VA to establish a grant program that would provide 
grants to State veterans' service agencies, nonprofits and 
veterans service organizations (VSOs) to develop new and 
innovative ways to provide transportation to veterans who 
reside in rural areas.
    This legislation also addresses issues of homelessness. VA 
is the largest single provider of direct services to homeless 
veterans, reaching 100,000 or 25 percent of homeless veterans a 
year through their various programs. Like their non-veteran 
counterparts, veterans are at high risk of homelessness due to 
extremely low or no livable income, extreme shortage of 
affordable housing, and lack of access to health care.
    Prior to becoming homeless, a large number of veterans at 
risk of homelessness have struggled with PTSD, or have 
addictions acquired during, or worsened by, their military 
service. H.R. 2874 begins to address the needs of homeless 
veterans by extending and expanding VA's authority for 
counseling services for at risk veterans transitioning from 
certain institutions and authorizing VA to provide financial 
assistance to provide supportive services for very low-income 
veteran families residing in permanent housing.

  GRANTS FOR SUPPORT OF THERAPEUTIC READJUSTMENT PROGRAMS FOR VETERANS

    This legislation would allow VA to establish a new grant 
program for nonprofit entities to conduct workshops to assist 
in the therapeutic readjustment and rehabilitation of OEF/OIF 
combat veterans. VA currently works with organizations to 
provide disabled veterans with opportunities for self-
development and for improving their quality of life through 
sports, recreational, and artistic activities. Additionally, VA 
medical facilities incorporate creative arts into their 
recreation therapy programs. Through these therapeutic 
readjustment programs, veterans will benefit from workshops or 
programs that allow them to express themselves and become 
healthy and productive members of society.

     TRANSPORTATION GRANTS FOR RURAL VETERANS SERVICE ORGANIZATIONS

    This legislation would establish a new grant program to 
provide transportation options to veterans living in rural 
areas. These grants will assist veterans in gaining access to 
quality health care. The Committee strongly recommends VA give 
preference in awarding these grants to VSOs; veterans helping 
veterans create an atmosphere of camaraderie and trust that is 
familiar to those who have served.

PERMANENT TREATMENT AUTHORITY FOR PARTICIPANTS IN DEPARTMENT OF DEFENSE 
   CHEMICAL AND BIOLOGICAL TESTING CONDUCTED BY DESERET TEST CENTER 
            (INCLUDING PROJECT SHIPBOARD HAZARD AND DEFENSE)

    Under current law, VA is authorized to provide higher 
priority health care to veterans who participated in Project 
Shipboard Hazard and Defense (SHAD), Project 112 or related 
land-based tests conducted by the Department of Defense Deseret 
Test Center, from 1962 through 1973, for any illness, without 
those veterans needing an adjudicated service-connected 
disability to establish their priority for care. This 
legislation would make permanent this special treatment 
authority that will expire on December 31, 2007. The Committee 
believes that these veterans should receive free VA medical 
care for conditions that may have resulted from their 
participation in military testing conducted by the Department 
of Defense Deseret Test Center. The VA requested this authority 
be made permanent.

             EXTENSION OF EXPIRING COLLECTIONS AUTHORITIES

    Public Law 101-508, the ``Omnibus Budget Reconciliation Act 
of 1990,'' required certain non-service connected veterans with 
higher incomes to pay a per diem copayment when they receive VA 
hospital care and allows VA to collect from a service-connected 
patient's insurance company for the cost of care provided for 
any non-service-connected disability. The VA requested this 
authority be made permanent. This legislation would extend this 
authority until 2009.

   EXPANSION AND EXTENSION OF AUTHORITY FOR PROGRAM OR REFERRAL AND 
  COUNSELING SERVICES FOR AT RISK VETERANS TRANSITIONING FROM CERTAIN 
                              INSTITUTIONS

    This legislation would expand and extend the counseling 
services for at-risk veterans programs from six to at least 12 
locations throughout the Veterans Health Administration. 
Significant numbers of incarcerated veterans are at risk for 
homelessness, substance abuse, mental illness, and chronic 
illness and infectious disease upon release. These veterans 
often need multiple services, including medical services, 
psychiatric care, substance abuse treatment, transitional 
housing, vocational/employment assistance, and veterans' 
benefits services.

PERMANENT AUTHORITY FOR DOMICILIARY SERVICES FOR HOMELESS VETERANS AND 
 ENHANCEMENT OF CAPACITY OF DOMICILIARY SERVICES FOR HOMELESS VETERANS 
  AND ENHANCEMENT OF CAPACITY OF DOMICILIARY CARE PROGRAMS FOR FEMALE 
                                VETERANS

    By 2010, it is projected that there will be 1.8 million 
women veterans. Today's female servicemember is much more 
likely to be exposed to combat or combat-like conditions than 
her predecessors in past conflicts. Women veterans now 
represent nearly four percent of the homeless veteran 
population as opposed to three percent five years ago. VA's 
domiciliary care programs are essential in assisting veterans 
and providing needed services to help them recover and become 
productive citizens again. This legislation enhances the 
capacity of domiciliary care programs for female veterans.

   FINANCIAL ASSISTANCE FOR SUPOPRTIVE SERVICES FOR VERY LOW-INCOME 
                 VETERAN FAMILIES IN PERMANENT HOUSING

    The U.S. Census Bureau estimates that 1.5 million of our 
nation's veterans live in poverty, including 702,000 veterans 
with disabilities and 404,000 veterans in households with 
children. Of the 1.5 million poor veterans 634,000 live in 
extreme poverty. These veterans face insecurity in housing as 
well as health and vocational challenges. Gaining access to 
supportive services has also proven to be difficult. This 
contributes to their inability to sustain housing and maintain 
independence for more costly public institutional care and 
support. This legislation would authorize the Secretary to 
provide financial assistance to nonprofit organizations and 
consumer cooperatives to provide and coordinate the provision 
of supportive services that address the needs of very low-
income veterans occupying permanent housing. Veterans 
transitioning from homelessness to permanent housing, poor 
disabled and older veterans requiring supportive services in 
home based settings, and poor veterans in rural areas with 
distance barriers to centrally located services would benefit 
from this legislation.

                EXPANSION OF ELIGIBILITY FOR DENTAL CARE

    VA can provide dental services to eligible homeless 
veterans as long as they have been receiving care for a period 
of 60 consecutive days in a domiciliary, therapeutic residence, 
community residential care coordinated by VA, or a setting for 
which the VA provides funds to a grant and per diem provider. 
Dental care includes treatment necessary for the veterans to 
gain or regain employment, and alleviate pain for moderate, 
severe, or severe and complicated gingival and periodontal 
pathology.
    The VA believes that the 60-day requirement serves as an 
incentive to keep the veteran in the rehabilitation program the 
veteran is in so they can receive the full range of services 
offered by VA. The Committee believes there are other 
incentives the VA offers to homeless veterans that would keep 
them in such a program including food, shelter and safety. This 
legislation would reduce the number of days that a homeless 
veteran would have to wait to receive dental treatment from 60 
days to 30 days.

                          TECHNICAL AMENDMENTS

    This section makes several technical amendments to title 
38, United States Code.

                          Legislative History

    On April 18, 2007, the Subcommittee on Health held a 
hearing entitled ``Access to VA Health Care: How Easy is it for 
Veterans: Addressing the Gaps.''
    On June 14, 2007, the Subcommittee on Health held a 
legislative hearing on a number of bills introduced by 110th 
Congress, including two Discussion Drafts of legislation 
concerning mental health and homeless veterans' issues.
    H.R. 2874, as amended, contains provisions from H.R. 2005, 
introduced by Representative John Salazar of Texas; H.R. 2689, 
introduced by Representative Ciro Rodriguez of Texas; and, H.R. 
2378, introduced by Representative Stephanie Herseth Sandlin of 
South Dakota.
    On June 28, 2007, the Subcommittee on Health marked up H.R. 
2874. The markup was recessed and on July 11, 2007, the 
Subcommittee on Health continued the markup. Chairman Michaud 
introduced an Amendment in the Nature of a Substitute to H.R. 
2874 which was agreed to by the Subcommittee by voice vote. 
Ranking Member Miller ordered it reported favorably to the 
Committee.
    On July 17, 2007, the full Committee met in open markup 
session and approved a number of bills, including H.R. 2874, as 
amended. The Committee, by voice vote, ordered H.R. 2874, as 
amended, reported favorably to the House of Representatives.

                           Section-By-Section


Section 1. Short title

    This section would provide the short title of H.R. 2874 as 
the ``Veterans' Health Care Improvement Act of 2007.''

Section 2. Grants for support of therapeutic readjustment programs for 
        veterans

    This section would create a new section in Subchapter II of 
chapter 5 of title 38, United States Code. New section 521A 
would authorize the VA to make grants to qualifying nonprofit 
entities to conduct workshop programs that have been shown to 
assist in therapeutic readjustment and rehabilitation of 
participants. VA would determine, through an application 
process, what entities are most qualified to receive the grant. 
VA would be required to submit to the House and Senate 
Committees on Veterans' Affairs, a detailed report on the 
number and amount of grants made during the previous fiscal 
year, the total number of veterans participating in workshop 
programs, and a description of the programs and the therapeutic 
benefits to veterans who participate.

Section 3. Transportation grants for rural veterans service 
        organizations

    This section would create a new section under subchapter I 
of chapter 17 of title 38, United States Code. New section 1709 
would authorize VA to establish a grant program to provide 
innovative transportation options to veterans living in rural 
areas. Grants may be awarded to State veterans' service 
agencies, veterans' service organizations, and nonprofits to 
help veterans living in rural areas travel to VA medical 
centers. The Secretary would be required to prescribe 
regulations for evaluating grant applications and administering 
the program.

Section 4. Permanent treatment authority for participants in Department 
        of Defense chemical and biological testing conducted by Deseret 
        Test Center (including Project Shipboard hazard and Defense)

    This section would make permanent VA's authority to treat 
participants in the Department of Defense (DOD) chemical 
biological testing conducted by Deseret Test Center (including 
SHAD)

Section 5. Extension of expiring collections authorities

    This section extends the expiring collection authorities 
from 2007 to 2009 for health care copayments and medical care 
cost recovery.

Section 6. Readjustment and mental health services for Operation 
        Enduring Freedom and Operation Iraqi Freedom veterans

    This section would create a new section 1712C that would 
authorize the Secretary to carry out programs to provide peer 
outreach services, peer support services, and readjustment and 
mental health services to OEF/OIF veterans. The VA would 
contract with community mental health centers in areas not 
adequately served by VA. These contracts should employ 
veterans, use telehealth services, participate in training 
programs, and comply with protocols subscribed to by VA. The 
centers would be required to submit a report to the Secretary 
on an annual basis that details the number of veterans served, 
diagnosed, and courses of treatment provided to veterans. Also 
included in the report would be demographic information and 
clinical summary information, as the Secretary may require, on 
each veteran. The VA would contract with a nonprofit mental 
health organization to train veterans to provide peer outreach 
and peer support services. VA would be required to conduct a 
training program for clinicians to ensure that each are able to 
provide the services that utilize best practices and 
technologies.

Section 7. Expansion and extension of authority for program of referral 
        and counseling services for at-risk veterans transitioning from 
        certain institutions

    This section would expand and extend the counseling 
services for at-risk veterans programs to at least 12 locations 
until September 30, 2011.

Section 8. Permanent authority for domiciliary services for homeless 
        veterans and enhancement of capacity of domiciliary services 
        for homeless veterans and enhancement of capacity of 
        domiciliary care programs for female veterans

    This section would require the VA to ensure that VA 
domiciliary programs are adequate in capacity and safety to 
meet the needs of women veterans.

Section 9. Financial assistance for supportive services for very low-
        income veterans families in permanent housing

    This section would create a new section 2044 that would 
authorize VA to provide financial assistance to eligible 
entities to provide supportive services for very low-income 
veteran families residing in permanent housing. VA may give 
preference to an entity that provides or coordinates supportive 
services for very low-income veteran families who are 
transitioning from homelessness to permanent housing. Eligible 
entities would apply to VA for financial assistance and VA 
would be required to ensure that assistance is equitably 
distributed across geographic regions, including rural 
communities and tribal lands. VA would also provide training 
and technical assistance to eligible entities that provide 
supportive services to very low-income veterans. To carry out 
this section, $25,000,000 would be authorized to be 
appropriated each fiscal year.

Section 10. Expansion of eligibility for dental care

    This section would amend section 2062(b) of title 38, 
United States Code to allow homeless veterans to become 
eligible for dental care after 30 consecutive days of receiving 
treatment rather than 60 consecutive days.

                        Committee Consideration

    On July 17, 2007, the Committee ordered H.R. 2874, 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. 2874, 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 
ofemployment 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. 2874. 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. 2874, 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. 2874, 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 27, 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. 2874, the 
Veterans' Health Care Improvement Act of 2007.
    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. 2874--Veterans' Health Care Improvement Act of 2007

    Summary: H.R. 2874 contains provisions that would both 
increase and decrease spending for veterans' health care. The 
bill would expand certain health care benefits available for 
veterans and would create new programs to help low-income 
veterans and veterans in rural areas. H.R. 2874 also would 
extend for two years the authority of the Department of 
Veterans Affairs (VA) to collect certain payments for medical 
care.
    The bill also would require VA to implement a new program 
to provide readjustment counseling and mental health care 
services to recent veterans. CBO does not have sufficient 
information about how VA might implement this requirement to 
estimate the cost. CBO estimates that the net effect of 
implementing the remainder of H.R. 2874 would be to reduce 
costs for veterans' health care by $22 million in 2008 and to 
increase costs by $199 million over the 2008-2012 period, 
assuming the availability of appropriated funds. Enacting the 
bill would not affect direct spending or revenues.
    H.R. 2874 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA); 
any costs to state, local, or tribal governments would be 
incurred voluntarily.
    Estimated cost to the Federal Government: The estimated 
budgetary impact of H.R. 2874 is shown in Table 1. The costs of 
this legislation fall within budget function 700 (veterans 
benefits and services).

           TABLE 1.--ESTIMATED BUDGETARY IMPACT OF H.R. 2847a
------------------------------------------------------------------------
                                        By fiscal year, in millions of
                                                  dollars--
                                    ------------------------------------
                                       2008    2009   2010   2011   2012
------------------------------------------------------------------------
              CHANGES IN SPENDING SUBJECT TO APPROPRIATION

Estimated Authorization Level......       42     43     43     43     38
Estimated Outlays..................      -22     33    100     46     42
------------------------------------------------------------------------
aThis table does not include the costs for implementing section 6 of
  H.R. 2874, which CBO cannot estimate at this time.

    Basis of estimate: For this estimate, CBO assumes that the 
legislation will be enacted near the start of fiscal year 2008, 
that the estimated amounts will be appropriated each year, and 
that outlays will follow historical spending patterns for the 
VA medical services program.

Offsetting collections

    VA has a number of authorities that allow it to bill third-
party insurance for care given to veterans, and to collect a 
variety of fees and copayments from veterans. Two specific 
authorities will expire at the end of fiscal year 2007. Those 
expiring authorities allow VA to collect a $10 daily payment 
for hospital stays from certain veterans and to bill insurance 
companies for care given to veterans who have a disability 
related to their service, but who are being treated for a 
nonservice-related condition. Based on information from VA, CBO 
estimates that the department will collect about $525 million 
in 2007 as a result of those two expiring authorities.
    Section 5 would allow VA to continue collecting those 
monies for another two years--until September 30, 2009. All VA 
collections are currently deposited into the Medical Care 
Collections Fund (MCCF). Amounts deposited to the MCCF are 
considered to be offsets to discretionary appropriations and 
spending from the MCCF is subject to annual appropriation 
action. Accounting for inflation and increased usage, CBO 
estimates that implementing this provision would increase--
relative to current law--offsetting collections deposited to 
the MCCF by $582 million in 2008 and about $1.2 billion over 
the 2008-2009 period.

  TABLE 2.--COMPONENTS OF THE ESTIMATED CHANGES IN SPENDING SUBJECT TO
                     APPROPRIATION UNDER H.R. 2847a
------------------------------------------------------------------------
                                        By fiscal year, in millions of
                                                   dollars--
                                     -----------------------------------
                                       2008    2009   2010   2011   2012
------------------------------------------------------------------------
Offsetting Collections:
    Estimated Authorization Level...       0      0      0      0      0
    Estimated Outlays...............     -58     -9     57      3      1
Help for Very-Low Income Veterans:
    Authorization Level.............      25     25     25     25     25
    Estimated Outlays...............      23     25     25     25     25
Dental Benefits for Homeless
 Veterans:
    Estimated Authorization Level...       7      7      7      7      8
    Estimated Outlays...............       6      7      7      7      8
Transportation Grants:
    Authorization Level.............       3      3      3      3      3
    Estimated Outlays...............       3      3      3      3      3
Veterans Released from Prison:
    Estimated Authorization Level...       4      4      4      4      0
    Estimated Outlays...............       1      3      4      4      3
Therapeutic Readjustment Grants:
    Authorization Level.............       2      2      2      2      0
    Estimated Outlays...............       2      2      2      2      0
Chemical and Biological Testing
 Participants:
    Estimated Authorization Level...       1      2      2      2      2
    Estimated Outlays...............       1      2      2      2      2
    Total Changes:a
        Estimated Authorization           42     43     43     43     38
         Level......................
        Estimated Outlays...........     -22     33    100     46     42
------------------------------------------------------------------------
aThis table does not include the cost of implementing section 6 of H.R.
  2874, which CBO cannot estimate at this time.

    Subject to annual appropriation action, VA can spend the 
money in the MCCF to provide medical care for veterans. CBO 
estimates that implementing section 5 would increase 
discretionary spending on medical care for veterans by $523 
million in 2008 and $1.1 billion over the 2008-2012 period, 
assuming appropriation of the collected amounts. Because CBO 
assumes that VA will spend the collections, the estimated 
budget authority for collections and spending offset each other 
exactly, while the outlays lag behind spending. This results in 
outlay savings in the first two years and costs in later years. 
Therefore, CBO estimates that the net budgetary impact of 
implementing H.R. 2874 would be a reduction in discretionary 
outlays of $58 million in 2008 and $6 million over the 2008-
2012 period.

Help for very-low income veterans

    Section 9 would authorize the appropriation of $25 million 
a year to provide financial assistance to qualified nonprofit 
organizations and consumer cooperatives that provide supportive 
services to very-low income veterans who live in permanent 
housing, with preference given to those entities that help 
veterans make a transition from homelessness to permanent 
housing. Very-low income veterans would be defined as those 
having an income that is less than half of the median income 
for the area in which the veteran lives. The authorized funding 
would support a wide array of services, including outreach, 
health care, counseling, transportation, assistance with daily 
living, and assistance in obtaining veterans benefits and other 
public benefits, among others. CBO estimates that implementing 
this section would cost $23 million in 2008 and $123 million 
over the 2008-2012 period.

Dental benefits for homeless veterans

    Section 10 would expand a benefit program that provides 
dental care to certain veterans. Under current law, veterans 
who have received 60 consecutive days of care through a VA 
program that provides rehabilitation and treatment for homeless 
veterans may receive dental care to alleviate pain, as part of 
treatment for a more severe periodontal disease, or to aid in 
getting a job. Section 10 would decrease the required number of 
days of care to 30, allowing homeless veterans who are 
receiving shorter-term treatment, such as for substance abuse, 
to receive the dental benefit.
    In late 2006, VA implemented a Homeless Veterans Dental 
Initiative to address the concern that homeless veterans were 
not able to get appointments for dental care because priority 
is given to veterans returning from overseas deployments. In 
2008, VA plans to use $10 million for this purpose. VA reports 
that, to date, about 4,500 veterans have received treatment 
under this program and that an additional 2,500 veterans would 
be eligible for the benefit under H.R. 2874. At an average cost 
of about $2,500 per veteran in 2007, and adjusting for medical 
inflation, CBO estimates that implementing this provision would 
increase the cost of this program by $6 million in 2008 and $35 
million over the 2008-2012 period.

Transportation grants

    Section 3 would authorize the appropriation of $3 million 
each year from 2008 through 2012 to provide grants to 
organizations that would assist veterans in rural areas to 
travel to VA medical facilities. Eligible entities would 
include state veterans agencies and nonprofit organizations. 
CBO estimates that implementing this section would cost $3 
million in 2008 and $15 million over the 2008-2012 period.

Veterans released from prison

    VA is currently working with the Department of Labor (DOL) 
on a demonstration program to provide counseling and referrals 
to veterans leaving penal institutions who are at risk of 
becoming homeless. VA hires case managers to oversee the 
program while DOL administers the grants to nonprofit 
organizations that provide the counseling and referrals. Under 
current law, the program is being conducted at six sites and 
will expire on September 30, 2007. Section 7 would double the 
number of program sites and extend the authority through fiscal 
year 2011. CBO estimates that, in total, implementing this 
provision would cost about $1 million in 2008 and $15 million 
over the 2008-2011 period.
    Based on information from VA that six case managers would 
be needed to oversee the 12 sites at an average cost of $80,000 
per person, CBO estimates that such additional staff would cost 
VA less than $500,000 in 2008 and $2 million over the 2008-2011 
period.
    Under this program, DOL issued grants totaling over $1.6 
million in 2007 through nonprofit organizations to provide 
counseling and referral services to almost 1,000 veterans 
leaving penal institutions. CBO estimates that increasing the 
size of the program would increase costs for such grants by 
less than $500,000 in 2008 and by $13 million over the 2008-
2011 period.

Therapeutic readjustment grants

    Section 2 would authorize the appropriation of $2 million 
in each year from 2008 through 2011 to be given as grants to 
nonprofit organizations that would provide therapeutic 
readjustment and rehabilitation programs to veterans who served 
in areas of combat after November 11, 1998. All grantees must 
show that their programs assist in the readjustment and 
rehabilitation of participants. CBO estimates that implementing 
this section would cost $2 million in 2008 and $8 million over 
the 2008-2011 period.

Chemical and biological testing participants

    From 1962 to 1973, the Department of Defense conducted 
certain tests to determine the vulnerability of personnel, 
buildings, and ships to various biological and chemical 
threats. Veterans who were exposed to agents used in those 
tests are eligible to receive free health care from VA, though 
copayments are required for treatment for diseases or injuries 
that are obviously not related to military service. The 
authority to provide this benefit expires on December 31, 2007. 
Section 4 would make this authority permanent.
    Based on data provided by VA that about 300 such veterans 
are receiving health care from the agency at an average cost of 
$5,800 in 2007, CBO estimates that implementing this section 
would cost $1 million in 2008 and $9 million over the 2008-2012 
period.

Mental health care and readjustment counseling

    Section 6 would require VA to implement a new program to 
provide readjustment counseling and mental health care to 
veterans who have served in combat operations since November 
11, 1998, and left active-duty service after September 11, 
2001. The program would include peer outreach and support 
services. In areas of the country where the Secretary 
determines there is inadequate coverage by VA medical 
facilities, the department would be required to contract with 
community mental health centers to provide these services. VA 
would be required to provide training to clinicians in those 
centers to ensure that the services provided are appropriate 
for veterans of Operation Iraqi Freedom and Operation Enduring 
Freedom. In addition, VA would be required to contract with 
nonprofit organizations to train combat veterans to provide 
peer outreach and support services.
    VA has not yet determined how it would implement the 
requirements of this section. According to VA, it currently has 
over 200 contracts with private-sector agencies to provide 
readjustment counseling to veterans, primarily in rural areas. 
However, other than ensuring that the agency is qualified to 
provide counseling, VA does not provide additional assistance 
to ensure that the services provided are appropriate for 
veterans who served in Iraq and Afghanistan. VA conducts 
training programs for veterans to provide peer outreach, but it 
does this with its own resources and not through contracts with 
nonprofit organizations. Because VA is not yet able to specify 
how its current programs would change under the requirements of 
this provision, CBO cannot estimate the costs of implementing 
section 6. Depending on how VA decides to implement those 
requirements, costs could range from a negligible amount to 
several million dollars a year.
    Intergovernmental and private-sector impact: H.R. 2874 
contains no intergovernmental or private-sector mandates as 
defined in URMA. Programs authorized in the bill would benefit 
state, local, and tribal governments that provide 
transportation or housing assistance to veterans. Any costs 
they might incur to comply with reporting requirements of the 
programs would be incurred voluntarily.
    Estimate prepared by: Federal Costs: Michelle S. Patterson; 
Impact on State, Local, and Tribal Governments: Lisa Ramirez-
Branum; Impact on the Private Sector: Victoria Liu.
    Estimate approved by: Peter H. Fontaine, Deputy 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 I--GENERAL PROVISIONS

           *       *       *       *       *       *       *


            CHAPTER 5--AUTHORITY AND DUTIES OF THE SECRETARY

Sec.

                    SUBCHAPTER I--GENERAL AUTHORITIES

501.  Rules and regulations.
     * * * * * * *

                   SUBCHAPTER II--SPECIFIED FUNCTIONS

521.  Assistance to certain rehabilitation activities.
521A.  Assistance to therapeutic readjustment programs.

           *       *       *       *       *       *       *


SUBCHAPTER II--SPECIFIED FUNCTIONS

           *       *       *       *       *       *       *


Sec. 521A. Assistance to therapeutic readjustment programs

  (a) Grant Program.--The Secretary of Veterans Affairs may 
make grants to qualified entities described in subsection (b) 
to conduct workshop programs that have been shown to assist in 
the therapeutic readjustment and rehabilitation of participants 
to assist in the therapeutic readjustment of covered veterans.
  (b) Qualified Entities.--In order to qualify for grant 
assistance under subsection (a), a private nonprofit entity 
must have, as determined by the Secretary, experience and 
expertise in offering programs to assist in the therapeutic 
readjustment of participants and that such programs will likely 
assist covered veterans.
  (c) Amount of Grant; Use of Funds.--A grant under this 
section shall not exceed $100,000 for any calendar year and 
shall be used by the recipient exclusively for the benefit of 
covered veterans.
  (d) Application.--An application for a grant under this 
section shall include details regarding the extent and nature 
of the proposed program, the therapeutic readjustment and 
rehabilitation benefits expected to be achieved by 
participants, and any other information the Secretary 
determines may be necessary to assist the Secretary in ensuring 
that covered veterans receive therapeutic readjustment and 
rehabilitation benefits.
  (e) Covered Veterans.--For the purposes of this subsection, a 
``covered veteran'' is a veteran who served on active duty in a 
theater of combat operations (as determined by the Secretary in 
consultation with the Secretary of Defense) during a period of 
war after the Persian Gulf War, or in combat against a hostile 
force during a period of hostilities (as defined in section 
1712A(a)(2)(B) of this title) after November 11, 1998, and who 
is discharged or released from active military, naval, or air 
service on or after September 11, 2001.
  (f) Reports.--Not later than 60 days after the last day of a 
fiscal year, the Secretary shall submit to the Committees on 
Veterans' Affairs of the Senate and House of Representatives a 
report detailing the number and amount of grants made under 
this section during the previous fiscal year, the total number 
of covered veterans participating in workshop programs funded 
by such grants, a description of the programs, and the 
therapeutic benefits to covered veterans of participation in 
the various programs funded.
  (g) Authorization of Appropriations.--There is authorized to 
be appropriated for each of fiscal years 2008 through 2011 
$2,000,000 to carry out this section.
  (h) Termination.--The authority of the Secretary to make a 
grant under subsection (a) shall terminate on September 30, 
2011.

           *       *       *       *       *       *       *


PART II--GENERAL BENEFITS

           *       *       *       *       *       *       *


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

Sec.

                          SUBCHAPTER I--GENERAL

1701.  Definitions.
     * * * * * * *
1709.  Grants for provision of transportation to Department medical 
          facilities for veterans in remote rural areas.

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

1710.  Eligibility for hospital, nursing home, and domiciliary care.
     * * * * * * *
1712C.  Provision of readjustment counseling and mental health services 
          for covered veterans.

           *       *       *       *       *       *       *


SUBCHAPTER I--GENERAL

           *       *       *       *       *       *       *


Sec. 1708. Temporary lodging

  (a) * * *

           *       *       *       *       *       *       *

  (d) The Secretary may establish charges for providing lodging 
under this section. The proceeds from such charges shall be 
credited to the [medical care account] medical services account 
and shall be available until expended for the purposes of 
providing such lodging.

           *       *       *       *       *       *       *


Sec. 1709. Grants for provision of transportation to Department medical 
                    facilities for veterans in remote rural areas

  (a) Grants Authorized.--(1) The Secretary shall establish a 
grant program to provide innovative transportation options to 
veterans in remote rural areas.
  (2) Grants awarded under this section may be used by State 
veterans' service agencies, veterans service organizations, and 
private nonprofit entities to assist veterans in remote rural 
areas to travel to Department medical facilities.
  (3) The amount of a grant under this section may not exceed 
$50,000.
  (4) The recipient of a grant under this section shall not be 
required to provide matching funds as a condition for receiving 
such grant.
  (b) Regulations.--The Secretary shall prescribe regulations 
for--
          (1) evaluating grant applications under this section; 
        and
          (2) otherwise administering the program established 
        by this section.
  (c) Authorization of Appropriations.--There is authorized to 
be appropriated $3,000,000 for each of fiscal years 2008 
through 2012 to carry out this section.

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

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

  (a) * * *

           *       *       *       *       *       *       *

  (e)(1) * * *

           *       *       *       *       *       *       *

  (3) Hospital care, medical services, and nursing home care 
may not be provided under or by virtue of subsection 
(a)(2)(F)--
                  (A) * * *
                  (B) in the case of care for a veteran 
                described in paragraph (1)(C), after December 
                31, 2002; and
                  (C) in the case of care for a veteran 
                described in paragraph (1)(D), after a period 
                of 2 years beginning on the date of the 
                veteran's discharge or release from active 
                military, naval, or air service[; and].
                  [(D) in the case of care for a veteran 
                described in paragraph (1)(E), after December 
                31, 2007.]

           *       *       *       *       *       *       *

  (f)(1) * * *
  (2) A veteran who is furnished hospital care or nursing home 
care under this section and who is required under paragraph (1) 
of this subsection to agree to pay an amount to the United 
States in order to be furnished such care shall be liable to 
the United States for an amount equal to--
                  (A) * * *
                  (B) before September 30, [2007] 2009, an 
                amount equal to $10 for every day the veteran 
                receives hospital care and $5 for every day the 
                veteran receives nursing home care.

           *       *       *       *       *       *       *


Sec. 1712A. Eligibility for readjustment counseling and related mental 
                    health services

  (a) * * *

           *       *       *       *       *       *       *

  [(d)] (c) The Under Secretary for Health may provide for such 
training of professional, paraprofessional, and lay personnel 
as is necessary to carry out this section effectively, and, in 
carrying out this section, may utilize the services of 
paraprofessionals, individuals who are volunteers working 
without compensation, and individuals who are veteran-students 
(as described in section 3485 of this title) in initial intake 
and screening activities.
  [(e)] (d)(1) * * *

           *       *       *       *       *       *       *

  [(f)] (e) The Secretary, in cooperation with the Secretary of 
Defense, shall take such action as the Secretary considers 
appropriate to notify veterans who may be eligible for 
assistance under this section of such potential eligibility.
  [(g)(1)(A) Except as provided in subparagraph (C) of this 
paragraph, the Secretary may close or relocate a center in 
existence on January 1, 1988, only as described in the national 
plan required by paragraph (3) of this subsection (or in a 
revision to such plan under paragraph (4) of this subsection in 
which the closure or relocation of that center is proposed).
  [(B) A closure or relocation of a center which is proposed in 
such national plan may be carried out only after the end of the 
120-day period beginning on the date on which the national plan 
is submitted. A closure or relocation of a center not proposed 
in such plan may be carried out only after the end of the 60-
day period beginning on the date the Secretary submits a 
revision to such plan in which the closure or relocation of 
that center is proposed.
  [(C) The Secretary may relocate a center in existence on 
January 1, 1988, without regard to the national plan (including 
any revision to such plan) if such relocation is to a new 
location away from a Department general health-care facility 
when such relocation is necessitated by circumstances beyond 
the control of the Department. Such a relocation may be carried 
out only after the end of the 30-day period beginning on the 
date on which the Secretary notifies the Committees on 
Veterans' Affairs of the Senate and the House of 
Representatives of the proposed relocation, of the 
circumstances making it necessary, and of the reason for the 
selection of the new site for the center.
  [(2)(A) Not later than April 1, 1988, the Secretary shall 
submit to the Committees on Veterans' Affairs of the Senate and 
House of Representatives a report on the Secretary's evaluation 
of the effectiveness in helping to meet the readjustment needs 
of veterans who served on active duty during the Vietnam era of 
the readjustment counseling and mental health services provided 
pursuant to this section (and of outreach efforts with respect 
to such counseling and services). Such report shall give 
particular attention, in light of the results of the study 
required by section 102 of the Veterans' Health Care Amendments 
of 1983 (Public Law 98-160), to the provision of such 
counseling and services to veterans with post-traumatic stress 
disorder and to the diagnosis and treatment of such disorder.
  [(B) The report required by subparagraph (A) of this 
paragraph shall include--
                  [(i) the opinion of the Secretary with 
                respect to (I) the extent to which the 
                readjustment needs of veterans who served on 
                active duty during the Vietnam era remain 
                unmet, and (II) the extent to which the 
                provision of readjustment counseling services 
                under this section in centers is needed to meet 
                such needs; and
                  [(ii) in light of the opinion submitted 
                pursuant to clause (i) of this subparagraph, 
                such recommendations for amendments to this 
                subsection and for other legislative and 
                administrative action as the Secretary 
                considers appropriate.
  [(3)(A) The Secretary, after considering the recommendations 
of the Under Secretary for Health, shall submit to such 
committees a report setting forth a national plan for all 
centers in existence on January 1, 1988. Such national plan 
shall set forth the Secretary's proposals as to each such 
center for a period (to be determined by the Secretary) of not 
less than 12 months beginning on the date of the submission of 
the report. The plan shall include, as to each center, whether 
the Secretary proposes to relocate the center to a general 
Department facility, relocate the center to a new location away 
from a general Department facility, expand the center in the 
same location, or close the center. The plan shall also set 
forth any proposal of the Secretary to open additional centers.
  [(B) The plan shall include the Secretary's evaluation as to 
how, in light of each of the criteria described in subparagraph 
(C) of this paragraph, the proposal set forth in the plan for 
each center covered by the plan would ensure the continued 
availability and effective furnishing of readjustment 
counseling services to eligible veterans needing such services 
in the geographic area served by that center.
  [(C) The Secretary shall make the evaluation described in 
subparagraph (B) of this paragraph with respect to any center 
in light of the following:
                  [(i) The distribution of Vietnam-era veterans 
                in the geographic area served by the center and 
                the relationships between the location of such 
                center and the general Department facility and 
                such distribution.
                  [(ii) The distance between the center and the 
                general Department facility.
                  [(iii) The availability of other entities 
                (such as State, local, or private outreach 
                facilities) which provide assistance to 
                Vietnam-era veterans in the area served by the 
                center.
                  [(iv) The availability of transportation to, 
                and parking at, the center and the general 
                Department facility.
                  [(v) The availability, cost, and suitability 
                of the space at the general Department 
                facility.
                  [(vi) The overall cost impact of the proposed 
                closure or relocation, including a comparison 
                of the recurring nonpersonnel costs of 
                providing readjustment counseling to the same 
                estimated number of veterans at the center and 
                the general Department facility.
                  [(vii) The workload trends over the two 
                previous fiscal years, and projected over the 
                next fiscal year (or longer), at the center.
                  [(viii) Such other factors as the Secretary 
                determines to be relevant to making the 
                evaluation described in subparagraph (B) of 
                this paragraph.
  [(D) For the purposes of this paragraph, the term ``general 
Department facility'' means a Department facility which is not 
a center and at which readjustment counseling would be 
furnished in a particular geographic area upon the closure or 
relocation of a center.
  [(4) After submitting the plan required by paragraph (3) of 
this subsection, the Secretary may submit to the committees a 
revision to such plan in order to modify the proposal set forth 
in the plan as to any center. Any such revision shall include, 
with respect to each center addressed in the revision, a 
description of the Secretary's evaluation of the matters 
specified in paragraphs (3)(B) and (3)(C) of this subsection.
  [(5) For purposes of determining a period of time under 
paragraph (1)(B) of this subsection, if the national plan (or a 
revision to the national plan) is submitted to the committees 
during the 121-day period beginning 60 days before and ending 
60 days after the final day of a session of the Congress, it 
shall be deemed to have been submitted on the sixty-first day 
after the final day of such session.]
  [(i)] (f) For the purposes of this section:
          (1) The term ``center'' means a facility [(including 
        a Resource Center designated under subsection (h)(3)(A) 
        of this section)] which is operated by the Department 
        for the provision of services under this section and 
        which (A) is situated apart from Department general 
        health-care facilities, or (B) was so situated but has 
        been relocated to a Department general health-care 
        facility.

           *       *       *       *       *       *       *


Sec. 1712C. Provision of readjustment counseling and mental health 
                    services for covered veterans

  (a) Program Required.--The Secretary shall carry out a 
program to provide peer outreach services, peer support 
services, and readjustment and mental health services to 
covered veterans.
  (b) Contracts with Community Mental Health Centers.--In 
carrying out the program required by subsection (a), the 
Secretary shall contract with community mental health centers 
and other qualified entities to provide the services referred 
to in that paragraph in areas the Secretary determines are not 
adequately served by health care facilities of the Department. 
Such contracts shall require each community health center or 
other entity--
          (1) to the extent practicable, to employ covered 
        veterans trained under subsection (c);
          (2) to the extent practicable, to use telehealth 
        services for the provision of such services;
          (3) to participate in the training program under 
        subsection (d);
          (4) to comply with applicable protocols of the 
        Department before incurring any liability on behalf of 
        the Department for the provision of such the services;
          (5) to submit annual reports to the Secretary 
        containing, with respect to the program required by 
        subsection (a) and for the last full calendar year 
        ending before the submission of such report--
                  (A) the number of veterans served, veterans 
                diagnosed, and courses of treatment provided to 
                veterans as part of the program required by 
                subsection (a); and
                  (B) demographic information for such 
                services, diagnoses, and courses of treatment;
          (6) to provide to the Secretary such clinical summary 
        information as the Secretary may require for each 
        veteran for whom the center or entity provides mental 
        health services under the contract; and
          (7) to meet such other requirements as the Secretary 
        may require.
  (c) Training Program for Veterans.--In carrying out the 
program required by subsection (a), the Secretary shall 
contract with a nonprofit mental health organization to carry 
out a program to train covered veterans to provide peer 
outreach and peer support services.
  (d) Training Program for Clinicians.--The Secretary shall 
conduct a training program for clinicians of community mental 
health centers or other entities that have entered into 
contracts with the Secretary under subsection (b) to ensure 
that such clinicians are able to provide the services required 
by subsection (a) in a manner that--
          (1) recognizes factors that are unique to the 
        experience of veterans who served on active duty in 
        Operation Iraqi Freedom or Operation Enduring Freedom 
        (including the combat and military training experiences 
        of such veterans); and
          (2) utilizes best practices and technologies.
  (e) Covered Veterans.--For the purposes of this subsection, a 
``covered veteran'' is a veteran who served on active duty in a 
theater of combat operations (as determined by the Secretary in 
consultation with the Secretary of Defense) during a period of 
war after the Persian Gulf War, or in combat against a hostile 
force during a period of hostilities (as defined in 
section1712A(a)(2)(B) of this title) after November 11, 1998, 
and who is discharged or released from active military, naval, 
or air service on or after September 11, 2001.

           *       *       *       *       *       *       *


   SUBCHAPTER III--MISCELLANEOUS PROVISIONS RELATING TO HOSPITAL AND 
NURSING HOME CARE AND MEDICAL TREATMENT OF VETERANS

           *       *       *       *       *       *       *


Sec. 1729. Recovery by the United States of the cost of certain care 
                    and services

  (a)(1) * * *
  (2) Paragraph (1) of this subsection applies to a non-
service-connected disability--
          (A) * * *

           *       *       *       *       *       *       *

          (E) for which care and services are furnished before 
        October 1, [2007] 2009, under this chapter to a veteran 
        who--
                  (i) * * *

           *       *       *       *       *       *       *


               CHAPTER 20--BENEFITS FOR HOMELESS VETERANS

       SUBCHAPTER I--PURPOSE; DEFINITIONS; ADMINISTRATIVE MATTERS

Sec.
2001.  Purpose.
     * * * * * * *

                  SUBCHAPTER III--TRAINING AND OUTREACH

     * * * * * * *
2023.  Referral and counseling services: veterans at risk of 
          homelessness who are transitioning from certain institutions.
     * * * * * * *

                    SUBCHAPTER V--HOUSING ASSISTANCE

     * * * * * * *
2044.  Financial assistance for supportive services for very low-income 
          veteran families residing in permanent housing.
     * * * * * * *

SUBCHAPTER III--TRAINING AND OUTREACH

           *       *       *       *       *       *       *


Sec. 2022. Coordination of outreach services for veterans at risk of 
                    homelessness

  (a) * * *

           *       *       *       *       *       *       *

  (f) Reports.--(1) * * *
  (2) Not later than December 31, 2005, the Secretary shall 
submit to the committees referred to in paragraph (1) an 
interim report on outreach activities carried out by the 
Secretary with respect to homeless veterans. The report shall 
include the following:
                  (A) * * *

           *       *       *       *       *       *       *

                  (C) A description of the implementation and 
                operation of the [demonstration] program under 
                section 2023 of this title.

           *       *       *       *       *       *       *


[Sec. 2023. Demonstration program of referral and counseling for 
                    veterans transitioning from certain institutions 
                    who are at risk for homelessness]

Sec. 2023. Referral and counseling services: veterans at risk of 
                    homelessness who are transitioning from certain 
                    institutions

  (a) Program Authority.--The Secretary and the Secretary of 
Labor (hereinafter in this section referred to as the 
``Secretaries'') shall carry out [a demonstration program for 
the purpose of determining the costs and benefits of providing] 
a program to provide referral and counseling services to 
eligible veterans with respect to benefits and services 
available to such veterans under this title and under State 
law.
  (b) Location of [Demonstration] Program.--The [demonstration] 
program shall be carried out [in at least six locations] in at 
least 12 locations. One location shall be a penal institution 
under the jurisdiction of the Bureau of Prisons.
  (c) Scope of Program.--(1) To the extent practicable, the 
[demonstration] program shall provide both referral and 
counseling services, and in the case of counseling services, 
shall include counseling with respect to job training and 
placement (including job readiness), housing, health care, and 
other benefits to assist the eligible veteran in the transition 
from institutional living.

           *       *       *       *       *       *       *

  (d) Duration.--The authority of the Secretaries to provide 
referral and counseling services under the demonstration 
program [shall cease on September 30, 2007.] shall cease on 
September 30, 2011.

           *       *       *       *       *       *       *


SUBCHAPTER V--HOUSING ASSISTANCE

           *       *       *       *       *       *       *


Sec. 2043. Domiciliary care programs

  (a) * * *
  [(b) Authorization of Appropriations.--There are authorized 
to be appropriated to the Secretary $5,000,000 for each of 
fiscal years 2003 and 2004 to establish the programs referred 
to in subsection (a).]
  (b) Enhancement of Capacity of Domiciliary Care Programs for 
Female Veterans.--The Secretary shall take appropriate actions 
to ensure that the domiciliary care programs of the Department 
are adequate, with respect to capacity and safety, to meet the 
needs of veterans who are women.

Sec. 2044. Financial assistance for supportive services for very low-
                    income veteran families residing in permanent 
                    housing

  (a) Distribution of Financial Assistance.--
          (1) The Secretary shall provide financial assistance 
        to eligible entities approved under this section to 
        provide and coordinate the provision of the supportive 
        services for very low-income veteran families residing 
        in permanent housing.
          (2)(A) Financial assistance under this section shall 
        consist of payments for each such family for which an 
        approved eligible entity provides or coordinates the 
        provision of supportive services.
          (B) The Secretary shall establish a formula for 
        determining the rate of payments provided to a very 
        low-income veteran family receiving supportive services 
        under this section. The rate shall be adjusted not less 
        than once annually to reflect changes in the cost of 
        living. In calculating the payment formula under this 
        subparagraph, the Secretary may consider geographic 
        cost of living variances, family size, and the cost of 
        services provided.
          (3) In providing financial assistance under paragraph 
        (1), the Secretary shall give preference to an entity 
        that provides or coordinates the provision of 
        supportive services for very low-income veteran 
        families who are transitioning from homelessness to 
        permanent housing.
          (4) The Secretary shall ensure that, to the extent 
        practicable, financial assistance under this subsection 
        is equitably distributed across geographic regions, 
        including rural communities and tribal lands.
          (5) Each entity receiving financial assistance under 
        this section to provide supportive services to a very 
        low-income veteran family shall notify the family that 
        such services are being paid for, in whole or in part, 
        by the Department.
          (6) The Secretary may require an entity receiving 
        financial assistance under this section to submit a 
        report to the Secretary describing the supportive 
        services provided with such financial assistance.
  (b) Application for Financial Assistance.--
          (1) An eligible entity seeking financial assistance 
        under subsection (a) shall submit to the Secretary an 
        application in such form, in such manner, and 
        containing such commitments and information as the 
        Secretary determines to be necessary.
          (2) An application submitted under paragraph (1) 
        shall contain--
                  (A) a description of the supportive services 
                proposed to be provided by the eligible entity;
                  (B) a description of the types of very low-
                income veteran families proposed to be provided 
                such services;
                  (C) an estimate of the number of very low-
                income veteran families proposed to be provided 
                such services;
                  (D) evidence of the experience of the 
                eligible entity in providing supportive 
                services to very low-income veteran families; 
                and
                  (E) a description of the managerial capacity 
                of the eligible entity to--
                          (i) coordinate the provision of 
                        supportive services with the provision 
                        of permanent housing, by the eligible 
                        entity or by other organizations;
                          (ii) continuously assess the needs of 
                        very low-income veteran families for 
                        supportive services;
                          (iii) coordinate the provision of 
                        supportive services with the services 
                        of the Department;
                          (iv) tailor supportive services to 
                        the needs of very low-income veteran 
                        families; and
                          (v) continuously seek new sources of 
                        assistance to ensure the long-term 
                        provision of supportive services to 
                        very low-income veteran families.
          (3) The Secretary shall establish criteria for the 
        selection of eligible entities to receive financial 
        assistance under this section.
  (c) Technical Assistance.--
          (1) The Secretary shall provide training and 
        technical assistance to eligible entities that receive 
        financial assistance under this section with respect to 
        the planning, development, and provision of supportive 
        services to very low-income veteran families occupying 
        permanent housing.
          (2) The Secretary may provide the training described 
        in paragraph (1) directly or through grants or 
        contracts with appropriate public or nonprofit private 
        entities.
  (d) Authorization of Appropriations.--There is authorized to 
be appropriated, for each fiscal year, $25,000,000, to carry 
out this section, of which not more than $750,000 for each 
fiscal year may be used to provide technical assistance under 
subsection (c).
  (e) Definitions.--For the purposes of this section:
          (1) The term ``very low-income veteran family'' means 
        a veteran family whose income does not exceed 50 
        percent of the median income for the area, as 
        determined by the Secretary in accordance with this 
        paragraph, except that--
                  (A) the Secretary shall make appropriate 
                adjustments to the income requirement under 
                subparagraph (A) based on family size; and
                  (B) the Secretary may establish an income 
                ceiling higher or lower than 50 percent of the 
                median income for an area if the Secretary 
                determines that such variations are necessary 
                because the area has unusually high or low 
                construction costs, fair market rents (as 
                determined under section 8 of the United States 
                Housing Act of 1937 (42 U.S.C. 1437f)), or 
                family incomes.
                  (C) the Secretary shall establish criteria 
                for determining the need for specific 
                supportive services (as defined by paragraph 
                (8)) of individual very low income veteran 
                families occupying permanent housing.
          (2) The term ``veteran family'' includes a veteran 
        who is a single person and a family in which the head 
        of household or the spouse of the head of household is 
        a veteran.
          (3) The term ``consumer cooperative'' has the meaning 
        given such term in section 202 of the Housing Act of 
        1959 (12 U.S.C. 1701q).
          (4) The term ``eligible entity'' means--
                  (A) a private nonprofit organization; or
                  (B) a consumer cooperative.
          (5) The term ``homeless'' has the meaning given the 
        term in section 103 of the McKinney-Vento Homeless 
        Assistance Act (42 U.S.C. 11302).
          (6) The term ``permanent housing'' means community-
        based housing without a designated length of stay.
          (7) The term ``private nonprofit organization'' 
        means--
                  (A) any incorporated private institution or 
                foundation--
                          (i) no part of the net earnings of 
                        which inures to the benefit of any 
                        member, founder, contributor, or 
                        individual;
                          (ii) which has a governing board that 
                        is responsible for the operation of the 
                        supportive services provided under this 
                        section; and
                          (iii) which is approved by the 
                        Secretary as to financial 
                        responsibility;
                  (B) a for-profit limited partnership, the 
                sole general partner of which is an 
                organization meeting the requirements of 
                clauses (i), (ii), and (iii) of subparagraph 
                (A);
                  (C) a corporation wholly owned and controlled 
                by an organization meeting the requirements of 
                clauses (i), (ii), and (iii) of subparagraph 
                (A); and
                  (D) a tribally designated housing entity (as 
                defined in section 4 of the Native American 
                Housing Assistance and Self-Determination Act 
                of 1996 (25 U.S.C. 4103)).
          (8) The term ``supportive services'' means the 
        following:
                  (A) Services provided by an eligible entity 
                or subcontractors that address the needs of 
                very low-income veteran families occupying 
                permanent housing, including--
                          (i) outreach services;
                          (ii) health care services, including 
                        diagnosis, treatment, and counseling 
                        for mental health and substance abuse 
                        disorders and for post-traumatic stress 
                        disorder, if such services are not 
                        readily available through the 
                        Department of Veterans Affairs medical 
                        center serving the geographic area in 
                        which the veteran family is housed;
                          (iii) habilitation and rehabilitation 
                        services;
                          (iv) case management services;
                          (v) daily living services;
                          (vi) personal financial planning;
                          (vii) transportation services;
                          (viii) vocational counseling;
                          (ix) employment and training;
                          (x) educational services;
                          (xi) assistance in obtaining veterans 
                        benefits and other public benefits, 
                        including health care provided by the 
                        Department;
                          (xii) assistance in obtaining income 
                        support;
                          (xiii) assistance in obtaining health 
                        insurance;
                          (xiv) fiduciary and representative 
                        payee services;
                          (xv) legal services to assist the 
                        veteran family with reconsiderations or 
                        appeals of veterans and public benefit 
                        claim denials and to resolve 
                        outstanding warrants that interfere 
                        with the family's ability to obtain or 
                        retain housing or supportive services;
                          (xvi) child care;
                          (xvii) housing counseling;
                          (xviii) other services necessary for 
                        maintaining independent living; and
                          (xix) coordination of services 
                        described in this paragraph.
                  (B) Services provided by an eligible entity 
                or subcontractors, including services described 
                in clauses (i) through (xix) of subparagraph 
                (A), that are delivered to very low-income 
                veteran families who are homeless and who are 
                scheduled to become residents of permanent 
                housing within 90 days of the date on which the 
                service is provided pending the location or 
                development of housing suitable for permanent 
                housing.
                  (C) Services provided by an eligible entity 
                or subcontractors, including services described 
                in clauses (i) through (xix) of subparagraph 
                (A), for very low-income veteran families who 
                have voluntarily chosen to seek other housing 
                after a period of tenancy in permanent housing, 
                that are provided, for a period of 90 days 
                beginning on the date on which such a family 
                exits permanent housing or until such a family 
                commences receipt of other housing services 
                adequate to meet the needs of the family, but 
                only to the extent that services under this 
                paragraph are designed to support such a family 
                in the choice to transition into housing that 
                is responsive to the individual needs and 
                preferences of the family.

           *       *       *       *       *       *       *


SUBCHAPTER VII--OTHER PROVISIONS

           *       *       *       *       *       *       *


Sec. 2062. Dental care

  (a) * * *
  (b) Eligible Veterans.--Subsection (a) applies to a veteran--
          (1) who is enrolled for care under section 1705(a) of 
        this title; and
          (2) who, for a period of [60 consecutive days] 30 
        consecutive days, is receiving care (directly or by 
        contract) in any of the following settings:
                  (A) * * *

           *       *       *       *       *       *       *

          (3) For purposes of paragraph (2), in determining 
        whether a veteran has received treatment for a period 
        of [60 consecutive days] 30 consecutive days, the 
        Secretary may disregard breaks in the continuity of 
        treatment for which the veteran is not responsible.

           *       *       *       *       *       *       *


Sec. 2065. Annual report on assistance to homeless veterans

  (a) * * *
  (b) General Contents of Report.--Each report under subsection 
(a) shall include the following:
          (1) * * *

           *       *       *       *       *       *       *

          (3) The Secretary's evaluation of the effectiveness 
        of the programs of the Department in providing 
        assistance to homeless veterans, including--
                  (A) * * *

           *       *       *       *       *       *       *

                  (C) contract care programs for alcohol and 
                drug-dependence or use disabilities[)].

           *       *       *       *       *       *       *


PART III--READJUSTMENT AND RELATED BENEFITS

           *       *       *       *       *       *       *


           CHAPTER 36--ADMINISTRATION OF EDUCATIONAL BENEFITS

                 SUBCHAPTER I--STATE APPROVING AGENCIES

Sec.
3670.  Scope of approval.
     * * * * * * *

                 SUBCHAPTER II--MISCELLANEOUS PROVISIONS

     * * * * * * *
[3684A.  Procedures relating to computer matching programs.]
3684A.  Procedures relating to computer matching program.

           *       *       *       *       *       *       *


SUBCHAPTER II--MISCELLANEOUS PROVISIONS

           *       *       *       *       *       *       *


Sec. 3684. Reports by veterans, eligible persons, and institutions; 
                    reporting fee

  (a)(1) Except as provided in paragraph (2) of this 
subsection, the veteran or eligible person and the educational 
institution offering a course in which such veteran or eligible 
person is enrolled under chapter 31, [34,,] 34, 35, or 36 of 
this title shall, without delay, report to the Secretary, in 
the form prescribed by the Secretary, such enrollment and any 
interruption or termination of the education of each such 
veteran or eligible person. The date of such interruption or 
termination will be the last date of pursuit, or, in the case 
of correspondence training, the last date a lesson was serviced 
by a school.

           *       *       *       *       *       *       *


    CHAPTER 41--JOB COUNSELING, TRAINING, AND PLACEMENT SERVICE FOR 
VETERANS

           *       *       *       *       *       *       *


Sec. 4110. Advisory Committee on Veterans Employment, Training, and 
                    Employer Outreach

  (a) * * *

           *       *       *       *       *       *       *

  (c)(1) The Secretary of Labor shall appoint at least 12, but 
no more than [15] 16, individuals to serve as members of the 
advisory committee as follows:
          (A) * * *

           *       *       *       *       *       *       *


PART IV--GENERAL ADMINISTRATIVE PROVISIONS

           *       *       *       *       *       *       *


           CHAPTER 51--CLAIMS, EFFECTIVE DATES, AND PAYMENTS

                          SUBCHAPTER I--CLAIMS

Sec.
5100.  Definition of ``claimant''.
     * * * * * * *
[5121.  Payment of certain accrued benefits upon death of beneficiary.]
5121. Payment of certain accrued benefits upon death of a beneficiary.

           *       *       *       *       *       *       *


PART V--BOARDS, ADMINISTRATIONS, AND SERVICES

           *       *       *       *       *       *       *


CHAPTER 73--VETERANS HEALTH ADMINISTRATION-ORGANIZATION AND FUNCTIONS

           *       *       *       *       *       *       *


SUBCHAPTER II--GENERAL AUTHORITY AND ADMINISTRATION

           *       *       *       *       *       *       *


Sec. 7314. Geriatric research, education, and clinical centers

  (a) * * *

           *       *       *       *       *       *       *

  (f) There are authorized to be appropriated such sums as may 
be necessary for the support of the research and education 
activities of the centers established pursuant to subsection 
(a). The Under Secretary for Health shall allocate to such 
centers from other funds appropriated generally for the 
Department [medical care account] medical services account and 
medical and prosthetics research account, as appropriate, such 
amounts as the Under Secretary for Health determines 
appropriate.

           *       *       *       *       *       *       *


Sec. 7320. Centers for mental illness research, education, and clinical 
                    activities

  (a) * * *

           *       *       *       *       *       *       *

  (j)(1) * * *
  (2) In addition to funds appropriated for a fiscal year 
pursuant to the authorization of appropriations in paragraph 
(1), the Under Secretary for Health shall allocate to such 
centers from other funds appropriated for that fiscal year 
generally for the Department of Veterans Affairs [medical care 
account] medical services account and the Department of 
Veterans Affairs medical and prosthetics research account such 
amounts as the Under Secretary for Health determines 
appropriate to carry out the purposes of this section.

           *       *       *       *       *       *       *


Sec. 7325. Medical emergency preparedness centers

  (a) * * *

           *       *       *       *       *       *       *

  (i) Funding.--(1) * * *
  (2) In addition to funds appropriated for a fiscal year 
specifically for the activities of the centers pursuant to 
paragraph (1), the Under Secretary for Health shall allocate to 
such centers from other funds appropriated for that fiscal year 
generally for the Department [medical care account] medical 
services account and the Department medical and prosthetics 
research account such amounts as the Under Secretary determines 
appropriate to carry out the purposes of this section. Any 
determination by the Under Secretary under the preceding 
sentence shall be made in consultation with the Assistant 
Secretary with responsibility for operations, preparedness, 
security, and law enforcement functions.

           *       *       *       *       *       *       *


Sec. 7328. Medical preparedness centers

  (a) * * *

           *       *       *       *       *       *       *

  (i) Funding.--(1) * * *
  (2) In addition to any amounts appropriated for a fiscal year 
specifically for the activities of the centers pursuant to 
paragraph (1), the Under Secretary for Health shall allocate to 
the centers from other funds appropriated for that fiscal year 
generally for the Department [medical care account] medical 
services account and the Department medical and prosthetic 
research account such amounts as the Under Secretary determines 
necessary in order to carry out the purposes of this section.

           *       *       *       *       *       *       *


CHAPTER 74--VETERANS HEALTH ADMINISTRATION - PERSONNEL

           *       *       *       *       *       *       *


SUBCHAPTER IV--PAY FOR NURSES AND OTHER HEALTH-CARE PERSONNEL

           *       *       *       *       *       *       *


Sec. 7458. Recruitment and retention bonus pay

  (a) * * *
  (b)(1) * * *
  (2) In the case of an agreement for employment on less than a 
full-time basis, the amount of bonus pay shall be [pro rated] 
pro-rated accordingly.

           *       *       *       *       *       *       *


PART VI--ACQUISITION AND DISPOSITION OF PROPERTY

           *       *       *       *       *       *       *


   CHAPTER 81--ACQUISITION AND OPERATION OF HOSPITAL AND DOMICILIARY 
    FACILITIES; PROCUREMENT AND SUPPLY; ENHANCED-USE LEASES OF REAL 
                                PROPERTY

SUBCHAPTER I--ACQUISITION AND OPERATION OF MEDICAL FACILITIES

           *       *       *       *       *       *       *


Sec. 8117. Emergency preparedness

  (a) Readiness of Department Medical Centers.--(1) The 
Secretary shall take appropriate actions to provide for the 
readiness of Department medical centers to protect the patients 
and staff of such centers from a public health emergency (as 
defined in section 2801 of the Public Health Service Act) or 
otherwise to respond to [such such] such an emergency so as to 
enable such centers to fulfill their obligations as part of the 
Federal response to such emergencies.

           *       *       *       *       *       *       *


                                  
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