[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) * * *

           *       *       *       *       *       *       *

  (d)(1) * * *

           *       *       *       *       *       *       *

  (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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