[House Report 110-639]
[From the U.S. Government Publishing Office]
110th Congress Report
HOUSE OF REPRESENTATIVES
2d Session 110-639
======================================================================
JUSTIN BAILEY VETERANS SUBSTANCE USE DISORDERS PREVENTION AND TREATMENT
ACT OF 2008
_______
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. 5554]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred
the bill (H.R. 5554) to amend title 38, United States Code, to
expand and improve health care services available to veterans
from the Department of Veterans Affairs for substance use
disorders, 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
Amendment........................................................ 2
Purpose and Summary.............................................. 4
Background and Discussion........................................ 4
Hearings......................................................... 6
Committee Consideration.......................................... 7
Committee Votes.................................................. 7
Committee Oversight Findings..................................... 7
Statement of General Performance Goals and Objectives............ 7
New Budget Authority, Entitlement Authority, and Tax Expenditures 7
Earmarks and Tax and Tariff Benefits............................. 8
Committee Cost Estimate.......................................... 8
Congressional Budget Office Estimate............................. 8
Federal Mandates Statement....................................... 10
Advisory Committee Statement..................................... 10
Constitutional Authority Statement............................... 10
Applicability to Legislative Branch.............................. 11
Section-by-Section Analysis of the Legislation................... 11
Changes in Existing Law Made by the Bill as Reported............. 12
Amendment
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1 SHORT TITLE.
This Act may be cited as the ``Justin Bailey Veterans Substance Use
Disorders Prevention and Treatment Act of 2008''.
SEC. 2. EXPANSION OF VETERANS SUBSTANCE USE DISORDER PROGRAMS.
Subsection (d) of section 1720A of title 38, United States Code, is
amended by adding at the end the following new paragraph:
``(3)(A) Each plan under paragraph (1) shall ensure that the medical
center provides ready access to a full continuum of care for substance
use disorders for veterans in need of such care.
``(B) In this paragraph, the term `full continuum of care' includes
all of the following care, treatment, and services:
``(i) Screening for substance use disorder in all settings,
including primary care settings.
``(ii) Detoxification and stabilization services.
``(iii) Intensive outpatient care services.
``(iv) Relapse prevention services.
``(v) Outpatient counseling services.
``(vi) Residential substance use disorder treatment.
``(vii) Pharmacological treatment to reduce cravings, and
opioid substitution therapy referred to in paragraph (2).
``(viii) Coordination with groups providing peer to peer
counseling.
``(ix) Short-term, early interventions for substance use
disorders, such as motivational counseling, that are readily
available and provided in a manner to overcome stigma
associated with the provision of such interventions and related
care.
``(x) Marital and family counseling.
``(C) The Secretary shall provide for outreach to veterans who served
in Operation Enduring Freedom or Operation Iraqi Freedom to increase
awareness of the availability of care, treatment, and services from the
Department for substance use disorders.''.
SEC. 3. REQUIREMENT FOR ALLOCATION OF DEPARTMENT RESOURCES TO ENSURE
AVAILABILITY FOR ALL VETERANS REQUIRING TREATMENT
FOR SUBSTANCE USE DISORDERS.
(a) Equitable Allocation of Funding; Annual Report.--Section 1720A of
title 38, United States Code, as amended by section 2, is further
amended by adding at the end the following new subsection:
``(e)(1) The Secretary shall ensure that amounts made available for
care, treatment, and services provided under this section are allocated
in such a manner that a full continuum of care (as defined in
subsection (d)(3)(B)) is available to veterans seeking such care,
treatment, or services, without regard to the location of the residence
of any such veterans.
``(2)(A) In addition to the report required under section 1703(c)(1)
of this title (relating to furnishing of contract care and services
under this section), the Secretary shall include in the budget
documents which the Secretary submits to Congress for any fiscal year a
detailed report on the care, treatment, and services furnished by the
Department under this section during the most recently completed fiscal
year.
``(B) Each report under subparagraph (A) shall include data on the
following for each medical facility of the Department:
``(i) The number of veterans who have been provided care,
treatment, or services under this section at the facility for
each 1,000 veterans who have received hospital care (if
applicable) or medical services at the facility.
``(ii) The number of veterans for whom substance use disorder
screening was carried out under subsection (d)(3)(B)(i) at the
facility.
``(iii) The number of veterans for whom a substance use
disorder was identified after a screening was carried out under
subsection (d)(3)(B)(i) at the facility.
``(iv) The number of veterans who were referred by the
facility for care, treatment, or services for substance use
disorders under this section.
``(v) The number of veterans who received care, treatment or
services at the facility for substance use disorders under this
section.
``(vi) Availability of the full continuum of care (as defined
in subsection (d)(3)(B)) at the facility.
``(C) Each report prepared under subparagraph (A) shall be reviewed
by the Committee on Care of Severely Chronically Mentally Ill Veterans
authorized by section 7321 of this title. The Committee shall provide
an independent assessment of the care, treatment, and services
furnished directly by the Department under this section to veterans.
Such assessment shall include a detailed analysis of the availability,
the barriers to access (if any), and the quality of such care,
treatment, and services.''.
(b) Effective Date.--The amendment made by subsection (a) shall apply
to fiscal years beginning on or after October 1, 2009.
SEC. 4. PILOT PROGRAM FOR INTERNET-BASED SUBSTANCE USE DISORDER
TREATMENT FOR VETERANS OF OPERATION IRAQI FREEDOM
AND OPERATION ENDURING FREEDOM.
(a) Findings.--Congress makes the following findings:
(1) Stigma associated with seeking treatment for mental
health disorders has been demonstrated to prevent some veterans
from seeking such treatment at a medical facility operated by
the Department of Defense or the Department of Veterans
Affairs.
(2) There is a significant incidence among veterans of post-
deployment mental health problems, especially among members of
a reserve component who return as veterans to civilian life.
(3) Computer-based self-guided training has been demonstrated
to be an effective strategy for supplementing the care of
psychological conditions.
(4) Younger veterans, especially those who served in
Operation Enduring Freedom or Operation Iraqi Freedom, are
comfortable with and proficient at computer-based technology.
(5) Veterans living in rural areas find access to treatment
for substance use disorder limited.
(6) Self-assessment and treatment options for substance use
disorders through an Internet website may reduce stigma and
provides additional access for individuals seeking care and
treatment for such disorders.
(b) In General.--Not later than October 1, 2009, the Secretary of
Veterans Affairs shall initiate a pilot program to test the feasibility
and advisability of providing veterans who seek treatment for substance
use disorders access to a computer-based self-assessment, education,
and specified treatment program through a secure Internet website
operated by the Secretary. Participation in the pilot program is
available on a voluntary basis for those veterans who have served in
Operation Enduring Freedom or Operation Iraqi Freedom.
(c) Elements of Pilot Program.--
(1) In general.--In designing and carrying out the pilot
program under this section, the Secretary of Veterans Affairs
shall ensure that--
(A) access to the Internet website and the programs
available on the website by a veteran (or family
member) does not involuntarily generate an identifiable
medical record of that access by that veteran in any
medical database maintained by the Department;
(B) the Internet website is accessible from remote
locations, especially rural areas; and
(C) the Internet website includes a self-assessment
tool for substance use disorders, self-guided treatment
and educational materials for such disorders, and
appropriate information and materials for family
members of veterans.
(2) Consideration of similar projects.--In designing the
pilot program under this section, the Secretary of Veterans
Affairs shall consider similar pilot projects of the Department
of Defense for the early diagnosis and treatment of post-
traumatic stress disorder and other mental health conditions
established under section 741 of the John Warner National
Defense Authorization Act of Fiscal Year 2007 (Public Law 109-
364; 120 Stat. 2304).
(3) Location of pilot program.--The Secretary shall carry out
the pilot program through those medical centers of the
Department of Veterans Affairs that have established Centers
for Excellence for Substance Abuse Treatment and Education or
that have established a Substance Abuse Program Evaluation and
Research Center.
(4) Contract authority.--The Secretary of Veterans Affairs
may enter into contracts with qualified entities or
organizations to carry out the pilot program required under
this section.
(d) Duration of Pilot Program.--The pilot program required by
subsection (a) shall be carried out during the two-year period
beginning on the date of the commencement of the pilot program.
(e) Authorization of Appropriations.--There are authorized to be
appropriated to the Secretary of Veterans Affairs $1,500,000 for each
of fiscal years 2010 and 2011 to carry out the pilot program under this
section.
(f) Report.--Not later than six months after the completion of the
pilot program, the Secretary shall submit to Congress a report on the
pilot program, and shall include in that report an assessment of the
feasibility and advisability of the pilot program, of any cost savings
or other benefits associated with the pilot program, and
recommendations for the continuation or expansion of the pilot program.
SEC. 5. REPORT ON RESIDENTIAL MENTAL HEALTH CARE FACILITIES OF THE
VETERANS HEALTH ADMINISTRATION.
(a) Review and Report.--Not later than six months after the date of
the enactment of this Act, the Secretary of Veterans Affairs, acting
through the Office of the Medical Inspector of the Department of
Veterans Affairs, shall--
(1) conduct a review of all residential mental health care
facilities, including domiciliary facilities, of the Veterans
Health Administration; and
(2) submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a report on the review conducted under
paragraph (1).
(b) Elements of Report.--The report required by subsection (a)(2)
shall include the following:
(1) A description of the availability of care in residential
mental health care facilities in each Veterans Integrated
Service Network (VISN).
(2) An assessment of the supervision and support provided in
the residential mental health care facilities of the Veterans
Health Administration.
(3) The ratio of staff members at each residential mental
health care facility to patients at such facility.
(4) An assessment of the appropriateness of rules and
procedures for the prescription and administration of
medications to patients in such residential mental health care
facilities.
(5) A description of the protocols at each residential mental
health care facility for handling missed appointments.
(6) Any recommendations the Secretary considers appropriate
for improvements to such residential mental health care
facilities and the care provided in such facilities.
SEC. 6. TRIBUTE TO JUSTIN BAILEY.
This Act is enacted in tribute to Justin Bailey, who, after returning
to the United States from service as a member of the Armed Forces in
Operation Iraqi Freedom, died in a domiciliary facility of the
Department of Veterans Affairs while receiving care for post-traumatic
stress disorder and a substance use disorder.
Purpose and Summary
H.R. 5554 was introduced by Representative Michael H.
Michaud of Maine, the Chairman of the Subcommittee on Health,
on March 6, 2008. This legislation would require the Department
of Veterans Affairs (VA) to provide the full continuum of care
for substance use disorder at every VA medical center. It would
direct the VA to conduct a pilot program for internet-based
substance use disorder treatment for veterans of Operation
Enduring Freedom and Operation Iraqi Freedom (OEF/OIF). This
bill would also require VA to conduct a review of all of the
residential mental health facilities and submit a report to
Congress.
Background and Discussion
The ability of the VA to provide treatment for substance
use disorders effectively and consistently across the VA Health
Care system has been, and continues to be, a significant
concern of this Committee.
The Substance Abuse and Mental Health Services
Administration issued an annual survey in 2007 on drug use and
health with data from 2004 to 2006 which indicated that 7.1
percent of veterans met the criteria in the past year for
substance use disorder (SUD). Veterans with family incomes of
less than $20,000 per year are more likely than veterans with
higher family incomes to have had a substance use disorder in
the past year. Furthermore, it has been reported that more than
70 percent of homeless veterans suffer from alcohol or other
drug abuse problems. According to data provided by the VA, of
the nearly 325,000 veterans of OEF/OIF who have received VA
health care between 2002 and the end of 2007, 54,415 have been
diagnosed with a substance use disorder.
During the late 1990's, VA cut its substance use treatment
programs significantly by closing inpatient beds and decreasing
services offered. In testimony given before the Subcommittee on
Health on March 11, 2008, VA testified that since the
implementation of the Mental Health Strategic Plan (2005), VHA
has dedicated more than $458 million to improve access and
quality of care for veterans who present with SUD treatment
needs.
Committee staff has received information that there are
discrepancies in the availability of treatment for substance
use disorder among VA medical facilities. Specifically, there
seems to be significant differences in the types of services
available in the VA health care system. While some medical
facilities provide comprehensive treatment services for
substance use disorder, others only provide services that are
less than comprehensive. This legislation seeks to eradicate
the inconsistencies in treatment for substance use disorders
across the VA health care system and ensure that all veterans,
regardless of their geographic location and which medical
facility they use, have access to comprehensive treatment for
substance use disorders. With OEF/OIF veterans entering the VA
system, it is critical that VA expand its substance abuse
treatment services.
H.R. 5554 would require VA to carry out a pilot program to
evaluate the feasibility of providing assessment, education,
and treatment for substance use disorder via the internet to
veterans of OEF/OIF. This generation of veterans uses the
internet for communication and to seek information. Committee
believes this pilot project can serve as a starting point for
future programs using innovative methods to provide outreach,
education, and when appropriate, treatment for substance use
disorders and mental health conditions to OEF/OIF veterans. The
Committee further believes that such innovative projects will
make young veterans more willing to seek information and
treatment for mental health conditions, including substance use
disorder, if they are able to seek information and treatment in
a venue that is familiar and private.
This legislation would also require that the VA conduct a
review of residential mental health facilities in the VA.
Representative Shelley Berkley of Nevada raised concerns about
VA's residential mental health and domiciliary care facilities
after the untimely death of her constituent, Lance Corporal
Justin Bailey. Upon returning from Iraq, Lance Corporal Bailey
was diagnosed with post-traumatic stress disorder, and was
discharged from the Marines in 2004. After his discharge, he
developed a substance use disorder and checked himself into a
VA facility in West Los Angeles. After being given five
prescription medications on a self-medication policy, Justin
overdosed and died on January 26, 2007.
The Office of Medical Inspector's (OMI) report that
included circumstances surrounding the death of Lance Corporal
Bailey listed several concerns and recommendations regarding
the treatment and quality of care he received in the inpatient
psychiatric unit and the Domiciliary. The concerns reported
were that he might not have been ready for discharge from the
inpatient service and he should have received a more extensive
evaluation; his self-medication was not appropriately
monitored; the facility did not perform a complete panel of
serum toxicology tests; and, Veterans Health Administration
(VHA) policy was not followed in regard to the supply of
certain controlled drugs.
Lance Corporal Bailey's death in a VA residential mental
health facility raises important questions about the
supervision of patient-staff ratio, and the procedures for
administering medications in VA's residential mental health
care facilities. This legislation pays tribute to Lance
Corporal Bailey.
Hearings
On March 11, 2008, the Subcommittee on Health held a
hearing entitled ``Substance Abuse/Co-Morbid Disorders:
Comprehensive Solutions to a Complex Problem. The following
witnesses testified: Ms. Patricia M. Greer, President, NAADAC,
the Association for Addiction Professionals; Mr. Richard A.
McCormick, Ph.D., Senior Scholar, Center for Health Care Policy
and Research, Case Western Reserve University, Cleveland, Ohio;
Ms. Joy J. Ilem, Assistant National Legislative Director,
Disabled American Veterans; Mr. Thomas J. Berger, Ph.D.,
Chairman, National PTSD and Substance Abuse Committee, Vietnam
Veterans of America; Mr. Todd Bowers, Director of Government
Affairs, Iraq and Afghanistan Veterans of America; Ms.
Antonette Zeiss, Ph.D., Associate Chief Consultant, Mental
Health Services, Veterans Health Administration, U.S.
Department of Veterans Affairs, accompanied by Mr. Charles
Flora, Executive Assistant of Readjustment Counseling Service,
U.S. Department of Veterans Affairs; and, Mr. John Paul Allen,
Ph.D., Associate Chief Consultant for Addictive Disorders,
Veterans Health Administration, U.S. Department of Veterans
Affairs. Those submitting statements for the record included:
Mr. Joseph L. Wilson, Deputy Director, Veterans Affairs and
Rehabilitation Commission, The American Legion.
On April 15, 2008, the Subcommittee on Health held a
legislative hearing on a number of bills introduced in the
110th Congress, including H.R. 5729. The following witnesses
testified: The Honorable Bob Filner of California; The
Honorable Michael H. Michaud of Maine; The Honorable Ginny
Brown-Waite of Florida; The Honorable Ed Perlmutter of
Colorado; The Honorable Christopher P. Carney of Pennsylvania;
The Honorable Brad Ellsworth of Indiana; 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, National
Legislative Services, Veterans of Foreign Wars of the United
States; Mr. Richard F. Weidman, Executive Director for Policy
and Government Affairs, Vietnam Veterans of America; Mr. Bernie
Edelman, Deputy Director, Vietnam Veterans of America; Gerald
M. Cross, MD, FAAFP, Principal Deputy Under Secretary for
Health, Veterans Health Administration, U.S. Department of
Veterans Affairs accompanied by Mr. Walter Hall, Assistant
General Counsel, U.S. Department of Veterans Affairs. Those
submitting statements for the record included: American
Veterans (AMVETS) 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. 5554, as amended, by voice vote. During
consideration of the bill the following amendments were
considered:
An amendment by Mr. Michaud of Maine to change the short
title to the ``Justin Bailey Veterans Substance Use Disorders
Prevention and Treatment Act'' and to amend section 2 of the
bill to address concerns raised by the VA that the language as
introduced was too restrictive, was agreed to by voice vote.
An amendment by Ms. Berkley of Nevada that requires a
report on VA residential mental health care facilities and
added a new section in tribute of Justin Bailey, was agreed to
by voice vote.
On April 30, 2008, the full Committee met in open markup
session, a quorum being present, and ordered H.R. 5554, as
amended, reported favorably to the House of Representatives, 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. 5554 reported to the House. A motion by Mr.
Buyer of Indiana to order H.R. 5554, as amended, 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. 5554 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.
5554 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. 5554 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. 5554, the Justin
Bailey Veterans Substance Use Disorders Prevention and
Treatment Act of 2008.
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. 5554--Justin Bailey Veterans Substance Use Disorders Prevention
and Treatment Act of 2008
Summary: H.R. 5554 would require the Department of Veterans
Affairs (VA) to expand the treatments and services available to
veterans suffering from substance use disorders. In total, CBO
estimates that implementing H.R. 5554 would cost about $360
million over the 2009-2013 period, assuming appropriation of
the specified and estimated amounts. Enacting the bill would
not affect direct spending or revenues.
H.R. 5554 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA)
and would not affect the budgets of state, local, or tribal
governments.
Estimated Cost to the Federal Government: The estimated
budgetary impact of H.R. 5554 is shown in the following table.
The costs of this legislation fall within budget function 700
(veterans benefits and services).
Basis of Estimate: CBO assumes that the legislation will be
enacted by the end of fiscal year 2008, that the specified and
estimated amounts will be appropriated each year, and that
outlays will follow historical spending patterns for the VA
medical services program.
----------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
-----------------------------------------------------------
2009-
2009 2010 2011 2012 2013 2013
----------------------------------------------------------------------------------------------------------------
CHANGES IN SPENDING SUBJECT TO APPROPRIATION
Treatment for Substance Use Disorders:
Estimated Authorization Level................... 73 70 73 76 79 371
Estimated Outlays............................... 65 69 72 75 78 359
Pilot Program:
Estimated Authorization Level................... 0 2 2 0 0 3
Estimated Outlays............................... 0 1 2 * * 3
Total Changes:
Estimated Authorization Level............... 73 72 75 76 79 374
Estimated Outlays........................... 65 70 74 75 78 362
----------------------------------------------------------------------------------------------------------------
Note: Numbers may not sum to totals because of rounding; * = less than $500,000.
Treatment for substance use disorders
Section 2 would require VA to provide certain services and
treatments to veterans suffering from substance use disorders,
either at VA medical facilities or through contracts at
community-based organizations. After adjusting for anticipated
inflation, CBO estimates that implementing this provision would
cost about $360 million over the 2009-2013 period, assuming
appropriation of the necessary amounts.
According to VA, some of the services and treatments
specified under the bill are already being provided. Most of
the costs of this provision (about $330 million over the five-
year period) stem from providing detoxification and
stabilization services, residential care, and intensive
outpatient care, which are discussed below. Other services,
such as screening, counseling, opioid substitution therapy,
other pharmacological treatments, and relapse prevention, would
result in additional costs of about $30 million over that
period, assuming appropriation of the necessary amounts.
Detoxification and Stabilization Services. Based on
information from VA, CBO estimates that to provide the
detoxification and stabilization services specified in the
bill, VA would need to hire 153 advanced practice nurses (one
at each medical center) at an annual cost of $135,000 each (in
2008 dollars). We estimate that implementing this provision
would cost $109 million over the 2009-2013 period, assuming
appropriation of the necessary amounts.
Residential Care. Based on information from VA, CBO
estimates that to provide the level of residential care
required by the bill, VA would need to add an additional 110
beds nationwide at an annual cost of $16 million and would have
start-up costs of $5 million. We estimate that implementing
this provision would cost $90 million over the 2009-2013
period, assuming appropriation of the necessary amounts.
Intensive Outpatient Care. According to VA, the intensive
outpatient care required under the bill could be provided at
both community-based outpatient clinics (CBOCs) and VA medical
centers. Based on information from VA, CBO estimates that VA
would hire the equivalent of 185 full-time counselors to work
in over 1,000 CBOCs. Each counselor would provide group
treatment (therapy of three hours a week over three months to
50 patients at a time) to about 200 patients a year, and would
be paid an average of $71,500 a year (in 2008 dollars).
Based on information from VA, CBO estimates that
establishing similar intensive outpatient care in VA medical
centers would require VA to upgrade programs in 50 medical
centers by hiring three additional employees at each center, at
an average annual cost of $71,500. In addition, we estimate
that VA would require additional appropriations of $1 million a
year to initiate specialty care for substance use disorders at
one medical center.
In total, and after adjusting for anticipated inflation,
CBO estimates that implementing this provision at CBOCs and
medical centers would cost $132 million over the 2009-2013
period, assuming appropriation of the necessary amounts.
Pilot program
Section 4 would require VA to operate a pilot program to
assess the feasibility of providing veterans access to self-
assessment, education, and treatment programs for substance
abuse on the Internet. For that purpose, the bill would
authorize the appropriation of $1.5 million a year in 2010 and
2011.
Intergovernmental and Private-Sector Impact: H.R. 5554
contains no intergovernmental or private-sector mandates as
defined in UMRA and would not affect the budgets of state,
local, or tribal governments.
Previous CBO estimate: On April 7, 2008, CBO transmitted a
cost estimate for S. 2162, the Veterans Mental Health
Improvements Act of 2007, as ordered reported by the Senate
Committee on Veterans' Affairs on November 14, 2007. Section
102 of S. 2162 and section 2 of H.R. 5554 are similar, as are
their estimated costs over the 2009-2013 period. Because CBO
assumed an earlier enactment date for S. 2162, we estimated
that section 102 would cost $17 million in 2008.
Estimate prepared by: Federal costs: Sunita D'Monte; Impact
on state, local, and tribal governments: Lisam 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. 5554 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.
5554.
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. 5554 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. 5554, as
amended, as the ``Justin Bailey Veterans Substance Use
Disorders Prevention and Treatment Act of 2008.''
Section 2. Expansion of veterans substance use disorder programs
This section amends section 1720A of title 38, United
States Code, to require that each VA Medical Center provide a
full continuum of care for substance use disorders for veterans
in need of such care. This section also defines the care,
treatment and services that should be provided as part of the
``full continuum of care.''
Section 3. Requirement for allocation of department resources to ensure
availability for all veterans requiring treatment for substance
use disorders
This section amends section 1720A of title 38, United
States Code, to require that money be made available so that a
full continuum of care is made available to veterans,
regardless of where they live. It requires that the Secretary
provide a detailed report on the substance use treatment
services furnished by the Department in the last fiscal year
and that this report be reviewed by the Committee on Care of
Severely and Chronically Mentally Ill Veterans.
Section 4. Pilot program for internet-based substance use disorder
treatment for veterans of Operation Iraqi Freedom and Operation
Enduring Freedom
This section requires that the Secretary carry out a 2-year
pilot program to test the feasibility and advisability of
providing assessment, education and treatment via the internet
to veterans with substance use disorders and requires the
Secretary to submit a report on the pilot program no later than
6 months after completion of the program. This section
authorizes appropriations in the amount of $1,500,000 for each
year of this pilot program.
Section 5. Report on residential mental health care facilities of the
Veterans Health Administration
This section requires that the Secretary of Veterans
Affairs conduct a review and submit a report to Congress on all
residential mental health care facilities in the Department of
Veterans Affairs.
Section 6. Tribute to Justin Bailey
This section recognizes Justin Bailey, an Operation Iraqi
Freedom veteran who died in a Department of Veterans Affairs
domiciliary facility while receiving treatment for post-
traumatic stress disorder and a substance use disorder.
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 (new matter is
printed in italic and existing law in which no change is
proposed is shown in roman):
SECTION 1720A OF TITLE 38, UNITED STATES CODE
Sec. 1720A. Treatment and rehabilitative services for persons with drug
or alcohol dependency
(a) * * *
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(d)(1) * * *
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(3)(A) Each plan under paragraph (1) shall ensure that the
medical center provides ready access to a full continuum of
care for substance use disorders for veterans in need of such
care.
(B) In this paragraph, the term ``full continuum of care''
includes all of the following care, treatment, and services:
(i) Screening for substance use disorder in all
settings, including primary care settings.
(ii) Detoxification and stabilization services.
(iii) Intensive outpatient care services.
(iv) Relapse prevention services.
(v) Outpatient counseling services.
(vi) Residential substance use disorder treatment.
(vii) Pharmacological treatment to reduce cravings,
and opioid substitution therapy referred to in
paragraph (2).
(viii) Coordination with groups providing peer to
peer counseling.
(ix) Short-term, early interventions for substance
use disorders, such as motivational counseling, that
are readily available and provided in a manner to
overcome stigma associated with the provision of such
interventions and related care.
(x) Marital and family counseling.
(C) The Secretary shall provide for outreach to veterans who
served in Operation Enduring Freedom or Operation Iraqi Freedom
to increase awareness of the availability of care, treatment,
and services from the Department for substance use disorders.
(e)(1) The Secretary shall ensure that amounts made available
for care, treatment, and services provided under this section
are allocated in such a manner that a full continuum of care
(as defined in subsection (d)(3)(B)) is available to veterans
seeking such care, treatment, or services, without regard to
the location of the residence of any such veterans.
(2)(A) In addition to the report required under section
1703(c)(1) of this title (relating to furnishing of contract
care and services under this section), the Secretary shall
include in the budget documents which the Secretary submits to
Congress for any fiscal year a detailed report on the care,
treatment, and services furnished by the Department under this
section during the most recently completed fiscal year.
(B) Each report under subparagraph (A) shall include data on
the following for each medical facility of the Department:
(i) The number of veterans who have been provided
care, treatment, or services under this section at the
facility for each 1,000 veterans who have received
hospital care (if applicable) or medical services at
the facility.
(ii) The number of veterans for whom substance use
disorder screening was carried out under subsection
(d)(3)(B)(i) at the facility.
(iii) The number of veterans for whom a substance use
disorder was identified after a screening was carried
out under subsection (d)(3)(B)(i) at the facility.
(iv) The number of veterans who were referred by the
facility for care, treatment, or services for substance
use disorders under this section.
(v) The number of veterans who received care,
treatment or services at the facility for substance use
disorders under this section.
(vi) Availability of the full continuum of care (as
defined in subsection (d)(3)(B)) at the facility.
(C) Each report prepared under subparagraph (A) shall be
reviewed by the Committee on Care of Severely Chronically
Mentally Ill Veterans authorized by section 7321 of this title.
The Committee shall provide an independent assessment of the
care, treatment, and services furnished directly by the
Department under this section to veterans. Such assessment
shall include a detailed analysis of the availability, the
barriers to access (if any), and the quality of such care,
treatment, and services.
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