[Senate Report 110-247]
[From the U.S. Government Publishing Office]



                                                       Calendar No. 540
110th Congress                                                   Report
                                 SENATE
 1st Session                                                    110-247

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



 
  ESTABLISHING EPILEPSY CENTERS OF EXCELLENCE IN THE VETERANS HEALTH 
                             ADMINISTRATION

                                _______
                                

               December 12, 2007.--Ordered to be printed

                                _______
                                

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

                              R E P O R T

                         [To accompany S. 2004]

    The Committee on Veterans' Affairs (hereinafter, ``the 
Committee''), to which was referred the bill (S. 2004) to amend 
title 38, United States Code, to establish epilepsy centers of 
excellence in the Veterans Health Administration of the 
Department of Veterans Affairs, and for other purposes, having 
considered the same, reports favorably thereon and recommends 
that the bill do pass.

                              Introduction

    On August 3, 2007, Senator Murray, for herself and Senator 
Craig, introduced S. 2004. S. 2004 would designate six health 
care facilities of the Department of Veterans Affairs as 
centers of excellence for research, education, and clinical 
care of epilepsy. S. 2004 is also cosponsored by Senators 
Lincoln and Obama.
    On October 24, 2007, the Committee held a hearing on 
pending veterans' health legislation at which testimony was 
offered by: the Honorable Michael J. Kussman, M.D., M.S., 
M.A.C.P., Under Secretary for Health, Department of Veterans 
Affairs, accompanied by Walter Hall, Assistant General Counsel, 
Department of Veterans Affairs; Carl Blake, National 
Legislative Director, Paralyzed Veterans of America; Joy J. 
Ilem, Assistant National Legislative Director, Disabled 
Veterans of America; Brenda Murdough, M.S.N., RN-C, Military/
Veterans Initiative Coordinator, American Pain Foundation; 
Brien J. Smith, M.D., Director, Epilepsy Monitoring Unit, Henry 
Ford Hospital; and Capt. Constance Walker, USN (Ret.), 
President, Southern Maryland Chapter of the National Alliance 
on Mental Illness.
    Earlier, on May 23, 2007, the Committee held a hearing on 
pending veterans' health legislation. The testimony of John 
Booss, M.D., American Academy of Neurology included a 
discussion about epilepsy care and research within VA and the 
veteran population.

                           Committee Meeting

    After carefully reviewing the testimony from the foregoing 
hearings, the Committee met in open session on November 14, 
2007, to consider, among other legislation, S. 2004. The 
Committee voted unanimously to report favorably S. 2004.

                     Summary of S. 2004 As Reported

    S. 2004, as reported, (hereinafter, ``the Committee bill'') 
would establish within the Veterans Health Administration 
epilepsy centers of excellence.
    Section (a) of the Committee bill would amend chapter 73 of 
title 38, United States Code, by adding a new section 7330A, 
consisting of six subsections (a) through (f) as follows:
    New subsection (a) would require the Secretary to designate 
not less than six Department health care facilities as 
locations for epilepsy centers of excellence, and, subject to 
the availability of appropriations, establish and operate such 
centers.
    New subsection (b) would stipulate that the Secretary may 
not designate a Department health care facility as a location 
for an epilepsy center of excellence without the approval of 
the peer review panel established under new subsection (c).
    New subsection (c) would establish a peer review panel to 
assess the scientific and clinical merit of proposals submitted 
to the Secretary for the designation of epilepsy centers of 
excellence. This subsection would also set forth requirements 
concerning the composition and operation of the peer review 
panel.
    New subsection (d) would define ``epilepsy center of 
excellence'' as a facility that has, or can develop, the 
necessary capacity to function as a center of excellence in 
research, education, and clinical care activities in the 
diagnosis and treatment of epilepsy.
    New subsection (e) would require the Secretary to designate 
an individual in the VHA to act as a national coordinator for 
epilepsy programs of the VHA, and would specify the duties of 
that coordinator.
    New subsection (f) would authorize $6,000,000 to be 
appropriated for the operation of the centers under this 
section for each fiscal year 2008 through 2012. In addition, 
such sums as may be necessary would be authorized to be 
appropriated to fund the national coordinator designated under 
subsection (e).
    Section (b) of the Committee bill would make a clerical 
amendment to the table of contents of chapter 73 of title 38.

                       Background and Discussion

    The Committee bill would add a new section 7330A to title 
38, United States Code, which would require the Secretary to 
designate not less than six Department facilities as locations 
for epilepsy centers of excellence. For a wide range of 
diseases and disabilities, VA Centers of Excellence are the 
model of innovation in the delivery of specialized health care 
and research. As discussed below, the centers would fill gaps 
in research, care, and education for epilepsy.
    The need for these centers has been demonstrated by both 
past experience and current research. Following the return of 
veterans from Vietnam, VA became a leader in research and 
treatment of epilepsy. VA's efforts were, however, reactive, 
and the opportunity to intervene early to prevent epilepsy was 
missed.
    Dr. John Booss, of the American Academy of Neurology, and 
formerly the national director of neurology for the VA, said in 
testimony before the Committee on May 23, 2007, that

        At one point, the VA was a national leader in care and 
        research for patients with epilepsy. As early as 1972 
        the VA recognized the need for VA health centers that 
        specialized in epilepsy. But starting in the 1990's 
        these epilepsy centers have languished due to lack of 
        funds.

    This sentiment was echoed by Dr. Brien J. Smith, Medical 
Director of the Comprehensive Epilepsy Program at the Henry 
Ford Hospital in Detroit, in testimony before the Committee on 
October 24, 2007.

        The VA established Epilepsy Centers as early as 1972, 
        but these Centers have languished over the years with 
        few staff and no national budget. The net result of 
        allowing these Centers to fall by the wayside is that 
        veterans with post traumatic brain injury epilepsy are 
        at the variable mercy of a system with markedly uneven 
        distribution of epilepsy services. This often results 
        in denial of services in locations without the 
        necessary epilepsy facilities and in which 
        administrators are hard pressed to meet their budget. 
        Sadly, the potential of these Centers to be the 
        backbone of a national epilepsy program never 
        materialized.

    The centers of excellence that would be created by this 
bill would provide VA with the wherewithal to research the 
connection between epilepsy and Traumatic Brain Injury (TBI), 
and to provide timely care to veterans who develop epilepsy.
    Although we do not yet have data on post-traumatic epilepsy 
for current conflicts, past experience suggests the rate may be 
high. Statistics from the Vietnam era indicate that soldiers 
with an open TBI faced at least a fifty percent chance of 
experiencing epilepsy. VA-funded research conducted in 
collaboration with the Department of Defense found that 53 
percent of veterans who suffered a penetrating TBI in Vietnam 
developed epilepsy within 15 years. The risk of epilepsy 
associated with closed TBI, a wound common among veterans of 
Operations Enduring Freedom and Iraqi Freedom, has not been 
clearly established. Dr. Booss testified that ``As 
neurologists, we believe that the rate of epilepsy from blast 
TBI will also be high.''
    The creation of national epilepsy centers of excellence is 
supported by the American Academy of Neurology, the Epilepsy 
Foundation, the Brain Injury Association of America, Disabled 
American Veterans, Paralyzed Veterans of America, Blinded 
Veterans Association, the Marine Corp League, Vietnam Veterans 
of America, Military Order of the Purple Heart and Iraq and 
Afghanistan Veterans of America.
    Subsections (b) and (c) of new section 7330A would 
establish and define a peer review panel to assess the 
scientific and clinical merit of proposals submitted to the 
Secretary for the designation of epilepsy centers of 
excellence. A similar process is used by VA to create and award 
other centers of excellence to ensure the awards are based on 
objective criteria. Similar panels have been used in the 
creation of centers of excellence for Parkinson's disease and 
multiple sclerosis. Other government agencies, such as the 
National Institutes of Health (NIH), use this mechanism to 
award clinical center contracts.
    Subsection (d) of new section 7330A would define ``epilepsy 
center of excellence'', and describes the purpose of the 
centers. In designating the centers, facilities would have to 
demonstrate a number of qualifications, or the ability to meet 
such requirements, including those described below.
    Facilities would be required to have or develop an 
affiliation with an accredited medical school that provides 
education and training in neurology. In testimony before the 
Committee on May 23, 2007, Dr. John Booss said that

        A VA health care facility affiliated with a medical 
        school that trains residents in the diagnosis and 
        treatment of epilepsy, including epilepsy surgery, 
        would be able to attract the participation of 
        clinicians and scientists capable of driving innovation 
        in the prevention and treatment of post-traumatic 
        epilepsy.

    Affiliations with research universities greatly expand the 
strength, range, and diversity of research capacities of 
affiliated VA research units.
    Facilities would also be required to have an advisory 
committee to advise the facility on policy matters pertaining 
to the activities of the center. Further, the facility would 
have to have the capability to conduct appropriate evaluations 
of the activities of the 
center.
    In the Committee's view, the proposed new epilepsy centers 
of excellence would serve a number of essential purposes. Most 
importantly, the centers would improve quality of care for 
veterans around the country. In addition, the centers would 
prepare VA to meet the growing demand for specialized treatment 
of epilepsy and seizure disorders, a demand that is likely to 
grow, given the high incidence of TBI among veterans of 
Operations Enduring Freedom and Iraqi Freedom.
    The Committee is concerned that VA lacks clear evidence-
based guidelines for the referral of veterans for epilepsy 
screening and treatment. To address this issue, facilities 
would be required to participate in research, education, and 
dissemination of clinical best-practices coordinated at a 
national level. These measures are essential to the effective 
promotion of quality care and treatment of epilepsy beyond the 
six centers to meet the needs of the entire veteran population. 
Coordination and collaboration with other Department facilities 
and centers, especially those focused on TBI, would also be 
required.
    The incidence of epilepsy among the veteran population is 
not precisely known, and the creation of these centers would 
improve VA's ability to study this population. In the general 
population, the incidence of epilepsy is approximately one 
percent. To study the veteran population more closely, VA 
officials appointed the Epilepsy Advisory Committee in 1999. 
This committee estimated that 50,000 veterans were seeking care 
at VA facilities for epilepsy or seizure disorders at the time 
of the study. That number may have grown to 79,000, based on 
the national rate, and on the number of veterans enrolled in VA 
health care today.
    Subsection (e) of new section 7330A would require the 
Secretary to designate an individual in the VHA to act as a 
national coordinator for epilepsy programs of the VHA. The 
national coordinator would supervise the operation of the 
centers established by this Act, and would coordinate and 
support the promotion of research, education and care for 
epilepsy throughout the Department. The national coordinator 
would also be responsible for regularly evaluating the centers.
    Subsection (f) of new section 7330A would authorize the 
appropriation of $6,000,000 for the operation of the centers 
under this section for each fiscal year 2008 through 2012, and 
would authorize for each fiscal year after 2012 such sums as 
may be necessary for the operation of the centers. Centers 
established with sufficient funding would lay the foundation 
for enduring programs in epilepsy care, research, and 
education. Once established, the Centers would be equipped to 
compete for funding from NIH, and funds from other sources, to 
further advance care for veterans with 
epilepsy.
    In addition, the Committee bill would authorize the 
appropriation of such sums as may be necessary to fund the 
national coordinator position that would be established by 
subsection (e).

                      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 $3,000,000 in 2008 and by $31,000,000 
over the 2008-2012 period, assuming appropriation of the 
necessary amounts. The Committee bill would not increase direct 
spending, based on information supplied by the CBO. 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:
                                     U.S. Congress,
                               Congressional Budget Office,
                                 Washington, DC, November 30, 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. 2004, a bill to 
amend title 38, United States Code, to establish epilepsy 
centers of excellence in the Veterans Health Administration of 
the Department of Veterans Affairs, and for other purposes.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Sunita 
D'Monte, who can be reached at 226-2840.
            Sincerely,
                                           Peter R. Orszag,
                                                          Director.
    Enclosure.
    cc: Honorable Richard Burr, Ranking Member.

S. 2004--A bill to amend title 38, United States Code, to establish 
        epilepsy centers of excellence in the Veterans Health 
        Administration of the Department of Veterans Affairs, and for 
        other purposes

    S. 2004 would require the Secretary of the Department of 
Veterans Affairs (VA) to establish at least six centers of 
excellence for epilepsy research, education, and clinical care 
at VA health care facilities, and to appoint a national 
coordinator for those centers and for other epilepsy programs 
at the Veterans Health Administration. The bill would authorize 
the appropriation of $6 million each year over the 2008-2012 
period and such sums as may be necessary for the national 
coordinator. CBO estimates that in addition to the specified 
authorizations, VA would require less than $500,000 annually 
for the national coordinator.
    In total, CBO estimates that implementing S. 2004 would 
cost $3 million in 2008 and $31 million over the 2008-2012 
period, assuming that the specified and estimated amounts are 
appropriated and that outlays follow historical spending 
patterns for similar programs. Enacting the bill would have no 
effect on direct spending or revenues.
    S. 2004 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act and 
would impose no costs on state, local, or tribal governments.
    The CBO staff contact for this estimate is Sunita D'Monte, 
who can be reached at 226-2840. This estimate was 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 November 14, 2007 meeting. On that 
date, the Committee ordered S. 2004 reported favorably to the 
Senate, by voice vote.

                             Agency Report

    On October 24, 2007, the Honorable Michael J. Kussman, 
Under Secretary for Health, Department of Veterans Affairs, 
appeared before the Committee and submitted testimony on, among 
other things, S. 2004. Excerpts from this statement are 
reprinted below:

              STATEMENT OF HON. MICHAEL J. KUSSMAN, UNDER 
             SECRETARY FOR HEALTH, DEPARTMENT OF VETERANS 
                                AFFAIRS

    Good morning Mr. Chairman and Members of the Committee:
    Thank you for inviting me here today to present the 
Administration's views on several bills that would affect 
Department of Veterans Affairs (VA) programs that provide 
veterans benefits and services. With me today is Walter A. 
Hall, Assistant General Counsel. I will address the five bills 
on today's agenda and then I would be happy to answer any 
questions you and the Committee members may have.
    S. 2004 would require the Secretary, not later than 120 
days after enactment of this provision, to designate at least 
six Department health-care facilities as epilepsy centers of 
excellence based on the recommendation of the Under Secretary 
for Health (USH). The mandate to establish and operate these 
centers, however, would be subject to the availability of 
appropriations for this purpose.
    The bill defines an ``epilepsy center of excellence'' as a 
Department health-care facility that has (or in the foreseeable 
future can develop) the necessary capacity to function as a 
center of excellence in research, education, and clinical care 
activities in the diagnosis and treatment of epilepsy. To 
qualify as a center, the facility would need:

     An affiliation with an accredited medical school 
that provides education and training in neurology (or may 
reasonably be anticipated to develop such an affiliation).
     The ability to attract scientists of ingenuity and 
creativity.
     An advisory committee composed of veterans and 
appropriate health-care and research representatives of the 
facility and of the affiliate.
     The capability to effectively evaluate the 
activities of the 
centers.
     The capability to coordinate the centers' 
education, clinical care, and research activities.
     The capability to develop a national consortium of 
providers with interest in treating epilepsy at VA medical 
centers; the consortium would have to include a designated 
epilepsy referral clinical in each Veterans Integrated Service 
Network.
     The capability to assist in the expansion of VA's 
use of information systems and databases to improve the quality 
and delivery of care.
     The capability to assist in the expansion of VA's 
tele-health program to develop, transmit, monitor, and review 
neurological diagnostic tests.
     The ability to perform epilepsy research, 
education, and clinical care activities in collaboration with 
VA's Poly-Trauma Centers.

    A number of specific requirements governing the competitive 
selection of the six facilities are set forth in the bill, 
including a requirement that the Secretary consider appropriate 
geographic distribution when making the selections.
    S. 2004 would further mandate the designation of an 
individual in VHA to act as a national coordinator for VHA's 
epilepsy programs. The bill includes a list of duties for that 
position, including that such individual report to the VHA 
official responsible for neurology.
    The bill would authorize $6 million for each of fiscal 
years 2008 through 2012 to establish and operate the centers; 
such sums as may be necessary for operating the centers for 
each fiscal year after fiscal year 2012 would also be 
authorized. For the first three years of the centers operation, 
the bill would require that the centers be designated as a 
special purpose program in order to avoid funds for the centers 
being allocated through the Veterans Equitable Resource 
Allocation system. In addition to those amounts, the USH would 
be required to allocate such amounts as he deems appropriate 
from other funds made available to VHA. The bill includes a 
separate authorization of appropriations to fund the national 
coordinator position.
    VA does not support S. 2004. As I have discussed in the 
past, I am concerned that statutory mandates for ``disease 
specific'' centers have the potential to fragment care in what 
is otherwise a well-designed, world-class integrated health 
care system. I am increasingly concerned about the 
proliferation of this disease-specific model and its impact on 
patient care and VA's integrated health care model. As it 
relates to a particular disease, I believe that it is much more 
important for VA to disseminate the best in evidence-based 
practices across its health care system than to establish 
centers that provide care for a particular disease.
    Treating epilepsy, like every other serious condition, 
requires an interdisciplinary approach. By mandating new 
``education, research, and clinical centers'' that are disease-
specific, flexibility to respond to changing combinations of 
related conditions is reduced. The centers' mandated 
collaboration with VA's Poly-trauma Centers would not cure this 
short-coming.
    It is also important to note that the ``models'' on which 
these Epilepsy Centers are based, the successful Geriatric 
Research, Education and Clinical Center (GRECC) and Mental 
Illness Research, Education and Clinical Center (MIRECC) 
programs, are not narrowly-focused on a disease process but 
address a wide gamut of issues facing a significant portion of 
the veteran population.

           *       *       *       *       *       *       *


                        Changes in Existing Law

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

                      TITLE 38--VETERANS BENEFITS

             PART V--BOARDS, ADMINISTRATIONS, AND SERVICES

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

           *       *       *       *       *       *       *


SEC. 7330A. EPILEPSY CENTERS OF EXCELLENCE.

           *       *       *       *       *       *       *


Subchapter II--General Authority and Administration

           *       *       *       *       *       *       *


SEC. 7330A. EPILEPSY CENTERS OF EXCELLENCE

    (a) Establishment of Centers.--(1) Not later than 120 days 
after the date of the enactment of this section, the Secretary 
shall, upon the recommendation of the Under Secretary for 
Health, designate not less than six Department health-care 
facilities as the locations for epilepsy centers of excellence.
    (2) Subject to the availability of appropriations for such 
purpose, the Secretary shall establish and operate epilepsy 
centers of excellence at the locations designated pursuant to 
paragraph (1).
    (b) Designation of Facilities.--(1) The Secretary may not 
designate a Department health-care facility as a location for 
an epilepsy center of excellence under subsection (a)(1) unless 
the peer review panel established under subsection (c) has 
determined under that subsection that the proposal submitted by 
such facility seeking designation as a location for an epilepsy 
center of excellence is among those proposals that meet the 
highest competitive standards of scientific and clinical merit.
    (2) In choosing from among the facilities meeting the 
requirements of paragraph (1), the Secretary shall also 
consider appropriate geographic distribution when designating 
the epilepsy centers of excellence under subsection (a)(1).
    (c) Peer Review Panel.--(1) The Under Secretary for Health 
shall establish a peer review panel to assess the scientific 
and clinical merit of proposals that are submitted to the 
Secretary for the designation of epilepsy centers of excellence 
under this section.
    (2)(A) The membership of the peer review panel shall 
consist of experts on epilepsy, including post-traumatic 
epilepsy.
    (B) Members of the peer review panel shall serve for a 
period of no longer than two years, except as specified in 
subparagraph (C).
    (C) Of the members first appointed to the panel, one half 
shall be appointed for a period of three years and one half 
shall be appointed for a period of two years, as designated by 
the Under Secretary at the time of appointment.
    (3) The peer review panel shall review each proposal 
submitted to the panel by the Under Secretary for Health and 
shall submit its views on the relative scientific and clinical 
merit of each such proposal to the Under Secretary.
    (4) The peer review panel shall not be subject to the 
Federal Advisory Committee Act.
    (d) Epilepsy Center of Excellence Defined.--In this 
section, the term ``epilepsy center of excellence'' means a 
Department health-care facility that has (or in the foreseeable 
future can develop) the necessary capacity to function as a 
center of excellence in research, education, and clinical care 
activities in the diagnosis and treatment of epilepsy and has 
(or may reasonably be anticipated to develop) each of the 
following:
          (1) An affiliation with an accredited medical school 
        that provides education and training in neurology, 
        including an arrangement with such school under which 
        medical residents receive education and training in the 
        diagnosis and treatment of epilepsy (including 
        neurosurgery).
          (2) The ability to attract the participation of 
        scientists who are capable of ingenuity and creativity 
        in health-care research efforts.
          (3) An advisory committee composed of veterans and 
        appropriate health-care and research representatives of 
        the facility and of the affiliated school or schools to 
        advise the directors of such facility and such center 
        on policy matters pertaining to the activities of the 
        center during the period of the operation of such 
        center.
          (4) The capability to conduct effectively evaluations 
        of the activities of such center.
          (5) The capability to coordinate (as part of an 
        integrated national system) education, clinical care, 
        and research activities within all facilities with such 
        centers.
          (6) The capability to develop jointly a national 
        consortium of providers with interest in treating 
        epilepsy at Department health-care facilities lacking 
        such centers in order to ensure better access to state-
        of-the-art diagnosis, research, clinical care, and 
        education for traumatic brain injury and epilepsy 
        throughout the health-care system of the Department. 
        Such consortium should include a designated epilepsy 
        referral clinic in each Veterans Integrated Service 
        Network.
          (7) The capability to assist in the expansion of the 
        Department's use of information systems and databases 
        to improve the quality and delivery of care for 
        veterans enrolled within the Department's health care 
        system.
          (8) The capability to assist in the expansion of the 
        Department telehealth program to develop, transmit, 
        monitor, and review neurological diagnostic tests.
          (9) The ability to perform epilepsy research, 
        education, and clinical care activities in 
        collaboration with Department medical facilities that 
        have centers for research, education, and clinical care 
        activities on complex multi-trauma associated with 
        combat injuries established under section 7327 of this 
        title.
    (e) National Coordinator for Epilepsy Programs.--(1) To 
assist the Secretary and the Under Secretary for Health in 
carrying out this section, the Secretary shall designate an 
individual in the Veterans Health Administration to act as a 
national coordinator for epilepsy programs of the Veterans 
Health Administration.
    (2) The duties of the national coordinator for epilepsy 
programs shall include the following:
          (A) To supervise the operation of the centers 
        established pursuant to this section.
          (B) To coordinate and support the national consortium 
        of providers with interest in treating epilepsy at 
        Department health-care facilities lacking such centers 
        in order to ensure better access to state-of-the-art 
        diagnosis, research, clinical care, and education for 
        traumatic brain injury and epilepsy throughout the 
        health-care system of the Department.
          (C) To conduct regular evaluations of the epilepsy 
        centers of excellence to ensure compliance with the 
        requirements of this section.
    (3) In carrying out duties under this subsection, the 
national coordinator for epilepsy programs shall report to the 
official of the Veterans Health Administration responsible for 
neurology.
    (f) Authorization of Appropriations.--(1) There are 
authorized to be appropriated $6,000,000 for each of fiscal 
years 2008 through 2012 for the support of the clinical care, 
research, and education activities of the epilepsy centers of 
excellence established and operated pursuant to subsection 
(a)(2).
    (2) There are authorized to be appropriated for each fiscal 
year after fiscal year 2012 such sums as may be necessary for 
the support of the clinical care, research, and education 
activities of the epilepsy centers of excellence established 
and operated pursuant to subsection (a)(2).
    (3) The Secretary shall ensure that funds for such centers 
are designated for the first three years of operation as a 
special purpose program for which funds are not allocated 
through the Veterans Equitable Resource Allocation system.
    (4) In addition to amounts authorized to be appropriated 
under paragraphs (1) and (2) for a fiscal year, the Under 
Secretary for Health shall allocate to such centers from other 
funds appropriated generally for the Department medical 
services account and medical and prosthetics research account, 
as appropriate, such amounts as the Under Secretary for Health 
determines appropriate.
    (5) In addition to amounts authorized to be appropriated 
under paragraphs (1) and (2) for a fiscal year, there are 
authorized to be appropriated such sums as may be necessary to 
fund the national coordinator established by subsection (e).

                                  
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