[House Report 110-78]
[From the U.S. Government Publishing Office]



110th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 1st Session                                                     110-78

======================================================================
 
PROVIDING FOR CONSIDERATION OF THE BILL (H.R. 1538) TO AMEND TITLE 10, 
    UNITED STATES CODE, TO IMPROVE THE MANAGEMENT OF MEDICAL CARE, 
PERSONNEL ACTIONS, AND QUALITY OF LIFE ISSUES FOR MEMBERS OF THE ARMED 
FORCES WHO ARE RECEIVING MEDICAL CARE IN AN OUTPATIENT STATUS, AND FOR 
                             OTHER PURPOSES

                                _______
                                

   March 27, 2007.--Referred to the House Calendar and ordered to be 
                                printed

                                _______
                                

    Ms. Castor, from the Committee on Rules, submitted the following

                              R E P O R T

                       [To accompany H. Res. 274]

    The Committee on Rules, having had under consideration 
House Resolution 274, by a nonrecord vote, report the same to 
the House with the recommendation that the resolution be 
adopted.

                SUMMARY OF PROVISIONS OF THE RESOLUTION

    The resolution provides for consideration of H.R. 1538 to 
improve the management of medical care, personnel actions, and 
quality of life issues for members of the Armed Forces who are 
receiving medical care in an outpatient status. The resolution 
provides for one hour and twenty minutes of general debate, 
with one hour equally divided and controlled by the Chairman 
and Ranking Minority Member of the Committee on Armed Services 
and twenty minutes equally divided and controlled by the 
Chairman and Ranking Minority Member of the Committee on 
Veterans' Affairs.
    The resolution waives all points of order against 
consideration of the bill except those arising under clause 9 
or 10 of rule XXI. The resolution makes in order the amendment 
in the nature of a substitute recommended by the Committee on 
Armed Services as the original bill for the purpose of further 
amendment.
    The resolution makes in order those amendments printed in 
this report. Finally, the resolution provides one motion to 
recommit with or without instructions.

                         EXPLANATION OF WAIVERS

    The resolution includes a waiver of all points of order 
against consideration of the bill except for those arising 
under clauses 9 and 10 of rule XXI. The waiver includes a 
waiver of clause 3(c)(4) of rule XIII (regarding statement of 
general performance goals and objectives in committee report).

                            COMMITTEE VOTES

    The results of each record vote on an amendment or motion 
to report, together with the names of those voting for and 
against, are printed below:

Rules Committee record vote No. 105

    Date: March 27, 2007.
    Measure: H.R. 1538.
    Motion by: Mr. Dreier.
    Summary of motion: To report an open rule.
    Results: Defeated 3-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Welch--Nay; Castor--Nay; Arcuri--
Nay; Sutton--Nay; Dreier--Yea; Hastings (WA)--Yea; Sessions--
Yea; Slaughter--Nay.

Rules Committee record vote No. 106

    Date: March 27, 2007.
    Measure: H.R. 1538.
    Motion by: Mr. Dreier.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Shays (#6) requiring the 
establishment, publication, and monitoring of medical holdover 
(MHO) process performance standards and requiring holdover and 
inspection reports to be submitted to the Secretary of Defense 
and the Defense Department Inspector General.
    Results: Defeated 3-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Welch--Nay; Castor--Nay; Arcuri--
Nay; Sutton--Nay; Dreier--Yea; Hastings (WA)--Yea; Sessions--
Yea; Slaughter--Nay.

Rules Committee record vote No. 107

    Date: March 27, 2007.
    Measure: H.R. 1538.
    Motion by: Mr. Hastings of Washington.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Moran of Kansas (#21) 
establishing a pilot program to allow combat veterans residing 
in highly rural areas to receive covered Department of 
Veterans' Affairs health care services through a non-VA 
provider.
    Results: Defeated 3-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Welch--Nay; Castor--Nay; Arcuri--
Nay; Sutton--Nay; Dreier--Yea; Hastings (WA)--Yea; Sessions--
Yea; Slaughter--Nay.

Rules Committee record vote No. 108

    Date: March 27, 2007.
    Measure: H.R. 1538.
    Motion by: Mr. Hastings of Washington.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Pearce (#14) requiring the VA 
Secretary to contract with local doctors and hospitals on a 
case-by-case basis to provide medical services, including 
primary care, for those veterans who live far away from VA 
medical centers.
    Results: Defeated 3-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Welch--Nay; Castor--Nay; Arcuri--
Nay; Sutton--Nay; Dreier--Yea; Hastings (WA)--Yea; Sessions--
Yea; Slaughter--Nay.

Rules Committee record vote No. 109

    Date: March 27, 2007.
    Measure: H.R. 1538.
    Motion by: Mr. Sessions.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Shays (#7) establishing a 
patient advocate or ``navigator'' program for wounded service 
members. The Navigators will be representatives for patients 
and their families, independent of current military service.
    Results: Defeated 3-9.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Cardoza--Nay; Welch--Nay; Castor--Nay; Arcuri--
Nay; Sutton--Nay; Dreier--Yea; Hastings (WA)--Yea; Sessions--
Yea; Slaughter--Nay.

                  SUMMARY OF AMENDMENTS MADE IN ORDER

    1. Barrow (GA): The amendment eliminates the deductible and 
changes the method of determining the mileage reimbursement 
rate under the beneficiary travel program administered by the 
Secretary of Veterans' Affairs. The reimbursement rate will be 
increased to the level at which Government employees are 
reimbursed for the use of privately owned vehicles on official 
business. (10 minutes)
    2. Skelton (MO): The amendment would make technical changes 
in section 101 to clarify the qualification of military 
officers who may supervise medical care case managers and in 
section 107 to require that the tracking system for reports to 
medical authorities regarding wounded warrior symptoms of post-
traumatic stress disorder or suicidal tendencies be developed 
not later than 180 days after the date of enactment and that 
the results be included in the Congressional reporting 
requirement. (10 minutes)
    3. Kline (MN): This amendment directs the Secretary of 
Defense to ensure that $10,000,000 is directed to support 
programs, activities, and facilities associated with the Marine 
Corps Wounded Warrior Regiment program from the Medical Support 
Fund created by this bill. (10 minutes)
    4. Sestak (PA)/Kennedy, Patrick (RI): The amendment adds a 
definition to Sec. 2 to clarify that ``medical care'' includes 
mental health care. (10 minutes)
    5. Brown, Corrine (FL): This amendment will ensure 
confidentiality for members of the military who call the 
hotline for help. (10 minutes)
    6. Johnson, Eddie Bernice (TX): The amendment strengthens 
language that professionals' training be ``improved'' rather 
than ``modified,'' and it also places greater emphasis on 
adequate training to detect mental health conditions among 
recovering service members. (10 minutes)
    7. Kennedy, Patrick (RI)/Sestak (PA): This amendment would 
require the Secretary of the Department of Defense to develop 
and implement a plan to help prevent Post-Traumatic Stress 
Disorder and other stress-related psychopathologies (including 
substance abuse conditions) trom developing in our military 
service members. In addition, this amendment would establish a 
new Peer-Reviewed research program within the Defense Health 
Program's research and development function to research the 
prevention of Post-Traumatic Stress Disorder and how to best 
strengthen the psychological resiliency of our military service 
members. (10 minutes)
    8. Hooley (OR): Amendment would give members of the Reserve 
Component the option to use Military Medical Treatment 
Facilities closest to home for treatment on an outpatient basis 
of injuries sustained in theater. (10 minutes)
    9. Hensarling (TX): This amendment would direct the 
Secretary of Veterans Affairs to conduct a study to determine 
what the average length of time is between the date for which a 
veteran requests an appointment and the date he is able to 
receive care. This amendment also requires that the Secretary 
report back to Congress within 180 days with recommendations as 
to how this time could be decreased to 15 days. (10 minutes)
    10. Bilirakis (FL): The amendment creates an office of the 
ombudsman within the Office of the Secretary of Defense which 
would develop policies for the military departments on 
providing assistance to recovering service members and their 
families. (10 minutes)
    11. Buchanan (FL): The amendment would direct the Secretary 
of Defense to submit to Congress a report on the feasibility of 
a Soldier Patient Tracking System so any patient can be located 
in the medical holdover (MHO) process. (10 minutes)
    12. Welch (VT): The amendment requires that the Secretary 
concerned provide the medical care managers and service member 
advocates with all the resources they need to expeditiously 
carry out their work. The amendment would also require the 
Department of Defense to conduct outreach to inform all service 
members and their families about the existence of and services 
available to them by the medical care managers and service 
member advocates contained in the bill. (10 minutes)

            TEXT OF AMENDMENTS MADE IN ORDER UNDER THE RULE

 1. An Amendment To Be Offered by Representative Barrow of Georgia, or 
                 His Designee, Debatable for 10 Minutes

  Add at the end of the bill the following new section:

SEC. 304. VETERANS BENEFICIARY TRAVEL PROGRAM.

  (a) Elimination of Deductible.--Subsection (c) of section 111 
of title 38, United States Code, is repealed.
  (b) Determination of Mileage Reimbursement Rate.--
          (1) Determination.--Paragraph (1) of subsection (g) 
        of such section is amended to read as follows:
  ``(1) In determining the amount of allowances or 
reimbursement to be paid under this section, the Secretary 
shall use the mileage reimbursement rates for the use of 
privately owned vehicles by Government employees on official 
business, as prescribed by the Administrator of General 
Services under section 5707(b) of title 5, United States 
Code.''.
          (2) Conforming amendment.--Subsection (g) of such 
        section is further amended by striking paragraphs (3) 
        and (4).
  (c) Source of Funds.--Such section is further amended by 
adding at the end the following new subsection:
  ``(i) Funds for payments made under this section shall be 
appropriated separately from other amounts appropriated for the 
Department.''.
  (d) Effective Date.--The amendments made by this Act shall 
apply with respect to travel expenses incurred after the 
expiration of the 90-day period that begins on the date of the 
enactment of this Act.
                              ----------                              


2. An Amendment To Be Offered by Representative Skelton of Missouri, or 
                 His Designee, Debatable for 10 Minutes

  At the end of section 1074l(a)(4)(B) of title 10, United 
States Code, as proposed to be added by section 101 of the 
bill, strike ``or Air Force Medical Service.'' and insert ``Air 
Force Medical Service, or other corps comprised of health care 
professionals at the discretion of the Secretary of Defense.''.

  In section 107(b), add at the end the following:

          (3) The progress made in developing the tracking 
        system under subsection (c) and the results of the 
        system.

  In section 107(c), strike ``The'' and insert ``Not later than 
180 days after the date of the enactment of this Act, the''.
                              ----------                              


3. An Amendment To Be Offered by Representative Kline of Minnesota, or 
                 His Designee, Debatable for 10 Minutes

  Insert the following after subsection (d) of section 111 (and 
redesignate subsection (e) as subsection (f)):

  (e) Wounded Warrior Regiment Program.--The Secretary of 
Defense shall ensure that $10,000,000 for fiscal year 2007 is 
transferred from the Medical Support Fund to support programs, 
activities, and facilities associated with the Marine Corps 
Wounded Warrior Regiment program, to be used as follows:
          (1) $6,550,000 for Case Management and Patient 
        Support.
          (2) $1,200,000 for Wounded Warrior Interim Regimental 
        Headquarters Building conversion.
          (3) $1,300,000 for Case Management System 
        Development.
          (4) $95,000 for Support Equipment.
                              ----------                              


4. An Amendment To Be Offered by Representative Sestak of Pennsylvania, 
               or His Designee, Debatable for 10 Minutes

  At the end of section 2, add the following:

          (5) Medical care.--The term ``medical care'' includes 
        mental health care.
                              ----------                              


    . An Amendment To Be Offered by Representative Corrine Brown of 
           Florida, or Her Designee, Debatable for 10 Minutes

  In section 1567 of title 10, United States Code, as proposed 
to be added by section 102 of the bill--
          (1) redesignate subsections (b), (c), and (d) as 
        subsections (c), (d), and (e), respectively; and
          (2) insert after subsection (a) the following new 
        subsection (b):
  ``(b) Confidentiality.--(1) Individuals who seek to provide 
information through use of the toll-free telephone number under 
subsection (a) shall be notified, immediately before they 
provide such information, of their option to elect, at their 
discretion, to have their identity remain confidential.
  ``(2) In the case of information provided through use of the 
toll-free telephone number by an individual who elects to 
maintain the confidentiality of his or her identity, any 
individual who, by necessity, has had access to such 
information for purposes of conducting the investigation or 
executing the response plan required by subsection (c) may not 
disclose the identity of the individual who provided the 
information.''.
                              ----------                              


 6. An Amendment To Be Offered by Representative Eddie Bernice Johnson 
          of Texas, or Her Designee, Debatable for 10 Minutes

  In section 107(a), in the first sentence, strike 
``modification of the training'' and insert ``improvement of 
the training''.
  In section 107(a), strike the second sentence and insert the 
following: ``The recommendations shall include, at a minimum, 
specific recommendations to ensure that such health care 
professionals, medical care case managers, and service member 
advocates are adequately trained and able to detect early 
warning signs of post-traumatic stress disorder (PTSD), 
suicidal tendencies, and other mental health conditions among 
recovering service members.''.
                              ----------                              


   7. An Amendment To Be Offered by Representative Kennedy of Rhode 
           Island, or His Designee, Debatable for 10 Minutes

  At the end of title I, add the following new section (and 
conform the table of contents accordingly):

SEC. 113. PLANS AND RESEARCH FOR REDUCING POST TRAUMATIC STRESS 
                    DISORDER.

  (a) Plans for Reducing Post Traumatic Stress Disorder.--
          (1) Plan for prevention.--
                  (A) In general.--The Secretary of Defense 
                shall develop a plan to incorporate evidence-
                based preventive and early-intervention 
                measures, practices, or procedures that reduce 
                the likelihood that personnel in combat will 
                develop post-traumatic stress disorder or other 
                stress-related psychopathologies (including 
                substance use conditions) into--
                          (i) basic and pre-deployment training 
                        for enlisted members of the Armed 
                        Forces, noncommissioned officers, and 
                        officers;
                          (ii) combat theater operations; and
                          (iii) post-deployment service.
                  (B) Updates.--The Secretary of Defense shall 
                update the plan under subparagraph (A) 
                periodically to incorporate, as the Secretary 
                considers appropriate, the results of relevant 
                research, including research conducted pursuant 
                to subsection (b).
          (2) Research.--Subject to subsection (b), the 
        Secretary of Defense shall develop a plan, in 
        consultation with the Department of Veterans Affairs, 
        the National Institutes of Health, and the National 
        Academy of Sciences, to conduct such research as is 
        necessary to develop the plan described in paragraph 
        (1).
  (b) Evidence-Based Research and Training.--
          (1) Working group.--The Secretary of Defense shall 
        conduct a study, in coordination with the Department of 
        Veterans Affairs, the National Institutes of Health, 
        and the National Academy of Sciences' Institute of 
        Medicine, to determine the feasibility of establishing 
        a working group tasked with researching and developing 
        evidence-based measures, practices, or procedures that 
        reduce the likelihood that personnel in combat will 
        develop post-traumatic stress disorder or other stress-
        related psychological pathologies (including substance 
        use conditions). The working group shall include 
        personnel with experience in a combat theater, and 
        behavioral health personnel who have experience 
        providing treatment to individuals with experience in a 
        combat theater.
          (2) Peer-reviewed research program.--Not later than 
        180 days after the date of the enactment of this Act, 
        the Secretary of Defense shall submit to Congress a 
        plan for a peer-reviewed research program within the 
        Defense Health Program's research and development 
        function to research and develop evidence-based 
        preventive and early intervention measures, practices, 
        or procedures that reduce the likelihood that personnel 
        in combat will develop post-traumatic stress disorder 
        or other stress-related psychopathologies (including 
        substance use conditions).
  (c) Report.--The Secretary of Defense shall submit to 
Congress annually a report on the plans and studies required 
under this section.
                              ----------                              


 8. An Amendment To Be Offered by Representative Hooley of Oregon, or 
                 Her Designee, Debatable for 10 Minutes

  At the end of title I, add the following new section (and 
conform the table of contents accordingly):

SEC. 113. OPTION FOR MEMBERS OF RESERVE COMPONENTS TO USE MILITARY 
                    MEDICAL TREATMENT FACILITIES CLOSEST TO HOME FOR 
                    CERTAIN INJURIES.

  The Secretary of Defense shall provide that, in the case of 
members of the reserve components returning from a combat 
theater, if a member requires treatment on an outpatient basis 
for injuries or wounds sustained in theater, the member may be 
provided treatment at the military medical treatment facility 
closest to the member's home rather than closest to the base 
from which the member was deployed.
                              ----------                              


9. An Amendment To Be Offered by Representative Hensarling of Texas, or 
                 His Designee, Debatable for 10 Minutes

  At the end of title II, add the following new section (and 
conform the table of contents accordingly):

SEC. 207. STUDY AND REPORT ON WAITING PERIODS FOR APPOINTMENTS AT 
                    DEPARTMENT OF VETERANS AFFAIRS MEDICAL FACILITIES.

  (a) Study Required.--The Secretary of Veterans Affairs shall 
conduct a study on the average length of time between the 
desired date for which a veteran seeks to schedule an 
appointment for health care at a Department of Veterans Affairs 
medical facility and the date on which such appointment is 
completed.
  (b) Focus of Study.--In conducting the study under subsection 
(a), the Secretary shall focus on appointments scheduled and 
completed at Department medical facilities located in both 
rural and urban areas.
  (c) Report.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary shall submit a report to 
Congress containing the findings of the study under subsection 
(a) and recommendations for decreasing the waiting time between 
the desired date of an appointment and the completion of the 
appointment to a maximum of 15 days.
                              ----------                              


10. An Amendment To Be Offered by Representative Bilirakis of Florida, 
               or His Designee, Debatable for 10 Minutes

  After section 101, insert the following new section (and 
conform the table of contents accordingly):

SEC. 102. ESTABLISHMENT OF A DEPARTMENT OF DEFENSE-WIDE OMBUDSMAN 
                    OFFICE.

  (a) Establishment.--The Secretary of Defense shall establish 
a Department of Defense-wide Ombudsman Office (in this section 
referred to as the ``Ombudsman Office'') within the Office of 
the Secretary of Defense.
  (b) Functions.--
          (1) In general.--The functions of the Ombudsman 
        Office are to provide policy guidance to, and oversight 
        of, the ombudsman offices in the military departments.
          (2) Policy guidance.--The Ombudsman Office shall 
        develop policy guidance with respect to the following:
                  (A) Providing assistance to and answering 
                questions from recovering service members and 
                their families regarding--
                          (i) administrative processes, 
                        financial matters, and non-military 
                        related services available to the 
                        members and their families throughout 
                        the member's evaluation, treatment, and 
                        recovery;
                          (ii) transfer to the care of the 
                        Veterans Administration; and
                          (iii) support services available upon 
                        the member's return home.
                  (B) Accountability standards, including--
                          (i) creating and maintaining case 
                        files for individual specific questions 
                        received, and initiating inquiries and 
                        tracking responses for all such 
                        questions;
                          (ii) setting standards for timeliness 
                        of responses; and
                          (iii) setting standards for 
                        accountability to recovering service 
                        members and their families, including 
                        requirements for daily updates to the 
                        members and their families about steps 
                        being taken to alleviate problems and 
                        concerns until problems are addressed
  (c) Status Reports.--The ombudsman office in each military 
department shall submit status reports of actions taken to 
address individual concerns to the Ombudsman Office, at such 
times as the Ombudsman Office considers appropriate.
  (d) Responses From Other Offices.--The Secretary of Defense 
shall ensure that all other offices within the Department of 
Defense and the military departments respond in a timely manner 
to resolve questions and requests from the Ombudsman Office on 
behalf of recovering service members and their families, 
including offices responsible for medical matters (including 
medical holdover processes), financial and accounting matters, 
legal matters, human resources matters, reserve component 
matters, installation and management matters, and physical 
disability matters.
  (e) Staff of the Office.--The staff of the Ombudsman Office 
shall include representatives from each military department, 
including persons with experience in medical holdover processes 
and other medical matters.
                              ----------                              


 11. An Amendment To Be Offered by Representative Buchanan of Florida, 
               or His Designee, Debatable for 10 Minutes

  At the end of title II, add the following new section:

SEC. 207. STUDY AND REPORT ON STANDARD SOLDIER PATIENT TRACKING SYSTEM.

  (a) Study Required.--The Secretary of Defense shall conduct a 
study on the feasibility of developing a joint soldier tracking 
system for recovering service members.
  (b) Matters Covered.--The study under subsection (a) shall 
include the following:
          (1) Review of the feasibility of allowing each 
        recovering service member, each family member of such a 
        member, each commander of a military installation 
        retaining medical holdover patients, each patient 
        navigator, and ombudsman office personnel, at all 
        times, to be able to locate and understand exactly 
        where a recovering service member is in the medical 
        holdover process.
          (2) A determination of whether the tracking system 
        can be designed to ensure that--
                  (A) the commander of each military medical 
                facility where recovering service members are 
                located is able to track appointments of such 
                members to ensure they are meeting timeliness 
                and other standards that serve the member; and
                  (B) each recovering service member is able to 
                know when his appointments and other medical 
                evaluation board or physical evaluation board 
                deadlines will be and that they have been 
                scheduled in a timely and accurate manner.
          (3) Any other information needed to conduct oversight 
        of care of the member throughout the medical holdover 
        process.
  (c) Report.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary of Defense shall submit to 
the Committees on Armed Services of the Senate and the House of 
Representatives a report on the results of the study, with such 
findings and recommendations as the Secretary considers 
appropriate.
                              ----------                              


 12. An Amendment To Be Offered by Representative Welch of Vermont, or 
                 His Designee, Debatable for 10 Minutes

  Insert at the end of section 1074l(a) of title 10, United 
States Code, as proposed to be added by section 101 of the 
bill, the following new paragraph:
  ``(6) The Secretary concerned shall ensure that medical care 
case managers have the resources necessary to ensure that they 
expeditiously carry out the responsibilities and duties of 
their position.
  Insert at the end of section 1074l(b) of title 10, United 
States Code, as proposed to be added by section 101 of the 
bill, the following new paragraph:
  ``(7) The Secretary concerned shall ensure that service 
member advocates have the resources necessary to ensure that 
they expeditiously carry out the responsibilities and duties of 
their position.
  Insert after subsection (b) of section 1074l of title 10, 
United States Code, as proposed to be added by section 101 of 
the bill, the following new subsection (and redesignate 
subsections (c) and (d) of such section as subsections (d) and 
(e), respectively):
  ``(c) Outreach.--The Secretary of Defense shall make 
available to each member in an outpatient status at a military 
medical treatment facility, and to the family members of all 
such members, information on the availability of services 
provided by the medical care case managers and service member 
advocates, including information on how to contact such 
managers and advocates and how to use their services.

                                  
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