[House Report 111-223]
[From the U.S. Government Publishing Office]
111th Congress Report
HOUSE OF REPRESENTATIVES
1st Session 111-223
======================================================================
VETERANS' INSURANCE AND HEALTH CARE IMPROVEMENTS ACT OF 2009
_______
July 23, 2009.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Filner, from the Committee on Veterans' Affairs, submitted the
following
R E P O R T
[To accompany H.R. 3219]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred
the bill (H.R. 3219) to amend title 38, United States Code, to
make certain improvements in the laws administered by the
Secretary of Veterans Affairs relating to insurance and health
care, and for other purposes, having considered the same,
report favorably thereon without amendment and recommend that
the bill do pass.
CONTENTS
Page
Purpose and Summary.............................................. 2
Background and Need for Legislation.............................. 3
Hearings......................................................... 9
Subcommittee Consideration....................................... 10
Committee Consideration.......................................... 10
Committee Votes.................................................. 10
Committee Oversight Findings..................................... 10
Statement of General Performance Goals and Objectives............ 10
New Budget Authority, Entitlement Authority, and Tax Expenditures 11
Earmarks and Tax and Tariff Benefits............................. 11
Committee Cost Estimate.......................................... 11
Congressional Budget Office Estimate............................. 11
Federal Mandates Statement....................................... 14
Advisory Committee Statement..................................... 14
Constitutional Authority Statement............................... 14
Applicability to Legislative Branch.............................. 14
Section-by-Section Analysis of the Legislation................... 14
Changes in Existing Law Made by the Bill as Reported............. 16
Purpose And Summary
H.R. 3219 was introduced by Representative Bob Filner of
California, Chairman of the Committee on Veterans' Affairs, on
July 15, 2009. H.R. 3219 would improve U.S. Department of
Veterans Affairs (VA) insurance programs. This legislation
would make permanent the two-year extension of the free
Servicemembers' Group Life Insurance (SGLI) coverage period for
totally disabled veterans following separation from active or
reserve duty. In addition, H.R. 3219 would enable veterans
insured under the Veterans' Group Life Insurance program to
increase the amount of their coverage under this program. This
legislation also would eliminate the reduction in the amount of
accelerated death benefits for terminally-ill persons insured
under the SGLI and Veterans' Group Life Insurance programs
(VGLI).
H.R. 3219 would provide for key expansions and improvements
in the provision of health care. This includes eliminating
copayments for veterans who are catastrophically disabled,
providing health care for certain Medal of Honor recipients who
are not eligible for enrollment under the current VA priority
group schedule, and providing enhanced treatment authority for
certain Vietnam-era herbicide exposed veterans and veterans of
the Persian Gulf War. It would also establish a Director of
Physician Assistants within the office of the Under Secretary
of Veterans Affairs for Health and would require the VA to
create a new Committee on Care of Veterans with Traumatic Brain
Injury.
H.R. 3219 would authorize, subject to the availability of
appropriations, a $1,000 monthly payment to all civilian
fighter groups of World War II who were given veteran status
under the G.I. Bill Improvement Act of 1977, Public Law 95-202
(91 Stat. 1433).
H.R. 3219 is comprised of a number of bills introduced in
the first session of the 111th Congress. These bills include
H.R. 1197, the Medal of Honor Health Care Equity Act of 2009,
introduced by Representative Harry E. Mitchell of Arizona; H.R.
1302, to establish the position of Director of Physician
Assistant Services in the office of the Under Secretary for
Health of the VA, introduced by representative Phil Hare of
Illinois; H.R. 1335, to prohibit the VA from collecting certain
copayments from catastrophically disabled veterans, introduced
by Representative Deborah L. Halvorson of Illinois; H.R. 1546,
the Caring for Veterans with Traumatic Brain Injury Act of
2009, introduced by Representative Jerry McNerney of
California; H.R. 2270, the Benefits for Qualified World War II
Veterans Act of 2009, introduced by Representative Steve Buyer
of Indiana; H.R. 2379, the Veterans' Group Life Insurance
Improvement Act of 2009, introduced by Representative Steve
Buyer of Indiana; H.R. 2774, the Families of Veterans Financial
Security Act, introduced by Representative Deborah L. Halvorson
of Illinois; H.R. 2926, to provide without expiration health
care services to certain Vietnam-era veterans exposed to
herbicide and to veterans of the Persian Gulf War, introduced
by Representative Glenn C. Nye of Virginia; and, H.R. 2968, to
eliminate the required reduction in the amount of the
accidental death benefit payable to certain terminally-ill
veterans insured under the Servicemembers' Group life Insurance
or Veterans' Group life Insurance programs, introduced by
Representative Ann Kirkpatrick of Arizona.
Background and Need for Legislation
TITLE I--MATTERS RELATING TO INSURANCE
Section 101 of H.R. 3219 would provide a permanent
extension of duration of SGLI coverage for totally disabled
veterans.
The SGLI program provides up to $400,000 of life insurance
coverage for individuals currently serving in the uniformed
services and for certain specified periods after separation or
release from periods of reserve duty. The program is supervised
by the VA but is administered by the Office of Servicemembers'
Group Life Insurance under terms specified in a group insurance
contract. Individuals eligible for full-time coverage are
commissioned, warrant and enlisted members of the Army, Navy,
Air Force, Marine Corps and Coast Guard; commissioned members
of the National Oceanic and Atmospheric Administration and the
Public Health Service; cadets or midshipmen of the four United
States Service Academies; and Ready Reservists, including
members of the National Guard, scheduled to perform at least 12
periods of inactive duty.
Public Law 109-233 (120 Stat. 397) extended the duration of
the free SGLI coverage period from one to two years for
servicemembers who are totally disabled on the date of their
separation from active duty or reserve status. This extension
in coverage was effective on the date of enactment for members
released prior to October 1, 2011. The law reduces the duration
of coverage for members released on or after October 1, 2011,
from two years to 18 months. The reduction to 18 months of
disability extension in 2011 will place totally disabled
veterans at a disadvantage and substantively interfere with
their ability to retain affordable life insurance coverage
during the period immediately after their separation from
service.
Maintaining the extension period at its current two-year
period for veterans would guarantee that those most in need,
who have been seriously disabled as a result of their service,
will be fully covered under the SGLI program during this
extended transition period. It would also maximize the
opportunity for totally disabled veterans, who have limited or
no opportunity of obtaining commercial insurance, to obtain
insurance coverage, thereby providing financial security for
their families. It also would allow the VA Insurance Special
Outreach Program for Disabled Veterans the additional time
needed to contact veterans and provide them with the
information they need to make informed decisions concerning
their life insurance options. Additionally, it would allow
automatic conversion at the end of the two-year total
disability extension period, when the member's SGLI coverage is
automatically converted to VGLI (subject only to the member's
timely remittance of premiums), thereby providing improved
financial security for their families. This permanent extension
would apply to those servicemembers released or separated on or
after June 15, 2005.
Section 102 of H.R. 3219 would provide for increased
insurance coverage under the VGLI program.
The VGLI program is administered by the VA. The purpose of
this program is to give veterans the option to convert their
SGLI coverage that they carry when they are in service to a
competitive life insurance product for them and their families
in post-military life. The VGLI program provides group term
life insurance coverage in amounts ranging from $10,000 to
$400,000; no more than $400,000 of combined SGLI and VGLI can
be carried at one time. VGLI is available to all veterans
separated from active duty or the Reserves, usually at the end
of their 120-day free SGLI coverage.
Under current law, veterans have up to one year to convert
the amount of SGLI coverage they carry to VGLI. Many separating
servicemembers are young and often do not see the need to carry
a large amount of life insurance coverage. However, as they get
older and have a family, many of these servicemembers have
expressed a desire to purchase additional coverage but are
barred from doing so according to current law. Since evidence
of health is not required, conversion is a valuable right to a
disabled veteran who might otherwise be required to pay an
extra premium to obtain commercial insurance or might be
uninsurable at any price.
This provision of H.R. 3219 would provide that veterans
insured under the VGLI program would be eligible to increase
coverage by $25,000 no more than once in each five-year period,
if the veteran is under 60 years of age and the total amount of
coverage does not exceed $400,000 (the limit authorized for a
veteran under SGLI). The costs of such increases in coverage
would be offset by the premiums veterans pay to the program, so
there is no direct cost to the Federal government.
Section 103 of H.R. 3219 would eliminate the reduction in
amount of accelerated death benefit for terminally-ill persons
insured under SGLI and VGLI.
The current SGLI/VGLI Accelerated Benefits Option (ABO)
regulation requires VA to discount or reduce the payout
available under both the SGLI and VGLI programs for terminally-
ill servicemembers and veterans who exercise the option to use
up to half of their policy in any way they see fit, such as
paying medical bills or otherwise improving the quality of
their remaining life. Currently, VA discounts this payment by
an amount commensurate with the interest rate earned by the
program on its investment in effect at the time that a
servicemember or veteran applies for the benefits, thereby
often significantly reducing the amount of the ABO payment. The
Committee firmly believes that individuals who qualify for the
ABO payment have financial needs that should not be further
exacerbated by reduction of the insurance coverage or eligible
payments that they are relying on to provide financial security
for themselves and their families.
H.R. 3219 would amend section 1980 of title 38, United
States Code by eliminating the requirement that the lump sum
payment be ``reduced by an amount necessary to assure that
there is no increase in the actuarial value of the benefit
paid.'' This change would eliminate any disparities between VA
and the commercial insurance industry in this regard and
provide a greater benefit to servicemembers, veterans and their
families by not discounting these payments.
TITLE II--MATTERS RELATING TO HEALTH CARE
Section 201 of H.R. 3219 would assign Medal of Honor
recipients to a priority group status equal to that of former
Prisoners of War (POWs) or Purple Heart recipients for seeking
health care through the VA.
Under the VA priority group schedule for enrollment,
veterans who are former POWs and veterans awarded a Purple
Heart medal are classified under Priority Group 3. Under
current law, Medal of Honor recipients are subject to standard
VA eligibility requirements, which include service-connected
disabilities and income limits. They are not expressly covered
in the priority group schedule. This legislation is anticipated
to affect a small population of veterans since the
Congressional Medal of Honor Society documents that there are
3,447 total recipients of the Medal of Honor, of which, only 96
are living.
Section 202 of H.R. 3219 would provide for enhanced
treatment authority for certain Vietnam-era veterans exposed to
herbicide and veterans of the Persian Gulf War.
Agent Orange was one of the defoliants used by the United
States military in the Vietnam War. In the 1970's, some
veterans became concerned about the delayed adverse health
effects potentially resulting from their exposure to Agent
Orange. Agent Orange contained dioxin and recent studies
suggest a link between dioxin and cancer and other disorders.
The VA has a list of diseases, which it presumes resulted from
exposure to herbicides such as Agent Orange. However, the full
impact of herbicides remains unknown and Vietnam-era veterans
continue to face challenges in linking their conditions to
herbicide exposure.
Similarly, veterans returning from the Gulf War faced
health problems. Symptoms included persistent memory and
concentration problems, chronic headaches, widespread pain,
gastrointestinal problems, and other chronic abnormalities not
explained by well-established diagnoses. Veterans were unable
to link these conditions to their service in the Gulf War and
thus, unable to establish a service connected disability
rating.
On November 17, 2008, the Research Advisory Committee on
Gulf War Veterans' Illnesses released a report entitled ``Gulf
War Illness and the Health of Gulf War Veterans: Scientific
Findings and Recommendations.'' The report indicated that Gulf
War Illness is real for some of the military personnel who
served in the 1990-1991 Gulf War and were exposed to some
potentially hazardous substances. With this report linking
symptoms of Gulf War Illness to the war, veterans of the Gulf
war era may now seek to establish service-connected
disabilities.
In 1981, Public Law 97-72 (95 Stat. 1047) provided the VA
with a special treatment authority to provide health care to
Vietnam veterans who may have been exposed to herbicides,
notwithstanding that there was insufficient medical evidence to
conclude that their disabilities were associated with exposure
to herbicides while serving in Vietnam. This authority was
extended through 1996 with Public Law 104-262 (110 Stat. 3177).
Similarly, Public Law 103-210 (102 Stat. 2760) provided special
treatment authority to veterans who served in the Persian Gulf
War in the Southwest Asia theater of operations who were
exposed to toxic substances or environmental hazards. In 1997,
Public Law 105-114 (111 Stat. 2277) removed the requirement
that the veteran had to be exposed to toxic substances or
environmental hazards and only required service in the
Southwest Asia theatre of operations during the Persian Gulf
War. In 1998, Public Law 105-368 (112 Stat. 3315) extended the
authority through 2001 and Public Law 107-135 (115 Stat. 2446)
provided for another extension through 2002.
Although this special treatment authority has lapsed, the
VA has continued to treat these veterans within Priority Group
6. H.R. 3219 would provide permanent authorization for the
special treatment authority of Vietnam-era herbicide exposed
veterans and Gulf War era veterans who have insufficient
medical evidence to establish a service-connected disability.
Section 203 of this legislation would help veterans who are
catastrophically disabled from non-service-connected causes and
who have income above the means tested levels by waiving
certain copayments.
Under the current law, these veterans are placed in
Priority Group 4 for enrollment purposes, but are required to
pay all health care fees and copayments as though they are in a
lower eligibility category. H.R. 3219 would prohibit the VA
from collecting copayments for hospital, nursing home,
outpatient, and other medical care from non-service-connected
veterans who are catastrophically disabled. Catastrophically
disabled veterans are defined as having a permanent, severely
disabling injury, disorder, or disease that compromises their
ability to carry out the activities of daily living to such a
degree that the individual requires personal or mechanical
assistance to leave home or bed or requires constant
supervision to avoid physical harm to self or others. As such,
the nature and severity of the disabilities experienced by
these veterans often precludes them from employment and a
steady form of income. This legislation would alleviate the
undue financial hardship that catastrophically disabled
veterans may face.
Section 204 of H.R. 3219 would create a full-time position
of the Director of Physician Assistant Services within the VA
Central Office, who reports to the Veterans Health
Administration's Under Secretary for Health.
Physician assistants (PAs) are health professionals who
practice medicine as members of a team with supervising
physicians. They deliver a broad range of medical and surgical
services which include conducting physical exams, diagnosing
and treating illnesses, ordering and interpreting tests,
providing counsel on preventive health care, assisting in
surgery, and prescribing medications. In addition, physicians
may delegate to PAs, the medical duties that are within the
physician's scope of practice, as allowed by the law. PAs are
certified by the National Commission on Certification of
Physician Assistants (NCCPA) and also are state-licensed.
According to the estimates of the American Association of
Physician Assistants (AAPA), about 68,124 people were in
clinical practice as PAs at the beginning of 2008. Also in
2008, about 257 million patients visited PAs and about 332
million medications were prescribed or recommended by PAs.
Of the PAs who work for the government, the VA is the
single largest employer. As of January 31, 2009, there were
1,842 PAs in medical centers and outpatient clinics of the VA
health care system. Throughout the 1990s, VA joined other
Federal entities in relying heavily on PAs to bolster medical
staff. Recognizing the potential of PAs, the PA Advisor
position was authorized by the Veterans Benefits and Health
Care Improvement Act of 2000, Public Law 106-419 (114 Stat.
1822). While the advisor has furthered the increased
utilization of PAs, it is a part-time, field-based position.
Therefore, there continues to be inconsistencies in the way
that PAs are used across the VA system. A Director of Physician
Assistant Services would help ensure efficient utilization and
full integration of the VA's PA workforce in VA patient care
programs and initiatives. The Director also would address
issues of education and training, and employment, as well as
ensure appropriate utilization and optimal participation of
physician assistants in the VA health care system.
Section 205 would create a committee to better assist
veterans with traumatic brain injury (TBI).
According to a 2008 RAND report, ``Invisible Wounds of War:
Summary and Recommendations for Addressing Psychological and
Cognitive Injuries,'' about a third of the returning troops
from Operation Enduring Freedom/Operation Iraqi Freedom (OEF/
OIF) reported symptoms of mental health or cognitive condition.
At the writing of the report, a total of 1.64 million
servicemembers had been deployed to Iraq and Afghanistan since
October 2001. Of this, about 300,000 returning veterans were
suffering from post-traumatic stress disorder (PTSD) or major
depression and about 320,000 may have experienced TBI during
deployment.
Although the VA has increased their capacity to provide
health services substantially for mental health and TBI, there
are gaps in access. The RAND study found that returning
servicemembers may face long wait times for medical
appointments at VA facilities. As such, 57 percent of returning
troops who sought medical attention had not been evaluated by a
physician for a brain injury. Those with untreated TBI
conditions are not only at higher risk for other psychological
problems, but are more likely to attempt suicide. They also
have higher rates of unhealthy behavior leading to physical
health problems and mortality. RAND also sought to measure the
total cost to society, including treatment costs, losses or
gains in productivity, and costs associated with suicide.
Despite much uncertainty surrounding the true cost of TBI, RAND
estimated that the total annual cost ranges between $591
million and $910 million.
Because brain injury is considered a signature wound of
OEF/OIF, this war will produce a generation of veterans with
life changing invisible wounds of war. In addition, there is
room for improvement in the diagnosis and treatment of veterans
with TBI as evidenced by the RAND report. This is why H.R. 3219
would direct the VA to establish a Committee on Care of
Veterans with Traumatic Brain Injury to assess and advise how
the VA can better meet the treatment and rehabilitation needs
of veterans with TBI.
Section 206 of H.R. 3219 would clarify the requirements of
a pilot program which was authorized in Public Law 110-387 (114
Stat. 1822), the Veterans' Mental Health and Other Care
Improvements Act of 2008.
This law authorized the VA to establish a pilot program for
highly rural veterans facing hardship so that they may receive
health care in non-VA facilities. Section 206 of H.R. 3219
would remove the ``highly rural'' and ``hardship''
requirements, and would define covered veterans by driving time
rather than distance to the nearest VA health care facility.
The Committee provided this clarification because of the VA's
concerns that it would have to undergo a lengthy process of
developing and issuing regulations to define the hardship
provision. In addition, the VA faced challenges in reconciling
the conflicting definition of a highly rural veteran as defined
by Public Law 110-387 versus the traditional definition based
on Census data. Section 206 of H.R. 3219 would help to ensure
timely implementation of the rural health pilot program.
TITLE III--MATTERS RELATING TO BENEFITS
Section 301 of H.R. 3219 would provide a $1,000 monthly
payment to all civilian groups of World War II (WWII) who were
given veteran status under the G.I Bill Improvement Act of
1977.
Those individuals who received benefits under the
Servicemen's Readjustment Act of 1944, Public Law 78-346 (
Stat. ), the G.I. Bill of Rights of 1944, would not be eligible
to receive benefits provided under this section. One group of
veterans who would be included under H.R. 3219 is the American
Volunteer Group known as the Flying Tigers. The Flying Tigers
were a group of American pilots and ground crews who helped
defend Rangoon and parts of China against Japan before and
after the attack on Pearl Harbor. The Flying Tigers are
credited with destroying an impressive 297 enemy aircraft and
had one of the best kill ratios of any air group in the Pacific
theater. There were approximately 80 pilots that flew for the
Flying Tigers, of which 21 died in service and 19 became aces.
Those members of the Flying Tigers who subsequently served in
the U.S. Armed Forces during WWII who received benefits
provided under the Servicemen's Readjustment Act of 1944 would
not qualify for the benefit that this section would provide.
Another group that would benefit from this amendment is the
Women Air Force Service Pilots (WASPS). These were female
pilots who flew every type of mission that any Army Air Force
male pilot flew during WWII, except combat missions. They freed
up male pilots for combat by flying planes from factories to
airfields and overall flew 60 million miles in every type of
aircraft in the Army Air Force arsenal from the fastest
fighters to the heaviest bombers. More than 25,000 women
applied for WASP service, and less than 1,900 were accepted.
After completing months of military flight training, 1,078 of
them earned their wings and became the first women in history
to fly American military aircraft. Thirty-eight of these brave
pilots died while serving their country.
The Congressional Budget Office estimates that this
provision of H.R. 3219 would cost $855 million in discretionary
funding over a five-year period. Notably, this cost reflects
the inclusion of the Merchant Mariners of WWII. The Committee
notes that Merchant Mariners would be entitled to receive a
$1,000 monthly payment under H.R. 23, the Belated Thank You to
the Merchant Mariners of WWII Act of 2009, which passed the
House of Representatives on May 12, 2009. H.R. 23 includes the
Merchant Mariners who served between August 15, 1945, and
December 31, 1946, a group not covered in section 301 of this
measure. It is not the intention of the Committee to require
two $1,000 monthly payments to the Merchant Mariners of WWII.
This would create inequity between the Merchant Mariners and
the other groups included in this provision.
Hearings
On May 21, 2009, the Subcommittee on Disability Assistance
and Memorial Affairs held a legislative hearing on several
bills introduced during the 111th Congress, including H.R.
2270. The following witnesses testified: The Honorable Nita M.
Lowey of New York, accompanied by Elizabeth Yeznach, a World
War II Cadet Nurse, as presented by Anne R. (Mandzak) Kakos of
Yonkers, New York; The Honorable Carolyn C. Kilpatrick of
Michigan; Major Ed Stiles, Sr., USAFR (Ret.), on behalf of the
American Volunteer Group (Flying Tigers); Bradley G. Mayes,
Director, Compensation and Pension Service, Veterans Benefits
Administration, U.S. Department of Veterans Affairs,
accompanied by Richard Hipolit, General Counsel, Office of
General Counsel, U.S. Department of Veterans Affairs. Those
submitting statements for the record included the American
Federation of Government Employees, AFL-CIO; The Honorable
Steve Buyer of Indiana; and, John L. Wilson, Associate National
Legislative Director, Disabled American Veterans.
On June 18, 2009, the Subcommittee on Health held a
legislative hearing on several bills introduced during the
111th Congress, including H.R. 1197, H.R. 1302, H.R. 1335, H.R.
1546, and H.R. 2926. The following witnesses testified: The
Honorable Harry Mitchell of Arizona; The Honorable Phil Hare of
Illinois; The Honorable Deborah L. Halvorson of Illinois; The
Honorable Jerry McNerney of California; The Honorable Thomas
S.P. Perriello of Virginia; The Honorable Harry Teague of New
Mexico; and, Fred Cowell, Senior Health Policy Analyst,
Paralyzed Veterans of America. Those submitting statements for
the record included: The Honorable Steve Buyer of Indiana; The
Honorable Jerry Moran of Kansas; Joy J. Ilem, Deputy National
Legislative Director, Disabled American Veterans; Joseph L.
Wilson, Deputy Director, Veterans Affairs and Rehabilitation
Commission, The American Legion; Chris Needham, Senior
Legislative Associate, Veterans of Foreign Wars of the United
States; Bernard Edelman, Deputy Director for Policy and
Government Affairs, Vietnam Veterans of America; the American
Academy of Physician Assistants; the National Association of
Veterans' Research and Education Foundation; the Wounded
Warrior Project; Barbara Cohoon, Ph.D., RN, Government
Relations Deputy Director, National Military Family
Association; and, Robert A. Petzel, M.D., Acting Principal
Deputy Under Secretary for Health, Veterans Health
Administration, U.S. Department of Veterans Affairs.
On June 24, 2009, the Subcommittee on Disability Assistance
and Memorial Affairs held a legislative hearing on several
bills introduced during the 111th Congress, including H.R.
2379, H.R. 2774, and H.R. 2968. The following witnesses
testified: The Honorable Joe Donnelly of Indiana; The Honorable
Deborah L. Halvorson of Illinois; The Honorable Ann Kirkpatrick
of Arizona; Bonnie Carroll, Chairman and Executive Director,
Tragedy Assistance Program for Survivors, Inc.; John Wilson,
Associate National Legislative Director, Disabled American
Veterans; Thomas M. Lastowka, Director, Veterans Affairs
Regional Office and Insurance Center, U.S. Department of
Veterans Affairs, accompanied by Richard J. Hipolit, Assistant
General Counsel, Office of General Counsel, U.S. Department of
Veterans Affairs. Those submitting statements for the record
included The Honorable Steve Buyer of Indiana and the Paralyzed
Veterans of America.
Subcommittee Consideration
On June 3, 2009, the Subcommittee on Disability Assistance
and Memorial Affairs met in open markup session and ordered
favorably forwarded to the full Committee H.R. 2270.
On July 9, 2009, the Subcommittee on Health met in open
markup session and ordered favorably forwarded to the full
Committee H.R. 1197, H.R. 1302, H.R. 1335, H.R. 1546, and H.R.
2926. During consideration of these bills the following
amendments were offered:
An amendment to H.R. 1335 by Ms. Halvorson of
Illinois to further eliminate copayments for medical
services for veterans who are catastrophically disabled
was agreed to by voice vote.
An amendment to H.R. 2926 by Mr. Michaud of Maine to
provide enhanced treatment authority for veterans of
Persian Gulf War I and clarifying the terms of a rural
health pilot program authorized in Public Law 110-387
was agreed to by voice vote.
On July 9, 2009, the Subcommittee on Disability Assistance
and Memorial Affairs met in open markup session and ordered
favorably forwarded to the full Committee H.R. 2379, H.R. 2774,
and H.R. 2968. During consideration of these bills the
following amendments were offered:
An amendment in the nature of a substitute to H.R.
2968 by Ms. Kirkpatrick of Arizona was agreed to by
voice vote.
Committee Consideration
On July 15, 2009, the full Committee met in an open markup
session, a quorum being present, and ordered H.R. 3219 reported
favorably to the House of Representatives, by voice vote.
Committee Votes
Clause 3(b) of rule XIII of the Rules of the House of
Representatives requires the Committee to list the record votes
on the motion to report the legislation and amendments thereto.
There were no record votes taken on amendments or in connection
with ordering H.R. 3219 reported to the House. A motion by Mr.
Buyer of Indiana to order H.R. 3219 reported favorably to the
House of Representatives was agreed to by voice vote.
Committee Oversight Findings
In compliance with clause 3(c)(1) of rule XIII and clause
2(b)(1) of rule X of the Rules of the House of Representatives,
the Committee's oversight findings and recommendations are
reflected in the descriptive portions of this report.
Statement Of General Performance Goals and Objectives
In accordance with clause 3(c)(4) of rule XIII of the Rules
of the House of Representatives, the Committee's performance
goals and objectives are reflected in the descriptive portions
of this report.
New Budget Authority, Entitlement Authority, and Tax Expenditures
In compliance with clause 3(c)(2) of rule XIII of the Rules
of the House of Representatives, the Committee adopts as its
own the estimate of new budget authority, entitlement
authority, or tax expenditures or revenues contained in the
cost estimate prepared by the Director of the Congressional
Budget Office pursuant to section 402 of the Congressional
Budget Act of 1974.
Earmarks and Tax and Tariff Benefits
H.R. 3219 does not contain any congressional earmarks,
limited tax benefits, or limited tariff benefits as defined in
clause 9(d), 9(e), or 9(f) of rule XXI of the Rules of the
House of Representatives.
Committee Cost Estimate
The Committee adopts as its own the cost estimate on H.R.
3219 prepared by the Director of the Congressional Budget
Office pursuant to section 402 of the Congressional Budget Act
of 1974.
Congressional Budget Office Cost Estimate
Pursuant to clause 3(c)(3) of rule XIII of the Rules of the
House of Representatives, the following is the cost estimate
for H.R. 3219 provided by the Congressional Budget Office
pursuant to section 402 of the Congressional Budget Act of
1974:
U.S. Congress,
Congressional Budget Office,
Washington, DC, July 23, 2009.
Hon. Bob Filner,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 3219, the
Veterans' Insurance and Health Care Improvement Act of 2009.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Dwayne M.
Wright.
Sincerely,
Douglas W. Elmendorf.
Enclosure.
H.R. 3219--Veterans' Insurance and Health Care Improvement Act of 2009
Summary: H.R. 3219 would affect several veterans' programs
dealing with medical care and insurance. H.R. 3219 also would
establish a new fund to provide benefits to certain veterans of
World War II. CBO estimates that implementing H.R. 3219 would
cost $229 million in 2010 and $895 million over the 2010-2014
period, assuming appropriation of the specified and estimated
amounts. Enacting the bill would have no impact on direct
spending or revenues.
H.R. 3219 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA)
and would not affect the budgets of state, local, or tribal
governments.
Estimated cost to the Federal Government: The estimated
budgetary impact of H.R. 3219 is shown in the following table.
The costs of this legislation fall within budget function 700
(veterans benefits and services). For the purpose of this
estimate, CBO assumes that H.R. 3219 will be enacted near the
start of fiscal year 2010 and that the necessary funds for
implementing the bill will be provided each year.
----------------------------------------------------------------------------------------------------------------
By fiscal year in millions of dollars--
-----------------------------------------------------
2010-
2010 2011 2012 2013 2014 2014
----------------------------------------------------------------------------------------------------------------
CHANGES IN SPENDING SUBJECT TO APPROPRIATION
Benefits to Qualified World War II Veterans:
Authorization level................................... 222 193 170 146 124 855
Estimated Outlays..................................... 222 193 170 146 124 855
Copayments from Certain Disabled Veterans:
Estimated Authorization level......................... 8 8 8 8 8 40
Estimated Outlays..................................... 7 8 8 8 8 39
Other Health Care Provisions:
Estimated Authorization level......................... * * * * * 1
Estimated Outlays..................................... * * * * * 1
Total Changes:
Estimated Authorization Level..................... 230 201 178 154 132 896
Estimated Outlays................................. 229 201 178 154 132 895
----------------------------------------------------------------------------------------------------------------
Notes: * = less than $500,000.
Numbers many not sum to totals because of rounding.
Basis of estimate: H.R. 3219 would affect several programs
administered by the Department of Veterans Affairs (VA),
including those providing medical care and insurance and would
establish a new fund to pay benefits to qualified World War II
veterans. CBO estimates that implementing H.R. 3219 would cost
$895 million over the 2010-2014 period, assuming appropriation
of the specified and estimated amounts.
Benefits to qualified World War II veterans
Under section 301 certain individuals who served during
World War II would be eligible to receive a monthly benefit of
$1,000, subject to the availability of funds provided for that
purpose. The benefit would be provided to veterans who were
retroactively deemed to have served on active duty by the GI
Bill Improvement Act of 1977 (Public Law 95-202) if they apply
within a year of the enactment of H.R. 3219.
To provide those benefits, section 301 would establish the
Qualified World War II Veterans Equity Compensation Fund.
Amounts in the fund would be used to pay the monthly benefit to
eligible individuals, on a first-come, first-served basis. The
bill would specifically authorize appropriations for each year
as shown in the table.
Based on information from VA and the Department of Defense
(DoD) on the number of qualified veterans that served during
the specified period, their average age, and on mortality rates
from DoD, CBO estimates that, in 2010, about 74,000 veterans
would qualify for the benefit. We estimate that one-quarter of
them, about 18,500, would apply for the benefit. The amount
authorized in section 301 ($222 million) would allow all of
those applicants to receive the full monthly benefit in 2010,
assuming appropriation of that amount.
Using the DoD mortality rates, CBO estimates that the
amounts authorized for 2011 through 2014, if appropriated,
would be sufficient to continue providing monthly payments to
surviving beneficiaries. In total, CBO estimates that
implementing section 301 would cost $855 million over the 2010-
2014 period.
Copayments from certain disabled veterans
Section 203 would prohibit the collection of copayments and
other fees from catastrophically disabled veterans who receive
hospital care or medical services from VA. Catastrophically
disabled veterans are those who have a permanent, severely
disabling condition that affects their ability to carry out the
activities of daily living to such a degree that they require
constant supervision or assistance to leave their homes.
In 2008, VA collected $8 million in copayments for medical
care and prescription drugs from such veterans; implementing
this provision would result in a loss of those collections.
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, CBO estimates
that implementing this provision would cost $40 million over
the 2010-2014 period.
Other Health Care Provisions. Taken together, CBO estimates
that implementing the following provisions would cost about $1
million over the 2010-2014 period, assuming availability of
appropriated funds:
Section 201 would authorize VA to provide medical
care to recipients of the Congressional Medal of Honor under
its third-highest priority category. According to the
Congressional Medal of Honor Society, there are fewer than 100
living recipients.
Section 204 would establish the position of a
Director of Physician Assistant Services within the VA. A
similar position already exists. (Thus, any additional costs
for the new position would be negligible.)
Section 205 would authorize VA employees to serve
on a committee to assess and advise the agency on treatment of
traumatic brain injuries.
Insurance programs
H.R. 3219 would make several changes to veterans insurance
programs, specifically Servicemembers Group Life Insurance
(SGLI) and Veterans Group Life Insurance (VGLI). Any costs
associated with these provisions in the short run would be
absorbed by the SGLI or VGLI fund. Over the long term, such
costs would be covered by increased premiums and would
therefore have no budgetary impact.
Intergovernmental and private-sector impact: H.R. 3219
contains no intergovernmental or private-sector mandates as
defined in UMRA and would not affect the budgets of state,
local, or tribal governments.
Previous CBO estimate: On May 7, 2009, CBO transmitted a
cost estimate for H.R. 23, the Belated Thank You to the
Merchant Mariners of World War II Act of 2009, as ordered
reported by the House Committee on Veterans' Affairs on May 6,
2009. Section 301 of H.R. 3129 and H.R. 23 would both create
funds to provide monthly benefits to certain World War II
veterans who were deemed retroactively to have served on active
duty. H.R. 3129 would provide benefits to several such
categories of veterans including Merchant Mariners, while H.R.
23 would only provide payments for Merchant Mariners.
Differences in the estimates reflect that difference in the
legislation.
Estimate prepared by: Federal costs: World War II Veterans
and Insurance--Dwayne M. Wright; Medical Care--Sunita D'Monte;
Impact on state, local, and tribal governments: Lisa Ramirez-
Branum; Impact on the private sector: Elizabeth Bass.
Estimate approved by: Theresa Gullo, Deputy Assistant
Director for Budget Analysis.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates regarding H.R. 3219 prepared by the Director of the
Congressional Budget Office pursuant to section 423 of the
Unfunded Mandates Reform Act.
Advisory Committee Statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act would be created by H.R.
3219.
Constitutional Authority Statement
Pursuant to clause 3(d)(1) of rule XIII of the Rules of the
House of Representatives, the Committee finds that the
Constitutional authority for H.R. 3219 is provided by Article
I, section 8 of the Constitution of the United States.
Applicability to Legislative Branch
The Committee finds that the legislation does not relate to
the terms and conditions of employment or access to public
services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act.
Section-by-Section Analysis of the Legislation
TITLE I--MATTERS RELATING TO INSURANCE
Section 101. Permanent extension of duration of Servicemembers' Group
Life Insurance coverage for totally disabled veterans
This section amends section 1968 of title 38, United States
Code, to permanently extend coverage under SGLI to two years
for separating servicemembers who are totally disabled.
Section 102. Increased amount of Veterans' Group Life Insurance
This section would amend section 1977 of title 38, United
States Code, to provide veterans insured under VGLI additional
opportunities to increase their amount of coverage.
This section provides that not more than once in each five-
year period, a veteran under the age of 60 may increase the
amount of coverage by $25,000 if the total amount of coverage
does not exceed $400,000 (the limit authorized for a veteran
under SGLI).
Section 103. Elimination of reduction in amount of accelerated death
benefit for terminally-ill persons insured under the
Servicemembers' Group Life Insurance and Veterans' Group Life
Insurance
This section would amend section 1980 of title 38, United
States Code, to eliminate the reduction in amount of
accelerated death benefit for terminally-ill persons insured
under SGLI and VGLI.
TITLE II--MATTERS RELATING TO HEALTH CARE
Section 201. Higher priority status for certain veterans who are Medal
of Honor recipients
This section assigns priority status for Medal of Honor
recipients equal to that of former prisoners of war or Purple
Heart recipients with respect to the provision of veterans'
hospital care and medical services provided through the VA.
Section 202. Provision of hospital care, medical services, and nursing
home care for certain Vietnam-era veterans exposed to herbicide
and veterans of the Persian Gulf War
This section provides permanent authorization for the VA to
provide hospital care, medical services, and nursing home care
to Vietnam-era herbicide exposed veterans and Gulf-War era
veterans who have insufficient medical evidence to establish a
service-connected disability.
Section 203. Prohibition on collection of copayments from
catastrophically disabled veterans
This section prohibits the collection by the VA of
copayments or other fees for hospital, nursing home, and
medical care for veterans who are catastrophically disabled
from non-service connected causes and who have income above the
means tested levels.
Section 204. Establishment of Director of Physician Assistant Services
at Veterans Health Administration of Department of Veterans
Affairs
This section establishes the position of Director of
Physician Assistant Services within the Veterans Health
Administration (VHA) of the VA who reports to the Under
Secretary for Health on all matters relating to the education
and training, employment, appropriate utilization, and optimal
participation of physician assistants within VHA programs and
initiatives. It also requires the Secretary of Veterans Affairs
to ensure that an individual is serving in such position no
later than 120 days after the enactment of this Act.
Section 205. Committee on Care of Veterans with Traumatic Brain Injury
This section establishes a ``Committee on Care of Veterans
with Traumatic Brain Injury'' within the Veterans Health
Administration. Committee members would consist of VA employees
with expertise in TBI who would be appointed by the Under
Secretary for Health. The Committee would evaluate the care,
identify system-wide problems, identify specific facilities in
need of improvement, and identify model programs for the
successful treatment and rehabilitation of veterans with TBI,
as well as provide recommendations to the Under Secretary for
Health on improving programs of care for TBI. It also requires
an annual report to Congress, due no later than June 1, 2010.
Section 206. Revision of certain requirements for the pilot program of
enhanced contract care authority for health care needs of
veterans in highly rural areas
This section clarifies Section 403 of Public law 110-387,
the Veterans' Mental Health and Other Care Improvements Act of
2008, which provided for a rural health pilot program. It
removes the requirement that the veteran resides in highly
rural areas and defines hardship by driving time to the nearest
VA health care facility. Specifically, ``hardship'' is defined
as a veteran who resides more than 60 minutes driving distance
from the nearest VA health care facility providing primary care
services; more than 120 minutes driving distance from the
nearest VA facility providing acute hospital care; and more
than 240 minutes driving distance from the nearest VA facility
providing tertiary care.
TITLE III--MATTERS RELATING TO BENEFITS
Section 301. Benefits for qualified World War II veterans
This section would amend title 38, United States Code, by
adding a new section creating, subject to the availability of
appropriations, a Qualified World War II Veterans Equity
Compensation Fund. The Secretary of VA would be required to
make a monthly payment of $1,000 out of the compensation fund
to eligible individuals in the order of receipt of applications
Eligible veterans are those given veteran status under the G.I
Bill Improvement Act of 1977 who have not received benefits
under the Servicemen's Readjustment Act of 1944.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (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, UNITED STATES CODE
* * * * * * *
PART I--GENERAL PROVISIONS
* * * * * * *
CHAPTER 5--AUTHORITY AND DUTIES OF THE SECRETARY
SUBCHAPTER I--GENERAL AUTHORITIES
Sec.
501. Rules and regulations.
* * * * * * *
SUBCHAPTER II--SPECIFIED FUNCTIONS
* * * * * * *
533. Qualified World War II Veterans Equity Compensation Fund.
* * * * * * *
SUBCHAPTER II--SPECIFIED FUNCTIONS
* * * * * * *
Sec. 533. Qualified World War II Veterans Equity Compensation Fund
(a) Compensation Fund.--(1) There is in the general fund of
the Treasury a fund to be known as the ``Qualified World War II
Veterans Equity Compensation Fund'' (in this section referred
to as the ``compensation fund'').
(2) Subject to the availability of appropriations for such
purpose, amounts in the compensation fund shall be available to
the Secretary without fiscal year limitation to make payments
to eligible individuals in accordance with this section.
(b) Eligible Individuals.--(1) An eligible individual is an
individual who--
(A) during the 1-year period beginning on the date of
the enactment of the Benefits for Qualified World War
II Veterans Act of 2009, submits to the Secretary an
application containing such information and assurances
as the Secretary may require;
(B) has not received benefits under the Servicemen's
Readjustment Act of 1944 (Public Law 78-346); and
(C) has engaged in qualified service.
(2) For purposes of paragraph (1), a person has engaged in
qualified service if the service of the person has been
determined to have been active duty service pursuant to section
1401 of the GI Bill Improvement Act of 1977 (38 U.S.C. 106
note).
(c) Amount of Payments.--The Secretary shall make a monthly
payment out of the compensation fund in the amount of $1,000 to
an eligible individual. The Secretary shall make such payments
to eligible individuals in the order in which the Secretary
receives the applications of the eligible individuals.
(d) Authorization of Appropriations.--(1) There are
authorized to be appropriated to the compensation fund amounts
as follows:
(A) For fiscal year 2010, $222,000,000.
(B) For fiscal year 2011, $193,000,000.
(C) For fiscal year 2012, $170,000,000.
(D) For fiscal year 2013, $146,000,000.
(E) For fiscal year 2014, $124,000,000.
(2) Funds appropriated to carry out this section shall remain
available until expended.
(e) Reports.--The Secretary shall include, in documents
submitted to Congress by the Secretary in support of the
President's budget for each fiscal year, detailed information
on the operation of the compensation fund, including the number
of applicants, the number of eligible individuals receiving
benefits, the amounts paid out of the compensation fund, the
administration of the compensation fund, and an estimate of the
amounts necessary to fully fund the compensation fund for that
fiscal year and each of the three subsequent fiscal years.
(f) Regulations.--The Secretary shall prescribe regulations
to carry out this section.
* * * * * * *
PART II--GENERAL BENEFITS
* * * * * * *
CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE
SUBCHAPTER I--GENERAL
Sec.
1701. Definitions.
* * * * * * *
SUBCHAPTER III--MISCELLANEOUS PROVISIONS RELATING TO HOSPITAL AND
NURSING HOME CARE AND MEDICAL TREATMENT OF VETERANS
* * * * * * *
1730A. Prohibition on collection of copayments from catastrophically
disabled veterans.
* * * * * * *
SUBCHAPTER I--GENERAL
* * * * * * *
Sec. 1705. Management of health care: patient enrollment system
(a) In managing the provision of hospital care and medical
services under section 1710(a) of this title, the Secretary, in
accordance with regulations the Secretary shall prescribe,
shall establish and operate a system of annual patient
enrollment. The Secretary shall manage the enrollment of
veterans in accordance with the following priorities, in the
order listed:
(1) * * *
* * * * * * *
(3) Veterans who are former prisoners of war or who
were awarded the Purple Heart, veterans who were
awarded the medal of honor under section 3741, 6241, or
8741 of title 10 or section 491 of title 14, veterans
with service-connected disabilities rated 10 percent or
20 percent, and veterans described in subparagraphs (B)
and (C) of section 1710(a)(2) of this title.
* * * * * * *
SUBCHAPTER II--HOSPITAL, NURSING HOME, OR DOMICILIARY CARE AND MEDICAL
TREATMENT
Sec. 1710. Eligibility for hospital, nursing home, and domiciliary care
(a) * * *
* * * * * * *
(e)(1)(A) * * *
* * * * * * *
(C) Subject to [paragraphs (2) and (3)] paragraph (2) of this
subsection, a veteran who served on active duty between August
2, 1990, and November 11, 1998, in the Southwest Asia theater
of operations during the Persian Gulf War is eligible for
hospital care, medical services, and nursing home care under
subsection (a)(2)(F) for any disability, notwithstanding that
there is insufficient medical evidence to conclude that such
disability may be associated with such service.
* * * * * * *
(3) Hospital care, medical services, and nursing home care
may not be provided under or by virtue of [subsection
(a)(2)(F)--
[(A) in the case of care for a veteran described in
paragraph (1)(A), after December 31, 2002;
[(B) in the case of care for a veteran described in
paragraph (1)(C), after December 31, 2002; and]
[(C) in the case] subsection (a)(2)(F) in the case of
of care for a veteran described in paragraph (1)(D)
who--
[(i)] (A) is discharged or released from the active
military, naval, or air service after the date that is
five years before the date of the enactment of the
National Defense Authorization Act for Fiscal Year
2008, after a period of five years beginning on the
date of such discharge or release; or
[(ii)] (B) is so discharged or released more than
five years before the date of the enactment of that Act
and who did not enroll in the patient enrollment system
under section 1705 of this title before such date,
after a period of three years beginning on the date of
the enactment of that Act.
* * * * * * *
SUBCHAPTER III--MISCELLANEOUS PROVISIONS RELATING TO HOSPITAL AND
NURSING HOME CARE AND MEDICAL TREATMENT OF VETERANS
* * * * * * *
Sec. 1730A. Prohibition on collection of copayments from
catastrophically disabled veterans
Notwithstanding subsections (f) and (g) of section 1710 of
this title, subsection (a) of section 1722A of this title, and
any other provision of law, the Secretary may not require a
veteran who is catastrophically disabled to make any copayment
for the receipt of hospital care or medical services under the
laws administered by the Secretary.
* * * * * * *
CHAPTER 19--INSURANCE
* * * * * * *
SUBCHAPTER III--SERVICEMEMBERS' GROUP LIFE INSURANCE
* * * * * * *
Sec. 1968. Duration and termination of coverage; conversion
(a) Each policy purchased under this subchapter shall contain
a provision, in terms approved by the Secretary, to the effect
that any insurance thereunder on any member of the uniformed
services, and any insurance thereunder on any insurable
dependent of such a member, unless discontinued or reduced upon
the written request of the insured (or discontinued pursuant to
section 1969(a)(2)(B) of this title), shall continue in effect
while the member is on active duty, active duty for training,
or inactive duty training scheduled in advance by competent
authority during the period thereof, or while the member meets
the qualifications set forth in subparagraph (B) or (C) of
section 1965(5) of this title and such insurance shall cease as
follows:
(1) With respect to a member on active duty or active
duty for training under a call or order to duty that
does not specify a period of less than 31 days,
insurance under this subchapter shall cease as follows:
(A) 120 days after the separation or release
from active duty or active duty for training,
unless on the date of such separation or
release the member is totally disabled, under
criteria established by the Secretary, in which
event the insurance shall cease on the earlier
of the following dates (but in no event before
the end of 120 days after such separation or
release):
(i) * * *
[(ii) The date that is--
[(I) two years after the date
of separation or release from
such active duty or active duty
for training, in the case of
such a separation or release
during the period beginning on
the date that is one year
before the date of the
enactment of Veterans' Housing
Opportunity and Benefits
Improvement Act of 2006 and
ending on September 30, 2011;
and
[(II) 18 months after the
date of separation or release
from such active duty or active
duty for training, in the case
of such a separation or release
on or after October 1, 2011.]
(ii) The date that is two years after
the date of separation or release from
such active duty or active duty for
training.
* * * * * * *
(4) With respect to a member of the Ready Reserve of
a uniformed service who meets the qualifications set
forth in subparagraph (B) or (C) of section 1965(5) of
this title, insurance under this subchapter shall cease
120 days after separation or release from such
assignment, unless on the date of such separation or
release the member is totally disabled, under criteria
established by the Secretary, in which event the
insurance shall cease on the earlier of the following
dates (but in no event before the end of 120 days after
separation or release from such assignment):
(A) * * *
[(B) The date that is--
[(i) two years after the date of
separation or release from such
assignment, in the case of such a
separation or release during the period
beginning on the date that is one year
before the date of the enactment of
Veterans' Housing Opportunity and
Benefits Improvement Act of 2006 and
ending on September 30, 2011; and
[(ii) 18 months after the date of
separation or release from such
assignment, in the case of such a
separation or release on or after
October 1, 2011.]
(B) The date that is two years after the date
of separation or release from such assignment.
* * * * * * *
Sec. 1977. Veterans' Group Life Insurance
(a)(1) Except as provided in paragraph (3), Veterans' Group
Life Insurance shall be issued in the amounts specified in
section 1967(a) of this title. In the case of any individual,
the amount of Veterans' Group Life Insurance may not exceed the
amount of Servicemembers' Group Life Insurance coverage
continued in force after the expiration of the period of duty
or travel under section 1967(b) or 1968(a) of this title. No
person may carry a combined amount of Servicemembers' Group
Life Insurance and Veterans' Group Life Insurance at any one
time in excess of the maximum amount for Servicemembers' Group
Life Insurance in effect under section 1967(a)(3)(A)(i) of this
title.
* * * * * * *
(3) Not more than once in each five-year period beginning on
the date a person becomes insured under Veterans' Group Life
Insurance, such person may elect in writing to increase the
amount for which the person is insured if--
(A) the person is under the age of 60;
(B) the increased amount is not more than $25,000;
and
(C) the amount for which the person is insured does
not exceed the amount provided for under section
1967(a)(3)(A)(i) of this title.
* * * * * * *
Sec. 1980. Option to receive accelerated death benefit
(a) * * *
(b)(1) A terminally ill person insured under Servicemembers'
Group Life Insurance or Veterans' Group Life Insurance may
elect to receive in a lump-sum payment a portion of the face
value of the insurance as an accelerated death benefit [reduced
by an amount necessary to assure that there is no increase in
the actuarial value of the benefit paid, as determined by the
Secretary].
* * * * * * *
PART V--BOARDS, ADMINISTRATIONS, AND SERVICES
* * * * * * *
CHAPTER 73--VETERANS HEALTH ADMINISTRATION - ORGANIZATION AND FUNCTIONS
SUBCHAPTER I--ORGANIZATION
Sec.
7301. Functions of Veterans Health Administration: in general.
* * * * * * *
SUBCHAPTER II--GENERAL AUTHORITY AND ADMINISTRATION
* * * * * * *
7321A. Committee on Care of Veterans with Traumatic Brain Injury.
* * * * * * *
SUBCHAPTER I--ORGANIZATION
* * * * * * *
Sec. 7306. Office of the Under Secretary for Health
(a) The Office of the Under Secretary for Health shall
consist of the following:
(1) * * *
* * * * * * *
[(9) The Advisor on Physician Assistants, who shall
be a physician assistant with appropriate experience
and who shall advise the Under Secretary for Health on
all matters relating to the utilization and employment
of physician assistants in the Administration.]
(9) The Director of Physician Assistant Services, who
shall serve in a full-time capacity at the Central
Office of the Department and who shall be a qualified
physician assistant, who shall be responsible to and
report directly to the Under Secretary for Health on
all matters relating to the education and training,
employment, appropriate utilization, and optimal
participation of physician assistants within the
programs and initiatives of the Administration.
* * * * * * *
SUBCHAPTER II--GENERAL AUTHORITY AND ADMINISTRATION
* * * * * * *
Sec. 7321A. Committee on Care of Veterans with Traumatic Brain Injury
(a) Establishment.--The Secretary shall establish in the
Veterans Health Administration a committee to be known as the
``Committee on Care of Veterans with Traumatic Brain Injury''.
The Under Secretary for Health shall appoint employees of the
Department with expertise in the care of veterans with
traumatic brain injury to serve on the committee.
(b) Responsibilities of Committee.--The committee shall
assess, and carry out a continuing assessment of, the
capability of the Veterans Health Administration to meet
effectively the treatment and rehabilitation needs of veterans
with traumatic brain injury. In carrying out that
responsibility, the committee shall--
(1) evaluate the care provided to such veterans
through the Veterans Health Administration;
(2) identify systemwide problems in caring for such
veterans in facilities of the Veterans Health
Administration;
(3) identify specific facilities within the Veterans
Health Administration at which program enrichment is
needed to improve treatment and rehabilitation of such
veterans; and
(4) identify model programs which the committee
considers to have been successful in the treatment and
rehabilitation of such veterans and which should be
implemented more widely in or through facilities of the
Veterans Health Administration.
(c) Advice and Recommendations.--The committee shall--
(1) advise the Under Secretary regarding the
development of policies for the care and rehabilitation
of veterans with traumatic brain injury; and
(2) make recommendations to the Under Secretary--
(A) for improving programs of care of such
veterans at specific facilities and throughout
the Veterans Health Administration;
(B) for establishing special programs of
education and training relevant to the care of
such veterans for employees of the Veterans
Health Administration;
(C) regarding research needs and priorities
relevant to the care of such veterans; and
(D) regarding the appropriate allocation of
resources for all such activities.
(d) Annual Report.--Not later than June 1 of 2010, and each
subsequent year, the Secretary shall submit to the Committees
on Veterans' Affairs of the Senate and House of Representatives
a report on the implementation of this section. Each such
report shall include the following for the calendar year
preceding the year in which the report is submitted:
(1) A list of the members of the committee.
(2) The assessment of the Under Secretary for Health,
after review of the initial findings of the committee,
regarding the capability of the Veterans Health
Administration, on a systemwide and facility-by-
facility basis, to meet effectively the treatment and
rehabilitation needs of veterans with traumatic brain
injury.
(3) The plans of the committee for further
assessments.
(4) The findings and recommendations made by the
committee to the Under Secretary for Health and the
views of the Under Secretary on such findings and
recommendations.
(5) A description of the steps taken, plans made (and
a timetable for the execution of such plans), and
resources to be applied toward improving the capability
of the Veterans Health Administration to meet
effectively the treatment and rehabilitation needs of
veterans with traumatic brain injury.
* * * * * * *
----------
SECTION 403 OF THE VETERANS' MENTAL HEALTH AND OTHER CARE IMPROVEMENTS
ACT OF 2008
SEC. 403. PILOT PROGRAM OF ENHANCED CONTRACT CARE AUTHORITY FOR HEALTH
CARE NEEDS OF VETERANS IN HIGHLY RURAL AREAS.
(a) * * *
[(b) Covered Veterans.--
[(1) In general.--For purposes of the pilot program
under this section, a covered veteran is any highly
rural veteran who is--
[(A) enrolled in the system of patient
enrollment established under section 1705(a) of
title 38, United States Code, as of the date of
the commencement of the pilot program under
subsection (a)(2); or
[(B) eligible for health care under section
1710(e)(3)(C) of title 38, United States Code.
[(2) Highly rural veterans.--For purposes of this
subsection, a highly rural veteran is any veteran who--
[(A) resides in a location that is--
[(i) more than 60 miles driving
distance from the nearest Department
health care facility providing primary
care services, if the veteran is
seeking such services;
[(ii) more than 120 miles driving
distance from the nearest Department
health care facility providing acute
hospital care, if the veteran is
seeking such care; or
[(iii) more than 240 miles driving
distance from the nearest Department
health care facility providing tertiary
care, if the veteran is seeking such
care; or
[(B) in the case of a veteran who resides in
a location less than the distance specified in
clause (i), (ii), or (iii) of subparagraph (A),
as applicable, experiences such hardship or
other difficulties in travel to the nearest
appropriate Department health care facility
that such travel is not in the best interest of
the veteran, as determined by the Secretary
pursuant to regulations prescribed for purposes
of this subsection.]
(b) Covered Veterans.--For purposes of the pilot program
under this section, a covered veteran is any veteran who--
(1) is--
(A) enrolled in the system of patient
enrollment established under section 1705(a) of
title 38, United States Code, as of the date of
the commencement of the pilot program under
subsection (a)(2); or
(B) eligible for health care under section
1710(e)(3)(C) of title 38, United States Code;
and
(2) resides in a location that is--
(A) more than 60 minutes' driving distance,
as determined by the Secretary, from the
nearest Department health care facility
providing primary care services, in the case of
a veteran seeking such services;
(B) more than 120 minutes' driving distance,
as determined by the Secretary, from the
nearest Department health care facility
providing acute hospital care, in the case of a
veteran seeking such care; or
(C) more than 240 minutes' driving distance,
as determined by the Secretary, from the
nearest Department health care facility
providing tertiary care, in the case of a
veteran seeking such care.
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