[Senate Report 110-147]
[From the U.S. Government Publishing Office]



                                                       Calendar No. 335
110th Congress                                                   Report
                                 SENATE
 1st Session                                                    110-147

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



 
VETERANS' TRAUMATIC BRAIN INJURY AND OTHER HEALTH PROGRAMS IMPROVEMENT 
                              ACT OF 2007

                                _______
                                

                August 29, 2007.--Ordered to be printed

  Filed, under authority of the order of the Senate of August 3, 2007

                                _______
                                

          Mr. Akaka, from the Committee on Veterans' Affairs, 
                        submitted the following

                              R E P O R T

                             together with

                           SUPPLEMENTAL VIEWS

                         [To accompany S. 1233]

    The Committee on Veterans' Affairs (hereinafter, ``the 
Committee''), to which was referred the bill (S. 1233), to 
provide and enhance intervention, rehabilitative treatment, and 
services to veterans with traumatic brain injury, and for other 
purposes, having considered the same, reports favorably thereon 
with amendments, and recommends that the bill, as amended, do 
pass.

                              Introduction

    On April 26, 2007, Chairman Akaka introduced S. 1233, the 
proposed ``Veterans Traumatic Brain Injury Rehabilitation Act 
of 2007.'' S. 1233 would provide and enhance intervention, 
rehabilitative treatment, and services to veterans with 
traumatic brain injury. S. 1233 is cosponsored by Senators 
Craig, Harkin, Specter, Stevens, and Sununu.
    Earlier, on January 4, 2007, Senator Obama introduced S. 
117, the proposed ``Lane Evans Health and Benefits Improvement 
Act of 2007.'' S. 117 would make changes in the delivery of 
mental health care, require the creation of an information 
system on veterans, and require quarterly reports on Department 
of Veterans Affairs (hereinafter ``VA'') Medical Center 
performance. S. 117 is cosponsored by Senators Biden, Brown, 
Cantwell, Durbin, Kerry, Lincoln, McCaskill, Mikulski, Murray, 
Rockefeller, Salazar, Schumer, Snowe, Tester, and Wyden.
    On January 24, 2007, Chairman Akaka introduced S. 383. S. 
383 would extend the period of eligibility for health care for 
combat service in the Persian Gulf War or future hostilities 
from two years to five years after discharge or release. S. 383 
is cosponsored by Senators Brown, Durbin, Murray, and 
Rockefeller.
    On February 1, 2007, Senator Allard introduced S. 472. S. 
472 would authorize construction of a new major medical 
facility in Denver, Colorado, in an amount not to exceed 
$523,000,000. S. 472 is cosponsored by Senator Salazar.
    On February 2, 2007, Senator Obama introduced S. 692, the 
proposed ``VA Hospital Quality Report Card Act of 2007.'' S. 
692 would require public reports on the quality of care in VA 
hospitals. S. 692 is cosponsored by Senator Wyden.
    On March 14, 2007, Senator Burr introduced S. 874, the 
proposed ``Services to Prevent Veterans Homelessness Act of 
2007.'' 
S. 874 would require the Secretary of Veterans Affairs to 
provide financial assistance to eligible entities to provide 
and coordinate a comprehensive range of supportive services for 
very low-income veteran families occupying permanent housing.
    On March 27, 2007, Senator Tester introduced S. 994, the 
proposed ``Disabled Veterans Fairness Act.'' S. 994 would 
increase the rate of reimbursement for travel to health care 
appointments for disabled veterans and eliminate the deductible 
for such reimbursement. S. 994 is cosponsored by Senators 
Boxer, Brown, McCaskill, Mikulski, Salazar, Sanders, Snowe, and 
Webb.
    On March 29, 2007, Senator Chambliss introduced S. 1026, 
which would designate the Department of Veterans Affairs 
Medical Center in Augusta, Georgia, as the ``Charlie Norwood 
Department of Veterans Affairs Medical Center.'' S. 1026 is 
cosponsored by Senators Brown, Burr, Coburn, Coleman, Graham, 
Hagel, Isakson, Kennedy, and Stevens.
    On May 18, 2007, Senator Salazar introduced S. 1146, the 
proposed ``Rural Veterans Health Care Improvement Act of 
2007.'' 
S. 1146 would require demonstration projects on alternatives 
for expanding care for veterans in rural areas. S. 1146 is 
cosponsored by Senators Baucus, Bingaman, Burr, Byrd, Cantwell, 
Collins, Dorgan, Enzi, Grassley, Hagel, Johnson, Kerry, 
Lincoln, Murkowski, Murray, Pryor, Smith, Snowe, Stevens, 
Tester, Thune, and Wyden.
    On April 18, 2007, Senator Murray introduced S. 1147, the 
proposed ``Honor Our Commitment to Veterans Act.'' S. 1147 
would allow for enrollment of Priority 8 veterans in the VA 
health care system. S. 1147 is cosponsored by Senators Brown, 
Mikulski, and Sanders.
    On May 8, 2007, Senator Sanders introduced S. 1326, the 
proposed ``Comprehensive Veterans Benefits Improvements Act of 
2007.'' S. 1326 is an omnibus measure which proposes changes in 
VA health care, housing, burial, and other benefits.
    On May 14, 2007, Chairman Akaka introduced S. 1384. S. 1384 
would eliminate the offset of per diem payments to service 
centers for homeless veterans by other sources of federal 
funding and allow these centers to use such funds for personnel 
expenses; expand programs to assist individuals transitioning 
to civilian life from active military service and penal 
institutions, and require the Secretary to take appropriate 
actions to ensure that domiciliary care programs meet the 
capacity and safety needs of veterans who are women.
    On May 15, 2007, Senator Specter introduced S. 1392. S. 
1392 would increase the authorization for the previously 
authorized major medical facility project to consolidate the 
medical centers of the Department of Veterans Affairs at the 
University Drive and 
H. John Heinz III divisions in Pittsburgh, Pennsylvania, from 
$189,200,000 to $248,000,000.
    On May 15, 2007, Senator Isakson introduced S. 1396. S. 
1396 would authorize a major medical facility project to 
modernize patient wards at the Department of Veterans Affairs 
Medical Center in Atlanta, Georgia, in the amount of 
$20,500,000.
    On March 27, 2007, the Committee held a hearing on 
Department of Veterans Affairs and Department of Defense 
collaboration and cooperation to meet the health care needs of 
returning servicemembers. Testimony was offered by: L. Tammy 
Duckworth, Director, Illinois Department of Veterans' Affairs; 
Jonathan D. Pruden, an Operation Iraqi Freedom veteran; Denise 
Mettie, mother of Evan Mettie and representing the Wounded 
Warrior Project; Bruce M. Gans, M.D., Executive Vice President 
and Chief Medical Officer, Kessler Institute for 
Rehabilitation; Michael J. Kussman, M.D., then-Acting Under 
Secretary for Health, Department of Veterans Affairs; and Ms. 
Ellen P. Embrey, Deputy Assistant Secretary of Defense for 
Force Health Protection and Readiness and Director, Deployment 
Health Support.
    On May 23, 2007, the Committee held a hearing on pending 
veterans' health legislation at which testimony was offered by: 
Gerald M. Cross, M.D., FAAFP, Acting Principal Deputy Under 
Secretary for Health, Department of Veterans Affairs; Carl 
Blake, National Legislative Director, Paralyzed Veterans of 
America; Dennis M. Cullinan, Director, National Legislative 
Service, Veterans of Foreign Wars of the United States; Joy J. 
Ilem, Assistant National Legislative Director, Disabled 
American Veterans; Shannon Middleton, Deputy Director for 
Health, Veterans Affairs and Rehabilitation Commission, The 
American Legion; Bernard Edelman, Deputy Director for Policy 
and Government Affairs, Vietnam Veterans of America; Jerry 
Reed, Executive Director, Suicide Prevention Action Network USA 
(SPAN USA); John Booss, M.D., American Academy of Neurology; 
and Meredith Beck, National Policy Director, Wounded Warrior 
Project.

                           Committee Meeting

    After carefully reviewing the testimony from the foregoing 
hearings, the Committee met in open session on June 27, 2007, 
to consider, among other legislation, an amended version of S. 
1233, consisting of provisions from S. 1233 as introduced and 
from the other legislation noted above. The Committee voted 
unanimously to report favorably S. 1233, as amended.

                     Summary of S. 1233 as Reported

    S. 1233, as reported, (hereinafter, ``the Committee bill'') 
would amend the title of the original bill, and would make 
numerous enhancements and expansions to VA health care and 
services.

                    TITLE I--TRAUMATIC BRAIN INJURY

    Section 101 would express the sense of Congress on VA's 
efforts in the rehabilitation and reintegration of veterans 
with traumatic brain injury (hereinafter, ``TBI'').
    Section 102 would require VA to develop individual 
rehabilitation and community reintegration plans for veterans 
and servicemembers with TBI.
    Section 103 would require the use of non-VA facilities, 
under certain specified conditions, for implementation of 
rehabilitation and community reintegration plans for TBI.
    Section 104 would require VA to establish a research, 
education, and clinical care program on severe TBI.
    Section 105 would require VA to carry out a pilot program 
on assisted living services for veterans with TBI.
    Section 106 would require age-appropriate nursing home care 
for veterans, such as those who suffer with more severe forms 
of TBI.
    Section 107 would require research on TBI.

               TITLE II--LANE EVANS BENEFITS IMPROVEMENTS

    Section 201 would extend, from two to five years following 
discharge, the period of time during which a veteran who served 
in a combat theater of operation (in the Persian Gulf War or in 
hostilities since that time) is eligible for VA health care.
    Section 202 would require an annual report on veterans and 
the provision to veterans of benefits and services by VA.
    Section 203 would establish a Hospital Quality Report Card 
Initiative to inform veterans and their families about the 
quality and performance of VA medical centers, utilizing 
existing data and reports concerning effectiveness, safety, 
timeliness, efficiency, and patient satisfaction. Such 
information would be available on the web site or promotional 
literature of VA medical centers.
    Section 204 would require that a preliminary mental health 
evaluation be provided to recently discharged combat veterans 
not later than 30 days after a veteran requests such an 
evaluation.

                     TITLE III--HEALTH CARE MATTERS

    Section 301 would rescind the Administration's January 2003 
regulation which prohibited enrollment of new Priority 8 
veterans.
    Section 302 would require the Secretary to submit an annual 
report on decisions on enrollment for VA health care and to 
then wait 45 days before implementing any change to existing 
enrollment guidelines.
    Section 303 would eliminate copayments for catastrophically 
disabled veterans for the receipt of hospital care or nursing 
home care.
    Section 304 would authorize transportation grants for rural 
veterans service organizations.
    Section 305 would require demonstration projects on 
alternatives for expanding care for veterans in rural areas.
    Section 306 would require a report to Congress on matters 
related to care for veterans who live in rural areas.
    Section 307 would increase the beneficiary travel mileage 
reimbursement rate from 11 cents per mile to 28.5 cents per 
mile for qualifying veterans who travel to VA medical 
facilities.
    Section 308 would extend from 90 days to 180 days the 
application period for dental benefits following discharge from 
active duty.
    Section 309 would exempt hospice care provided in any 
setting from the long-term care copayment requirement.

                  TITLE IV--HOMELESS VETERANS MATTERS

    Section 401 would repeal the requirement that the Secretary 
adjust the per diem payments to homeless veterans' service 
centers to account for the receipt of other sources of income.
    Section 402 would create a demonstration program to 
identify members of the Armed Forces on active duty who are at 
risk of becoming homeless upon discharge or release from active 
duty and to provide referral, counseling, and support services 
to prevent such members from becoming homeless.
    Section 403 would expand and extend the authority for a 
program of referral and counseling services for at-risk 
veterans transitioning from certain institutions.
    Section 404 would permit the use of VA grant funds to 
homeless service centers for personnel costs.
    Section 405 would make the VA domiciliary care program for 
homeless veterans permanent, and would also require the 
Secretary to take appropriate actions to ensure that 
domiciliary care programs are adequate, with respect to 
capacity and safety, to meet the needs of women veterans.
    Section 406 would require the Secretary to provide grants 
to eligible entities (private nonprofit organizations or 
consumer cooperatives) to provide and coordinate the provision 
of a comprehensive range of supportive services for very low-
income veteran families occupying permanent housing, with 
preference for those transitioning from homelessness to 
permanent housing. It would require equitable geographic 
distribution of such assistance, and that the Secretary provide 
training and technical assistance to participating entities 
regarding the planning, development, and provision of such 
services. It would also require a 2-year study of the 
effectiveness of the program.

                     TITLE V--CONSTRUCTION MATTERS

    Section 501 would authorize construction of a new VA major 
medical facility in Denver, Colorado, in an amount not to 
exceed $548,000,000.
    Section 502 would increase the authorization for the major 
medical facility project to consolidate the medical centers of 
the VA at the University Drive and H. John Heinz III divisions 
in Pittsburgh, Pennsylvania, from $189,200,000 to $248,000,000.
    Section 503 would authorize a major medical facility 
project to modernize patient wards at the VA Medical Center in 
Atlanta, Georgia, in the amount of $20,534,000.
    Section 504 would authorize the appropriation of 
$627,329,000 for the projects authorized in Sections 501-503.
    Section 505 would designate the VA Medical Center in 
Augusta, Georgia, as the ``Charlie Norwood Department of 
Veterans Affairs Medical Center.''

                        TITLE VI--OTHER MATTERS

    Section 601 would reinstate until 2012 the health 
professional scholarship program provided for in subchapter II 
of chapter 76 of title 38, United States Code.
    Section 602 would repeal requirements for reports on the 
following information: authorities to enhance retention of 
experienced nurses; survey of health care positions; pay for 
nurses and other health care professionals; long range health 
planning; and sharing of health care resources.
    Section 603 would define the term ``Post 9/11 Global 
Operations'' to mean the period of the Persian Gulf War 
beginning on September 11, 2001, and ending on the date 
thereafter prescribed by Presidential proclamation or by law.

                       Background and Discussion


                    TITLE I--TRAUMATIC BRAIN INJURY

    Section 101 of the Committee bill would express the sense 
of Congress on VA's efforts in the rehabilitation and 
reintegration of veterans with TBI. There is a clear need for 
greater expertise within VA on the diagnosis, treatment, and 
management of TBI. VA and the Department of Defense have made 
progress in this area, but more should be done. The steps 
required by the provisions of this title would advance this 
goal.
    The current conflicts in Iraq and Afghanistan have left a 
significant population of servicemembers with both moderate and 
severe TBI. On March 27, 2007, the Committee held a hearing on 
VA's ability to respond to the health care needs of returning 
servicemembers, including TBI. The provisions of this bill are 
a direct outgrowth of that hearing, especially the testimony 
given by those who suffer with TBI.
    The brain can be harmed by the shock of an explosion or by 
impacts to the head as a consequence of the explosion. The 
symptoms of TBI are varied, complex, and subject to change over 
time, making diagnosis difficult.
    Blast injuries account for over 60 percent of all combat 
wounds suffered by U.S. forces in Iraq. As of March 2007, there 
were 1,882 diagnosed cases of servicemembers who have suffered 
from TBI, and this number continues to grow. Given the high 
incidence of powerful explosions in Iraq and Afghanistan from 
Improvised Explosive Devices (IEDs), thousands of Operation 
Enduring Freedom (the name given to operations in Afghanistan) 
and Operation Iraqi Freedom (the name given to operations in 
Iraq) veterans, in addition to those that have been identified, 
may have incurred some form of brain damage or impairment that 
has gone undiagnosed.
    Many servicemembers survive injuries which would have been 
fatal in previous conflicts, and often suffer brain damage in 
addition to other injuries. New approaches are required to meet 
the complex health care needs of these veterans.
    The provisions in this title address the immediate needs of 
veterans with TBI and provide VA clinicians with additional 
resources to meet the lifelong needs of these veterans.
    The American Legion, Disabled American Veterans, Paralyzed 
Veterans of America, Vietnam Veterans of America, Brain Injury 
Association of America, American Academy of Neurology, American 
Academy of Physical Medicine and Rehabilitation, American 
Congress of Rehabilitation Medicine, American Therapeutic 
Recreation Association, and the Commission on Accreditation of 
Rehabilitation Facilities have expressed strong support for the 
various provisions in this title.
    Section 102 of the Committee bill would amend title 38 so 
as to add a new section 1710C entitled ``Traumatic Brain 
Injury: plans for rehabilitation and reintegration into the 
community.'' This new section would require VA to develop 
individual rehabilitation and community reintegration plans for 
veterans and servicemembers with TBI who are being treated in 
the VA system. An individual plan is required for each veteran 
or servicemember because TBI takes many forms and requires 
close coordination of care.
    Such a plan would be required prior to discharge from 
inpatient care or at the time of enrollment in outpatient care 
and would address physical, cognitive, vocational and 
psychosocial objectives, as well as specific treatments. It 
would also identify a case manager to oversee the long-term 
implementation of the plan and would specify dates for review 
of the plan. Family education and support would ensure that the 
veteran's needs are properly addressed.
    A veteran or servicemember's rehabilitation plan would be 
based on a comprehensive evaluation to be conducted by a broad 
group of experts listed in the new subsection.
    At the Committee hearing on May 23, 2007, John Booss, M.D., 
of the American Academy of Neurology, testified that the team 
approach to developing a rehabilitation plan is ideal. He also 
spoke about the value of including the veteran and the 
veteran's family in the process:

        We support the provision . . . which requires involving 
        the family and veteran in the development and review of 
        the rehabilitation plan. TBI is a devastating and life-
        altering event which affects the veteran and his or her 
        family. Families of veterans with TBI need support and 
        education, and should be part of the rehabilitative 
        team to the greatest extent possible.

    Joy Ilem, Assistant National Legislative Director of the 
Disabled American Veterans, testified at that hearing that by 
developing the plan before discharge from acute care, delays 
and missteps would be minimized.
    The Committee believes that in order to ensure that each 
veteran or servicemember who is treated at VA for TBI receives 
appropriate and high-quality care suited specifically to the 
needs of the patient, these plans must be mandated, and 
families must be a part of the process. Some of the more 
severely wounded individuals will require others to monitor the 
implementation of the plan, get them to appointments, and 
otherwise assist them in various aspects of their recovery, and 
as such, inclusion of family caregivers is imperative.
    Section 103 of the Committee bill would amend title 38 so 
as to add a new section 1710D, entitled ``Traumatic Brain 
Injury: use of non-Department facilities for rehabilitation.'' 
This new section would require the use of non-VA facilities for 
implementation of rehabilitation and community reintegration 
plans for traumatic brain injury under certain specified 
circumstances. Non-VA facilities would be used when the 
Secretary cannot provide treatment or services at the frequency 
or for the duration required by the veteran or servicemember's 
individual plan, or when the Secretary determines that it is 
optimal for the veteran or servicemember's recovery and 
rehabilitation.
    VA has done much to develop the capability to treat TBI. 
However, VA has only recently begun treating younger veterans 
with those debilitating injuries. As such, in some 
circumstances, VA may find the service of a non-VA facility to 
be better suited to providing the care required by some 
veterans with TBI.
    Section 104 of the Committee bill would amend title 38 so 
as to add a new section 7330A, entitled ``Severe traumatic 
brain injury research, education, and clinical care program.'' 
This new section would require VA to develop and implement a 
research, education, and clinical care program on severe 
traumatic brain injury. Given the complexity of TBI, and the 
wide range of symptoms, there is a clear need for additional 
research on all aspects of this injury. A better understanding 
of the nature of TBI will lead to better care and treatment.
    To carry out the programs under this proposed new section, 
$10,000,000 would be authorized to be appropriated for each of 
fiscal years 2008 through 2012.
    Shannon Middleton, Deputy Director for Health, Veterans 
Affairs and Rehabilitation Commission of The American Legion, 
testified before the Committee on May 23, 2007, in support of 
the research provisions in section 104 as well as those in 
section 107, described below. Carl Blake, National Legislative 
Director, Paralyzed Veterans of America, and Dennis M. 
Cullinan, Director, National Legislative Service, Veterans of 
Foreign Wars of the United States, expressed similar support 
for this research at that hearing.
    Section 105 would require VA, in collaboration with the 
Defense and Veterans Brain Injury Center, to carry out a pilot 
program during a five-year period on assisted living services 
for veterans with traumatic brain injury. As veterans and 
servicemembers recovering from TBI reintegrate back into their 
communities and progress with rehabilitation, they will require 
significant support. VA has made progress in providing 
effective support, and this pilot program will bring greater 
attention to this important area of care.
    The pilot program would be carried out in locations 
selected by the Secretary, with at least one in each health 
care region of the Veterans Health Administration that contains 
a polytrauma center. Other locations shall be in areas with 
high concentrations of veterans with TBI. Special consideration 
for veterans in rural areas would also be required to improve 
access to VA care in these areas. Long-term care is often 
sparsely available in rural locations. The Committee bill, in 
giving special consideration to veterans and servicemembers in 
rural areas, seeks to ensure that those who do not reside in 
areas with the highest population concentrations will still 
have access to assisted living services.
    In carrying out this pilot program, the Secretary would be 
authorized to enter into agreements with providers 
participating under a State plan or a waiver under title XIX of 
the Social Security Act contained in section 1396 of title 42, 
United States Code.
    To carry out this pilot program, $8,000,000 would be 
authorized to be appropriated for each of the fiscal years 2008 
through 2013.
    Section 106 of the Committee bill would amend section 1710A 
of title 38 to require VA to provide age-appropriate nursing 
home care to veterans, such as those who suffer with more 
severe forms of TBI. The deployment of over 1.5 million 
soldiers around the globe in the wake of September 11, 2001, 
has resulted in a growing number of young men and women who 
will require nursing home care for the foreseeable future due 
to catastrophic injuries, including TBI.
    This population of veterans has needs and expectations very 
different from those of older veterans. The Committee firmly 
believes that VA must address the needs of this generation with 
new services and environments that are geared specifically 
towards the long-term care needs of younger veterans.
    Section 107 would require that, as part of VA's overall 
research activities, the Department carry out research on the 
sequelae of TBI. Of particular importance are visually-related 
neurological conditions, seizure disorders, and research on 
means of improving diagnosis, treatment, and prevention of such 
sequelae.
    The Committee notes that tinnitus has been demonstrated to 
be caused by blast injuries and frequently accompanies TBI. The 
genesis and nature of this condition require further study.
    John Booss, M.D., testified at the Committee's May 23, 
2007, hearing on the need for extensive additional research, 
particularly in the area of post-traumatic epilepsy, resulting 
from penetrating or blast TBI:

        This condition has been thoroughly documented among 
        Vietnam veterans. For service-connected Vietnam 
        veterans, the relative risk for developing epilepsy 
        more than 10 to 15 years after their [TBI] injury was 
        25 times higher than their age related civilian cohorts 
        . . . At one point, the VA was a national leader in 
        care and research for patients with epilepsy . . . But 
        starting in the 1990's these epilepsy centers have 
        languished due to lack of funds.

    Joy Ilem of the Disabled American Veterans also testified 
to the importance of this research, and to the need for 
revitalizing VA's Epilepsy Centers of Excellence.

               TITLE II--LANE EVANS BENEFITS IMPROVEMENTS

    This title of the Committee bill is named for 
Representative Lane Evans. He has devoted his adult life to 
serving our Nation and its veterans. Evans joined the United 
States Marine Corps in 1969, and served until 1971 in the U.S. 
and in Okinawa, Japan. In 1982, after completing law school at 
Georgetown University, Evans was elected by his home town 
district of Rock Island, Illinois, to the United States House 
of Representatives. For the next 24 years, Evans served on the 
House Veterans' Affairs Committee. In 1997, he was chosen as 
the Ranking Democratic Member, where he remained for 10 years. 
Representative Evans was a hard hitting advocate for veterans. 
He did not seek reelection to the House in 2006 due to the 
debilitating effects of Parkinson's disease, but he has 
remained strong in his conviction and actions in championing 
veterans and their rights. His voice in the House of 
Representatives is missed.
    Section 201 of the Committee bill, which is drawn from S. 
383, would amend section 17101(e)(3)(C) of title 38 United 
States Code so as to extend the period during which veterans of 
combat after the Persian Gulf War have eligibility for VA 
health care, without regard to other criteria, from two to five 
years. In 1998, Congress enacted the Veterans Programs 
Enhancement Act, (P.L. 105-368), section 102 of which gave two 
years of priority eligibility for health care to any veteran 
who served in a combat theater of operations following 
discharge or release from active duty.
    The extension is necessary to ensure veterans returning 
from combat receive health care during their transition from 
military to civilian life. With this extension, physical and 
mental health disorders, including post-traumatic stress 
disorder (hereinafter, ``PTSD''), which may take years to 
manifest and treat, will be better addressed. VA and the 
veterans service organizations expressed support for this 
provision in their testimony of May 23, 2007, and the Committee 
has found wide support for this provision over the course of 
its oversight activities.
    Section 202 of the Committee bill, which is derived from S. 
117, would add a new section 530A to title 38 under which VA 
would be required to provide specific information to the 
Committees on Armed Services, Appropriations and Veterans' 
Affairs of the Senate and House concerning the benefits and 
services provided to veterans who have served in the period of 
the Persian Gulf War since September 11, 2001.
    VA is required to provide a variety of reports to Congress. 
Many of those reports provide information concerning veterans 
who served during the time period known as the ``Persian Gulf 
War'' which, for purposes of title 38, United States Code, 
began on August 2, 1990, and has not ended. However, those 
reports do not generally recognize and account separately for 
the benefits and services used by persons who have served since 
September 11, 2001, in the Post 9/11 Global Operations theater. 
During that time, the United States has engaged in military 
action in Afghanistan, Iraq and various other countries and 
locations. In order for Congress to provide effective oversight 
of the benefits and services provided to veterans of this 
service, the Committee finds that additional specific 
information is needed.
    Under new section 530A, the Secretary would be required to 
provide an annual report containing demographic and other 
information on veterans who participate in a covered tour of 
duty during the period beginning September 11, 2001. The report 
would require separate information concerning veterans who 
served only in Afghanistan, only in Iraq, in both Afghanistan 
and Iraq, the 
Post 9/11 Global Operations theater (determined by reference to 
the geographic locations specified for award of the Global War 
on Terrorism Expeditionary Medal) and any other location.
    Veterans who served in Afghanistan, but who did not serve 
in Iraq or any other Post 9/11 Global Operations theater, would 
be considered veterans who served only in Afghanistan. The 
Committee intends that data concerning veterans who served only 
in Afghanistan would be determined by award of the Afghanistan 
campaign medal or other evidence of military service in 
Afghanistan. Veterans would be considered to have served only 
in Iraq if they did not serve in Afghanistan or any other Post 
9/11 Global Operations theater. The Committee intends that data 
concerning veterans who served only in Iraq would be determined 
by award of the Iraq campaign medal or other evidence of 
military service in Iraq.
    The Committee intends that a veteran who served in both 
Afghanistan and Iraq with or without service in other locations 
identified in the Post 9/11 Global Operations theater would be 
categorized under the covered tour of duty for both Iraq and 
Afghanistan. The Committee intends that data concerning a 
veteran who served in the Post 9/11 Global Operations theater 
would be determined by award of the Global War on Terrorism 
Expeditionary Medal or other evidence of military service in 
the geographic locations which qualify a veteran for such an 
award.
    In addition to demographic information such as sex, age, 
marital status, residence, Armed Force, Reservist and 
separation status, the Secretary would be required to provide 
other information for each covered tour of duty category, such 
as the number of claims for service-connected compensation, the 
average amount of monthly compensation paid at each rating 
level (the number of veterans paid at each percentage level and 
the average monthly amount paid to such veterans at each 
level), claims for Dependency and Indemnity Compensation (DIC), 
claims for non-service-connected pension, veterans provided 
services by Vet Centers including use by members of the 
National Guard or Reserves, the provision of health services 
including inpatient and outpatient services, the location where 
such services were provided, including separate information for 
veterans served by a specialized care facility such as a 
polytrauma center, information on the number of veterans since 
December 31, 2002, who have been diagnosed with or treated for 
PTSD, depressive disorders, neurotic disorders, substance abuse 
disorders, acute reaction to stress, or other mental disorders 
as determined by the Secretary. This additional information 
will facilitate effective Congressional oversight.
    In addition to the annual report, the Secretary would be 
required to provide a quarterly report with information 
concerning the number of claims for service-connected 
compensation and non-service connected pension which have been 
received and processed, and the number which are pending, have 
been granted, or have been denied. This information is similar 
to that currently provided by the Veterans Benefits 
Administration's Gulf War Veterans Information System. However, 
that report provides specific data concerning veterans who 
served in Southwest Asia during the period ending on July 31, 
1991, but does not provide such specific information for 
veterans who have served since September 11, 2001.
    The purpose of these reports is to provide the Committees 
with information to enable them to conduct oversight of VA and 
to identify the need for changes in legislation warranted by 
the specific benefit and health care needs of veterans who have 
served since September 11, 2001. During the Committee's hearing 
on May 23, 2007, Shannon Middleton, Deputy Director, Veterans 
Affairs and Rehabilitation Commission of The American Legion, 
expressed support for the provisions of S. 117. Ms. Middleton 
noted that ``differentiating veterans who served in OIF, OEF, 
those who served in both and those who served in neither will 
also be important when anticipating long-term health effects.''
    Section 203 of the Committee bill, derived from S. 692, 
would add a new section 1730A to title 38, United States Code, 
which would require VA to establish a Hospital Quality Report 
Card Initiative to inform veterans and their families of the 
quality and performance of VA hospitals. The initiative is 
intended to assist veterans and their families in making 
informed health care choices, and to raise public awareness and 
understanding of hospital quality issues.
    Under this section, the Secretary would be required to 
incorporate current information on facility performance in the 
web site or promotional literature of each VA hospital. The 
information, which would cover performance measures in the 
areas of effectiveness, safety, timeliness, efficiency, and 
patient satisfaction, would be obtained from sources determined 
appropriate by the Secretary. These could include the Joint 
Commission on Accreditation of Healthcare Organizations, the 
Office of Inspector General or Office of the Medical Inspector, 
other offices involved in the collection of hospital 
performance data, media outlets, and professional journals. 
Additionally, the Secretary would be required to ensure that 
the information is posted in a manner conducive for comparisons 
with other local or regional hospitals.
    A list of Internet links and data summaries on the web site 
or brochure of each VA hospital would publicize a large volume 
of practical information that was previously inaccessible or 
unknown to most VA patients and other stakeholders. It would 
also serve to further accountability and openness in the VA 
health care system. Subject to individual privacy concerns, all 
relevant metrics and reports would be made available to the 
public at large.
    Section 204, which is also drawn from S. 117, would amend 
section 1702 of title 38, United States Code, so as to require 
that VA provide a preliminary mental health evaluation to a 
recently discharged combat veteran not later than thirty days 
after a request for such an evaluation.
    While VA has made significant efforts to provide veterans 
with mental health evaluations in a timely manner, there is 
much room for improvement. VA has made progress in reaching out 
to servicemembers in need of services, and should continue to 
make commensurate efforts to provide those services in a timely 
way.
    This provision has broad support from the veterans' service 
organizations, including Paralyzed Veterans of America, 
Veterans of Foreign Wars of the United States, Disabled 
American Veterans, The American Legion, and Vietnam Veterans of 
America.

                     TITLE III--HEALTH CARE MATTERS

    Section 301 of the Committee bill, which is derived from S. 
1147, would rescind section 17.36(c) of title 38, Code of 
Federal Regulations, the January 2003 regulation which halted 
the enrollment of Priority 8 veterans into VA health care. 
Priority 8 veterans are those whose income level exceeds the 
Department of Housing and Urban Development's ``low-income'' 
geographic means test, as defined in section 1437a of title 42, 
United States Code.
    On January 17, 2003, former Secretary of Veterans Affairs 
Anthony J. Principi issued a regulation which precluded 
Priority 8 veterans from enrolling in the Veterans Health 
Administration. On February 26, 2003, former Secretary 
Principi, in testimony before the Committee, stated that the 
ban on Priority 8 enrollments would be temporary until VA could 
better meet veterans' expectations, with particular attention 
to timely access to care. However, the prohibition on Priority 
8 veterans has continued to the present, and veterans who need 
and deserve care are being turned away.
    In the Committee's Views and Estimates letter submitted by 
the Democratic Members of the Committee and Senator Sanders to 
the Budget Committee on March 1, 2007, the Majority members 
recommended including sufficient funding to allow VA, in fiscal 
year 2008, to accommodate Priority 8s in the total medical care 
funding allocation. The Budget Committee and the full Senate 
subsequently supported this funding authorization level in the 
Fiscal Year 2008 Budget Resolution, and it was included in the 
final Budget Resolution adopted by both the House and the 
Senate.
    Section 302 would require that the Secretary annually, by 
August 1, publish notice in the Federal Register of which 
categories of veterans are eligible to be enrolled in VA health 
care in the coming fiscal year.
    Also, in any year in which the Secretary proposes to 
restrict enrollment, the Secretary would be required to provide 
an estimate of the cost of enrolling all eligible veterans to 
the Committees on Veterans' Affairs of the House and Senate.
    After proposing the August 1 notice, the Secretary would be 
required to wait 45 days before implementing any change in 
enrollment. This notice-and-wait requirement would provide 
Congress with an opportunity to oversee the enrollment of 
veterans in the Veterans Health Administration, and to respond 
to any proposed limitation on enrollment.
    It is the view of the Committee that when resources are 
provided by Congress to enable the Department to keep pace with 
demand for services, as set forth in section 1705 of title 38, 
United States Code, the system should be open to all veterans 
who seek care.
    Section 303 of the Committee bill, which is derived from S. 
1326, would amend section 1710 of title 38, United States Code, 
so as to eliminate the requirement that ``catastrophically 
disabled veterans'' make copayments for the receipt of hospital 
care or nursing home care.
    The veterans who would be affected by this change, such as 
those with spinal cord injury, require ongoing care and 
services. Private insurers do not cover this kind of service, 
and most other health programs do not offer the level of care 
provided by VA. These veterans should not be required to pay 
fees and copayments for their care, as they utilize and rely on 
VA health care at a much higher rate than many other veterans.
    Paralyzed Veterans of America testified in support of this 
provision before the Committee on May 23, 2007.
    Section 304 of the Committee bill, which is derived from S. 
1146, would require the Secretary to establish a grant program 
to provide innovative transportation options to veterans in 
rural areas.
    Over 1.5 million servicemembers have been deployed in 
operations OEF and OIF, of which over 686,000 have already been 
discharged. A significant portion of these forces are members 
of the National Guard and Reserve. After discharge from active 
duty, many of those who have served will return to small towns 
across the country, often many miles from military bases and VA 

facilities.
    The provisions in section 304 would authorize grants for 
rural veterans' service organizations and community-based 
organizations to provide innovative transportation options to 
veterans in remote rural areas. For each fiscal year 2008 
through 2012, $6,000,000 would be authorized to be appropriated 
for this grant program. No individual grant may exceed $50,000. 
The grants would be awarded to State veterans' service 
agencies, veterans service organizations, and qualified 
community transportation organizations.
    Community transportation organizations range from public 
sector entities--either at the federal (generally through the 
Department of Transportation or through Medicaid) or state 
level--to nonprofit private entities, and often employ a 
combined network of public and private methods of 
transportation (such as taxicabs) to help patients get to their 
health care appointments. The Committee bill would enable VA to 
utilize these already existing networks at the local level to 
provide transportation to veterans who need to get to a VA 
facility for care.
    The Committee recognizes the need for transportation 
alternatives for rural veterans since these veterans do not 
have the same access to public transportation that urban and 
suburban veterans do. The program currently run by the Disabled 
American Veterans is another successful model, and the 
Committee encourages building on and expanding this program.
    Section 305 of the Committee bill, derived from S. 1146, 
would require demonstration projects on alternatives for 
expanding care for veterans in rural areas. Under the 
provision, two demonstration projects would be required to be 
carried out in geographically dispersed areas. As part of these 
projects, VA would be required to partner with the Department 
of Health and Human Services, and to coordinate with the Indian 
Health Service to expand care for Native American veterans.
    The need for innovative options for ensuring access to care 
for rural veterans is also an issue of concern to the 
Committee. While the Committee recognizes that the integrity of 
the VA system as a whole must be preserved, there is clearly 
room for increased collaboration with other federal agencies in 
areas where VA cannot effectively or efficiently reach veteran 
patients.
    Section 306 of the Committee bill, also derived from S. 
1146, would require VA to submit a report to Congress on 
matters related to care for veterans who live in rural areas. 
The report would be submitted with the annual budget proposal.
    This report would be required to include information on the 
implementation of sections 304 through 306 of the Committee 
bill, the establishment and function of the Office of Rural 
Health, the establishment of a partnership between VA and the 
Centers for Medicare and Medicaid Services of the Department of 
Health and Human Services, and on plans for VA to employ the 
use of telemedicine to serve rural veterans.
    The first such report would be required to contain 
information on the fee-basis health-care program required by 
subsection (b) of section 212 of the Veterans Benefits, Health 
Care, and Information Technology Act of 2006 (Public Law 109-
461), and the outreach program required by section 213 of that 
public law.
    Section 307 of the Committee bill, which is derived from S. 
994, would amend section 111(g) of title 38, United States 
Code, relating to payments to qualifying veterans for travel to 
VA medical facilities. At present, veterans are compensated at 
the rate of 11 cents per mile for routine visits and 17 cents 
per mile for Compensation and Pension examinations, subject to, 
under most circumstances, a deductible of $3 per one-way trip. 
These mileage rates are not set in statute, but rather are left 
to the discretion of the Secretary. However, the rates have not 
changed since 1978.
    This section is designed to modernize VA's beneficiary 
travel program and bring payments under the program closer in 
line with today's cost of travel, taking into account the cost 
of fuel and vehicle maintenance. It would direct the Secretary 
to reimburse qualifying veterans at the particular rate 
authorized for Government employees under section 5707(b) of 
title 5, United States Code, which presently stands at $.28 per 
mile. By linking VA mileage reimbursement to a Government rate, 
periodic increases in the rate would be guaranteed. The 
Administrator of General Services, who prescribes Government 
mileage rates under title 5, generally raises them no less 
often than once every two years. Thus, a situation whereby 
reimbursements stagnate for 30 years would not be 
repeated.
    Additionally, this section would strike a provision that 
allows the Secretary to raise or lower the deductible for 
reimbursements in proportion to a change in the mileage rate. 
This would have the effect of holding the deductible at $3 per 
one-way trip until such rate is changed by law, irrespective of 
future increases to the Government rate. Under this approach, 
the deductible will likely eventually become inconsequential 
relative to the average reimbursement payout.
    The Committee expects that this section will provide the 
most benefit to veterans living in remote rural areas, some of 
whom must drive hundreds of miles each month to receive 
essential VA health care, by ensuring reimbursement at a fair 
rate that defrays the cost of travel expenses.
    Section 308 of the Committee bill would amend section 
1712(a)(1)(B)(iv) of title 38, United States Code, so as to 
extend from 90 days to 180 days the period during which 
recently discharged servicemembers can apply for VA dental 
benefits.
    Under current law, returning servicemembers must apply for 
dental benefits within 90 days from the date of discharge. 
Recently returned servicemembers often face significant 
challenges readjusting, and dental concerns may not be a top 
priority. In addition, members of the National Guard and 
Reserve are often given 90 days of leave following discharge 
from active duty, and upon return to their units the 
opportunity to apply for dental benefits has passed.
    The Committee believes that the extension to 180 days would 
improve access to care and facilitate a smoother transition 
from military to civilian life.
    Section 309 of the Committee bill would amend section 1710 
of title 38, United States Code, so as to exempt hospice care 
provided in all settings from the copayment requirement for VA 
long-term care. Under current law, only hospice care provided 
in a VA nursing home is exempted from copayment. The Committee 
believes that this system is inequitable and creates 
institutional bias, as many veterans choose to receive hospice 
care in nursing homes rather than in other settings to avoid 
daily copayments.

                  TITLE IV--HOMELESS VETERANS MATTERS

    Section 401 of the Committee bill, which is drawn from S. 
1384, would amend section 2012(a)(2) of title 38, United States 
Code, so as to eliminate the authority of the Secretary to 
offset per diem payments to homeless service providers by the 
amount of non-VA funding they receive. Per diem payments from 
VA compensate service centers for homeless veterans for the 
services they provide to veterans. The current rate of $27 per 
day for each veteran served is not sufficient to cover existing 
costs, and rising energy prices and other external factors have 
placed increasing strain on current resources.
    To meet the needs of their clients, many shelters must seek 
additional sources of funding. Under current law, VA per diem 
payments are reduced in proportion to non-VA funding. The 
amendment proposed by section 401 of the Committee bill would 
eliminate this offset. This will enable service centers to 
expand their services with these additional resources and 
incentivize new programs to get off the ground.
    Section 402 of the Committee bill, which is also derived 
from 
S. 1384, would require VA to carry out a demonstration program 
to identify members of the Armed Forces on active duty who are 
at risk of becoming homeless upon discharge or release from 
active duty and to provide referral, counseling, and support 
services to prevent such members from becoming homeless. The 
Committee does not believe that a significant portion of 
separating servicemembers are at risk of immediate 
homelessness, but certain indicators can help identify those 
individuals who may in the future be at risk of homelessness. 
This program will allow and encourage preventive action before 
a veteran becomes homeless. It is imperative for those who are 
at-risk of homelessness to be identified as early as possible 
following their discharge to prevent them from becoming 
homeless.
    A similar program, discussed below under section 403 of the 
Committee bill, to aid incarcerated veterans who may be at risk 
of becoming homeless in their transition back to civilian life, 
has been largely successful and warrants replication. VA, in 
testimony addressing a similar proposal to that of the 
Committee bill, H.R. 5960, introduced in the 109th Congress by 
Representative Michaud, expressed support for a program like 
this.
    This program would be required to be carried out in at 
least three locations, and $2,000,000 would be authorized to be 
appropriated. The authorization for this program would expire 
in 2011. The Secretary would be authorized to enter into 
contracts for services with such entities or organizations as 
the Secretary deems appropriate.
    Section 403 of the Committee bill, which is also derived 
from 
S. 1384, would amend section 2023 of title 38, United States 
Code, so as to extend and expand the authority for a program to 
aid incarcerated veterans in their transition back to civilian 
life. The program would be extended until September 30, 2011, 
and would be expanded to twelve locations. The program 
identifies at risk individuals prior to their discharge and 
refers them to counseling and services, including health care, 
job training and placement, and housing.
    The demonstration program that section 403 would extend has 
proven to be widely successful. Seven sites were chosen 
nationwide as pilot sites, and the program is funded and 
administered primarily through the Department of Labor's 
Homeless Veterans Reintegration Program (hereinafter, 
``HVRP''), another successful program. HVRP employs a 
collaboration of nonprofit, state and federal entities, 
including VA, to carry out the programs.
    Subsection 404 of the Committee bill, which is also drawn 
from S. 1384, would amend section 2011 of title 38, United 
States Code, so as to permit the use of VA grant funds for 
homeless service centers for personnel costs. Under current 
law, grants made to homeless service centers may not be used 
for personnel costs which are essential to the daily operations 
of such centers. Yet, these daily operational costs are 
burdensome to homeless service providers. The Committee bill 
would give providers more flexibility in spending VA grant 
funds for the purpose of serving homeless veterans.
    Subsection 405 of the Committee bill, which is also drawn 
from S. 1384, would amend section 2043 of title 38, United 
States Code, to make permanent an existing authority to expand 
domiciliary care for homeless women veterans.
    Women veterans are a growing proportion of the military and 
veteran population, and homelessness affects a significant 
proportion of the veteran population as a whole. Many VA 
facilities do not yet have adequate capacity to meet the needs 
of these veterans. Domiciliary care is an essential component 
of the services for homeless veterans, especially for mental 
health and substance abuse treatment programs.
    This provision would require VA to ensure that domiciliary 
programs have the capacity to accommodate the specific needs of 
women veterans. While VA is already undertaking many efforts to 
improve capacity and services for women veterans and 
specifically direct programs and sections of medical care 
facilities to meet the needs of these patients, the Committee 
believes it is necessary to codify the need for maintaining 
capacity and specialized services in the domiciliary care 
program for women veterans.
    Section 406 of the Committee bill, which is derived from S. 
874, would amend title 38 so as to add a new section 2044, 
relating to supportive services for very low-income veterans 
and their families occupying permanent housing. The Committee 
is concerned that some of the servicemembers deployed to Iraq 
and Afghanistan will be at risk for homelessness upon 
separation from active duty, in addition to older veterans who 
are struggling to maintain employment or are faced with other 
financial issues. Preventive efforts by VA to support 
transitioning servicemembers and veterans can reduce this 
number, and reduce the demand for VA services in the future.
    The provisions in the new section 2044 would direct VA to 
provide grants to eligible entities to provide and coordinate 
the provision of a comprehensive range of supportive services 
for very low-income veteran families occupying permanent 
housing, including those transitioning from homelessness to 
such housing. Those families may be occupying permanent 
housing, moving into permanent housing within 90 days, or 
moving from one permanent residence to another to better suit 
their needs.
    Entities eligible to receive grants under this provision 
are public or private nonprofit organizations which have 
demonstrated the capacity and experience necessary to deliver 
the services outlined in the proposed new section, described 
below.
    Under the provisions of the new section 2044, grants would 
be provided for a wide range of services, so as to give 
families a broad set of tools to maintain a permanent 
residence. To this end, providers could receive grants to 
furnish outreach, case management, assistance in obtaining and 
coordinating VA benefits, and assistance in obtaining and 
coordinating other public benefits provided by federal, state, 
or local agencies or organizations.
    The Committee believes that the following services, in 
addition to others, help families maintain permanent housing: 
health care and health insurance, daily living services, 
personal finance planning, transportation, income support, 
fiduciary and representative payee services, legal services, 
child care, and housing counseling.
    VA would be required to ensure equitable geographic 
distribution of assistance under the new authority, including 
in rural and on tribal lands.
    Under subsection (c) of section 406 of the Committee bill, 
VA would be required to study the effectiveness of this 
permanent housing program compared to other programs delivering 
housing and services to veterans, and submit a report on that 
study to the Committees on Veterans' Affairs of the House and 
Senate by 
March 31, 2010.
    Subsection (d) of the new section 2044 would require VA, 
through the authority in section 2064 of title 38, to provide 
training and technical assistance to participating entities 
regarding the planning, development, and provision of services.
    For the programs that would be authorized by new section 
2044 of title 38, the following funds would be authorized to be 
available from amounts appropriated to VA for Medical Services: 
$15,000,000 in Fiscal Year 2008, $20,000,000 in Fiscal Year 
2009, and $25,000,000 in Fiscal Year 2010. Of these funds, not 
more that $750,000 would be available in any fiscal year for 
technical assistance; however, there is specific authorization 
for $1,000,000 to be appropriated to carry out the technical 
assistance in each of the fiscal years 2008 through 2010.
    Veterans of Foreign Wars of the United States, Paralyzed 
Veterans of America, and Vietnam Veterans of America expressed 
their support for the provisions under section 406 in testimony 
before the Committee on May 23, 2007.
    In testimony before the Committee at the May 23, 2007, 
hearing, VA presented views opposing an earlier version of the 
provisions under section 406. The Committee bill's provision 
contains many of the changes suggested by VA.

                     TITLE V--CONSTRUCTION MATTERS

    Section 501 of the Committee bill, which is derived from S. 
472, would authorize construction of a new major medical 
facility in Denver, Colorado, in an amount not to exceed 
$548,000,000. Last year, in S. 3421 as reported in the Senate, 
the Committee authorized $52,000,000 in land acquisition funds 
for the commencement of this project, to be carried out in 
collaboration with the University of Colorado. This amount was 
increased to $98,000,000 in the final bill as signed into law.
    However, due to potential increases in the total cost of 
the project due the incremental authorization process that VA 
has undertaken as part of their capital plan, the Committee 
believes the total amount of the project needs to be authorized 
in order to attempt to keep construction costs contained.
    Section 502 of the Committee bill, which is derived from S. 
1392, would increase the authorization for the major medical 
facility project to consolidate the medical centers of the VA 
at the University Drive and H. John Heinz III divisions in 
Pittsburgh, Pennsylvania, from $189,200,000 to $248,000,000. 
Due to VA's plan to request appropriations for this project on 
an incremental basis, the total cost of the project has 
increased from previous authorizations and a new authorization 
for the total cost of the project is 
necessary.
    Section 503 of the Committee bill, which is derived from S. 
1396, would authorize a major medical facility project to 
modernize patient wards at the VA Medical Center in Atlanta, 
Georgia, in the amount of $20,500,000. The Department of 
Veterans Affairs expected to complete this construction prior 
to the end of the previous authorization, but additional time 
is required. As the project is already fully funded, no new 
appropriation is required.
    Section 504 of the Committee bill would authorize the 
appropriation of $627,329,000 for the major medical facility 
projects authorized in sections 501 through 503.
    Section 505 of the Committee bill, which is derived from S. 
1026, would designate the VA Medical Center in Augusta, 
Georgia, as the ``Charlie Norwood Department of Veterans 
Affairs Medical Center''.
    Charlie Norwood served as a Member of the United States 
House of Representatives from 1995 until his death on February 
13, 2007. At the time of his death, Norwood was the 
Representative of the 10th District of Georgia. He served as a 
Captain in the United States Army from 1967 to 1969, beginning 
with an assignment to the U.S. Army Dental Corps. He served on 
forward bases in Vietnam, and in the United States. 
Representative Norwood meets Committee requirements for naming 
of VA facilities.

                        TITLE VI--OTHER MATTERS

    Section 601 of the Committee bill would amend section 7618 
of title 38 United States Code to reinstate the authority for 
the Health Professional Scholarship Program until 2012. This 
program, which expired in 1998, is an essential element of the 
VA's Nursing Academy, a collaborative program established 
between the Office of Academic Affiliations and the Office of 
Nursing Services. The financial assistance awarded to 
competitive candidates is intended to improve recruitment and 
retention and, broadly, help reduce the national nursing 
shortage.
    This program was originally established by P.L. 96-330 and 
awarded scholarships from 1982 until 1995 to 3,300 students. 
Authority for the program was extended through 1998, but was 
discontinued in 1998 in favor of other recruitment options. Two 
similar programs, the Employee Incentive Scholarship Program 
and the Education Debt Reduction Program, were implemented in 
March 2000 and awarded 4,905 scholarships by March 2003. In the 
face of ongoing nursing shortages, the Committee finds that the 
Health Professional Scholarship Program should be reauthorized.
    Section 602 of the Committee bill would eliminate a number 
of reports required by current law.
    The report on ``Use of Authorities to Enhance Retention of 
Experienced Nurses'' was implemented by VA to improve retention 
of experienced nurses. It has been in place for some time and 
has fulfilled its purpose.
    The report on ``Survey of Health-Care Positions'' was 
implemented in 2000 to ensure that the locality pay system was 
adequately addressing VA nursing staff needs. This report has 
demonstrated the effectiveness of the salary surveys and has 
fulfilled its purpose.
    The report on ``Pay for Nurses and Other Health Care 
Personnel'' is of minimal value because nurses are now 
guaranteed at least the annual general pay increase.
    The information contained in the report on ``Long Range 
Health Planning'' is already contained in VA's budget proposals 
and in the five-year strategic plans. As such, this report is 
redundant.
    The Committee believes that the information contained in 
the report on ``Sharing of Health-Care Resources'' would be 
more efficiently presented in the annual budget submission.
    Section 603 of the Committee bill would clarify that the 
term ``Post 9/11 Global Operations'' means the period of the 
Persian Gulf War beginning on September 11, 2001, and ending on 
the date thereafter prescribed by Presidential proclamation or 
by law.
    This term differentiates periods of time, and its use will 
be helpful in identifying periods of service. Use of this term 
will also allow for greater precision in statistical analysis 
of military operations and service. Currently, the ``Persian 
Gulf War'' period that began back in 1991 is ongoing.

                      Committee Bill Cost Estimate

    In compliance with paragraph 11(a) of rule XXVI of the 
Standing Rules of the Senate, the Committee, based on 
information supplied by the CBO, estimates that enactment of 
the Committee bill would, relative to current law, increase 
discretionary spending by $1.4 billion in 2008 and by $10.6 
billion over the 2008-2012 period, assuming appropriation of 
the necessary amounts. The Committee bill would increase direct 
spending by less than $500,000 in 2008, and by $3 million over 
the 2008-2012 period. Enactment of the Committee bill would not 
affect receipts, and would not affect the budget of state, 
local or tribal governments.
    The cost estimate provided by CBO, setting forth a detailed 
breakdown of costs, follows:

                               Congressional Budget Office,
                                   Washington, DC, August 23, 2007.
Hon. Daniel K. Akaka,
Chairman,
Committee on Veterans' Affairs,
U.S. Senate, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for S. 1233, the Veterans 
Traumatic Brain Injury and Health Programs Improvement Act of 
2007.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Michelle S. 
Patterson, who can be reached at 226-2840.
            Sincerely,
                                           Peter R. Orszag,
                                                          Director.
    Enclosure
    cc: Honorable Larry E. Craig, Ranking Member.

S. 1233--Veterans Traumatic Brain Injury and Health Programs 
        Improvement Act of 2007

    Summary: S. 1233 would create new programs to treat combat 
veterans with traumatic brain injuries, authorize the 
construction of hospitals for the Department of Veterans 
Affairs (VA), and expand health care benefits for veterans. In 
particular, S. 1233 would allow veterans without disabilities 
related to military service to enroll in the VA health care 
system regardless of their income level.
    The bill also has two provisions that would modify a VA 
program that funds hundreds of community agencies that provide 
services to homeless veterans, potentially allowing those 
service providers to receive significantly increased funding. 
CBO cannot determine the costs of those provisions at this time 
because neither VA nor CBO can predict how the service agencies 
would alter their requests for VA funding under S. 1233; 
however, CBO expects the annual cost of those two provisions 
would probably be in the tens of millions of dollars. CBO 
estimates that implementing the remainder of S. 1233 would 
increase discretionary costs for veterans' health care by about 
$1.4 billion in 2008 and $10.6 billion over the 2008-2012 
period, assuming the appropriations of the necessary amounts. 
In addition, CBO estimates that enacting the bill would 
increase direct spending by less than $500,000 in 2008 and $3 
million over the 2008-2012 period. Enacting the bill would have 
no effect on federal revenues.
    S. 1233 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act; any 
costs to state, local, or tribal governments would result from 
complying with conditions of federal assistance.
    Estimated cost to the Federal Government: The estimated 
budgetary impact of S. 1233 is summarized in Table 1. The costs 
of this legislation fall within budget function 700 (veterans 
benefits and services).

                                 Table 1. Estimated Budgetary Impact of S. 1233
----------------------------------------------------------------------------------------------------------------
                                                                  By fiscal year, in millions of dollars--
                                                          ------------------------------------------------------
                                                              2008       2009       2010       2011       2012
----------------------------------------------------------------------------------------------------------------
                                  CHANGES IN SPENDING SUBJECT TO APPROPRIATIONa

Estimated Authorization Level............................      2,178      2,122      2,186      2,216      2,251
Estimated Outlays........................................      1,385      2,190      2,355      2,347      2,293

                                          CHANGES IN DIRECT SPENDINGb,c

Estimated Budgetary Authority............................          *          *          *          *          *
Estimated Outlays........................................          *          *          *          *          *
----------------------------------------------------------------------------------------------------------------
Note: * = less than $500,000.
aThis table does not include the costs for implementing sections 401 and 404 of S. 1233, which CBO cannot
  estimate.
bIn addition to the direct spending effects shown here, enacting S. 1233 would have additional effects on direct
  spending after 2012. The estimated increase in direct spending would total $1 million over the 2008-2012
  period and $3 million over the 2008-2017 period.
cNumbers may not add up to totals in text because of rounding.

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

Spending subject to appropriation

    S. 1233 would create new programs to treat traumatic brain 
injury for combat veterans, authorize the construction of 
hospitals for the Department of Veterans Affairs, and expand 
health care benefits for certain veterans, especially for those 
without disabilities connected to military service. It also 
would change the rules for funding service agencies which 
provide assistance to homeless veterans, the cost of which CBO 
cannot estimate because neither VA nor CBO can predict how the 
hundreds of service agencies would alter their requests for VA 
funding. (We expect those costs would probably be in the tens 
of millions of dollars per year.) CBO estimates that 
implementing the remainder of S. 1233 would result in 
discretionary outlays of about $1.4 billion in 2008 and $10.6 
billion over the 2008-2012 period (see Table 2).
    Enrollment for Priority 8 Veterans. Veterans enrolling in 
the VA health care system are assigned to one of eight priority 
care groups, based on such factors as disability rating and 
income. Each year the Secretary of Veterans Affairs announces 
which enrollment categories of veterans will be eligible to 
receive VA health care in the following year. That 
determination is based on an estimate of health care costs and 
available resources. Once enrolled, however, veterans are not 
excluded, regardless of enrollment category.
    Since January 2003, VA has not accepted new enrollments of 
priority 8 veterans--veterans without a service-connected 
disability and with incomes above certain thresholds--and VA 
has announced that the ban on enrollment of category 8 veterans 
will continue through 2008. Section 301 would void that 
exclusion for 2008. Section 302 would codify the Secretary's 
responsibility to announce the annual enrollment decision in 
the Federal Register and require the simultaneous submission of 
a report on that decision to the Congress. Based on VA's 
repeated determinations to exclude priority 8 veterans, CBO 
expects that the effect of these two sections would be the 
enrollment of priority 8 veterans during 2008 only. (Because 
the bill's provision to void an exclusion for 2008 applies only 
to that year, we expect that enrollment of new priority 8 
veterans would not continue after 2008 under this bill.)
    Based on data from VA about the projected population of 
potential priority 8 enrollees and the cost of current priority 
8 enrollees, CBO estimates that implementing section 301 would 
allow about 1.3 million new priority 8 veterans to enroll in 
the VA health care program at an average annual net cost of 
about $1,400 in 2008. (The net cost equals the cost of care 
minus copayments and third-party reimbursements.) After 
adjusting for expected inflation, CBO estimates that 
implementing this provision would increase VA health care costs 
by $1.2 billion in 2008 and almost $8.8 billion over the 2008-
2012 period, assuming appropriation of the necessary amounts.
    Increase in Veterans' Travel Benefits. Section 307 would 
increase the travel allowance available to certain veterans for 
medical or vocational rehabilitation appointments. Veterans 
with a low income and veterans seeking treatment for a service-
related disability are currently eligible to receive 11 cents 
per mile traveled for medical appointments at VA facilities, 
with a $3 deductible each way. Those traveling for a disability 
rating examination receive 17 cents per mile with no 
deductible. Those travel reimbursements are discretionary costs 
and are covered in this part of the estimate. (Travel 
reimbursements for vocational rehabilitation appointments are 
classified as mandatory spending, and those costs are discussed 
later in the ``Direct Spending'' section.)
    Current law calls for the $3 deductible to increase 
proportionately with any increase in the mileage reimbursement 
rate. Section 307 would freeze the deductible at $3 and link 
the mileage reimbursement rate to that used by the federal 
government to reimburse employees for work-related travel in 
their personal vehicles when government vehicles are available 
for their use. That rate is currently 28.5 cents per mile. In 
2006, VA spent about $55 million to reimburse veterans for 
travel to medical appointments and about $5 million in travel 
reimbursements for veterans traveling for disability rating 
examinations. Based on information from VA, CBO estimates that, 
in 2008, increasing the mileage rates and freezing the 
deductible for medical appointments would require the 
appropriation of $113 million in that year. That cost reflects 
CBO's expectation that increasing the mileage rate also would 
increase the number claims for travel reimbursement by 10 
percent. Assuming that mileage reimbursement rates would 
increase by about 2 percent each year, CBO estimates that 
implementing this section would cost about $750 million over 
the 2008-2012 period, assuming the appropriation of the 
necessary amounts.

                         Table 2. Components of Discretionary Spending Under S. 1233 a,b
----------------------------------------------------------------------------------------------------------------
                                                                  By fiscal year, in millions of dollars--
                                                          ------------------------------------------------------
                                                              2008       2009       2010       2011       2012
----------------------------------------------------------------------------------------------------------------
Enrollment for Priority 8 Veterans:
    Estimated Authorization Level........................      1,363      1,866      1,916      1,966      2,015
    Estimated Outlays....................................      1,192      1,771      1,884      1,946      1,997

Increase in Veterans' Travel Benefits:
    Estimated Authorization Level........................        113        155        158        162        165
    Estimated Outlays....................................        102        153        156        160        164

Major Medical Facility Projects:
    Authorization Level..................................        627          0          0          0          0
    Estimated Outlays....................................         28        169        204        151         57

Health Professionals Scholarship Program:
    Estimated Authorization Level........................         12         25         27         28         15
    Estimated Outlays....................................         11         24         27         28         16

Extending Time for Preferred Health Care:
    Estimated Authorization Level........................         10         20         25         25         25
    Estimated Outlays....................................          9         19         24         25         25

Help for Very-Low-Income Veterans:
    Authorization Level..................................         16         21         26          0          0
    Estimated Outlays....................................         14         20         25          2          *

Traumatic Brain Injury Program:
    Authorization Level..................................         10         10         10         10         10
    Estimated Outlays....................................          9         10         10         10         10
Assisted Living Pilot Program:
    Authorization Level..................................          8          8          8          8          8
    Estimated Outlays....................................          7          8          8          8          8

Rural Veterans Transportation:
    Authorization Level..................................          6          6          6          6          6
    Estimated Outlays....................................          5          6          6          6          6

Copayments for the Catastrophically Disabled:
    Estimated Authorization Level........................          6          6          6          6          6
    Estimated Outlays....................................          6          6          6          6          6

Veterans Released from Prison:
    Estimated Authorization Level........................          4          4          4          4          0
    Estimated Outlays....................................          1          3          4          4          3

Homeless Demonstration Program:
    Authorization Level..................................          2          0          0          0          0
    Estimated Outlays....................................          1          *          *          *          0
----------------------------------------------------------------------------------------------------------------
        Total Changes:
            Estimated Authorization Level................      2,178      2,122      2,186      2,216      2,251
            Estimated Outlays............................      1,385      2,190      2,355      2,347      2,293
----------------------------------------------------------------------------------------------------------------
Note: * = less than $500,000.
aThis table does not include the costs of implementing sections 401 and 404 of S. 1233, which CBO cannot
  estimate.
bNumbers may not add up to totals because of rounding.

    Major Medical Facility Projects. Sections 501 through 503 
would authorize work on three medical facility projects. CBO 
estimates that implementing those sections would cost $28 
million in 2008 and $609 million over the 2008-2012 period, 
assuming appropriation of the necessary amounts.
    Section 501 would authorize VA to replace the medical 
center in Denver. The bill would authorize the appropriation of 
$548 million in 2008 for this project. Section 501 also would 
authorize VA to spend any unobligated amounts in the major 
construction account on the Denver medical center. Based on 
information from VA, CBO does not expect that funding in excess 
of that which is specifically appropriated for the project will 
be needed.
    Section 502 would authorize the appropriation of $59 
million in 2008 for the consolidation of medical centers in 
Pittsburgh.
    Section 503 would authorize the appropriation of $21 
million in 2008 for the modernization of inpatient wards at the 
medical center in Atlanta.
    Health Professionals Scholarship Program. Section 601 would 
revive a health professionals scholarship program that expired 
in 1998. The provision would give VA the authority to provide 
funds to cover tuition, fees, the costs of books and laboratory 
equipment, and a stipend for students in certain medical or 
nursing school programs, such as general medicine, dentistry, 
or psychology. The scholarships could be from one to four 
years, though preference would be given to students in their 
last year of school. In exchange for financial assistance, 
recipients would be obligated to work at VA for a specified 
period of time.
    Based on information from VA, CBO estimates that under 
S. 1233 VA would grant about 250 awards each year with an 
average award of $46,000 in 2008. Estimating an average 
scholarship of two years, and taking in to account an estimated 
6 percent increase in tuition and other costs each year, CBO 
estimates that implementing this provision would cost $11 
million in 2008 and $106 million over the 2008-2012 period, 
assuming the availability of appropriated funds.
    Extending Time for Preferred Health Care. Under current 
law, veterans entering the VA health care system who have 
served in combat zones are automatically placed in priority 
category 6 until they receive a rating for a service-connected 
disability or until two years from the date of their discharge 
from active duty. Those who are determined to have a service-
connected disability are reassigned to the highest priority 
categories--1, 2, or 3. At the end of the two-year period, all 
others are moved to the lowest priority categories--7 or 8--
depending on their level of income. Veterans in those lowest 
two categories generally pay higher copayments for treatments 
and medications than veterans in the higher priority 
categories.
    Section 201 would extend the period during which combat 
veterans can receive care in priority category 6--from the 
current two years from their date of discharge to five years. 
Thus, under this bill, veterans currently in category 6 would 
be allowed to remain at that priority level for an extra three 
years. Veterans who had already been reassigned to category 7 
or 8, but had been discharged within the last five years, would 
be returned to category 6 for whatever remained of that five-
year period. And combat veterans who had not yet sought care 
from VA would have up to three additional years to enter the 
health care system.
    CBO estimates that enacting this provision would cause 
about 4,500 new combat veterans to enroll in the VA health care 
program in 2008, and 9,000 to enroll in 2009. Thereafter, 
however, CBO estimates that only a few hundred would enter each 
year and receive the additional benefit, as the number of 
combat veterans being discharged from active duty is expected 
to decline. Based on information from VA, CBO estimates that 
the cost of treating those additional veterans would be about 
$12 million in 2008, but that those same veterans would pay VA 
an additional $2 million that year in copayments. (For injuries 
or illnesses that are obviously not 
service-connected, such as those from a recent car accident or 
a bout with the flu, VA charges copayments.) Over the 2008-2012 
period, CBO estimates that treatment of those veterans would 
increase costs by $120 million. During this same period, CBO 
estimates VA would receive additional copayments of about $25 
million, which reduce the net level of appropriations necessary 
for health care.
    CBO also estimates that, under this provision, VA would 
lose about $1 million each year in copayments from veterans who 
would be in priority category 6 rather than priority category 7 
or 8. Veterans in the lowest two categories have no service-
connected conditions and are charged copayments for all 
treatments. When veterans in priority category 6 seek 
treatment, their medical condition is assumed to be related to 
their military service--unless that is obviously not the case--
and as a result, they are not charged copayments for those 
treatments. Thus, CBO estimates the total net cost of 
implementing section 201 would be about $10 million in 2008 and 
about $100 million over the 2008-2012 period, assuming 
appropriation of the necessary amounts.
    Help for Very-Low-Income Veterans. Section 406 would 
authorize the appropriation of a total of $63 million over 
three years to provide financial assistance to qualified 
nonprofit organizations and consumer cooperatives that provide 
supportive services to very-low income veterans who live in 
permanent housing, with preference given to those entities that 
help veterans make a transition from homelessness to permanent 
housing. Very-low-income veterans would be defined as those 
having an income that is less than half of the median income 
for the area in which the veteran lives. The authorized funding 
would support a wide array of services, including outreach, 
health care, counseling, transportation, assistance with daily 
living, and assistance in obtaining veterans benefits and other 
public benefits, among others. It also would support technical 
assistance from VA to the nonprofit organizations for the 
planning and provision of services to veterans. CBO estimates 
that implementing this section would cost $14 million in 2008 
and $63 million over the 2008-2012 period.
    Traumatic Brain Injury Program. Section 104 would require 
VA to establish a program to provide neurologic rehabilitation 
to veterans with severe traumatic brain injury. The program 
would include research, education, and clinical care and would 
be done in collaboration with the Defense and Veterans Brain 
Injury Center--a program funded by the Department of Defense 
and operated in conjunction with VA and a private neuro-care 
center in Virginia. Section 104 would authorize the 
appropriation of $10 million each year from 2008 through 2012 
to carry out this program. CBO estimates that implementing this 
provision would cost $9 million in 2008 and $49 million over 
the 2008-2012 period.
    Assisted Living Pilot Program. Section 105 would require VA 
to carry out a five-year pilot program in at least four parts 
of the country to provide assisted living services to enhance 
the rehabilitation, quality of life, and community integration 
of veterans with traumatic brain injury. S. 1233 would 
authorize the appropriation of $8 million each year from 2008 
through 2013 to implement and run the pilot program. CBO 
estimates that section 105 would cost $7 million in 2008 and 
$39 million over the 2008-2012 period.
    Rural Veterans Transportation. Section 304 would authorize 
the appropriation of $6 million each year from 2008 through 
2012 to provide grants to organizations that would assist 
veterans in rural areas to travel to VA medical facilities. 
Eligible entities would include state veterans agencies and 
nonprofit organizations. CBO estimates that implementing this 
section would cost $5 million in 2008 and $29 million over the 
2008-2012 period.
    Copayments for the Catastrophically Disabled. Section 303 
would prohibit the collection of copayments and other fees from 
catastrophically disabled veterans who receive medical or 
nursing home care from VA. Data from VA shows that the 
Department collected about $6 million in medical care and 
nursing home fees in 2006 from catastrophically disabled 
veterans, who are priority category 4 veterans because their 
disabilities are not related to military service. Because those 
copayments and fees are not linked to any inflation index and 
the population of those veterans has been relatively stable 
over the last several years, CBO estimates that implementing 
this provision would decrease collections by $6 million per 
year. Such collections are offsets to discretionary 
appropriations. As part of the annual appropriations process, 
the Congress gives VA authority to spend those collections. 
Therefore, maintaining the same level of health care services 
for veterans would necessitate additional funding each year to 
make up for the loss of copayments under this bill. Thus, 
implementing section 303 would cost $6 million in 2008 and $30 
million over the 2008-2012 period.
    Veterans Released From Prison. VA is currently working with 
the Department of Labor (DOL) on a demonstration program to 
provide counseling and referrals to veterans leaving penal 
institutions who are at risk of becoming homeless. VA hires 
case managers to oversee the program while DOL administers the 
grants to nonprofit organizations that provide the counseling 
and referrals. Under current law, the program is being 
conducted at six sites and will expire on September 30, 2007. 
Section 403 would double the number of program sites and extend 
the authority through fiscal year 2011. CBO estimates that, in 
total, implementing this provision would cost about $1 million 
in 2008 and $15 million over the 2008-2012 period.
    Based on information from VA that six case managers would 
be needed to oversee the 12 sites at an average cost of $80,000 
per person, CBO estimates that such additional staff would cost 
VA less than $500,000 in 2008 and $2 million over the 2008-2012 

period.
    Under this program, DOL issued grants totaling over $1.6 
million in 2007 through nonprofit organizations to provide 
counseling and referral services to almost 1,000 veterans 
leaving penal institutions. CBO estimates that increasing the 
size of the program would increase costs for such grants by 
less than $500,000 in 2008 and by $13 million over the 2008-
2012 period.
    Homeless Demonstration Program. Section 402 would require 
VA to develop and implement a demonstration program to identify 
active-duty servicemembers who are at risk of becoming homeless 
after being discharged from the military and to provide 
referrals, counseling, and other supportive services to help 
prevent their homelessness. The program would have to be 
carried out in at least three locations and would expire at the 
end of September 2011. Section 402 would authorize the 
appropriation of $2 million for the program. CBO estimates that 
implementing section 402 would cost $1 million in 2008 and $2 
million over the 2008-2012 period.
    Hospice Copayments. Section 309 would prohibit VA from 
collecting copayments from veterans receiving hospice care. 
This prohibition would apply to care received at both inpatient 
and outpatient facilities. Depending upon where veterans get 
hospice care, copayments range from $15 per day to a maximum of 
$97 per day. Most veterans receiving this type of care from VA 
are not charged copayments--only veterans whose disabilities 
are unrelated to their military service and whose incomes are 
above a certain level are required to make copayments.
    Based on information from VA that fewer than 450 veterans 
made copayments averaging about $800 last year for hospice 
care, CBO estimates that implementing this provision would 
decrease collections by less than $500,000 each year and by 
about $2 million over the 2008-2012 period. Those collections 
are funding offsets to discretionary appropriations. As part of 
the annual appropriations process, the Congress gives VA 
authority to spend those collections. Therefore, maintaining 
the same level of health care services for veterans would 
necessitate additional funding each year to make up for the 
loss of copayments under this bill. Therefore, implementing 
section 309 would cost less than $500,000 in 2008 and about $2 
million over the 2008-2012 period.
    Homeless Providers Grant and Per Diem Program (GPD). VA's 
Homeless Providers Grant and Per Diem Program funds community-
based agencies providing services to homeless veterans. The GPD 
provides two levels of funding--capital grants and per diem 
payments. Capital grants can provide up to 65 percent of the 
cost of establishing or expanding a community program offering 
transitional housing assistance, meals, vocational counseling 
and training, and other related services to homeless veterans. 
Capital grants may not be used for salaries or other 
operational costs. GPD provided about $5 million in capital 
grants in 2006.
    Community agencies are also eligible for per diem payments, 
which fund operational costs. Per diem payment rates reflect 
the daily cost of services furnished to eligible veterans, but 
are reduced by the amounts of payments for similar purposes 
from other governmental agencies or private organizations. GPD 
distributed about $59 million in per diem payments to about 300 
agencies in 2006. The program has received funding of $92 
million for grants and payments in 2007.
    Section 404 would allow capital grants to be used to pay 
staff salaries, thus potentially increasing the dollar amount 
of the grants community agencies would be eligible to receive. 
In addition, section 401 would require that per diem payments 
not be reduced by the amounts of payments from other 
organizations. Based on the current usage of the grant and per 
diem program, CBO expects that implementing sections 401 and 
404 would probably increase discretionary outlays for capital 
grants and per diem payments by tens of millions of dollars a 
year. CBO cannot provide a more specific estimate because 
neither VA nor CBO can predict how the many community agencies 
would alter their requests for VA funding under these 
provisions.
    Other Provisions. There are several sections in S. 1233 
that would have an insignificant impact on discretionary 
spending. These provisions would require reports or plans or 
would authorize VA to do something it is already doing or 
planning to do, such as providing ageappropriate nursing home 
care or conducting research on traumatic brain injuries. Other 
sections that would have an insignificant impact on 
discretionary spending include:

     Section 203 would require VA to aggregate 
information from various sources on the quality of its medical 
centers and provide this information to the public on the 
Internet or through promotional literature.
     Section 204 would require VA to provide a mental 
health evaluation for certain war veterans within 30 days of 
receiving 
a request.
     Section 305 would require VA to establish a 
demonstration project to examine alternatives for expanding 
care for veterans in rural areas.
     Section 505 would designate a medical center in 
Augusta, Georgia, the ``Charlie Norwood Department of Veterans 
Affairs Medical Center.''

Direct spending

    Section 307 would increase the mileage rate used to 
reimburse certain veterans for travel to and from some 
appointments at VA facilities. (For more details on the travel 
benefits program and an estimate of the discretionary costs for 
implementing this provision, see the discussion under 
``Spending Subject to Appropriation.'') Veterans who travel to 
a required appointment to receive counseling and evaluation 
before beginning vocational rehabilitation are reimbursed at 17 
cents per mile. This section would link the veterans' mileage 
payment rate to the rate used by the federal government when 
reimbursing employees who travel in their personal vehicles for 
business when government vehicles are available for their use. 
That rate is currently 28.5 cents per mile and is increased at 
intervals to account for inflation.
    VA reports that it spends about $400,000 per year to 
reimburse veterans for traveling to appointments for vocational 
rehabilitation, which is a mandatory program. Increasing the 
mileage rate under this provision would increase spending by $1 
million over the 2008-2012 period and $3 million over the 2008-
2017 period.
    Intergovernmental and private-sector impact: S. 1233 
contains no intergovernmental or private-sector mandates as 
defined in the Unfunded Mandates Reform Act. State, local, and 
tribal governments that participate in programs to assist 
disabled or homeless veterans would benefit from research and 
new programs authorized in the bill. Any costs they might incur 
would result from complying with conditions of federal 
assistance.
    Previous CBO estimates: On May 21, 2007, CBO transmitted a 
cost estimate for H.R. 612, the Returning Servicemember VA 
Healthcare Insurance Act of 2007, as ordered reported by the 
House Committee on Veterans' Affairs on May 15, 2007. Section 
201 of S. 1233 is similar to H.R. 612, though it would not 
extend the benefit to those whose period of priority health 
care has already expired. Therefore, the estimated cost for 
section 201 is less than the cost for H.R. 612.
    On July 24, 2007, CBO transmitted a cost estimate for H.R. 
2623, a bill to amend title 38, United States Code, to prohibit 
the collection of copayments for all hospice care furnished by 
the Department of Veterans Affairs, as ordered reported by the 
House Committee on Veterans' Affairs on July 17, 2007. That 
bill would prohibit the collection of copayments for hospice 
care furnished by VA. Section 309 of S. 1233 is similar to H.R. 
2623 and the estimated costs are the same.
    On July 27, 2007, CBO transmitted a cost estimate for H.R. 
2874, the Veterans' Health Care Improvement Act of 2007, as 
ordered reported by the House Committee on Veterans' Affairs on 
July 17, 2007. Sections 304, 403, and 406 of S. 1233 are 
similar to provisions found in H.R. 2874. Section 406 of S. 
1233 and section 9 of H.R. 2874 would provide funding to 
organizations that help very-low-income veterans, though each 
bill would authorize appropriations of different amounts each 
year for the new program. Section 304 of S. 1233 and section 3 
of H.R. 2874 would establish grants for organizations that 
provide transportation to veterans in rural areas in need of 
medical care, though S. 1233 would authorize a higher amount of 
funding. Section 403 of S. 1233 and section 7 of H.R. 2874 
would expand a program to help veterans leaving penal 
institutions. Differences in the estimated costs for these 
provisions reflect differences in the bills.
    On August 21, 2007, CBO transmitted a revised cost estimate 
for H.R. 760, the Filipino Veterans Equity Act of 2007, as 
ordered reported by the House Committee on Veterans' Affairs on 
July 18, 2007. Both section 5 of H.R. 760 and section 307 of S. 
1233 would increase the milage rate of the travel benefit for 
veterans receiving certain kinds of care. However, the increase 
under H.R. 760 would be more generous than under S. 1233. The 
provision in H.R. 760 would eliminate the deductible while the 
one in S. 1233 would only freeze the deductible. The estimated 
costs of the two provisions differ for those reasons.
    Estimate prepared by: Federal Costs: Michelle S. Patterson 
(226-2840); Impact on State, Local, and Tribal Governments: 
Lisa Ramirez-Branum (225-3220); Impact on the Private Sector: 
Victoria Liu (226-2900).
    Estimate approved by: Peter H. Fontaine, Assistant Director 
for Budget Analysis.

                      Regulatory Impact Statement

    In compliance with paragraph 11(b) of rule XXVI of the 
Standing Rules of the Senate, the Committee on Veterans' 
Affairs has made an evaluation of the regulatory impact that 
would be incurred in carrying out the Committee bill. The 
Committee finds that the Committee bill would not entail any 
regulation of individuals or businesses or result in any impact 
on the personal privacy of any individuals and that the 
paperwork resulting from enactment would be minimal.

                 Tabulation of Votes Cast in Committee

    In compliance with paragraph 7 of rule XXVI of the Standing 
Rules of the Senate, the following is a tabulation of votes 
cast in person or by proxy by Members of the Committee on 
Veterans' Affairs at its June 27, 2007 meeting. On that date, 
the Committee ordered S. 1233 reported favorably to the Senate, 
by voice vote.
    On that date, the Committee considered the Craig amendment 
on Priority 8 veterans, to modify the underlying statute by 
requiring Secretarial certification prior to any change to 
enrollment that enrollment of Priority 8 veterans will not have 
a detrimental effect on access to and quality of care provided 
to veterans, and that the Department has sufficient staff, 
facilities, and equipment to provide quality care to all 
enrolled veterans. The Craig amendment was defeated by a 5 to 
10 vote.


----------------------------------------------------------------------------------------------------------------
                Yeas                                 Senator                                 Nays
----------------------------------------------------------------------------------------------------------------
                                     Mr. Rockefeller                                                          X
                                     Ms. Murray                                                               X
                                     Mr. Obama                                                          X PROXY
                                     Mr. Sanders                                                              X
                                     Mr. Brown                                                          X PROXY
                                     Mr. Webb                                                           X PROXY
                                     Mr. Tester                                                               X
                                 X   Mr. Craig
                                     Mr. Specter                                                        X PROXY
                                 X   Mr. Burr
                                     Mr. Isakson                                                              X
                           X PROXY   Mr. Graham
                           X PROXY   Ms. Hutchison
                           X PROXY   Mr. Ensign
                                     Mr. Chairman                                                             X
----------------------------------------------------------------------------------------------------------------
                                 5   TALLY                                                                   10
----------------------------------------------------------------------------------------------------------------


   SUPPLEMENTAL VIEWS OF HON. LARRY E. CRAIG, RANKING MEMBER, SENATE 
                      VETERANS' AFFAIRS COMMITTEE

    The underlying legislation provides many important 
provisions that will improve the health care services and 
benefits available to America's veterans. I am particularly 
pleased that Title I takes many important steps towards 
improving the care provided to those veterans suffering with a 
traumatic brain injury.
    However, in a few areas, I believe the legislation not only 
fails to improve the current benefits and health care system 
available for veterans, it in fact dilutes certain benefits 
available for service-connected veterans and may undermine the 
access and quality of care provided to the current users of 
VA's health care system.
    Let me explain my concerns.

          Repeal of the Regulation Concerning the Enrollment 
                         of Priority 8 Veterans

    The underlying legislation repeals a regulation issued by 
former Secretary of Veterans Affairs, Anthony J. Principi, 
concerning enrollment priorities. That regulation prohibited 
enrollment into VA's health care system by any veteran in 
Priority 8 status who had not enrolled prior to January 17, 
2003. At the time Secretary Principi announced the new 
regulation, a VA news release stated:

        VA has been unable to provide all enrolled veterans 
        with timely access to health care services because of 
        the tremendous growth in the number of veterans seeking 
        VA health care. . . .

        In order to ensure VA has capacity to care for veterans 
        for whom our Nation has the greatest obligation--[those 
        with] military-related disabilities, lower-income 
        veterans or those needing specialized care like 
        veterans who are blind or have spinal cord injuries--
        Principi has suspended additional enrollments for 
        veterans with the lowest statutory priority. This 
        category includes veterans who are not being 
        compensated for a military-related disability and who 
        have higher incomes.

    Since that decision was rendered, many Veterans Service 
Organizations and individual veterans have advocated re-opening 
the health care system to all veterans. However, none has 
advocated abolishing the priority system developed under the 
Eligibility Reform Act of 1996, which was the basis for 
Principi's decision in 2003. Continuing that trend, the 
underlying bill does not repeal the eligibility prioritization 
structure created under the 1996 law.
    Given that the statutory priorities for health care 
enrollment still exist, it would be reasonable to presume that 
the majority had made a determination that VA was now providing 
all currently enrolled veterans with timely access to quality 
health care. And therefore the conditions which drove Secretary 
Principi's earlier decision (an inability to provide enrolled 
veterans with timely access to health care services) no longer 
existed. The record, however, does not suggest that such a 
conclusion has been reached by the majority.
    Instead, the record shows many Senators expressing concerns 
about servicemembers returning from Iraq and Afghanistan 
facing--what are often described as--lengthy waiting times for 
care. In the face of such assessments, I do not understand how 
the majority could suggest that opening up the health care 
system to 
hundreds-of-thousands--if not millions--of new patients is wise 
policy.
    Moreover, it appears that the provision in this bill would 
open VA to new enrollees on the day the legislation is signed 
into law. There is no plan required to ensure that the 
enrollment process would be orderly and executed in a way that 
would minimize its effect on current patients. Nor is there any 
requirement that the necessary funding be available prior to 
its implementation. Instead, VA would simply open the doors and 
wait to see who arrives. I believe that is irresponsible and 
unfair to the current enrollees.
    That is not just my view. Rather, my opinion echoes that of 
the Disabled American Veterans who, while commenting on the 
issue of re-opening VA to priority 8's, stated that ``without a 
major infusion of new funding, enactment of this bill [S. 1147] 
would worsen VA's financial situation, not improve it, and 
would likely have a negative impact on the system as a whole.''
    To address my concerns, I offered an amendment during the 
Committee's consideration of the legislation. My amendment 
would have required Secretarial certification of three facts 
prior to enrollment being deemed ``open.''
    First, the Secretary would have had to certify that quality 
of care and access thereto for enrolled veterans in Priority 
groups 1-6 would not be adversely affected by the newer 
patients. Because current law treats those veterans as a higher 
priority, I believe that VA must demonstrate conclusively that 
it is already offering high quality, timely care to our 
service-connected and lower income veterans. As I've already 
stated, recent observations and statements by some Senators 
suggest otherwise.
    Second, the Secretary would have had to certify that troops 
returning from Iraq and Afghanistan were provided timely, high 
quality health care already and that such timeliness and 
quality would not suffer because of newer enrollees. In my 
view, VA's health care system was created primarily for the 
purpose of caring for ``he who shall have borne the battle.'' 
Congress should ensure that this unique group of veterans is 
not unduly burdened by any new influx of higher income veterans 
with no military-related disabilities.
    Finally, my amendment would have required that the 
Secretary certify to Congress that VA had the capability to see 
a large influx of new patients. My amendment asked for an 
assessment as to whether VA had the physical infrastructure, 
human resources, and medical equipment to treat any new influx 
of veterans.
    I recognize that many Senators believe that money is the 
only obstacle to providing all veterans with health care 
through VA. However, any money provided for new patients would 
be used to buy new staff, new equipment, and new space. 
Therefore, I felt it was important to know whether each of 
those three goods or services was possible to obtain.
    The issue of whether VA has the capability to hire new 
staff alone should give any Senator pause in supporting the 
expansion in this legislation. It is widely known that the 
Nation is struggling to provide a stable supply of primary care 
physicians and nurses to provide basic health care services in 
non-VA facilities. This issue was made clear in a July 2007 
report from the Health Research Institute of 
PricewaterhouseCoopers which showed that the United States will 
be short nearly one million nurses and 24,000 physicians by 
2020. In that environment, simply finding new staff to hire 
will be a challenge for any health care system, including VA.
    Further, assuming the requisite staff can be found, I 
remain skeptical that VA has the necessary clinical space in 
which to provide more primary and specialty care services. I am 
also equally skeptical that many VA facilities could open the 
additional operating rooms, post-surgical recovery units, and 
intensive care units that would be required with a large 
increase in patients.
    My amendment failed in Committee. Still, while the answers 
to the questions may not be required by law prior to opening 
the health care system to all veterans, I continue to believe 
it would be a mistake to proceed without the knowledge set 
forth in my amendment. As such, I oppose Section 301 of the 
bill.

               Repeal of Inpatient Copayment Requirement 
                         on Priority 4 Veterans

    The underlying legislation also contains a provision 
waiving required inpatient care copayments for Priority 4 
veterans with higher incomes. I have concerns with this 
provision as well.
    Under current law, veterans rated at 50 percent or more 
service-connected disabled do not pay copayments for medical 
care. In addition, VA charges no copayment if the care provided 
is for the treatment of a service-connected condition. Veterans 
classified as Priority 4, by definition, have no service-
related disabilities. Finally, there is no medical copayment 
charged if the veteran qualifies as a Priority 5 due to limited 
financial resources.
    It is important to note that Priority 5 qualification does 
not mean one must be placed in Priority 5 in order to qualify 
for cost-free care. For example, a veteran with a 10 percent 
disability rating would be placed in Priority group 3 under the 
current system. As noted above, the veteran would pay no 
copayments for the treatment of his or her service-connected 
disability. If the same veteran had an income level that would 
place him or her in Priority 5 if not for the 10 percent 
rating, then VA would charge no copayment to the veteran when 
he or she receives care for non-service-
connected conditions. Otherwise, the veteran would pay 
copayments for non-service-connected care.
    This same analysis applies to Priority 4 veterans who would 
be Priority 5 if not for the catastrophic disability. As such, 
the provision in this bill relieves only higher income Priority 
4 veterans from the copayment requirement.
    The problem I have is that with passage of this provision, 
VA will have a policy of charging service-connected disabled 
veterans with higher incomes a copayment for the care of a non-
service-
connected condition. But, VA will not charge higher income 
veterans for the treatment of non-service-connected conditions 
if the veteran is catastrophically disabled.
    I recognize that veterans with catastrophic disabilities 
face innumerable challenges each and everyday. In fact, it is 
for this reason that I strongly support the current law which 
provides premium-free access to VA's health care system, 
including its nationally recognized spinal cord injury and 
blind rehabilitation programs to those afflicted with a 
catastrophic impairment. Still, I believe there must be 
reasonable lines drawn in the allocation of VA's benefits. I 
believe a copayment is that reasonable line.
    A grateful nation has seen fit to provide cost-free care 
for service-connected conditions. And a generous nation has 
extended the same benefit to those with limited economic means. 
Unfortunately, with this provision, it is no longer relevant to 
this Committee whether one can afford to contribute even 
modestly to the cost of their care. Rather, cost-free care is 
now provided to a population of patients based solely their 
health status. That is a bad 
precedent.
    If this legislation passes, I believe that in the not too 
distant future, it will be strongly argued by higher income, 
service-connected veterans that their benefit (cost free care 
for service-connected conditions) has been diluted. And the 
dilution is not fair because now they are charged for non-
service-connected care when those with similar economic means 
in Priority 4 are not forced to make copayments for the same 
type of care. With this provision as precedent, a future 
Congress will be forced to concede to the dilution and its 
unfairness. Then they will probably be forced to accede to the 
change.
    For these reasons I oppose Section 303 of the bill.

                   Rural Transportation Grant Program

    The underlying bill also contains a provision that would 
create a VA rural transportation grant program. Under the plan, 
VA is authorized to spend up to $6 million per year for five 
years providing grants of up to $50,000 to: State veterans' 
service agencies; veterans' service organizations; or qualified 
community transportation organizations. The legislation does 
not require the recipient to provide any matching funds.
    As a Senator from a largely rural State, I fully understand 
the challenges facing veterans (and others) who live in remote 
areas far from health care providers. However, I simply cannot 
defend the creation of an entire rural transportation system 
dedicated solely to providing transportation to veterans as a 
remedy to that problem.
    First, a transportation program, such as the one proposed 
in this bill, is well outside the boundaries of VA's basic 
mission of providing care and compensatory benefits to veterans 
of the Armed Forces. In fact, it is so far from VA's mission, 
that Congress has created an entirely separate federal agency--
the U.S. Department of Transportation--to undertake that 
mission for the public at large. If an entirely new 
transportation program is warranted, I believe managing the 
creation of the new program belongs with the Department of 
Transportation.
    Second, while transportation is not VA's mission, that does 
not mean Congress has not recognized that it is an element 
necessary to consider when attempting to provide health care to 
veterans. As such, Congress has created a mileage reimbursement 
program for service-connected disabled veterans, which 
reimbursement rate this legislation raises.
    Further, VA and Congress strongly and actively support the 
volunteer van program operated by the Disabled American 
Veterans. Under the van program, DAV has donated over 1,800 
vans to VA at a cost of $20 million. Further, the organization 
has matched those vans with nearly $40 million in volunteer 
driver services. VA's ownership of the vans helps address 
difficult insurance questions and the voluntary nature of the 
program helps to ensure the program's benevolent purpose--
helping veterans--remains its focus.
    I fear that the program created under this legislation will 
ultimately undermine the charitable endeavor represented by 
DAV's van program.
    For these reasons I oppose Section 304 of this bill.

          Changes in Existing Law Made by the Committee Bill, 
                              as Reported

    In compliance with rule XXVI paragraph 12 of the Standing 
Rules of the Senate, changes in existing law made by the 
Committee bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italic, existing law in which no change is 
proposed is shown in roman):

                      TITLE 38--VETERANS' BENEFITS

                       PART I--GENERAL PROVISIONS

                           CHAPTER 1--GENERAL

SEC. 101. DEFINITIONS.

           *       *       *       *       *       *       *


    (34) The term `Post 9/11 Global Operations' means the 
period of the Persian Gulf War beginning on September 11, 2001, 
and ending on the date thereafter prescribed by Presidential 
proclamation or by law.

           *       *       *       *       *       *       *


SEC. 111. PAYMENTS OR ALLOWANCES FOR BENEFICIARY TRAVEL.

           *       *       *       *       *       *       *


    (c)(1) * * *
    (2) In the case of a person who is determined by the 
Secretary to be a person who is required to make six or more 
one-way trips for needed examination, treatment, or care during 
the remainder of the calendar month in which the determination 
is made or during any subsequent calendar month during the one-
year period following the last day of the month in which the 
determination is made, the amount deducted by the Secretary 
pursuant to paragraph (1) of this subsection from payments for 
trips made to or from such facility during any such month shall 
not [, except as provided in paragraph (5) of this subsection,] 
exceed $18.

           *       *       *       *       *       *       *

    [(5) Whenever the Secretary increases or decreases the 
rates of allowances or reimbursement to be paid under this 
section, the Secretary shall, effective on the date on which 
such increase or decrease takes effect, adjust proportionately 
the dollar amounts specified in paragraphs (1) and (2) of this 
subsection as such amounts may have been increased or decreased 
pursuant to this paragraph before such date.]

           *       *       *       *       *       *       *

    (g)(1) [In carrying out the purposes of this section, the 
Secretary, in consultation with the Administrator of General 
Services, the Secretary of Transportation, the Comptroller 
General of the United States, and representatives of 
organizations of veterans, shall conduct periodic 
investigations of the actual cost of travel (including lodging 
and subsistence) to beneficiaries while traveling to or from a 
Department facility or other place pursuant to the provisions 
of this section, and the estimated cost of alternative modes of 
travel, including public transportation and the operation of 
privately owned vehicles. The Secretary shall conduct such 
investigations immediately following any alteration in the 
rates described in paragraph (3)(C) of this subsection, and, in 
any event, immediately following the enactment of this 
subsection and not less often than annually thereafter, and 
based thereon, shall determine rates of allowances or 
reimbursement to be paid under this section.] Subject to 
paragraph (3), in determining the amount of allowances or 
reimbursement to be paid under this section, the Secretary 
shall use the mileage reimbursement rate for the use of 
privately owned vehicles by Government employees on official 
business (when a Government vehicle is available), as 
prescribed by the Administrator of General Services under 
section 5707(b) of title 5.

           *       *       *       *       *       *       *

    (3) Subject to the availability of appropriations, the 
Secretary may modify the amount of allowances or reimbursement 
to be paid under this section using a mileage reimbursement 
rate in excess of that prescribed under paragraph (1).
    [(3) In conducting investigations and determining rates 
under this section, the Secretary shall review and analyze, 
among other factors, the following factors:
          [(A)(i) Depreciation of original vehicle costs;
          [(ii) gasoline and oil costs;
          [(iii) maintenance, accessories, parts, and tire 
        costs;
          [(iv) insurance costs; and
          [(v) State and Federal taxes.
          [(B) The availability of and time required for public 
        transportation.
          [(C) The per diem rates, mileage allowances, and 
        expenses of travel authorized under sections 5702 and 
        5704 of title 5 for employees of the United States.]
    [(4) Before determining rates or adjusting amounts under 
this section and not later than sixty days after any alteration 
in the rates described in paragraph (3)(C) of this subsection, 
the Secretary shall submit to the Committees on Veterans' 
Affairs of the House of Representatives and the Senate a report 
containing the rates and amounts the Secretary proposes to 
establish or continue with a full justification therefor in 
terms of each of the limitations and factors set forth in this 
section.]

           *       *       *       *       *       *       *


CHAPTER 5--AUTHORITY AND DUTIES OF THE SECRETARY

           *       *       *       *       *       *       *


Sec.
530A. Annual report on veterans and the provision to veterans of 
            benefits and services by the Department.

Subchapter II--Specified Functions

           *       *       *       *       *       *       *



SEC. 530A. REPORT ON VETERANS AND THE PROVISION TO VETERANS OF BENEFITS 
                    AND SERVICES BY THE DEPARTMENT.

    (a) Annual Report Required.--(1) Not later than 90 days 
after the end of the fiscal year in which this section is 
enacted and every fiscal year thereafter, the Secretary shall 
submit to the appropriate committees of Congress a report on 
veterans and the provision to veterans of benefits and services 
under the laws administered by the Secretary.
    (2) Each report required by paragraph (1) shall provide the 
information specified in subsection (c), current as of the last 
day of the fiscal year for which the report is submitted.
    (b) Quarterly Report Required.--(1) Not later than 60 days 
after the end of the first quarter following the date on which 
this section is enacted and quarterly thereafter, the Secretary 
shall submit to the appropriate committees of Congress a report 
on the claims of veterans for service-connected compensation 
under section 1114 of this title.
    (2) Each report required by paragraph (1) shall provide the 
information specified in subparagraphs (A) and (F) of 
subsection (c)(2), current as of the last day of the quarter 
for which the report is submitted.
    (c) Covered Information.--The information specified in this 
subsection for a report under subsection (a) is information on 
veterans and the provision to veterans of benefits and services 
under the laws administered by the Secretary as follows:
          (1) For each covered tour of duty category, 
        aggregated personal information on veterans provided 
        benefits and services under the laws administered by 
        the Secretary, including demographic information as 
        follows:
                  (A) Sex.
                  (B) Age.
                  (C) Marital status (whether married, single, 
                separated, or divorced).
                  (D) Residence (by State, territory, or 
                country).
                  (E) Armed Force, as of the date of discharge 
                or separation.
                  (F) Service as a member of a regular 
                component of the Armed Forces or as a Reserve 
                (including whether National Guard or Reserve).
                  (G) Separation status.
          (2) For each covered tour of duty category, 
        aggregated information on the compensation, pension, 
        and other benefits and services provided by the 
        Department to veterans, or provided with respect to 
        such veterans as the case may be, including the 
        following:
                  (A) The claims of such veterans for service-
                connected compensation under section 1114 of 
                this title, including the following set forth 
                by:
                          (i) The number of such claims 
                        received.
                          (ii) The number of such claims 
                        processed.
                          (iii) The number of such claims 
                        pending.
                          (iv) The number of such claims 
                        granted.
                          (v) The number of such claims denied.
                          (vi) The number of such claims with a 
                        combined disability rating of 10 
                        percent or more.
                  (B) The amount of such compensation paid to 
                such veterans, stated as an average monthly 
                amount of such veterans receiving such 
                compensation set forth by the following:
                          (i) Such veterans with a disability 
                        rating of zero percent.
                          (ii) Such veterans with a disability 
                        rating of 10 percent.
                          (iii) Such veterans with a disability 
                        rating of 20 percent.
                          (iv) Such veterans with a disability 
                        rating of 30 percent.
                          (v) Such veterans with a disability 
                        rating of 40 percent.
                          (vi) Such veterans with a disability 
                        rating of 50 percent.
                          (vii) Such veterans with a disability 
                        rating of 60 percent.
                          (viii) Such veterans with a 
                        disability rating of 70 percent.
                          (ix) Such veterans with a disability 
                        rating of 80 percent.
                          (x) Such veterans with a disability 
                        rating of 90 percent.
                          (xi) Such veterans with a disability 
                        rating of 100 percent.
                          (xii) Such veterans paid special 
                        monthly compensation under any of 
                        subsections (k) through (s) of section 
                        1114 of this title.
                  (C) The claims for dependency and indemnity 
                compensation under chapter 13 of this title, 
                with respect to such veterans, including the 
                following:
                          (i) The number of such claims 
                        received.
                          (ii) The number of such claims 
                        processed.
                          (iii) The number of such claims 
                        pending.
                          (iv) The number of such claims 
                        granted.
                          (v) The number of such claims denied.
                  (D) The amount of such dependency and 
                indemnity compensation paid with respect to 
                survivors of such veterans, stated as an 
                average monthly amount.
                  (E) The number of such survivors who have one 
                or more dependent children under the age of 18 
                and who receive additional benefits under 
                section 1311(f) of this title by reason 
                thereof.
                  (F) The claims for pension under chapter 15 
                of this title, for or with respect to such 
                veterans, including the following:
                          (i) The number of such claims 
                        received.
                          (ii) The number of such claims 
                        processed.
                          (iii) The number of such claims 
                        pending.
                          (iv) The number of such claims 
                        granted.
                          (v) The number of such claims denied.
                  (G) The amount of such pension paid for or 
                with respect to such veterans, stated as an 
                average monthly amount set forth by whether 
                such veterans have--
                          (i) no eligible dependents;
                          (ii) one or more dependents;
                          (iii) benefits paid at the house 
                        bound rate; and
                          (iv) benefits paid at the rate for 
                        aid and attendance.
          (3) For each covered tour of duty category, 
        aggregated information on the use of vet centers by 
        veterans, including the number of veterans using 
        services of vet centers set forth by whether such 
        veterans are members of the National Guard or the 
        Reserves.
          (4) For each covered tour of duty category, 
        aggregated information on the provision to veterans of 
        health care services by the Veterans Health 
        Administration, set forth by the following:
                  (A) Whether the services provided were 
                inpatient or outpatient services.
                  (B) Aggregate information about such veterans 
                served, including the number of such veterans 
                set forth by the following:
                          (i) Sex.
                          (ii) Age.
                          (iii) Armed Force, as of the date of 
                        discharge or separation.
                          (iv) Service as a member of a regular 
                        component of the Armed Forces or as a 
                        Reserve (including whether National 
                        Guard or Reserve).
                  (C) Where such services were provided, 
                including whether such services were provided 
                in a hospital, vet center, or a specialty care 
                facility such as a polytrauma center.
          (5) For each covered tour of duty category, 
        aggregated information on mental health disorders of 
        veterans, including the number of veterans who after 
        December 31, 2002, have been diagnosed or treated for 
        one or more of the following:
                  (A) Post-traumatic stress disorder.
                  (B) Depressive disorders.
                  (C) Neurotic disorders.
                  (D) Substance use disorders.
                  (E) Acute reaction to stress.
                  (F) Such other mental disorders as the 
                Secretary considers appropriate.
    (d) Protection of Identities.--The Secretary shall take 
appropriate actions in preparing and submitting reports under 
this section to ensure that no personally identifying 
information on any particular veteran is included or otherwise 
improperly released in such reports.
    (e) Definitions.--In this section:
          (1) The term `appropriate committees of Congress' 
        means--
                  (A) the Committees on Armed Services, 
                Appropriations, and Veterans' Affairs of the 
                Senate; and
                  (B) the Committees on Armed Services, 
                Appropriations, and Veterans' Affairs of the 
                House of Representatives.
          (2) The term `duty in the Post 9/11 Global Operations 
        theater' means service in the active military, naval, 
        or air service during the Post 9/11 Global Operations 
        in a location (including the airspace above) as 
        follows:
                  (A) Afghanistan.
                  (B) Iraq.
                  (C) Any geographic location specified for an 
                award of the Global War on Terrorism 
                Expeditionary Medal to members of the Armed 
                Forces.
          (3) The term `covered tour of duty category' means 
        the following:
                  (A) Deployment in only in Afghanistan.
                  (B) Deployment in only in Iraq.
                  (C) Deployment in both Afghanistan and Iraq.
                  (D) Duty in the Post 9/11 Global Operations 
                theater other than in Afghanistan or Iraq.
                  (E) Any other duty not covered by 
                subparagraphs (A) through (D).
          (4) The term `vet center' means a center for the 
        provision of readjustment counseling and related mental 
        health services under section 1712A of this title.

           *       *       *       *       *       *       *


                       PART II--GENERAL BENEFITS

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

           *       *       *       *       *       *       *


Sec.
1710C. Traumatic brain injury: plans for rehabilitation and 
            reintegration into the community.
1710D. Traumatic brain injury: use of non-Department facilities 
            for rehabilitation.
    * * *
1730A. Hospital Quality Report Card Initiative.

           *       *       *       *       *       *       *


                         Subchapter I--General


SEC. 1702. PRESUMPTION RELATING TO [PSYCHOSIS] MENTAL 
                    ILLNESS.

    For the purposes of this chapter, any veteran of World War 
II, the Korean conflict, the Vietnam era, or the Persian Gulf 
War who developed an active [psychosis] mental illness (1) 
within two years after discharge or release from the active 
military, naval, or air service, and (2) before July 26, 1949, 
in the case of a veteran of World War II, before February 1, 
1957, in the case of a veteran of the Korean conflict, before 
May 8, 1977, in the case of a Vietnam era veteran, or before 
the end of the two-year period beginning on the last day of the 
Persian Gulf War, in the case of a veteran of the Persian Gulf 
War, shall be deemed to have incurred such disability in the 
active military, naval, or air service.

           *       *       *       *       *       *       *


SEC. 1705. MANAGEMENT OF HEALTH CARE: PATIENT ENROLLMENT SYSTEM.

           *       *       *       *       *       *       *


    (d)(1) In operating the system of annual patient enrollment 
in accordance with subsection (a), the Secretary shall, not 
later than August 1 of each year, publish in the Federal 
Register notice of which categories of veterans the Secretary 
has determined will be eligible to be enrolled in the next 
fiscal year beginning after such publication.
    (2)(A) If, in a notice published in accordance with 
paragraph (1), the Secretary proposes to restrict the 
categories of veterans to be eligible to be enrolled in the 
system of annual patient enrollment in a fiscal year, the 
Secretary shall, on the same date that such notice is 
published, submit to the Committee on Veterans' Affairs of the 
Senate and the Committee on Veterans' Affairs of the House of 
Representatives a report setting forth an estimate of the 
difference between--
          (i) the cost to the Department in such fiscal year of 
        enrolling in such system any veterans who would 
        otherwise be enrolled if not for the operation of such 
        restriction, and
          (ii) the cost to the Department in such fiscal year 
        of enrolling veterans as proposed by the Secretary in 
        such notice.
    (B) The Secretary may not implement any restriction on the 
categories of veterans eligible to be enrolled in a fiscal year 
until 45 days after the date on which the report on such 
restriction under subparagraph (A) is submitted under that 
subparagraph.

           *       *       *       *       *       *       *


  Subchapter II--Hospital, Nursing Home, Domiciliary Care and Medical 
                               Treatment


SEC. 1710. ELIGIBILITY FOR HOSPITAL, NURSING HOME, AND DOMICILIARY CARE

           *       *       *       *       *       *       *


    (a)(1) * * *
    (4) The requirement in paragraphs (1) and (2) that the 
Secretary furnish hospital care and medical services, the 
requirement in section 1710A(a) of this title that the 
Secretary provide nursing home care, the requirement in section 
1710B of this title that the Secretary provide a program of 
extended care services, the requirement in section 1710D of 
this title that the Secretary provide certain intervention, 
rehabilitative treatment, or services, and the requirement in 
section 1745 of this title to provide nursing home care and 
prescription medicines to veterans with service-connected 
disabilities in State homes shall be effective in any fiscal 
year only to the extent and in the amount provided in advance 
in appropriations Acts for such purposes.

           *       *       *       *       *       *       *

    (e)(3) * * *
          (C) in the case of care for a veteran described in 
        paragraph(1)(D), after a period of [2 years] 5 years 
        beginning on the date of the veteran's discharge or 
        release from active military, naval, or air service; 
        and

           *       *       *       *       *       *       *

    (f)(1) * * *
    (6) This subsection does not apply to hospital care or 
nursing home care that constitute hospice care.
    (g)(1) * * *
    (4) This subsection does not apply to medical services that 
constitute hospice care.
    (h) Notwithstanding any other provision of this section, a 
veteran who is catastrophically disabled shall not be required 
to make any payment otherwise required under subsection (f) or 
(g) for the receipt of hospital care or nursing home care under 
this section.
    [(h)] (i) Nothing in this section requires the Secretary to 
furnish care to a veteran to whom another agency of Federal, 
State, or local government has a duty under law to provide care 
in an institution of such government.

           *       *       *       *       *       *       *


SEC. 1710A. REQUIRED NURSING HOME CARE.

           *       *       *       *       *       *       *


    (c) The Secretary shall ensure that nursing home care 
provided under subsection (a) is provided in an age-appropriate 
manner.
    [(c)] (d) The provisions of subsection (a) shall terminate 
on December 31, 2008.

           *       *       *       *       *       *       *


SEC. 1710C. TRAUMATIC BRAIN INJURY: PLANS FOR REHABILITATION AND 
                    REINTEGRATION INTO THE COMMUNITY.

    (a) Plan Required.--The Secretary shall, for each veteran 
or member of the Armed Forces who receives inpatient or 
outpatient rehabilitation care from the Department for a 
traumatic brain injury--
          (1) develop an individualized plan for the 
        rehabilitation and reintegration of such individual 
        into the community; and
          (2) provide such plan in writing to such individual 
        before such individual is discharged from inpatient 
        care, following transition from active duty to the 
        Department for outpatient care, or as soon as 
        practicable following diagnosis.
    (b) Contents of Plan.--Each plan developed under subsection 
(a) shall include, for the individual covered by such plan, the 
following:
          (1) Rehabilitation objectives for improving the 
        physical, cognitive, and vocational functioning of such 
        individual with the goal of maximizing the independence 
        and reintegration of such individual into the 
        community.
          (2) Access, as warranted, to all appropriate 
        rehabilitative components of the traumatic brain injury 
        continuum of care.
          (3) A description of specific interventions, 
        rehabilitative treatments, and other services to 
        achieve the objectives described in paragraph (1), 
        which description shall set forth the type, frequency, 
        duration, and location of such interventions, 
        treatments, and services.
          (4) The name of the case manager designated in 
        accordance with subsection (d) to be responsible for 
        the implementation of such plan.
          (5) Dates on which the effectiveness of the plan will 
        be reviewed in accordance with subsection (f).
    (c) Comprehensive Assessment.--
          (1) In general.--Each plan developed under subsection 
        (a) shall be based upon a comprehensive assessment, 
        developed in accordance with paragraph (2), of--
                  (A) the physical, cognitive, vocational, and 
                neuropsychological and social impairments of 
                such individual; and
                  (B) the family education and family support 
                needs of such individual after discharge from 
                inpatient care.
          (2) Formation.--The comprehensive assessment required 
        under paragraph (1) with respect to an individual is a 
        comprehensive assessment of the matters set forth in 
        that paragraph by a team, composed by the Secretary for 
        purposes of the assessment from among, but not limited 
        to, individuals with expertise in traumatic brain 
        injury, including the following:
                  (A) A neurologist or neuropsychiatrist.
                  (B) A rehabilitation physician.
                  (C) A social worker.
                  (D) A neuropsychologist.
                  (E) A physical therapist.
                  (F) A vocational rehabilitation specialist.
                  (G) An occupational therapist.
                  (H) A speech language pathologist.
                  (I) A rehabilitation nurse.
                  (J) An educational therapist.
                  (K) An audiologist.
                  (L) A blind rehabilitation specialist.
                  (M) A recreational therapist.
                  (N) A low vision optometrist.
                  (O) An orthotist or prosthetist.
                  (P) An assistive technologist or 
                rehabilitation engineer.
                  (Q) An ophthalmologist.
                  (R) An otolaryngology physician.
                  (S) A dietician.
    (d) Case Manager.--(1) The Secretary shall designate a case 
manager for each individual described in subsection (a) to be 
responsible for the implementation of the plan, and 
coordination of such care, required by such subsection for such 
individual.
    (2) The Secretary shall ensure that such case manager has 
specific expertise in the care required by the individual to 
whom such case manager is designated, regardless of whether 
such case manager obtains such expertise through experience, 
education, or training.
    (e) Participation and Collaboration in Development of 
Plans.--(1) The Secretary shall involve each individual 
described in subsection (a), and the family or legal guardian 
of such individual, in the development of the plan for such 
individual under that subsection to the maximum extent 
practicable.
    (2) The Secretary shall collaborate in the development of a 
plan for an individual under subsection (a) with a State 
protection and advocacy system if--
          (A) the individual covered by such plan requests such 
        collaboration; or
          (B) in the case such individual is incapacitated, the 
        family or guardian of such individual requests such 
        collaboration.
    (3) In the case of a plan required by subsection (a) for a 
member of the Armed Forces who is on active duty, the Secretary 
shall collaborate with the Secretary of Defense in the 
development of such plan.
    (4) In developing vocational rehabilitation objectives 
required under subsection (b)(1) and in conducting the 
assessment required under subsection (c), the Secretary shall 
act through the Under Secretary for Health in coordination with 
the Vocational Rehabilitation and Employment Service of the 
Department of Veterans Affairs.
    (f) Evaluation.--
          (1) Periodic review by secretary.--The Secretary 
        shall periodically review the effectiveness of each 
        plan developed under subsection (a). The Secretary 
        shall refine each such plan as the Secretary considers 
        appropriate in light of such review.
          (2) Request for review by veterans.--In addition to 
        the periodic review required by paragraph (1), the 
        Secretary shall conduct a review of the plan of a 
        veteran under paragraph (1) at the request of such 
        veteran, or in the case that such veteran is 
        incapacitated, at the request of the guardian or the 
        designee of such veteran.
    (g) State Designated Protection and Advocacy System 
Defined.--In this section, the term `State protection and 
advocacy system' means a system established in a State under 
subtitle C of the Developmental Disabilities Assistance and 
Bill of Rights Act of 2000 (42 U.S.C. 15041 et seq.) to protect 
and advocate for the rights of persons with development 
disabilities.

SEC. 1710D. TRAUMATIC BRAIN INJURY: USE OF NON-DEPARTMENT 
                    FACILITIES FOR REHABILITATION.

    (a) In General.--Subject to section 1710(a)(4) of this 
title and subsection (b) of this section, the Secretary shall 
provide rehabilitative treatment or services to implement a 
plan developed under section 1710C of this title at a non-
Department facility with which the Secretary has entered into 
an agreement for such purpose, to an individual--
          (1) who is described in section 1710C(a) of this 
        title; and
          (2)(A) to whom the Secretary is unable to provide 
        such treatment or services at the frequency or for the 
        duration prescribed in such plan; or
          (B) for whom the Secretary determines that it is 
        optimal with respect to the recovery and rehabilitation 
        of such individual.
    (b) Standards.--The Secretary may not provide treatment or 
services as described in subsection (a) at a non-Department 
facility under such subsection unless such facility maintains 
standards for the provision of such treatment or services 
established by an independent, peer-reviewed organization that 
accredits specialized rehabilitation programs for adults with 
traumatic brain injury.
    (c) Authorities of State Protection and Advocacy Systems.--
With respect to the provision of rehabilitative treatment or 
services described in subsection (a) in a non-Department 
facility, a State designated protection and advocacy system 
established under subtitle C of the Developmental Disabilities 
Assistance and Bill of Rights Act of 2000 (42 U.S.C. 15041 et 
seq.) shall have the authorities described under such subtitle.

           *       *       *       *       *       *       *


SEC. 1712. DENTAL CARE; DRUGS AND MEDICINES FOR CERTAIN DISABLED 
                    VETERANS; VACCINES.

    (a)(1) * * *
          (B) * * *
                  (iv) the veteran's certificate of discharge 
                or release from active duty does not bear a 
                certification that the veteran was provided, 
                within the [90-day] 180-day period immediately 
                before the date of such discharge or release, a 
                complete dental examination (including dental 
                X-rays) and all appropriate dental services and 
                treatment indicated by the examination to be 
                needed;

           *       *       *       *       *       *       *


   Subchapter III--Miscellaneous Provisions Relating to Hospital and 
Nursing Home Care and Medical Treatment of Veterans

           *       *       *       *       *       *       *



SEC. 1730A. HOSPITAL QUALITY REPORT CARD INITIATIVE.

    (a) In General.--Not later than 18 months after the date of 
the enactment of this section, the Secretary shall establish 
and implement a Hospital Quality Report Card Initiative (in 
this section referred to as the `Initiative') to report on 
health care quality in VA hospitals.
    (b) Availability of Information on Quality and Performance 
of VA Hospitals.--(1)(A) Under the initiative, the Secretary 
shall make available to the public the most current information 
on the quality and performance of each VA hospital on the 
Internet web site or in the promotional literature of each such 
VA hospital. Such information shall include quality measures 
that allow for an assessment of the following, with respect to 
health care provided by VA hospitals:
          (i) Effectiveness.
          (ii) Safety.
          (iii) Timeliness.
          (iv) Efficiency.
          (v) Patient satisfaction.
    (B) In reporting information pursuant to subparagraph (A), 
the Secretary may display or provide links to reports or 
analyses on VA hospital quality and performance from all 
available objective sources, which may include the following:
          (i) The Joint Commission on Accreditation of 
        Healthcare Organizations.
          (ii) The Office of the Inspector General.
          (iii) The Office of the Medical Inspector.
          (iv) Offices of the Department involved in the 
        collection and dissemination of data on the performance 
        of individual hospitals.
          (v) National and local media entities.
          (vi) Professional journals.
          (vii) Such other sources as the Secretary considers 
        appropriate.
    (C) In reporting information as provided for under 
subparagraph (A), the Secretary may risk adjust quality 
measures to account for differences relating to--
          (i) the characteristics of the reporting VA hospital, 
        such as licensed bed size, geography, and teaching 
        hospital status; and
          (ii) patient characteristics, such as health status, 
        severity of illness, and socioeconomic status.
    (D) Under the Initiative, the Secretary may verify 
information reported under this paragraph to ensure accuracy 
and validity.
    (E) The Secretary shall disclose the nature and scope of 
information reported under this paragraph to all VA hospitals 
that are the subject of any such information.
    (F)(i) The Secretary shall inform the Committee on 
Veterans' Affairs of the Senate and the Committee on Veterans' 
Affairs of the House of Representatives of the nature and scope 
of information to be reported under this paragraph.
    (ii) The Secretary shall ensure that information on health 
care quality is provided in a manner that is conducive for 
comparisons with other local hospitals or regional hospitals, 
as appropriate.
    (iii) The Secretary shall establish procedures for making 
information under this paragraph available to the public in 
accordance with the requirements of subparagraph (A).
    (G) The analytic methodologies and limitations on 
information sources utilized by the Secretary to develop and 
disseminate information under this paragraph may be identified 
and acknowledged in a notice or disclaimer, and may include the 
appropriate and inappropriate uses of such information.
    (H) Not less frequently than annually, the Secretary may 
compare quality measures data submitted by each VA hospital to 
the Secretary with quality measures data submitted to the 
Secretary in the prior year or years by each such VA hospital 
in order to identify actions that could lead to false or 
artificial improvements in the quality measurements of such VA 
hospitals.
    (2)(A) The Secretary shall develop and implement effective 
safeguards to protect against the unauthorized use or 
disclosure of VA hospital data that is reported under this 
section.
    (B) The Secretary shall develop and implement effective 
safeguards to protect against the dissemination of 
inconsistent, incomplete, invalid, inaccurate, or subjective VA 
hospital data.
    (C) The Secretary shall ensure that identifiable patient 
data shall not be released to the public.
    (c) Definition of VA Hospital.--In this section, the term 
`VA hospital' means a Department of Veterans Affairs Medical 
Center administered by the Secretary.

           *       *       *       *       *       *       *


                       PART II--GENERAL BENEFITS

CHAPTER 20--BENEFITS FOR HOMELESS VETERANS

           *       *       *       *       *       *       *


Sec.
[2023. Demonstration program of referral and counseling for 
            veterans transitioning from certain institutions who 
            are at risk for homelessness.]
2023. Referral and counseling services: veterans at risk of 
            homelessness who are transitioning from certain 
            institutions.
    * * *
2044. Financial assistance for supportive services for very low-
            income veteran families in permanent housing.

           *       *       *       *       *       *       *


             Subchapter II--Comprehensive Service Programs


SEC. 2011. GRANTS.

           *       *       *       *       *       *       *


    (i) Availability of Grant Funds for Service Center 
Personnel.--A grant under this section for a service center for 
homeless veterans may be used to provide funding for staff as 
necessary in order for the center to meet the service 
availability requirements of subsection(g)(1).

           *       *       *       *       *       *       *


SEC. 2012. PER DIEM PAYMENTS.

    (a)(1) * * *
    (2)(A) [The rate] Except as provided in subparagraph (B), 
the rate for such per diem payments shall be the daily cost of 
care estimated by the grant recipient or eligible entity 
[adjusted by the Secretary under subparagraph (B)].
    (B) In no case may the rate determined under this paragraph 
exceed the rate authorized for State homes for domiciliary care 
under subsection (a)(1)(A) of section 1741 of this title, as 
the Secretary may increase from time to time under subsection 
(c) of that section.
    [(B) The Secretary shall adjust the rate estimated by the 
grantrecipient or eligible entity under subparagraph (A) to 
exclude other sources of income described in subparagraph (D) 
that the grant recipient or eligible entity certifies to be 
correct.]
    (C) Each grant recipient or eligible entity shall provide 
to the Secretary such information with respect to other sources 
of income as the Secretary may require [to make the adjustment 
under subparagraph (B)].
    [(D) The other sources of income referred to in 
subparagraphs (B) and (C) are payments to the grant recipient 
or eligible entity for furnishing services to homeless veterans 
under programs other than under this subchapter, including 
payments and grants from other departments and agencies of the 
United States, from departments or agencies of State or local 
government, and from private entities or organizations.]

           *       *       *       *       *       *       *


                 Subchapter III--Training and Outreach


SEC. 2022. COORDINATION OF OUTREACH SERVICES FOR VETERANS AT RISK OF 
                    HOMELESSNESS.

           *       *       *       *       *       *       *


    (f)(1) * * *
    (2) * * *
          (C) A description of the implementation and operation 
        of the [demonstration] program under section 2023 of 
        this title.

           *       *       *       *       *       *       *


SEC. 2023. [DEMONSTRATION PROGRAM OF REFERRAL AND COUNSELING FOR 
                    VETERANS TRANSITIONING FROM CERTAIN INSTITUTIONS 
                    WHO ARE AT RISK FOR HOMELESSNESS.] REFERRAL AND 
                    COUNSELING SERVICES: VETERANS AT RISK OF 
                    HOMELESSNESS WHO ARE TRANSITIONING FROM CERTAIN 
                    INSTITUTIONS.

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

           *       *       *       *       *       *       *

    (d) Duration.--The authority of the Secretaries to provide 
referral and counseling services under the demonstration 
program [shall cease on the date that is four years after the 
date of the commencement of the program] shall cease on 
September 30, 2011.

           *       *       *       *       *       *       *


                    Subchapter V--Housing Assistance


SEC. 2043. DOMICILIARY CARE PROGRAMS.

           *       *       *       *       *       *       *


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

SEC. 2044. FINANCIAL ASSISTANCE FOR SUPPORTIVE SERVICES FOR VERY LOW-
                    INCOME VETERAN FAMILIES IN PERMANENT HOUSING.

    (a) Distribution of Financial Assistance.--(1) The 
Secretary shall provide financial assistance to eligible 
entities approved under this section to provide and coordinate 
the provision of supportive services described in subsection 
(b) for very low-income veteran families occupying permanent 
housing.
    (2) Financial assistance under this section shall consist 
of grants for each such family for which an approved eligible 
entity is providing or coordinating the provision of supportive 
services.
    (3)(A) The Secretary shall provide such grants to each 
eligible entity that is providing or coordinating the provision 
of supportive services.
    (B) The Secretary is authorized to establish intervals of 
payment for the administration of such grants and establish a 
maximum amount to be awarded, in accordance with the services 
being provided and their duration.
    (4) In providing financial assistance under paragraph (1), 
the Secretary shall give preference to entities providing or 
coordinating the provision of supportive services for very low-
income veteran families who are transitioning from homelessness 
to permanent housing.
    (5) The Secretary shall ensure that, to the extent 
practicable, financial assistance under this subsection is 
equitably distributed across geographic regions, including 
rural communities and tribal lands.
    (6) Each entity receiving financial assistance under this 
section to provide supportive services to a very low-income 
veteran family shall notify that family that such services are 
being paid for, in whole or in part, by the Department.
    (7) The Secretary may require entities receiving financial 
assistance under this section to submit a report to the 
Secretary that describes the projects carried out with such 
financial assistance.
    (b) Supportive Services.--The supportive services referred 
to in subsection (a) are the following:
          (1) Services provided by an eligible entity or a 
        subcontractor of an eligible entity that address the 
        needs of very low-income veteran families occupying 
        permanent housing, including--
                  (A) outreach services;
                  (B) case management services;
                  (C) assistance in obtaining any benefits from 
                the Department which the veteran may be 
                eligible to receive, including, but not limited 
                to, vocational and rehabilitation counseling, 
                employment and training service, educational 
                assistance, and health care services;
                  (D) assistance in obtaining and coordinating 
                the provision of other public benefits provided 
                in federal, State, or local agencies, or any 
                organization defined in subsection (f), 
                including--
                          (i) health care services (including 
                        obtaining health insurance);
                          (ii) daily living services;
                          (iii) personal financial planning;
                          (iv) transportation services;
                          (v) income support services;
                          (vi) fiduciary and representative 
                        payee services;
                          (vii) legal services to assist the 
                        veteran family with issues that 
                        interfere with the family's ability to 
                        obtain or retain housing or supportive 
                        services;
                          (viii) child care;
                          (ix) housing counseling; and
                          (x) other services necessary for 
                        maintaining independent living.
          (2) Services described in paragraph (1) that are 
        delivered to very low-income veteran families who are 
        homeless and who are scheduled to become residents of 
        permanent housing within 90 days pending the location 
        or development of housing suitable for permanent 
        housing.
          (3) Services described in paragraph (1) for very low-
        income veteran families who have voluntarily chosen to 
        seek other housing after a period of tenancy in 
        permanent housing, that are provided, for a period of 
        90 days after such families exit permanent housing or 
        until such families commence receipt of other housing 
        services adequate to meet their current needs, but only 
        to the extent that services under this paragraph are 
        designed to support such families in their choice to 
        transition into housing that is responsive to their 
        individual needs and preferences.
    (c) Application for Financial Assistance.--(1) An eligible 
entity seeking financial assistance under subsection (a) shall 
submit to the Secretary an application therefor in such form, 
in such manner, and containing such commitments and information 
as the Secretary determines to be necessary to carry out this 
section.
    (2) Each application submitted by an eligible entity under 
paragraph (1) shall contain--
          (A) a description of the supportive services proposed 
        to be provided by the eligible entity and the 
        identified needs for those services;
          (B) a description of the types of very low-income 
        veteran families proposed to be provided such services;
          (C) an estimate of the number of very low-income 
        veteran families proposed to be provided such services;
          (D) evidence of the experience of the eligible entity 
        in providing supportive services to very low-income 
        veteran families; and
          (E) a description of the managerial capacity of the 
        eligible entity--
                  (i) to coordinate the provision of supportive 
                services with the provision of permanent 
                housing by the eligible entity or by other 
                organizations;
                  (ii) to assess continuously the needs of very 
                low-income veteran families for supportive 
                services;
                  (iii) to coordinate the provision of 
                supportive services with the services of the 
                Department;
                  (iv) to tailor supportive services to the 
                needs of very low-income veteran families; and
                  (v) to seek continuously new sources of 
                assistance to ensure the long-term provision of 
                supportive services to very low-income veteran 
                families.
    (3) The Secretary shall establish criteria for the 
selection of eligible entities to be provided financial 
assistance under this section.
    (d) Technical Assistance.--(1) The Secretary shall provide 
training and technical assistance to participating eligible 
entities regarding the planning, development, and provision of 
supportive services to very low-income veteran families 
occupying permanent housing, through the Technical Assistance 
grants program in section 2064 of this title.
    (2) The Secretary may provide the training described in 
paragraph (1) directly or through grants or contracts with 
appropriate public or nonprofit private entities.
    (e) Funding.--(1) From amounts appropriated to the 
Department for Medical Services, there shall be available to 
carry out subsection (a), (b), and (c) amounts as follows:
          (A) $15,000,000 for fiscal year 2008.
          (B) $20,000,000 for fiscal year 2009.
          (C) $25,000,000 for fiscal year 2010.
    (2) Not more than $750,000 may be available under paragraph 
(1) in any fiscal year to provide technical assistance under 
subsection (d).
    (3) There is authorized to be appropriated $1,000,000 for 
each of the fiscal year 2008 through 2010 to carry out the 
provisions of subsection (d).
    (f) Definitions.--In this section:
          (1) The term `consumer cooperative' has the meaning 
        given such term in section 202 of the Housing Act of 
        1959 (12 U.S.C. 1701q).
          (2) The term `eligible entity' means--
                  (A) a private nonprofit organization; or
                  (B) a consumer cooperative.
          (3) The term `homeless' has the meaning given that 
        term in section 103 of the McKinney-Vento Homeless 
        Assistance Act (42 U.S.C. 11302).
          (4) The term `permanent housing' means community-
        based housing without a designated length of stay.
          (5) The term `private nonprofit organization' means 
        any of the following:
                  (A) Any incorporated private institution or 
                foundation--
                          (i) no part of the net earnings of 
                        which inures to the benefit of any 
                        member, founder, contributor, or 
                        individual;
                          (ii) which has a governing board that 
                        is responsible for the operation of the 
                        supportive services provided under this 
                        section; and
                          (iii) which is approved by the 
                        Secretary as to financial 
                        responsibility;
                  (B) A for-profit limited partnership, the 
                sole general partner of which is an 
                organization meeting the requirements of 
                clauses (i), (ii), and (iii) of subparagraph 
                (A).
                  (C) A corporation wholly owned and controlled 
                by an organization meeting the requirements of 
                clauses (i), (ii), and (iii) of subparagraph 
                (A).
                  (D) A tribally designated housing entity (as 
                defined in section 4 of the Native American 
                Housing Assistance and Self-Determination Act 
                of 1996 (25 U.S.C. 4103)).
          (6)(A) Subject to subparagraphs (B) and (C), the term 
        `very low-income veteran family' means a veteran family 
        whose income does not exceed 50 percent of the median 
        income for an area specified by the Secretary for 
        purposes of this section, as determined by the 
        Secretary in accordance with this paragraph.
          (B) The Secretary shall make appropriate adjustments 
        to the income requirement under subparagraph (A) based 
        on family size.
          (C) The Secretary may establish an income ceiling 
        higher or lower than 50 percent of the median income 
        for an area if the Secretary determines that such 
        variations are necessary because the area has unusually 
        high or low construction costs, fair market rents (as 
        determined under section 8 of the United States Housing 
        Act of 1937 (42 U.S.C. 1437f)), or family incomes.
          (7) The term `veteran family' includes a veteran who 
        is a single person and a family in which the head of 
        household or the spouse of the head of household is a 
        veteran.

           *       *       *       *       *       *       *


             PART V--BOARDS, ADMINISTRATIONS, AND SERVICES

CHAPTER 73--VETERANS HEALTH ADMINISTRATION--ORGANIZATION AND FUNCTIONS

           *       *       *       *       *       *       *


Sec.
[7324. Annual report on use of authorities to enhance retention 
            of experienced nurses.]
    * * *
7330A. Severe traumatic brain injury research, education, and 
            clinical care program.

           *       *       *       *       *       *       *


Subchapter II--General Authority and Administration

           *       *       *       *       *       *       *



[SEC. 7324. ANNUAL REPORT ON USE OF AUTHORITIES TO 
                    ENHANCE RETENTION OF EXPERIENCED NURSES.]

    [(a) Annual report. Not later than January 31 each year, 
the Secretary, acting through the Under Secretary for Health, 
shall submit to Congress a report on the use during the 
preceding year of authorities for purposes of retaining 
experienced nurses in the Veterans Health Administration, as 
follows:
          [(1) The authorities under chapter 76 of this title.
          [(2) The authority under VA Directive 5102.1, 
        relating to the Department of Veterans Affairs nurse 
        qualification standard, dated November 10, 1999, or any 
        successor directive.
          [(3) Any other authorities available to the Secretary 
        for those purposes.]
    [(b) Report elements. Each report under subsection (a) 
shall specify for the period covered by such report, for each 
Department medical facility and for each geographic service 
area of the Department, the following:
          [(1) The number of waivers requested under the 
        authority referred to in subsection (a)(2), and the 
        number of waivers granted under that authority, to 
        promote to the Nurse II grade or Nurse III grade under 
        the Nurse Schedule under section 7404(b)(1) of this 
        title any nurse who has not completed a baccalaureate 
        degree in nursing in a recognized school of nursing, 
        set forth by age, race, and years of experience of the 
        individuals subject to such waiver requests and 
        waivers, as the case may be.
          [(2) The programs carried out to facilitate the use 
        of nursing education programs by experienced nurses, 
        including programs for flexible scheduling, 
        scholarships, salary replacement pay, and on-site 
        classes.]

           *       *       *       *       *       *       *


SEC. 7330A. SEVERE TRAUMATIC BRAIN INJURY RESEARCH, EDUCATION, AND 
                    CLINICAL CARE PROGRAM.

    (a) Program Required.--The Secretary shall establish a 
program on research, education, and clinical care to provide 
intensive neuro-rehabilitation to veterans with a severe 
traumatic brain injury, including veterans in a minimally 
conscious state who would otherwise receive only long-term 
residential care.
    (b) Collaboration Required.--The Secretary shall establish 
the program required by subsection (a) in collaboration with 
the Defense and Veterans Brain Injury Center and academic 
institutions selected by the Secretary from among institutions 
having an expertise in research in neuro-rehabilitation.
    (c) Education Required.--As part of the program required by 
subsection (a), the Secretary shall, in collaboration with the 
Defense and Veterans Brain Injury Center, conduct educational 
programs on recognizing and diagnosing mild and moderate cases 
of traumatic brain injury.
    (d) Authorization of Appropriations.--There is authorized 
to be appropriated to the Secretary for each of fiscal years 
2008 through 2012, $10,000,000 to carry out the program 
required by subsection (a).

           *       *       *       *       *       *       *


         CHAPTER 74--VETERANS HEALTH ADMINISTRATION--PERSONNEL


     Subchapter IV--Pay for Nurses and Other Health-Care Personnel


SEC. 7451. NURSES AND OTHER HEALTH-CARE PERSONNEL: COMPETITIVE PAY.

           *       *       *       *       *       *       *


    (c)(1) For each grade in a covered position, there shall be 
a range of basic pay. The maximum rate of basic pay for a grade 
shall be 133 percent of the minimum rate of basic pay for the 
grade, except that, if the Secretary determines that a higher 
maximum rate is necessary with respect to any such grade in 
order to recruit and retain a sufficient number of high-quality 
health-care personnel, the Secretary may raise the maximum rate 
of basic pay for that grade to a rate not in excess of 175 
percent of the minimum rate of basic pay for the grade. 
Whenever the Secretary exercises the authority under the 
preceding sentence to establish the maximum rate of basic pay 
at a rate in excess of 133 percent of the minimum rate for that 
grade, the Secretary shall[, in the next annual report required 
by subsection (g), (1)] provide justification for doing so to 
the Committees on Veterans' Affairs of the Senate and House of 
Representatives.

           *       *       *       *       *       *       *

    (e)(1) * * *
    [(5) Not later than September 30 of each year, the 
Secretary shall submit to the Committees on Veterans' Affairs 
of the Senate and House of Representatives a report on staffing 
for covered positions at Department health care facilities. 
Each such report shall include the following:
          [(A) A summary and analysis of the information 
        contained in the most recent reports submitted by 
        facility directors under paragraph (4).
          [(B) The information for each such facility specified 
        in paragraph (4).]
    [(f) Not later than March 1 of each year, the Secretary 
shall submit to the Committees on Veterans' Affairs of the 
Senate and House of Representatives a report regarding any pay 
adjustments under the authority of subsection (d) effective 
during the 12 months preceding the submission of the report. 
Each such report shall set forth, by health-care facility, the 
percentage of such increases and, in any case in which no 
increase was made, the basis for not providing an increase.]
    [(g)] (f) For the purposes of this section, the term 
``health-care facility'' means a medical center, an independent 
outpatient clinic, or an independent domiciliary facility.

SEC. 7452. NURSES AND OTHER HEALTH-CARE PERSONNEL: ADMINISTRATION OF 
                    PAY.

           *       *       *       *       *       *       *


    (b)[(1) Under regulations] Under regulations which the 
Secretary prescribes for the administration of this section, 
the director of a Department healthcare facility (A) shall pay 
a cash bonus (in an amount to be determined by the director not 
to exceed $2,000) to an employee in a covered position at that 
facility who becomes certified in a specialty recognized by the 
Department, and (B) may provide such a bonus to an employee in 
such a position who has demonstrated both exemplary job 
performance and exemplary job achievement. The authority of the 
Secretary under this subsection is in addition to any other 
authority of the Secretary to provide job performance 
incentives.
    [(2) The Secretary shall include in the annual report under 
section 7451(g) (1) of this title a discussion of the use 
during the period covered by the report of the payment of 
bonuses under this subsection and other job performance 
incentives available to the Secretary.]

           *       *       *       *       *       *       *

    (e) An employee in a covered position employed under 
section 7401(1) of this title who (without a break in 
employment) transfers from one Department health-care facility 
to another may not be reduced in grade or step within grade 
(except pursuant to a disciplinary action otherwise authorized 
by law) if the duties of the position to which the employee 
transfers are similar to the duties of the position from which 
the employee transferred. The rate of basic pay of such 
employee shall be established at the new health-care facility 
in a manner consistent with the practices at that facility for 
an employee of that grade and step, except that in the case of 
an employee whose transfer (other than pursuant to a 
disciplinary action otherwise authorized by law) to another 
healthcare facility is at the request of the Secretary, the 
Secretary may provide that for at least the first year 
following such transfer the employee shall be paid at a rate of 
basic pay up to the rate applicable to such employee before the 
transfer, if the Secretary determines that such rate of pay is 
necessary to fill the position. [Whenever the Secretary 
exercises the authority under the preceding sentence relating 
to the rate of basic pay of a transferred employee, the 
Secretary shall, in the next annual report required under 
section 7451(g) (1) of this title, provide justification for 
doing so.]

           *       *       *       *       *       *       *


    CHAPTER 76--HEALTH PROFESSIONALS EDUCATIONAL ASSISTANCE PROGRAM


                   Subchapter II--Scholarship Program


SEC. 7618. EXPIRATION OF PROGRAM.

    The Secretary may not furnish scholarships to new 
participants in the Scholarship Program after [December 31, 
1998] December 31, 2012.

           *       *       *       *       *       *       *


            PART VI--ACQUISITION AND DISPOSITION OF PROPERTY

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

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Sec.
[8107. Operational and construction plans for medical 
            facilities.]

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     Subchapter I--Acquisition and Operation of Medical Facilities


[SEC. 8107. OPERATIONAL AND CONSTRUCTION PLANS FOR MEDICAL FACILITIES.]

    [(a) In order to promote effective planning for the 
efficient provision of care to eligible veterans, the 
Secretary, based on the analysis and recommendations of the 
Under Secretary for Health, shall submit to each committee an 
annual report regarding long-range health planning of the 
Department. The report shall be submitted each year not later 
than the date on which the budget for the next fiscal year is 
submitted to the Congress under section 1105 of title 31.
          [(1) A five-year strategic plan for the provision of 
        care under chapter 17 of this title to eligible 
        veterans through coordinated networks of medical 
        facilities operating within prescribed geographic 
        service-delivery areas, such plan to include provision 
        of services for the specialized treatment and 
        rehabilitative needs of disabled veterans (including 
        veterans with spinal cord dysfunction, blindness, 
        amputations, and mental illness) through distinct 
        programs or facilities of the Department dedicated to 
        the specialized needs of those veterans.
          [(2) A description of how planning for the networks 
        will be coordinated.
          [(3), (4) [Deleted]]
    [(c) The Secretary shall submit to each committee not later 
than January 31 of each year a report showing the location, 
space, cost, and status of each medical facility (1) the 
construction, alteration, lease, or other acquisition of which 
has been approved under section 8104(a) of this title, and (2) 
which was uncompleted as of the date of the last preceding 
report made under this subsection.]
    [(d) (1) The Secretary shall submit to each committee, not 
later than January 31 of each year, a report showing the 
current priorities of the Department for proposed major medical 
construction projects. Each such report shall identify the 20 
projects, from within all the projects in the Department's 
inventory of proposed projects, that have the highest priority 
and, for those 20 projects, the relative priority and rank 
scoring of each such project and the projected cost of such 
project (including the projected operating costs, including 
both recurring and nonrecurring costs). The 20 projects shall 
be compiled, and their relative rankings shall be shown, by 
category of project (including the categories of ambulatory 
care projects, nursing home care projects, and such other 
categories as the Secretary determines).
    [(2) The Secretary shall include in each report, for each 
project listed, a description of the specific factors that 
account for the relative ranking of that project in relation to 
other projects within the same category.
    [(3) In a case in which the relative ranking of a proposed 
project has changed since the last report under this subsection 
was submitted, the Secretary shall also include in the report a 
description of the reasons for the change in the ranking, 
including an explanation of any change in the scoring of the 
project under the Department's scoring system for proposed 
major medical construction projects.]

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     Subchapter IV--Sharing of Medical Facilities, Equipment, and 
                              Information


SEC. 8153. SHARING OF HEALTH-CARE RESOURCES.

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    [(g) The Secretary shall submit to the Congress not later 
than February 1 of each year a report on the activities carried 
out under this section during the preceding fiscal year. Each 
report shall include--
          [(1) an appraisal of the effectiveness of the 
        activities authorized in this section and the degree of 
        cooperation from other sources, financial and 
        otherwise; and
          [(2) recommendations for the improvement or more 
        effective administration of such activities.]

                                  
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