[House Report 110-638]
[From the U.S. Government Publishing Office]
110th Congress Report
HOUSE OF REPRESENTATIVES
2d Session 110-638
======================================================================
VETERANS EMERGENCY CARE FAIRNESS ACT OF 2007
_______
May 15, 2008.--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. 3819]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred
the bill (H.R. 3819) to amend title 38, United States Code, to
require the Secretary of Veterans Affairs to reimburse veterans
receiving emergency treatment in non-Department of Veterans
Affairs facilities for such treatment until such veterans are
transferred to Department facilities, and for other purposes,
having considered the same, report favorably thereon without
amendment and recommend that the bill do pass.
CONTENTS
Page
Purpose and Summary.............................................. 2
Background and Discussion........................................ 2
Hearings......................................................... 3
Committee Consideration.......................................... 3
Committee Votes.................................................. 3
Committee Oversight Findings..................................... 3
Statement of General Performance Goals and Objectives............ 4
New Budget Authority, Entitlement Authority, and Tax Expenditures 4
Earmarks and Tax and Tariff Benefits............................. 4
Committee Cost Estimate.......................................... 4
Congressional Budget Office Estimate............................. 4
Federal Mandates Statement....................................... 6
Advisory Committee Statement..................................... 6
Constitutional Authority Statement............................... 7
Applicability to Legislative Branch.............................. 7
Section-by-Section Analysis of the Legislation .................. 7
Changes in Existing Law Made by the Bill as Reported............. 7
Purpose and Summary
H.R. 3819 was introduced by Representative Zack Space of
Ohio. This legislation would require the Secretary of Veterans
Affairs (VA) to reimburse certain veterans for the cost of
emergency treatment received in a non-VA facility. It would
also require the Secretary to reimburse certain veterans with a
service-connected disability or a non-service-connected
disability associated with, or aggravated by, a service-
connected disability for the value of emergency treatment for
which such veterans have made payment from sources other than
the VA.
The bill would also define ``emergency treatment'' in both
sections to that of a ``prudent layperson'' standard and define
``emergency treatment'' as continuing until the veteran could
have been transferred safely to a VA or other Federal facility,
or a VA or other Federal facility agrees to accept such
transfer if, at the time the veteran could have been
transferred safely, the non-VA provider makes and documents
reasonable attempts to transfer the veteran to a VA facility or
other Federal facility.
Background and Discussion
During a Joint House and Senate Committee on Veterans'
Affairs meeting in New Philadelphia, Ohio, on May 29, 2007,
several issues were brought to the attention of the Committee
regarding recurring problems with reimbursement or payment of
emergency treatment by VA to non-VA facilities. Testimony
highlighted delays in receiving transfer approvals in order to
transfer veterans from a non-VA community hospital to an
appropriate VA medical center, withdrawal of previously
provided approvals by VA, and delays in receiving
reimbursement. VA medical centers are often full, or are
unwilling to accept the transfer of these patients, leaving
them in the care of non-VA facilities. These facilities are
often small community hospitals who often feel obligated to
continue providing medical care with no promise of
reimbursement from the VA.
VA is currently authorized to provide reimbursement to non-
VA hospitals for emergency care provided for treatment of a
service-connected disability, or a non-service connected
disability aggravated by a service-connected condition, up to
the point of stabilization of the patient. VA can also
reimburse or pay for the reasonable value of expenses incurred
by a covered veteran for non-VA emergency treatment for a non-
service connected condition. Once the patient is stable enough
to be transferred, he or she must be moved to a VA hospital.
After the point of stabilization, if a VA hospital does not
have a bed available, or they are unwilling to accept the
transfer, VA currently is not required to reimburse the non-VA
facility for the cost of care.
This legislation would mandate that the VA reimburse or pay
for the reasonable value of treatment for any veteran who meets
eligibility criteria and defines ``emergency treatment'' as
continuing until the veteran can be transferred safely to a VA
or other Federal facility, and the VA or other Federal facility
agrees to accept such a transfer. This change would ensure that
veterans' emergency care at a non-VA facility will be paid for
until he or she can be safely transferred to an available VA or
other Federal facility. This legislation would also standardize
the emergency reimbursement programs by applying the ``prudent
layperson'' definition of emergency treatment to all emergency
situations, where the standard for determining whether
treatment is covered is whether a prudent layperson would have
thought it reasonable to seek immediate medical attention.
Hearings
On January 17, 2008, the Subcommittee on Health held a
legislative hearing on a number of bills introduced in the
110th Congress, including H.R. 3819. The following witnesses
testified: The Honorable Phil Hare of Illinois; The Honorable
Stephanie Herseth Sandlin of South Dakota; The Honorable
Zachary T. Space of Ohio; The Honorable Shelley Moore Capito of
West Virginia; The Honorable Michael M. Honda of California;
The Honorable Leonard L. Boswell of Iowa; The Honorable Steve
Kagen of Wisconsin; Mr. Joseph L. Wilson, Deputy Director,
Veterans Affairs and Rehabilitation Commission, The American
Legion; Ms. Joy J. Ilem, Assistant National Legislative
Director, Disabled American Veterans; Mr. Christopher Needham,
Senior Legislative Associate, Veterans of Foreign Wars of the
United States; Mr. Richard F. Weidman, Executive Director for
Policy and Government Affairs, Vietnam Veterans of America;
Gerald M. Cross, M.D., FAAFP, Principal Deputy Under Secretary
for Health, Veterans Health Administration, U.S. Department of
Veterans Affairs, accompanied by Mr. Walter A. Hall, Assistant
General Counsel, U.S. Department of Veterans Affairs. Those
submitting statements for the record included: American Academy
of Physician Assistants; The Honorable Shelley Berkley of
Nevada; Mental Health America; and, the Paralyzed Veterans of
America.
Committee Consideration
On April 23, 2008, the Subcommittee on Health met in open
markup session and ordered favorably forwarded to the full
Committee H.R. 3819, without amendment, by voice vote.
On April 30, 2008, the full Committee met in open markup
session, a quorum being present, and ordered H.R. 3819
favorably reported to the House of Representatives, without
amendment, by voice vote.
Committee Votes
Clause 3(b) of rule XIII of the Rules of the House of
Representatives requires the Committee to list the record votes
on the motion to report the legislation and amendments thereto.
There were no record votes taken on amendments or in connection
with ordering H.R. 3819 reported to the House. A motion by Mr.
Buyer of Indiana to order H.R. 3819, reported favorably to the
House of Representatives was agreed to by voice vote.
Committee Oversight Findings
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.
New Budget Authority, Entitlement Authority, and Tax Expenditures
In compliance with clause 3(c)(2) of rule XIII of the Rules
of the House of Representatives, the Committee adopts as its
own the estimate of new budget authority, entitlement
authority, or tax expenditures or revenues contained in the
cost estimate prepared by the Director of the Congressional
Budget Office pursuant to section 402 of the Congressional
Budget Act of 1974.
Earmarks and Tax and Tariff Benefits
H.R. 3819 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 Cost Estimate
The Committee adopts as its own the cost estimate on H.R.
3819 prepared by the Director of the Congressional Budget
Office pursuant to section 402 of the Congressional Budget Act
of 1974.
Congressional Budget Office Cost Estimate
Pursuant to clause 3(c)(3) of rule XIII of the Rules of the
House of Representatives, the following is the cost estimate
for H.R. 3819 provided by the Congressional Budget Office
pursuant to section 402 of the Congressional Budget Act of
1974:
U.S. Congress,
Congressional Budget Office,
Washington, DC, May 12, 2008.
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. 3819, the Veterans
Emergency Care Fairness Act of 2007.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Sunita
D'Monte.
Sincerely,
Robert A. Sunshine
(For Peter R. Orszag, Director).
Enclosure.
H.R. 3819--Veterans Emergency Care Fairness Act of 2007
Summary: H.R. 3819 would require the Department of Veterans
Affairs (VA) to pay for the emergency care certain veterans
receive at non-VA medical facilities, or to reimburse veterans
if they have paid for that care. CBO estimates that
implementing H.R. 3819 would cost $323 million over the 2009-
2013 period, assuming appropriation of the estimated amounts.
Enacting the bill would not affect direct spending or revenues.
H.R. 3819 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA)
and would impose no costs on state, local, or tribal
governments.
Estimated Cost to the Federal Government: The estimated
budgetary impact of H.R. 3819 is shown in the following table.
The costs of this legislation fall within budget function 700
(veterans benefits and services).
----------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
--------------------------------------------
2009 2010 2011 2012 2013
----------------------------------------------------------------------------------------------------------------
CHANGES IN SPENDING SUBJECT TO APPROPRIATION
Estimated Authorization Level...................................... 52 58 65 73 82
Estimated Outlays.................................................. 49 57 64 72 81
----------------------------------------------------------------------------------------------------------------
Basis of Estimate: For this estimate, CBO assumes that the
legislation will be enacted before the end 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.
Under two different sections of law, VA currently has the
authority to reimburse certain veterans or to pay for emergency
care provided at non-VA facilities. H.R. 3819 would amend and
enhance those authorities. Based on information from VA, CBO
estimates that by requiring VA to pay for longer (on average)
lengths of stay in private medical facilities, the bill would
cost $323 million over the 2009-2013 period, assuming
appropriation of the estimated amounts.
Reimbursements under current law
Under 38 U.S.C. 1725, VA may reimburse veterans or pay for
emergency treatment of a nonservice-connected condition, if VA
is the payer of last resort. Under this section of law,
emergency treatment is defined as care or services provided for
a medical emergency where a prudent layperson could reasonably
expect that a delay in seeking medical attention would be
hazardous to life or health. According to VA data on payments
made under 38 U.S.C. 1725, VA paid a total of $123 million in
2006--$103 million for inpatient treatment provided to about
18,200 veterans ($1,200 per day, for an average length of stay
of 4.7 days) and $20 million for ancillary care.
Under 38 U.S.C. 1728, VA may reimburse certain veterans
with service-connected conditions or those who are covered for
purposes of a vocational rehabilitation program if medical
professionals determine that a medical emergency exists. Data
from VA on payments made under 38 U.S.C. 1728 indicate that in
2006 VA paid $83 million for treatment provided to 7,800
veterans ($1,900 per day, for an average length of stay of 5.6
days).
Under both sections of current law, VA can make payments
only until the veteran's condition has stabilized and he or she
can be transferred safely to a VA or other federal facility,
regardless of whether any such facility is actually available
to accept such a transfer.
Additional reimbursements under H.R. 3819
H.R. 3819 would amend those authorities by establishing the
prudent layperson definition of emergency treatment for both
sections of law and requiring VA to pay for treatment until the
veteran is transferred to a VA or other federal facility, or
the veteran is otherwise discharged from the hospital. Under
the bill, some veterans who incur medical costs after they are
deemed to be stable but before they are transferred to a VA or
other federal facility would now be eligible for additional
payments from VA.
Data from the 2005 National Hospital Discharge Survey
indicate that male patients over age 45 who were admitted
through the emergency department stayed in the hospital for an
average of 5.4 days. CBO estimates that under the bill, the
average length of stay for which veterans would be reimbursed
would rise from 4.7 days to 5.4 days, and VA's costs under 38
U.S.C. 1725 would increase by an average of $30 million a year
over the 2009-2013 period, assuming appropriation of the
estimated amounts.
Based on information from VA, CBO estimates that under H.R.
3819, veterans who are eligible for reimbursement under 38
U.S.C. 1728--primarily veterans with service-connected
disabilities--would be reimbursed for hospital stays averaging
6.6 days. CBO also expects that by establishing a prudent
layperson definition of medical emergencies, the bill would
increase the number of eligible veterans by 5 percent each
year. Thus, CBO estimates that under the bill, costs under 38
U.S.C. 1728 would rise by an average of $35 million a year over
the 2009-2013 period, assuming appropriation of the estimated
amounts.
Intergovernmental and private-sector impact: H.R. 3819
contains no intergovernmental or private-sector mandates as
defined in UMRA and would impose no costs on state, local, or
tribal governments.
Previous CBO Estimate: On January 16, 2008, CBO transmitted
a cost estimate for S. 2142, the Veterans Emergency Care
Fairness Act of 2007, as ordered reported by the Senate
Committee on Veterans' Affairs on November 14, 2007. The bills
are similar and their estimated costs are the same over the
2009-2013 period. Because CBO assumed an earlier enactment date
for S. 2142, we estimated that bill would cost $20 million in
2008.
Estimate prepared by: Federal costs: Sunita D'Monte; Impact
on state, local, and tribal governments: Lisa Ramirez-Branum;
Impact on the private sector: Daniel Frisk.
Estimate approved by: Theresa Gullo, Deputy Assistant
Director for Budget Analysis.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates regarding H.R. 3819 prepared by the Director of the
Congressional Budget Office pursuant to section 423 of the
Unfunded Mandates Reform Act.
Advisory Committee Statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act would be created by H.R.
3819.
Constitutional Authority Statement
Pursuant to clause 3(d)(1) of rule XIII of the Rules of the
House of Representatives, the Committee finds that the
Constitutional authority for H.R. 3819 is provided by Article
I, section 8 of the Constitution of the United States
Applicability to Legislative Branch
The Committee finds that the legislation does not relate to
the terms and conditions of employment or access to public
services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act.
Section-by-Section Analysis of the Legislation
Section 1. Short title
This section would provide the short title of H.R. 3819 as
the ``Veterans Emergency Care Fairness Act of 2007.''
Section 2. Requires that the Department of Veterans Affairs provide
reimbursement to veterans receiving emergency treatment in non-
Department of Veterans Affairs facilities until transfer to
department facilities
This section would amend section 1725 of title 38, United
States Code, to require the VA to reimburse veterans who
receive emergency treatment in non-VA facilities until the time
when the veteran can be safely transferred to a VA facility and
the VA agrees to accept such transfer. This section also would
amend section 1728 of title 38, United States Code, to require
the VA to reimburse certain veterans with a service-connected
disability or a non-service-connected disability associated
with or aggravating a service-connected disability for the
value of emergency treatment for which such veterans have made
payment from sources other than the VA.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italic, existing law in which no change is
proposed is shown in roman):
TITLE 38, UNITED STATES CODE
* * * * * * *
PART II--GENERAL BENEFITS
* * * * * * *
CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE
* * * * * * *
SUBCHAPTER III--MISCELLANEOUS PROVISIONS RELATING TO HOSPITAL AND
NURSING HOME CARE AND MEDICAL TREATMENT OF VETERANS
* * * * * * *
Sec. 1725. Reimbursement for emergency treatment
(a) General Authority.--(1) Subject to subsections (c) and
(d), the Secretary [may reimburse] shall reimburse a veteran
described in subsection (b) for the reasonable value of
emergency treatment furnished the veteran in a non-Department
facility.
* * * * * * *
(f) Definitions.--For purposes of this section:
(1) The term ``emergency treatment'' means medical
care or services furnished, in the judgment of the
Secretary--
(A) * * *
* * * * * * *
[(C) until such time as the veteran can be
transferred safely to a Department facility or
other Federal facility.]
(C) until--
(i) such time as the veteran can be
transferred safely to a Department
facility or other Federal facility; or
(ii) such time as a Department
facility or other Federal facility
agrees to accept such transfer if--
(I) at the time described in
clause (i), no Department
facility or other Federal
facility agrees to accept such
transfer; and
(II) the non-Department
facility in which such medical
care or services is furnished
makes and documents reasonable
attempts to transfer the
veteran to a Department
facility or other Federal
facility.
* * * * * * *
Sec. 1728. Reimbursement of certain medical expenses
[(a) The Secretary may, under such regulations as the
Secretary shall prescribe, reimburse veterans entitled to
hospital care or medical services under this chapter for the
reasonable value of such care or services (including travel and
incidental expenses under the terms and conditions set forth in
section 111 of this title), for which such veterans have made
payment, from sources other than the Department, where--
[(1) such care or services were rendered in a medical
emergency of such nature that delay would have been
hazardous to life or health;
[(2) such care or services were rendered to a veteran
in need thereof (A) for an adjudicated service-
connected disability, (B) for a non-service-connected
disability associated with and held to be aggravating a
service-connected disability, (C) for any disability of
a veteran who has a total disability permanent in
nature from a service-connected disability, or (D) for
any illness, injury, or dental condition in the case of
a veteran who (i) is a participant in a vocational
rehabilitation program (as defined in section 3101(9)
of this title), and (ii) is medically determined to
have been in need of care or treatment to make possible
such veteran's entrance into a course of training, or
prevent interruption of a course of training, or hasten
the return to a course of training which was
interrupted because of such illness, injury, or dental
condition; and
[(3) Department or other Federal facilities were not
feasibly available, and an attempt to use them
beforehand would not have been reasonable, sound, wise,
or practical.]
(a) The Secretary shall, under such regulations as the
Secretary shall prescribe, reimburse veterans entitled to
hospital care or medical services under this chapter for the
reasonable value of emergency treatment (including travel and
incidental expenses under the terms and conditions set forth in
section 111 of this title) for which such veterans have made
payment, from sources other than the Department, where such
emergency treatment was rendered to such veterans in need
thereof for any of the following:
(1) An adjudicated service-connected disability.
(2) A non-service-connected disability associated
with and held to be aggravating a service-connected
disability.
(3) Any disability of a veteran in the veteran has a
total disability permanent in nature from a service-
connected disability.
(4) Any illness, injury, or dental condition of a
veteran who--
(A) is a participant in a vocational
rehabilitation program (as defined in section
3101(9) of this title); and
(B) is medically determined to have been in
need of care or treatment to make possible the
veteran's entrance into a course of training,
or prevent interruption of a course of
training, or hasten the return to a course of
training which was interrupted because of such
illness, injury, or dental condition.
(b) In any case where reimbursement would be in order under
subsection (a) of this section, the Secretary may, in lieu of
reimbursing such veteran, make payment of the reasonable value
of [care or services] emergency treatment directly--
(1) to the hospital or other health facility
furnishing the [care or services] emergency treatment;
or
* * * * * * *
(c) In this section, the term ``emergency treatment'' has the
meaning given such term in section 1725(f)(1) of this title.
* * * * * * *