[Senate Report 111-286]
[From the U.S. Government Publishing Office]
Calendar No. 557
111th Congress Report
SENATE
2d Session 111-286
======================================================================
VETERANS TELEHEALTH AND OTHER CARE IMPROVEMENTS ACT OF 2010
_______
September 2, 2010.--Ordered to be printed
Filed, under authority of the order of the Senate of August 5, 2010
_______
Mr. Akaka, from the Committee on Veterans' Affairs,
submitted the following
R E P O R T
together with
SUPPLEMENTAL VIEWS
[To accompany S. 3325]
The Committee on Veterans' Affairs (hereinafter, ``the
Committee"), to which was referred the bill (S. 3325), a bill
to amend title 38, United States Code, to authorize the waiver
of the collection of copayments for telehealth and telemedicine
visits of veterans, and for other purposes, having considered
an amendment to the bill in the nature of a substitute,
unanimously reports favorably thereon with an amendment, and an
amendment to the title, and recommends that the bill, as
amended, do pass.
Introduction
On May 6, 2010, Senator Begich introduced S. 3325. S. 3325
would authorize the Secretary of Veterans Affairs (hereinafter,
``the Secretary'') to waive the collection of copayments for
telehealth and telemedicine visits of veterans.
Earlier, on November 9, 2009, Senator Cornyn introduced
S. 2751, to name the Department of Veterans Affairs medical
center in Big Spring, Texas as the ``George H. O'Brien Jr.,
Department of Veterans Affairs Medical Center.''
On February 24, 2010, Senator Baucus introduced S. 3035,
the proposed ``Veterans Traumatic Brain Injury Care Improvement
Act of 2010.'' S. 3035 would require the Secretary to report to
the Congress on the feasibility and advisability of
establishing a polytrauma rehabilitation center or polytrauma
network site in the Dakotas or northern Rockies.
On May 5, 2010, Senator Brown of Ohio introduced S. 3314.
S. 3314 would require the Secretary of Veterans Affairs and the
Appalachian Regional Commission to carry out a program of
outreach for veterans who reside in Appalachia.
On May 7, 2010, Senator Casey introduced S. 3330, the
proposed ``Veterans' Health and Radiation Safety Act of 2010.''
S. 3330 would require an annual report on low volume programs,
training on use of radioactive isotopes, and enhanced oversight
of care provided by contractors.
On May 12, 2010, Senator Klobuchar introduced S. 3355, the
proposed ``Veterans One Source Act of 2010.'' S. 3355 would
require the Secretary to establish an internet website designed
to provide an interactive one-stop source of information on
benefits, health care, and services for which veterans may be
eligible.
On May 14, 2010, Senator Burr introduced S. 3377. S. 3377
would improve the multifamily transitional housing loan program
of the Department of Veterans Affairs by requiring the
Secretary of Veterans Affairs to issue loans for the
construction of, rehabilitation of, or acquisition of, land for
multifamily transitional housing projects instead of
guaranteeing loans for such purposes.
On April 5, 2010, the Committee held a field hearing on
benefits and services for veterans in Appalachia. Testimony was
offered by: Kim Graves, Eastern Area Director, Veterans
Benefits Administration, Department of Veterans Affairs,
accompanied by Joyce Cange, Director, Cleveland Regional
Office, Jack Hetrick, Director, VA Health care System of Ohio,
and Jeffrey Gering, Director, Chillicothe VA Medical Center;
Bill Hartnett, Director, Ohio Department of Veterans Services;
Rich Greenlee, MSW, PhD, Dean, Ohio University Eastern Campus;
Lucinda Maupin, Veterans Service Officer, Belmont County; Ed
Acevedo, U.S. Army Veteran, Operation Enduring Freedom and
Operation Iraqi Freedom; and Andrea Neutzling, U.S. Army
Veteran, Operation Iraqi Freedom.
On May 5, 2010, the Committee held an oversight hearing on
traumatic brain injury. Testimony was offered by: Lucille Beck,
PhD, Chief Consultant, Rehabilitation Services, Department of
Veterans Affairs, accompanied by Karen Guice, MD, MPP,
Director, Federal Recovery Coordination Program, Joel Scholten,
MD, Associate Chief of Staff for Physical Medicine and
Rehabilitation, Washington DC VA Medical Center, and Sonja
Batten, PhD, Deputy Director, Department of Defense Center of
Excellence for Psychological Health and Traumatic Brain Injury;
Colonel Michael S. Jaffee, MD, National Director, Defense and
Veterans Brain Injury Center; Karen Bohlinger, Second Lady,
State of Montana; Jonathan Barrs, Operation Iraqi Freedom
Veteran; Bruce M. Gans, MD, Executive Vice President and Chief
Medical Officer, Kessler Institute for Rehabilitation; Michael
F. Dabbs, President, Brain Injury Association of Michigan; and
Michelle C. LaPlaca, PhD, Associate Professor, Wallace H.
Coulter Department of Biomedical Engineering, Georgia Institute
of Technology.
On May 19, 2010, the Committee held a hearing on pending
health and benefits legislation. Testimony was offered by:
Thomas J. Pamperin, Associate Deputy Under Secretary for Policy
and Program Management, Veterans Benefits Administration,
Department of Veterans Affairs, and Robert Jesse, MD, Acting
Principal Deputy Under Secretary for Health, Veterans Health
Administration, accompanied by Richard J. Hipolit, Assistant
General Counsel, and Walter A. Hall, Assistant General Counsel;
The Honorable Raymond Jefferson, Assistant Secretary of
Veterans' Employment and Training Service, Department of Labor;
Ian DePlanque, Assistant Director, Veterans Affairs and
Rehabilitation Commission, The American Legion; Eric A.
Hilleman, National Legislative Director, Veterans of Foreign
Wars; Rick Weidman, Executive Director for Policy and
Government Affairs, Vietnam Veterans of America, accompanied by
Alan Oates, Chairman, Agent Orange/Dioxin and Other Toxic
Substances Committee; and Tom Tarantino, Legislative Associate,
Iraq and Afghanistan Veterans of America.
On June 16, 2010, the Committee held a hearing on VA health
care in rural areas. Testimony was offered by: Robert Jesse,
MD, Acting Principal Deputy Under Secretary for Health,
Department of Veterans Affairs, accompanied by Glen W. Grippen,
Network Director, Veterans Integrated Service Network 19;
Adrian Atizado, Assistant National Legislative Director,
Disabled American Veterans; James F. Ahrens, Chairman, Veterans
Rural Health Advisory Committee, Department of Veterans
Affairs; Ronald Putnam, Veteran Service Officer, Haywood
County, North Carolina; William Schoenhard, Deputy Under
Secretary for Health for Operations and Management, Department
of Veterans Affairs; Dan Winkelman, Vice President for
Administration & General Counsel, the Yukon-Kuskokwim Health
Corporation, Alaska; and Brigadier General Deborah McManus,
Assistant Adjutant General of Air, Joint Forces Headquarters,
Alaska, and Commander, Alaska Air National Guard, accompanied
by Verdie Bowen, Director, Office of Veterans Affairs, Alaska
Department of Military and Veterans Affairs.
Committee Meeting
After carefully reviewing the testimony from the forgoing
hearings, the Committee met in open session on August 5, 2010,
to consider, among other legislation, an amended version of
S. 3325, consisting of S. 3325 as introduced and provisions
derived from the other legislation noted above, as well as
freestanding provisions. The Committee voted unanimously to
report favorably S. 3325, as amended.
Summary of S. 3325 as Reported
S. 3325, as reported (hereinafter, ``the Committee bill''),
would improve the quality of health care provided by the
Department of Veterans Affairs (hereinafter, ``VA'' or ``the
Department''), to increase access to health care and benefits
provided by the Department, to authorize major medical facility
construction projects of the Department, and for other
purposes.
TITLE I--QUALITY OF CARE AND ACCESS MATTERS
Section 101 would waive the collection of copayments from
veterans for telehealth and telemedicine visits.
Section 102 would require the Secretary to carry out a
program of outreach to veterans who reside in a region served
by one of the Federally chartered regional commissions or
authorities, as well as other non-Federally chartered
development boards or authorities, and would authorize the
Secretary to partner with such a commission or authority in
order to carry out such a program of outreach.
Section 103 would require an annual report on low volume
procedures involving the use of radioactive isotopes at
Department facilities.
Section 104 would require all VA employees who handle or
perform procedures utilizing radioactive isotopes to receive
appropriate training.
Section 105 would provide further oversight of medical
services provided by contractors at Department facilities.
Section 106 would improve the multifamily transitional
housing loan program of the Department by requiring the
Secretary to issue loans for the construction of,
rehabilitation of, or acquisition of land for multifamily
transitional housing projects.
Section 107 would require a report on the establishment of
a Polytrauma Rehabilitation Center or Polytrauma Network Site
of the Department in the northern Rockies or Dakotas.
Section 108 would authorize the Secretary to create an
Internet website for information on benefits, resources,
services, and opportunities for veterans and their families and
caregivers.
TITLE II--CONSTRUCTION AND NAMING MATTERS
Section 201 would authorize fiscal year 2011 major medical
facility projects previously appropriated, but not authorized.
Section 202 would make an additional authorization for a
fiscal year 2007 major medical facility project previously
authorized.
Section 203 would authorize fiscal year 2011 major medical
facility leases.
Section 204 would authorize appropriations to carry out the
provisions of sections 201 through 203.
Section 205 would require the Secretary to submit a report
to Congress on the use of energy efficient technologies and
best practices in Department facilities.
Section 206 would designate the VA medical center in Big
Spring, Texas, as the ``George H. O'Brien, Jr., Department of
Veterans Affairs Medical Center.''
Section 207 would require that savings realized from bid
negotiation be used for major medical facility projects already
authorized.
Background and Discussion
TITLE I--QUALITY OF CARE AND ACCESS MATTERS
Title I of the Committee bill contains a variety of
provisions that are designed to improve VA outreach efforts to
veterans and the quality of VA health care delivery.
Sec. 101. Waiver of Collection of Copayments for Telehealth and
Telemedicine Visits of Veterans.
Section 101 of the Committee bill, derived from S. 3325 as
introduced, would waive the collection of copayments from
veterans for telehealth and telemedicine visits.
Background. For purposes of providing greater access to
care and reducing the amount of travel required for patients,
especially in rural areas, VA delivers care through telehealth
modalities such as telephone consultations, videoconferencing,
and use of robotic technology. Telehealth visits can be made
from patient homes or community-based outpatient clinics.
In December 2008, Adam Darkins, MD, VA Office of Care
Coordination Services, spearheaded a study entitled, ``Care
Coordination/Home Telehealth: The Systematic Implementation of
Health Informatics, Home Telehealth, and Disease Management to
Support the Care of Veteran Patients with Chronic Conditions.''
That study found that VA patients using home telehealth
experienced a 19 percent reduction in hospitalizations and a 25
percent reduction in days hospitalized. A RAND Corporation
study, ``Health Insurance and the Demand for Medical Care''
(Manning et al, 1988), found that copayment rates were highly
influential on the likelihood that an enrollee would use any
medical care. Under current law, VA charges full copayments for
care delivered through telehealth technologies. Currently, VA
patients are charged fifteen dollars for primary care
telehealth visits and fifty dollars for specialty care
telehealth visits.
Committee Bill. Section 101 of the Committee bill would add
a new section 1722B to title 38, United States Code. New
section 1722B, entitled ``Copayments: waiver of collection of
copayments for telehealth and telemedicine visits of
veterans,'' would prohibit VA from collecting any copayments
for a veteran's utilization of telehealth or telemedicine. The
new section 1722B would contain a five-year sunset on the
waiver of these copayments, and would require the Secretary to
report to the Committees on Veterans' Affairs of the Senate and
of the House of Representatives on whether the waiver of such
copayments has resulted in higher utilization of telehealth by
veterans, and on the costs or savings realized by the
Department as a result of the waiver of such copayments.
Sec. 102. Program of Outreach to Veterans.
Section 102 of the Committee bill, which is derived from
S. 3314 as introduced, would require the Secretary to carry out
a program of outreach to veterans who reside in a region served
by one of the Federally chartered regional commissions or
authorities, as well as other non-Federally chartered
development boards or authorities, and would authorize the
Secretary to partner with such a commission or authority in
order to carry out the required program of outreach.
Background. There are seven Federally chartered regional
commissions or authorities: the Appalachian Regional
Commission, established in 1965 by Public Law 89-4; the Delta
Regional Authority, established in 1988 by Public Law 100-460;
the Northern Great Plains Regional Authority, established in
1994 by Public Law 103-318; the Denali Commission, established
in 1998 by Public Law 105-277; the Southeast Crescent Regional
Commission, established in 2008 by Public Law 110-246; the
Southwest Border Regional Commission, established in 2008 by
Public Law 110-246; and the Northern Border Regional
Commission, established in 2008 by Public Law 110-246.
These commissions are regional economic development
entities that represent a partnership of federal, state, and
local governments and are intended to coordinate the efforts of
agencies and community organizations to promote economic
development and infrastructure improvements in certain
underdeveloped or economically distressed areas. A 2005 study
by Ohio University's Appalachian Rural Health Institute found
that:
Residents living in the ARHI project counties have
health access problems related to availability of
medical resources, especially health care providers and
medical specialists * * *. Constraints to obtaining
medical care related to access also include personal
perceptions related to family traditions, cultural
traits, and individual motivation * * *. Rural
residents could benefit from the formation of
collaborative partnerships with local agencies,
institutions, and health care providers, faculty and
researchers from academia, and consider possibilities
of multi-county coalitions.
At a Committee field hearing on April 5, 2010, in Cambridge
Ohio, Richard W. Greenlee, MSW, PhD, Associate Professor of
Social Work and Dean of Ohio University Eastern Campus, stated:
Military veterans have been found to be less likely
than the general population to seek mental health
services due to perceived stigma (Hoge, Castro, Messer,
McGurk, Cotting, & Koffman, 2004). Combine this with
the Appalachians' resistance to seeking mental health
treatment or help of any kind (Behringer and Friedell,
2006), and the combination of the two cultures, one
military, the other regional affiliation, and it is
highly unlikely that Appalachian veterans will
voluntarily seek help for depression, anxiety or post
traumatic stress disorder that they may be experiencing
upon returning home from the service.
There are other regions that have similar socio-economic
characteristics to Appalachia, and consequently have poor
access to, and low utilization of, health care. On June 16,
2010, at a Committee hearing on rural health, Dan Winkelman,
Vice President for Administration and General Counsel of the
Yukon-Kuskokwim Health Corporation, described remote western
Alaska as a region faced with an unemployment rate of over 20
percent, an average per capita income of $15,000, and where
over 6,000 homes do not have access to safe drinking water. He
stated:
This is the environment where many Alaska Native
veterans were born and raised and then return to after
serving our great Country. For Alaska Native/American
Indian veterans, who serve at the highest per capita
rate of any U.S. race, to lack access upon their return
from duty to culturally appropriate and quality health
care services by the Veterans Administration (VA) is a
shame. In Alaska, highly rural veterans must break
through several barriers in order to receive care.
There are almost no VA facilities in rural Alaska. The
existing IHS and tribal facilities, managed by tribal
health organizations like YKHC, are underfunded
according to the IHS by approximately 50 percent.
Committee Bill. Section 102 of the Committee bill would
require the Secretary to carry out a program of outreach for
veterans who reside in a region served by one of the Federally
chartered regional commissions or authorities, as well as other
non-Federally chartered development boards or authorities
located in areas that are severely economically distressed or
face unusual economic challenges, such as areas separated from
the mainland United States. In carrying out this program of
outreach, the Secretary would be authorized to partner with
such commissions or authorities. The program would be required
to increase veterans' awareness of, access to, and use of
benefits and services for which they are eligible. The
commissions would be authorized to provide technical
assistance, award grants, or enter into contracts with
individuals or entities in their respective region for these
purposes. The Department would be authorized to enter into
agreements with Federal, State, or local agencies to achieve
these purposes. There would be a five-year sunset on the
program of outreach, and the Secretary would be required to
provide a comprehensive report to the Committees on Veterans'
Affairs of the Senate and of the House of Representatives on
the Department's outreach activities and the efficacy of those
activities. This program would be authorized to receive
appropriations of an amount not to exceed $7 million in the
first year and of an amount not to exceed $35 million over five
years.
Sec. 103. Annual Report on Low Volume Procedures Involving Use of
Radioactive Isotopes at Department of Veterans Affairs Medical
Facilities.
Section 103 of the Committee bill, which is derived from
S. 3330 as introduced, would require the Department to submit
an annual report to Congress on low volume procedures that
involve the use of radioactive isotopes, at each medical
facility.
Background. On May 5, 2008, a patient of the Philadelphia
VAMC (hereinafter, ``PVAMC'') underwent prostate brachytherapy
in treatment for prostate cancer. Brachytherapy is a procedure
in which radioactive metal seeds are implanted in a patient in
order to kill cancerous cells. The patient was implanted with
radioactive seeds of the wrong strength, and this error was not
discovered until seven days later. An Office of Inspector
General (hereinafter, ``OIG'') investigation, published on May
3, 2010 (hereinafter, ``the report''), found that several
patients at PVAMC were implanted with radioactive seeds of
incorrect strength resulting in patients receiving a dose lower
than was prescribed by the oncologist. This event triggered a
comprehensive review of PVAMC's entire brachytherapy program by
the Veterans Health Administration's (hereinafter, ``VHA'')
National Health Physics Program (hereinafter, ``NHPP''), the
entity to which the U.S. National Regulatory Commission
(hereinafter, ``NRC'') delegates responsibility for providing
regulatory oversight of VA nuclear medicine.
NHPP found that of the 114 patients who underwent prostrate
brachytherapy at PVAMC, 97 experienced what are considered
``medical events'' wherein either patients received underdosing
to the prostrate, or, overdosing to non-prostatic tissue. On
June 29, 2009, the Committee held a field hearing in
Philadelphia, Pennsylvania to examine the PVAMC cancer
treatment program. Ultimately, VA suspended the PVAMC's
prostrate brachytherapy program, and a $227,500 fine was levied
against the facility by the NRC, the second largest fine ever
imposed by NRC to that date.
Committee Bill. Section 103 of the Committee bill would
require the Department to submit an annual report for three
years, beginning not later than 270 days after the enactment of
the legislation, on low volume procedures involving the use of
radioactive isotopes carried out in such year, at each medical
facility.
For purposes of this section, the Secretary would establish
a minimum threshold for each type of procedure involving
radioactive isotopes, carried out at Department facilities. A
``low volume procedure'' would be defined as a procedure
performed on fewer patients than the minimum threshold
prescribed by the Secretary. It is the Committee's intent that
in making such determination, the Secretary may consider the
minimum number of procedures of a specific type that a provider
must carry out annually to be considered competent in that
procedure. Each annual report would be required to include
evaluations of and findings regarding low volume procedures
involving radioactive material, and how to incorporate
consideration of such procedures in quality assurance plans at
the facility level.
Sec. 104. Use of Radioactive Isotopes at Department of Veterans Affairs
Hospitals.
Section 104 of the Committee bill, which is derived from
S. 3330 as introduced, would require all employees who handle
or perform procedures utilizing radioactive isotopes at a VA
facility to receive appropriate training on what constitutes a
medical event.
Background. VHA holds a Master Materials License issued by
NRC. VA administers its nuclear medicine program under the
authority of that license. Although VA establishes its own
procedure for how and when a physician will measure the
radiation dose given to a patient, it is the NRC's
responsibility to ensure patients receive the physician's
intended dose of radiation. Though VA has the authority and
responsibility to ensure proper quality management and safety
in using radioactive materials in medical treatment, the
Department is also responsible for reporting medical events to
the NRC. In the May 3, 2010 report OIG found a number of
concerns on the part of both VA and NRC with respect to the
operating definition of a ``medical event,'' and recommended VA
and NRC senior leadership work to resolve these discrepancies.
Committee Bill. Section 104 of the Committee bill would
require every employee, including those hired under a contract
with a non-government entity, who handles or performs
procedures involving radioactive material, to receive
appropriate training on the definition of a medical event, and
when and to whom such a medical event should be reported. Under
this section, should the Secretary find that a facility has
failed to provide the required training to any employee, that
employee would be barred from using radioactive isotopes until
the training is completed.
It is the Committee's intent to ensure all VA employees
involved in any procedure involving radioactive materials are
aware of what constitutes a medical event, as a safeguard to
ensure that any future adverse outcomes for procedures
involving radioactive isotopes are detected and resolved in a
timely and efficient manner.
Sec. 105. Requirements Relating to Contracts for the Provision of
Medical Services.
Section 105 of the Committee bill, which is derived from
S. 3330 as introduced, would provide further oversight of
medical services provided by contractors.
Background. Radiation therapy services have been provided
by the University of Pennsylvania Health System (hereinafter,
``UPHS'') to PVAMC since 1996. The first contract was awarded
in May 1996 for one year with an additional two option years.
However, OIG found that PVAMC paid UPHS for radiation therapy
services from May 1999 to April 2005 without a contract or
other agreement authorizing payment for such services, and from
April 2005 through 2009, PVAMC paid UPHS for radiation therapy
services under an Interim Agreement that violated VA policy
limits on the length and extensions of contracts, as mandated
in VA Directive 1663.
OIG also found that, ``quality management processes
pertaining to PVAMC's practice of prostrate brachytherapy were
deficient,'' and that, ``from 2002 to 2006, no peer review or
quality assessments took place at PVAMC for prostrate
brachytherapy.'' OIG also found that, from November 2006 to
November 2007, PVAMC experienced an information technology
failure where brachytherapists were unable to perform a
standard post-operative computed tomography scan so as to
measure the amount of radiation given to the patient in order
to ensure the procedure was properly performed. The OIG
identified similar quality management deficiencies in other VHA
brachytherapy programs as well. After a national assessment of
VHA prostate brachytherapy programs, such programs were
suspended at the Washington, DC VAMC in September 2008, the
Philadelphia VAMC in June 2008, and the Jackson VAMC in
September 2008, due to possible under-dosing of radiation. In
October 2008, the program at the Cincinnati VAMC was suspended
as well but was subsequently approved to restart in February
2010.
Committee Bill. Section 105 of the Committee bill would add
a new section 1703A to title 38, United States Code, entitled
``Oversight of medical services provided by contractors.'' This
new section would require that Department quality management
include oversight of medical services provided under contracts
with non-government entities. Such oversight would include
periodic peer reviews, periodic written evaluations by
supervisors of the individual providing services, and any other
evaluation the Secretary deems necessary. The Secretary would
also be required to gather and analyze data on the quality of
medical services provided under contract at every Department
facility and any Department contracting officer would be
required to consider such data prior to extending or renewing a
contract, 270 days after enactment of the legislation. The
Committee expects that the collection of detailed information
at this level of specificity will help avoid a similar future
incident.
Sec. 106. Conversion of Multifamily Transitional Housing Loan Program
to Loan Issuance Program.
Section 106 of the Committee bill, which is derived from
S. 3377 as introduced, would improve the multifamily
transitional housing loan program of the Department by
requiring the Secretary to issue loans for the construction of,
rehabilitation of, or acquisition of land for multifamily
transitional housing projects.
Background. In section 601 of Public Law 105-368, the
Veterans Programs Enhancement Act of 1998, Congress authorized,
under subchapter VI of chapter 20 of title 38, the Loan
Guarantee for Multifamily Transitional Housing Program. Under
this program VA was authorized to guarantee up to 15 secured
loans with an aggregate dollar amount of $100 million to
develop transitional housing with onsite supportive services
for homeless veterans. In 1999, Public Law 106-74, the
Departments of Veterans Affairs and Housing and Urban
Development, and Independent Agencies Appropriations Act of
2000 provided $48 million in appropriations for the original
loan guarantee program. Because only one loan has been
guaranteed since the program's inception, most of that funding,
approximately $43 million, remains available for obligation.
The Loan Guarantee for Multifamily Transitional Housing
Program was designed to encourage lenders to make low-interest
loans, backed by a VA guarantee, available to homeless
providers for the acquisition, construction, and improvement of
transitional housing units. Only one provider, St. Leo Campus
for Veterans in Chicago, Illinois, operated by Catholic
Charities, received a VA-backed housing loan.
St. Leo Campus has been faced with numerous operational
challenges that are typical for a provider servicing the
homeless population. What exacerbates the challenge is the
rigidity of the original VA loan program. Without flexibility
in loan terms and conditions, St. Leo Campus struggles to make
ends meet, which has brought into question the sustainability
of the project. To provide the necessary services to homeless
veterans, St. Leo Campus has relied on one-time grants and
donations which, in a difficult economy, are a highly volatile
source of revenue. Flexibility in the terms of its VA loan
would give St. Leo Campus and other homeless providers a chance
to weather cyclical funding challenges.
In 2009, VA terminated the Loan Guarantee for Multifamily
Transitional Housing Program pursuant to a recommendation made
in the 2008 Annual Report of its Advisory Committee on Homeless
Veterans. However, prior to terminating the program, VA issued
a report detailing how the program might be modified and made
more attractive to providers. The Committee bill tracks the
recommendations made in VA's report.
Committee Bill. Section 106 of the Committee bill would
transform the program under subchapter VI of chapter 20 of
title 38 from a loan guarantee program to a program that
actually issues loans. As a result, the title of this
subchapter would be amended to read ``Multifamily Transitional
Housing.'' Although this transformation of the program would
not affect the validity of any loan guaranteed before the date
of the enactment, it would prohibit, under subsection (a)(3) of
section 106, the Secretary from guaranteeing any loans under
this program from that date forward.
As part of the new loan issuing program, section 106 would
create a revolving fund, under subsection (b), which would
serve as the source of loans under the new authority. The
assets of the new revolving fund would consist of all amounts
received by the Secretary from operations relating to the
issuance of loans under this program. These amounts include,
among other things, any fees imposed on a loan recipient under
any provision of law or regulation which is established by the
Secretary. The revolving fund would also include all amounts
previously appropriated for the loan guarantee program. This
would allow the Secretary to access and utilize the $43 million
remaining from the terminated loan guarantee program to fund
new issued loans.
In addition, section 106 would make improvements to the
terms and conditions of the loan program. These improvements
would give the Secretary greater flexibility in the types of
loans VA may offer and the conditions attached to repayment.
Subsection (a)(2) of section 106 would authorize the Secretary
to delegate loan approval to a State or local government
entity. Subsection (c) of section 106 would allow the Secretary
to consider reasonable terms and conditions of the loan to
include payment deferral, forbearance, and debt forgiveness.
Subsection (d) of section 106 would clarify that projects
financed with a VA loan may include space for job training
programs, other types of residential units, neighborhood retail
or other commercial activities, or other uses that the
Secretary determines necessary for the sustainability of the
multifamily transitional housing projects. Subsection (e) of
section 106 would give VA the authority to sell, rent, operate,
or otherwise dispose of a multifamily transitional housing
project in the event of default. Lastly, subsection (f) of
section 106 would preempt any Federal, State, or local housing
statute that limits a project from offering preferential
treatment to veterans.
Sec. 107. Report on Establishment of a Polytrauma Rehabilitation Center
or Polytrauma Network Site of the Department of Veterans
Affairs in the Northern Rockies or Dakotas.
Section 107 of the Committee bill, which is derived from
S. 3035 as introduced, would require a report on the
feasibility and advisability of establishing a VA polytrauma
rehabilitation center (hereinafter, ``PRC'') or polytrauma
network site in the northern Rockies or Dakotas.
Background. Polytrauma refers to the cumulative state of
health resulting from exposure to a single event which has
caused multiple and complex injuries. Such injuries can impact
the brain, limbs, spinal cord, and musculoskeletal system, and
in turn, can adversely affect hearing, vision, and cognition.
The VA Polytrauma System of Care provides treatment to
veterans with polytrauma through four PRCs, located in Palo
Alto, Tampa, Richmond, and Minneapolis, which offer
comprehensive inpatient and outpatient treatment. A fifth PRC
is, as of the date of this report, being constructed at the
VAMC in San Antonio, Texas. There are also 22 polytrauma
network sites which provide a full range of comprehensive
follow-on medical and rehabilitative services, both inpatient
and outpatient. This system of care covers most of the nation;
however, according to testimony the Committee received during a
May 5, 2010 hearing on VA care for traumatic brain injury
(hereinafter, ``TBI''), there is a gap in availability of care
in the northern Rockies and Dakotas, an area that encompasses
approximately 740,000 square miles.
An April 2008 RAND Corporation study estimated that 320,000
veterans may have suffered brain injuries, from mild
concussions to severe wounds, and that 57 percent of those who
reported experiencing a probable TBI were never evaluated by a
physician. Veterans with severe polytrauma who do not live in
proximity of a polytrauma care presence face difficulties in
receiving necessary treatment. In testimony before the
Committee, Karen Bohlinger, Second Lady of Montana, testified
that she had to fly from Montana to Seattle, Washington every
ten days, at personal expense, in order to follow up on care
for her son, an Army Special Forces officer who had sustained a
TBI. She further testified that there were insufficient
Department resources in Montana that would have allowed her son
to be treated close to their home.
Committee Bill. Section 107 of the Committee bill would, in
a freestanding provision, require the Secretary to conduct a
study and report to the Congress, within 180 days after
enactment, on the feasibility and advisability of establishing
a PRC or polytrauma network site in the northern Rockies or
Dakotas. This section would specify that the Fort Harrison VAMC
be one of the sites evaluated for potential placement of a PRC
or a polytrauma network site.
The report would be required to include an assessment of
the adequacy of existing services provided at Department
facilities, and of the availability of the types of services
that would otherwise be provided by a PRC or polytrauma network
site. The report would also be required to include a
comparative assessment of the effectiveness of TBI
rehabilitation programs in urban versus rural settings, an
assessment of whether the low cost of living in the region
could reduce the financial burden on families of a veteran
undergoing TBI care and thereby improve that care, and whether
any stress caused by living in an urban area can impede
therapies to prevent or remediate the development of secondary
neurologic conditions related to TBI. The Department would be
required to consult with State and local government entities in
preparing this report.
Sec. 108. One-Stop Internet Website for Information on Benefits,
Resources, Services, and Opportunities for Veterans and their
Families and Caregivers.
Section 108 of the Committee bill, which is derived from
S. 3355 as introduced, would authorize the Secretary to
establish an Internet website for information on benefits,
resources, services, and opportunities for veterans and their
families and caregivers.
Background. Currently, VA's website and other related sites
have a wealth of information regarding the benefits for which
veterans may be eligible, including health care services,
education and employment assistance, pension, home loan
guaranties, and life insurance. While an extensive array of
benefits and services are available to veterans, there is no
single-source information repository that veterans can use to
easily find information on the benefits and services for which
they may be eligible, or how to access such benefits and
services. As veterans of Operation Enduring Freedom and
Operation Iraqi Freedom (hereinafter, ``OEF and OIF'') return
home, it is important that the Department help ease their
transition and assist them in adapting to civilian life.
Committee Bill. Section 108 of the Committee bill would, in
a freestanding provision, authorize the Secretary to create an
interactive, comprehensive internet website to provide
information on benefits, resources, services, and opportunities
for veterans and family members. It is the Committee's
expectation that such a website be user-friendly and increase
interoperability and the sharing of information.
This information would be required to include benefits
provided by the Department, the Department of Labor, the Small
Business Administration, as well as tax and social security
benefits. Additionally, the website would be required to
include information on resources for families, caregivers,
education and mental health professionals, and others that
provide services for veterans. Information on child care, home
care, stress management, mental health care, discounts,
volunteer opportunities, and community events, as well as links
to state and local resources and veterans service organizations
would also be required to be included. Finally, the website
would be required to assist veterans and family members in
applying for and receiving these benefits.
In implementing this section, the Secretary would be
required to consult with the Secretary of Defense, the
Secretary of Labor, the Secretary of Education, the
Commissioner of Internal Revenue, the Commissioner of Social
Security, the Administrator of the Small Business
Administration, other Federal officials, appropriate advisory
committees, and other appropriate individuals. Additionally,
the Secretary would both report on the status and impact of the
website, in the Department's biennial plan for outreach, as
mandated by Public Law 109-233.
It is the Committee's intent that such a website be
functionally similar to the Military One-Source website of the
Department of Defense, and that it would serve as a single,
all-inclusive source of information on, or references to
information on, benefits, resources, services, and
opportunities for veterans, and their families and caregivers.
TITLE II--CONSTRUCTION AND NAMING MATTERS
Title II of the Committee bill contains a variety of
provisions that are designed to provide authorization for both
leases and the construction of Department medical facilities.
Sec. 201. Authorization of fiscal year 2011 major medical facility
construction projects previously appropriated but not
authorized.
Section 201 of the Committee bill would authorize the
Secretary to carry out the construction of a new major medical
facility project in New Orleans, Louisiana for which some
funding has been appropriated but for which only $300,000,000
was authorized in Public Law 109-461.
Background. The VAMC in New Orleans, Louisiana sustained
catastrophic damage as a result of Hurricane Katrina. The
facility was closed and a system of leased clinics was created
to continue the provision of outpatient services, while
surgical procedures and inpatient care are purchased through
local providers or referred to VA facilities outside of New
Orleans. The proposed project would be a tertiary care medical
complex that would reestablish a full continuum of medical
services, including acute and long-term inpatient beds, primary
care, mental health, specialty care, surgical capabilities,
expanded treatment, diagnostic, and ancillary services, and a
parking structure, all in compliance with hurricane hardening
and federal security standards.
This project received $75,000,000 of budget authority in
fiscal year 2006 through the Department of Defense, Emergency
Supplemental Appropriations to Address Hurricanes in the Gulf
of Mexico, and Pandemic Influenza Act, 2006, Public Law 109-
148, and an additional $550,000,000 through the Emergency
Supplemental Appropriations Act for Defense, the Global War on
Terror, and Hurricane Recovery, 2006, Public Law 109-234.
Committee Bill. Section 201 of the Committee bill would
authorize appropriations of an amount not to exceed
$995,000,000 to construct a new major medical facility in New
Orleans, Louisiana.
Sec. 202. Additional authorization for a 2007 major medical facility
construction project previously authorized.
Section 202 of the Committee bill would authorize the
Secretary to carry out seismic corrections for Buildings 7 and
126 at the Long Beach, California VAMC.
Background. The Long Beach, California Seismic Corrections
for Buildings 7 and 126 project would involve the seismic
upgrade and modernization of two seismically deficient
buildings at the Long Beach VAMC. These buildings would house
the pharmacy and multiple specialty medical and surgical
outpatient clinics in line with the projected growth in
outpatient demand and consolidate administrative, support
service, and research administration staff in a single
building. This project will also create a 24-bed Blind
Rehabilitation Center adjacent to the Spinal Cord Injury
Center.
This project received $51,700,000 of budget authority in
fiscal year 2001 through the Veterans Benefits and Health Care
Improvement Act of 2000, Public Law 106-419; an additional
$10,300,000 of budget authority in fiscal year 2004 through the
Veterans Health Care, Capital Asset, and Business Improvement
Act of 2003, Public Law 108-170; and an additional $107,800,000
of budget authority in fiscal year 2007 through the Veterans
Benefits, Health Care, and Information Technology Act of 2006,
Public Law 109-461.
Committee Bill. Section 202 of the Committee bill would
authorize an amount not to exceed $129,545,000 to conduct
seismic corrections at the VAMC in Long Beach, California.
Sec. 203. Authorization of fiscal year 2011 major medical facility
leases.
Section 203 of the Committee bill would authorize five
leases for fiscal year 2011: a community based outpatient
clinic (hereinafter, ``CBOC'') in Billings, Montana; an
outpatient clinic in Boston, Massachusetts; a CBOC in San
Diego, California; a research laboratory in San Francisco,
California; and a mental health facility in San Juan, Puerto
Rico.
Background. Section 8104 of title 38, United States Code
requires authorization of any major medical facility
construction project or lease. The Department has requested
authorization for five pending leases in order to improve
health care. The existing Billings CBOC is facing significant
space shortages. According to the Department, expansion would
enable the clinic to provide more comprehensive outpatient
services and would allow veterans to get medical treatment
locally rather than traveling to the Fort Harrison VAMC.
The Boston, Massachusetts replacement outpatient clinic
lease would address the significant space shortage at the
existing clinic and allow space for growing primary care and
mental health programs.
The Administration has indicated that the San Diego,
California replacement CBOC would enhance existing outpatient
services by housing newly created programs such as a women's
health clinic, blind services, dental services, and ambulatory
surgery. It would also consolidate services into a single,
larger location, closer to where veterans reside.
The San Francisco VAMC houses VA's largest research program
but its facilities are deficient in terms of available space
and compliance with VA's seismic safety policy. The Department
determines the amount of space needed for research programs
based on the amount of grant dollars awarded. Using that
analysis, VA estimates a need for approximately 400,000 square
feet of research space at the San Francisco VAMC. The proposed
50,000 square foot lease would not entirely resolve the current
shortfall in space, but would help alleviate some of the
pressure.
The San Juan, Puerto Rico VAMC currently lacks a mental
health residential rehabilitation treatment program and a
psychosocial residential rehabilitation center. Both programs
are integral to assist veterans in transitioning between
inpatient and outpatient services and the community. Veterans
who need services from either program are currently referred to
other VISN 8 facilities in the continental United States, where
they sometimes lack the family support and linguistic fluency
to fully profit from the programs. VA's proposed lease will
allow the Department to provide more comprehensive care for the
veterans who live in Puerto Rico.
Committee Bill. Section 203 of the Committee bill would
authorize the lease of a replacement outpatient clinic in
Billings, Montana. The new clinic will support the parent
facility at the Fort Harrison VAMC through the acquisition of
approximately 70,000 net usable square feet of clinical space.
The Committee bill would fully authorize the lease in the
amount of $7,149,000.
The Boston, Massachusetts replacement outpatient clinic
lease will support the Boston VA Health Care System through the
lease of approximately 29,000 net usable square feet of
clinical space. The Committee bill would fully authorize the
lease in the amount of $3,316,000.
The San Diego, California replacement CBOC lease will
support the parent facility at the San Diego VAMC through the
lease of approximately 164,000 net usable square feet for a
replacement CBOC. The Committee bill would fully authorize the
lease in the amount of $21,495,000.
The San Francisco, California Biomedical Research Complex
lease would consist of approximately 50,000 net usable square
feet for wet labs and research space. This would partially
alleviate the San Francisco VAMC's space shortage. The
Committee bill would fully authorize the lease in the amount of
$10,055,000.
The San Juan, Puerto Rico Mental Health Residential and
Psychosocial Rehabilitation Program lease will provide an
approximately 52,000 net usable square foot facility that will
house 40 beds and will provide a smoother transition from
treatment back to the community. The Committee bill would fully
authorize the lease in the amount of $5,323,000.
Sec. 204. Authorization of appropriations.
Section 204 of the Committee bill would authorize
appropriations for the projects authorized in sections 201
through 203 of the Committee bill.
Committee Bill. Section 204 of the Committee bill would
authorize an appropriation for fiscal year 2011 of
$1,124,545,000 from the Construction, Major Projects account
for projects authorized in sections 201 and 202 of the
Committee bill. It would also authorize an appropriation for
fiscal year 2011 of $47,338,000 from the Medical Facilities
account for the leases authorized in section 203 of the
Committee bill.
Sec. 205. Report on use of energy efficient technologies and best
practices in Department of Veterans Affairs medical facilities.
Section 205 of the Committee bill would require the
Secretary to submit a report to Congress on the use of energy
efficient technologies and best practices in Department
facilities.
Background. On October 5, 2009, President Obama signed
Executive Order 13514, ``Federal Leadership in Environmental,
Energy, and Economic Performance,'' which expanded on energy
reduction and ecological performance requirements contained in
Executive Order 13423, ``Strengthening Federal Environmental,
Energy, and Transportation Management.'' Executive Order 13514
establishes targets for federal agencies regarding
accountability and transparency, strategic sustainability
performance planning, greenhouse gas management, sustainable
buildings and communities, water efficiency, electronic
products and services, fleet and transportation management, and
pollution prevention and waste reduction. Such key targets
include reducing government-wide greenhouse gas emissions by 28
percent by 2020 and for agency sustainability plans to be
released in August 2010.
Committee Bill. Section 205 of the Committee bill would
require the Secretary to submit a report to Congress regarding
the use of energy efficient technologies and best practices in
VA medical facilities. The report would include a description
of the technologies and best practices the Department currently
employs to make facilities more energy efficient; an assessment
of the energy efficiency of VA medical facilities' heating,
ventilation, air conditioning systems, lighting, elevators,
water heating, information technology and electronics, and any
other features related to energy efficiency the Secretary deems
appropriate; and, a description of the Department medical
facilities' compliance with current law, as it relates to
energy efficiency. The Secretary would be required to
collaborate with private sector experts and industry leaders in
energy efficiency, such as the American Society of Heating,
Refrigeration, and Air-Conditioning Engineers, the Illuminating
Engineering Society of North America, and the American
Institute of Architects, in developing the report.
Sec. 206. Designation of George H. O'Brien Jr., Department of Veterans
Affairs Medical Center.
Section 206 of the Committee bill, which is derived from
S. 2751 as introduced, would designate the Department of
Veterans Affairs medical center in Big Spring, Texas, as the
George H. O'Brien, Jr., Department of Veterans Affairs Medical
Center.
Background. George H. O'Brien, Jr. served as a seaman in
the United States Merchant Marine from December 1944 until May
1946. In July 1946, while attending college at Texas Technical
College (now known as Texas Tech University), he enlisted in
the United States Marine Corps Reserve. After graduating
college in 1950, he was ordered to active duty and served in
the Korean War until September 1952. He was awarded the Medal
of Honor for his heroic actions during the Battle of the Hook
on October 27, 1952, as detailed in the citation accompanying
his award. He also received the Purple Heart Medal with gold
star in lieu of a second award, the Korean Service Medal with
two bronze stars, and the United Nations Service Medal, among
other military honors. After his active duty service, O'Brien
began a career as a petroleum geologist in Texas, while serving
on the Marine Corps Scholarship Foundation as well as in the
Medal of Honor Society.
Committee Bill. Section 206 of the Committee bill would
name the VAMC in Big Spring, Texas the ``George H. O'Brien,
Jr., Department of Veterans Affairs Medical Center.'' Since all
members of the Texas Congressional delegation have expressed
their support for naming this facility, in writing, and the
Texas chapters of all veterans service organizations with
national memberships of at least 500,000 individuals have
endorsed this facility being named in honor of George H.
O'Brien, this provision meets the Committee rules regarding the
naming of Department facilities.
Sec. 207. Requirement that bid savings on major medical facility
projects of Department of Veterans Affairs be used for other
major medical facility construction projects of the Department.
Section 207 of the Committee bill would require that bid
savings from major medical facility projects be utilized for
other major medical facility construction projects.
Background. Due to a favorable bid environment, VA has been
able to save money on several authorized major construction
projects. As of May 2010, VA estimated that the Department
would realize $103 million in bid savings from 12 major
construction projects. It is the Committee's intent, given the
importance of long-term planning and the size of the
Department's construction backlog, that projects that have
already been vetted and prioritized be funded accordingly.
Committee Bill. Section 207 of the Committee bill would add
a new section 8104(d) to title 38, United States Code. This
section would require that, for any fiscal year, unobligated
funds resulting from major medical facility project bid savings
be obligated only for other major medical facility projects
authorized for that fiscal year or a previous fiscal year.
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 Congressional Budget Office
(hereinafter, ``CBO''), estimates that implementing the bill
would cost $690 million over the 2011-2015 period, assuming
appropriation of the specified and estimated amounts. CBO
further estimates that enacting the bill would increase direct
spending by $43 million over the 2011-2015 period as a result
of reallocating funds, but would not increase budget authority
or affect revenues. Enactment of the Committee bill would not
affect receipts and though the Committee bill would affect
state and local laws, it would have minimal effect on the
budget of state, local or tribal governments. The cost estimate
provided by CBO, setting forth a detailed breakdown of costs,
follows:
Congressional Budget Office,
Washington, DC, August 6, 2010
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. 3325, the Veterans
Telehealth and Other Care Improvements Act of 2010.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Sunita
D'Monte.
Sincerely,
Douglas W. Elmendorf,
Director.
Enclosure.
S. 3325--Veterans Telehealth and Other Care Improvements Act of 2010
Summary: S. 3325 would authorize the construction,
renovation, or leasing of several medical facilities and make
other changes to health care programs offered by the Department
of Veterans Affairs (VA). In total, CBO estimates that
implementing the bill would cost $690 million over the 2011-
2015 period, assuming appropriation of the specified and
estimated amounts. In addition, CBO estimates that enacting the
bill would increase direct spending by $43 million over the
2011-2020 period but would not affect revenues.
Pay-as-you-go procedures apply because enacting the
legislation would affect direct spending.
S. 3325 contains an intergovernmental mandate as defined in
the Unfunded Mandates Reform Act (UMRA) because it would
preempt state and local laws. CBO estimates the cost of
complying with the mandate would be small and would fall well
below the threshold established in UMRA for intergovernmental
mandates ($70 million in 2010, adjusted annually for
inflation). S. 3325 contains no new private-sector mandates as
defined in UMRA.
Estimated cost to the Federal Government: The estimated
budgetary impact of S. 3325 is shown in the following table.
The costs of this legislation fall within budget function 700
(veterans benefits and services).
Basis of estimate: For this estimate, CBO assumes the
legislation will be enacted in 2010, that the necessary amounts
will be appropriated each year, and that outlays will follow
historical patterns for similar and existing programs.
----------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
-----------------------------------------------------------------
2011 2012 2013 2014 2015 2011-2015
----------------------------------------------------------------------------------------------------------------
CHANGES IN SPENDING SUBJECT TO APPROPRIATION
Medical Construction Projects
Estimated Authorization Level............. 547 25 25 25 25 647
Estimated Outlays......................... 65 162 187 145 71 630
Outreach
Estimated Authorization Level............. 7 7 7 7 7 35
Estimated Outlays......................... 7 7 7 7 7 35
Loss of Copayments for Telehealth and
Telemedicine Programs
Estimated Authorization Level............. 2 3 4 6 8 23
Estimated Outlays......................... 2 3 4 6 8 23
Veterans' Resources Web Site
Estimated Authorization Level............. * * * * * 1
Estimated Outlays......................... * * * * * 1
Other Provisions
Estimated Authorization Level............. * * * * * 1
Estimated Outlays......................... * * * * * 1
-----------------------------------------------------------------
Total Changes
Estimated Authorization Level......... 556 35 36 38 40 707
Estimated Outlays..................... 74 172 198 158 86 690
CHANGES IN DIRECT SPENDING
Estimated Budget Authority................ 0 0 0 0 0 0
Estimated Outlays......................... 8 8 9 9 9 43
----------------------------------------------------------------------------------------------------------------
Note: * = less than $500,000.
Spending subject to appropriation
S. 3325 would authorize funding for the construction,
renovation, or leasing of several medical facilities and make
other changes in VA health care programs. In total, CBO
estimates that implementing the bill would add $690 million to
discretionary spending over the 2011-2015 period, assuming
appropriation of the specified and estimated amounts.
Medical Construction Projects. Title II would authorize
funding to construct, renovate, or lease several medical
facilities. CBO estimates that implementing those provisions
would cost $630 million over the 2011-2015 period, assuming
appropriation of the authorized and estimated amounts.
Section 204 would authorize the appropriation of $995
million to construct a new medical center in New Orleans,
Louisiana and $130 million for seismic corrections at
facilities in Long Beach, California. Public Laws 109-148 and
109-234 provided $75 million and $550 million respectively to
plan and construct the New Orleans facility. Based on VA's
current estimated construction costs for that facility of $995
million, CBO estimates that VA would require additional funding
of $370 million for the New Orleans facility. Adding in the
specified authorization of $130 million for the Long Beach
facilities, CBO estimates a total authorization of $500 million
for both projects; carrying out those projects would cost $485
million over the 2011-2015 period, assuming appropriation of
the authorized and estimated amounts.
Section 204 also would authorize the appropriation of $47
million for leasing five medical facilities. Based on
information from VA's 2011 budget request for leasing medical
facilities, CBO expects that VA would enter into 20-year lease
agreements for those facilities. CBO estimates that in addition
to the specified amounts authorized to be appropriated in 2011,
VA would incur additional costs of $25 million a year starting
in 2012. (Costs are higher in the first year than in other
years because VA would pay up front for necessary
improvements.) CBO estimates that entering into those leases
would cost $145 million over the 2011-2015 period, assuming
appropriation of the authorized and estimated amounts.
Outreach. Section 102 would require VA to establish an
outreach program designed to increase veterans' awareness of
and access to federal, state, and local programs providing
compensation and benefits to veterans. Section 102 also would
allow VA to enter into agreements with federal and state
agencies for that purpose. VA also would be authorized to enter
into agreements with and to provide technical assistance and
award grants to certain commissions and authorities. Those
commissions and authorities include the Appalachian Regional
Commission; the Delta Regional Authority; the Denali
Commission; the Northern Great Plains Regional Authority; the
Southeast Crescent, Southwest Border, and Northern Border
Regional Commission; and certain nonfederally chartered
entities that serve Native Americans, Alaska Natives, or native
Hawaiians.
Under this section, $35 million would be authorized over
the 2011-2015 period to carry out those programs. CBO estimates
that implementing section 102 would cost $35 million over the
2011-2015 period, subject to appropriation of the necessary
amounts.
Loss of Copayments for Telehealth and Telemedicine
Programs. Section 101 would prohibit VA from charging
copayments to veterans for any telehealth or telemedicine
consultations and would require VA to report to the Congress on
the effects of that change. Under current law, VA charges
copayments of $15 for primary care visits and $50 for specialty
care visits. Based on information from the department, CBO
estimates that in 2011 VA will have a workload of 60,000 such
consultations for which it will receive $2 million in
copayments. In recent years those programs have experienced a
30 percent annual rate of growth in workload. Some of that
growth represents new workload in terms of medical visits that
would not have been made for reasons of distance or other
difficulty in accessing VA care. The remainder of the growth is
accounted for by veterans using telehealth and telemedicine in
place of physical visits to a VA facility. CBO expects that
eliminating the copayments for virtual visits will accelerate
the shift from regular visits, which will still incur
copayments. CBO estimates that implementing this provision
would decrease collections by $2 million in 2011, growing to $8
million by 2015.
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 $23
million over the 2011-2015 period, assuming appropriation of
the necessary amounts.
Veterans' Resources Web site. Section 108 would grant VA
the authority to establish and maintain a Web site with the
purpose of providing information and links from other Web sites
referring to benefits, resources, services, and opportunities
for veterans. VA would be required to consult with other
federal agencies to determine a comprehensive list of benefits
and links for veterans' benefits and resources. CBO assumes
that VA would either hire an individual to develop and maintain
the Web site or hire a contractor to do so; therefore, we
estimate that implementing section 102 would cost $1 million
over the 2011-2015 period, subject to appropriation of the
necessary amounts.
Other Provisions. Several sections of the bill, when taken
individually, would increase spending subject to appropriation
by less than $500,000 a year. Taken together, CBO estimates
that implementing the following provisions would have a total
cost of $1 million over the 2011-2015 period, assuming
availability of appropriated funds:
Section 103 would require an annual report on the
use of radioactive isotopes at VA medical facilities.
Section 104 would require certain training on the
use of radioactive isotopes; CBO estimates that VA would be
able to incorporate those requirements into existing training
programs at minimal cost.
Section 105 would require certain oversight of
medical services provided by contractors; VA already complies
with most of those requirements.
Section 107 would require a report on the
feasibility of establishing a polytrauma center in the northern
Rockies or the Dakotas.
Section 205 would require a report on the use of
energy-efficient technologies in VA medical facilities.
Direct spending
Section 106 would direct VA to provide up to five direct
loans to help nonprofit organizations acquire, construct,
modify, or rehabilitate transitional housing for veterans and
their families. It also would establish the Multifamily
Transitional Housing Loan Program Revolving Fund to cover the
subsidy costs of those loans. (Transitional housing provides
temporary lodging for homeless individuals and families, and is
used in combination with services such as education, job
training and placement, substance abuse counseling, and child
care, to help residents transition to permanent housing.)
The Veterans Programs Enhancement Act of 1998 (Public Law
105-368) authorized VA to provide guaranteed loans for
transitional housing and provided permanent, indefinite budget
authority for the subsidy cost of those loans. Subsequently,
the Department of Veterans Affairs and Housing and Urban
Development, and Independent Agencies Appropriations Act, 2000
(Public Law 106-74) provided $48 million in mandatory budget
authority for the loan guarantees, of which $43 million remains
available. The department has indicated that it will not use
the remaining budget authority to guarantee any more loans for
transitional housing because there are no applicants for the
program. Section 106 would terminate the authority to guarantee
loans and transfer the unobligated balances from the specific
mandatory appropriation to the direct loan revolving fund.
Because the guaranteed loan program is moribund, CBO
expects no further outlays for that purpose under current law.
Thus, new outlays would arise from authorizing VA to use the
remaining budget authority to make direct loans.
Section 106 would credit the repayments of principal and
interest on the direct loans to the revolving fund, and make
those amounts available for new direct loans, without further
Congressional action. However, the concept of reusing loan
repayments for new loans is inconsistent with the proper
budgetary accounting of direct loans as specified in the
Federal Credit Reform Act (FCRA). CBO estimates that
redirecting those payments to a purpose other than retiring the
debt for the original loan would increase the estimated subsidy
costs of the loans to 100 percent of the face value of those
loans.
Under FCRA, projected cash flows associated with direct
loans--such as disbursements of loan proceeds, collections of
principal and interest repayments, and recoveries of amounts
subsequent to any defaults--are discounted using the average
interest rate on Treasury securities of similar maturity to the
loan cash flows. The net present value of those cash flows is
recorded as the subsidy cost of the loans.
Repayments of loans are unavailable for spending and new
loan obligations may be made only to the extent that new budget
authority is provided in advance to cover anticipated credit
subsidy costs. Thus, direct loan repayments are not available
to ``revolve'' into new loans. Instead, such repayments are a
means of financing the original loans, and the availability of
repayments only for that purpose is implicit in the usual
subsidy calculation. If principal and interest repayments are
not returned to the Treasury, but are instead used for new
loans, the net cost to the federal government is the total
amount disbursed for the original loans.
CBO expects that VA would use the amounts transferred to
the revolving fund to issue one direct loan annually over the
next five years. Outlays are recorded in the year in which the
loan is disbursed; thus, enacting section 106 would increase
direct spending by $43 million over the 2011-2015 period.
Pay-As-You-Go Considerations: The Statutory Pay-As-You-Go
Act of 2010 establishes budget reporting and enforcement
procedures for legislation affecting direct spending or
revenues. S. 3325 would authorize VA to provide direct loans to
organizations providing transitional housing to veterans. The
net changes in outlays that are subject to those pay-as-you-go
procedures are shown in the following table.
--------------------------------------------------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
--------------------------------------------------------------------------------------------------
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2010-2015 2010-2020
--------------------------------------------------------------------------------------------------------------------------------------------------------
NET INCREASE OR DECREASE (-) IN THE DEFICIT
Statutory Pay-As-You-Go Impact....................... 0 8 8 9 9 9 0 0 0 0 0 43 43
--------------------------------------------------------------------------------------------------------------------------------------------------------
Estimated impact on State, Local, and Tribal Governments
S. 3325 contains an intergovernmental mandate as defined in
UMRA because it would preempt state laws that prohibit certain
transitional housing programs from offering preferential
treatment to veterans. While the preemption would limit the
application of state and local laws, it would impose no duty
that would result in significant additional spending.
Consequently, CBO estimates that the costs would fall well
below the threshold established in the UMRA for
intergovernmental mandates ($70 million in 2010, adjusted
annually for inflation).
Estimated impact on the Private Sector
S. 3107 contains no new private-sector mandates as defined
in UMRA.
Previous CBO estimate
On July 29, 2010, CBO transmitted an estimate for H.R.
5226, the Appalachian Veterans Outreach Improvement Act, as
ordered reported by the House Committee on Transportation and
Infrastructure on July 1, 2010. Section 102 of S. 3325 contains
language similar to that in H.R. 5226 but also includes
additional commissions and agencies for VA to partner with in
order to improve their outreach efforts in various regions.
Also, S. 3325 would authorize specified amounts to implement
the outreach efforts while H.R. 5226 would not. The estimates
reflect those differences.
Estimate prepared by: Federal Costs: VA Housing Loan
Program--David Newman; VA Outreach Programs--Dwayne Wright;
Other VA Programs--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.
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 August 5, 2010, meeting. On that date,
the Committee ordered S. 3325, as amended, reported favorably
to the Senate by voice vote with no dissent. One amendment was
accepted by voice vote. The following senators were present:
Mr. Rockefeller, Mrs. Murray, Mr. Sanders, Mr. Brown of Ohio,
Mr. Webb, Mr. Tester, Mr. Begich, Mr. Burris, Mr. Specter, Mr.
Burr, Mr. Isakson, Mr. Wicker, Mr. Johanns, Mr. Brown of
Massachusetts, and Chairman Akaka.
Agency Report
On May 19, 2010, Thomas J. Pamperin, Associate Deputy Under
Secretary for Policy and Program Management, Veterans Benefits
Administration, and Robert Jesse, MD, Acting Principal Deputy
Under Secretary for Health, Veterans Health Administration,
appeared before the Committee and submitted written testimony
on various provisions of S. 3325 incorporated into the
Committee bill. Pursuant to Mr. Pamperin's request to provide
official views on additional legislation, enumerated below,
Secretary Shinseki submitted additional views in writing to the
Committee on July 29, 2010. Excerpts of the testimony and the
additional views are reprinted below:
STATEMENT OF THOMAS J. PAMPERIN, ASSOCIATE DEPUTY UNDER SECRETARY FOR
POLICY AND PROGRAM MANAGEMENT, VETERANS BENEFITS ADMINISTRATION, U.S.
DEPARTMENT OF VETERANS AFFAIRS
Mr. Chairman, I am pleased to be here today to provide the
Department of Veterans Affairs' (VA) views on pending
legislation. Also testifying this morning is Dr. Robert Jesse,
Acting Principal Deputy Under Secretary for Health, Veterans
Health Administration, and accompanying us are Assistant
General Counsels Richard J. Hipolit and Walter A. Hall.
I will not be able to address a few of the bills on today's
agenda because we did not have sufficient time to develop and
coordinate the Administration's position and cost estimates,
but with your permission we will provide that information in
writing for the record. Those bills are S. 3286, S. 3314,
S. 3325, S. 3330, S. 3348, S. 3352, S. 3355, S. 3367, S. 3368,
S. 3370, and Senator Burr's draft bill to improve VA's
multifamily transitional housing program. Similarly, for most
of the bills that I will address on today's agenda, we request
permission to provide cost estimates for the record at a later
date.
* * * * * * *
S. 3325
S. 3325 would authorize VA to waive the imposition or
collection of copayments for telehealth and telemedicine visits
of Veterans. The mission of VA's Telehealth program office is
to expand access to care for Veterans through telehealth
technologies. Telehealth is a new modality of care. We believe
it would be inappropriate to waive copayments for Veterans who
receive telehealth services at a VA facility while Veterans who
see their VA provider in person in the same facility would be
charged a copayment.
VA is examining the impact of copayments for care provided
by video telehealth in a patient's home. A video consultation
into the home is used to provide remote case management, health
promotion/disease prevention, enhancement of patient self-
management, and early recognition of deleterious symptoms and
signs of patient deterioration from chronic disease conditions.
The use of video consultation into the home is analogous to
that of telephone call for which no co-payment is required, and
not comparable to a clinic visit.
Recent VA experience demonstrates that co-payments for
home-telehealth may have resulted in a reduced use of this
intervention. To ensure convenient and cost-effective care to
populations of patients who will otherwise delay care and incur
larger costs from emergency room visits and hospital admissions
VA will take the appropriate action to waive or modify
copayments for in-home video telehealth care for Veterans.
Because VA already has the authority to waive or modify the
imposition of co-payments for such care, legislation is not
required.
VA estimates a revenue loss of $2 million in the first
year, $17.7 million over 5 years and $83.4 million over 10
years if VA stops collecting copayments for all telehealth
visits.
* * * * * * *
S. 3314
S. 3314 would require VA and the Appalachian Regional
Commission to jointly carry out a program of outreach to
Veterans who reside in the Appalachian region for purposes of
increasing access and use by Veterans of Federal, state, and
local Veterans benefits programs and increasing awareness of,
and eligibility for, such programs.
VA supports the objective of improving outreach to Veterans
and other potential claimants, but does not support this bill
because it would mandate outreach to only one geographic area
and because it is unnecessary in light of VA's ongoing efforts
to provide outreach in this area.
VA is currently making special efforts to provide medical
care and access in the Appalachian region. Throughout the
states and counties within this region, VA has set up an
extensive and diverse array of rural initiatives, including
Outreach Clinics, Community-Based Outpatient Clinics, expanded
Care Coordination Home Telehealth initiatives, and the use of
unscheduled Mobile Medical Units to perform assessments and
physicals at events.
VA has also taken aggressive steps to ensure awareness of
the facilities, initiatives, and benefits available to
Veterans. Examples include partnering with states such as
Maryland to use unoccupied offices in rural areas to conduct
mental health assessments and provide services; collaborating
with rural community health centers, such as the community
health center in Harrisonburg, Virginia, to increase enrollment
and improve coordination of care; and activating rural health
literacy outreach, such as in the Asheville, North Carolina,
area, where events were held or scheduled in an area covering
the 20 counties of Western North Carolina. This is only the
beginning. VA plans to continue its outreach efforts to
Veterans and their families in this region. Because of VA's
substantial outreach efforts to Veterans in this region, we do
not believe this bill is necessary and thus do not support it.
However, VA would be happy to meet with the Committee to
discuss the special needs of Appalachian Veterans.
VA cannot estimate costs for this program without
additional information because it is unclear to what extent VA
would need to enter into contracts for the outreach that this
bill would mandate.
* * * * * * *
S. 3330
S. 3330, the ``Veterans' Health and Radiation Safety Act of
2010,'' would require VA to report to Congress annually on low-
volume programs (defined as programs that treat 100 patients or
fewer annually) at VA medical facilities. The report would have
to include the Secretary's evaluation and findings with respect
to such programs. Additionally, S. 3330 would require employees
working at VA hospitals where radioactive isotopes are used to
receive training on recognizing and reporting medical events.
Hospitals failing to provide this training would be prohibited
from using radioactive isotopes for a period of time determined
by the Secretary. Lastly, the bill would require VA to evaluate
non-government medical services contractors through weekly
independent peer reviews, written evaluations, and other
evaluations VA determines are appropriate. A contracting
officer would be required to review and consider the results of
these evaluations before VA renews any contracts with non-
government medical services contractors.
We are aware of a very unfortunate lapse that occurred at a
brachytherapy program at one of our facilities. We testified
about this incident before the House Committee on Veterans'
Affairs on July 22, 2009. On May 3, 2010, the Office of the
Inspector General (OIG) issued a report on this incident with
five recommendations. Specifically, the OIG recommended that
the Veterans Health Administration (VHA) standardize, to a
practical extent, the privileging, delivery of care, and
quality controls for the procedures required to provide this
treatment. This has been accomplished. Standardized procedures
have been developed, and site visits have verified that they
are uniformly in place at all facilities and that steps have
been taken to ensure that patients who received low radiation
doses in the course of brachytherapy are evaluated to ensure
that their cancer treatment plan is appropriate. We have
contacted all Veterans who were potentially impacted for
follow-up testing and monitoring at other VA and private
facilities and are reviewing the controls that are in place to
ensure that VA contracts for health care comply with applicable
laws and regulations. Where necessary, we will make
organizational and/or procedural changes to bring this
contracting effort into compliance. A template that outlines
basic requirements for all contracts is currently in
development.
The OIG also recommended that senior VA leadership meet
with senior Nuclear Regulatory Commission leadership to
determine if there is a way forward that will ensure the goals
of both organizations are achieved. VA is currently working to
arrange this meeting. Finally, the OIG recommended that VHA
work with the OIG to develop a list of documents that should
routinely be provided to the OIG when an outside agency is
notified of a possible untoward medical event. VHA will work
closely with the OIG to meet this recommendation.
We appreciate the intent behind S. 3330, but for a number
of reasons we do not support it. First, we note that section 2
would require the Secretary to submit annual reports to
Congress on low volume programs. However, the definition of a
``program'' is not clear. Any treatment ``program'' could be
defined so narrowly that no facility treats 100 patients or
more per year in a particular program or so broadly that almost
every program includes more than 100 patients annually.
Moreover, treatment quality is not always related to patient
volume or patient volume just within a given VA facility. Many
VA facilities have on staff specialist providers who also work
elsewhere in the community. If all care provided by a
specialist is combined, the volume can be, and many times is,
significantly more than can be accounted for just within VA
workload. In addition, standard credentialing, privileging, and
review of quality of care are required at every facility
regardless of the size of a program.
All procedures that are performed and all medical care that
is provided at any VA facility involve quality assessment and
oversight. The first procedure each year has precisely the same
quality assessment requirements as the last, whether the annual
procedure total is 5, 50, or 500. Further, each procedure is
performed by a fully credentialed and privileged physician.
Instead of the requirement to provide an annual report on ``low
volume'' programs, we would like to work with Congress to
identify what information would be useful for Congress to
receive annually.
The mandatory training that would be required by section 3
would apply to all VHA staff and would not be limited to staff
directly involved in the use of radioactive materials. Nuclear
Regulatory Commission regulations already require all staff
involved in the use of radioactive materials to have training
and facilities to provide evidence of that training. Competency
and training requirements for staff are based upon their
defined duties and risks associated with those duties. In VHA,
radiation safety training and education are provided annually,
through the VA Learning Management System, to all staff
involved in the use or handling of radioactive material. This
includes all contract staff or physicians working in VA Nuclear
Medicine services as a condition of their authorization to
practice at a VA medical center. The definition of a medical
event and reporting requirements are taught to, and reviewed
annually with, all Nuclear Medicine technologists and
physicians. VA's National Health Physics Program provides a
mechanism to ensure that the training provided is completed as
required by VA policy. In addition, VA currently supports and
trains all staff in reporting any untoward events or potential
events consistent with guidance provided by the National Center
for Patient Safety and the facility safety programs. As a
result, many of the requirements of section 3 are duplicative
of current VA policy.
The requirement in section 4 to obtain weekly independent
peer reviews of all medical services provided pursuant to a
contract, and written evaluations of the services carried out
by the supervisor or manager of the employee providing the
services, is excessive and would add unwarranted cost in staff
time spent procuring and developing the reports. The
requirement to undertake peer reviews each week may be
ineffective if the number of procedures in a week is
insufficient to carry out a statistically valid review. The
requirement for additional reporting and oversight of all
medical services provided by contract, most of which have not
reported adverse events, would be a waste of resources. Given
current VA procedures related to peer review and reporting,
some of the provisions in this bill are not necessary. We are
available to meet with Committee staff to discuss these issues
in more detail.
While VA appreciates the Committee's focus on this issue,
we believe that these additional measures are not necessary in
view of the above regulatory requirements, safeguards, and
training. VA estimates that costs for this bill, if enacted,
would be $64.2 million for the first year, $347.5 million over
5 years, and $770.5 million over 10 years.
* * * * * * *
S. 3377
S. 3377 would convert VA's multifamily transitional housing
loan guarantee program into one that would instead provide
direct loans to qualified organizations. Under current
subchapter VI of chapter 20, title 38, United States Code, the
Secretary is authorized to guarantee not more than 15 loans, or
an aggregate amount of $100 million, for multifamily
transitional housing projects. This bill would terminate the
Secretary's authority to issue any new guarantees under section
2051, but would require the Secretary to make at least five
direct loans to qualified organizations that plan to develop
multifamily housing projects. The source of funds for the
program would be the Multifamily Transitional Housing Loan
Program Revolving Fund, established under section 1(b) of the
bill.
VA does not support enactment of S. 3377. VA spent the
better part of a decade testing the model and trying to make
the multifamily transitional housing loan guarantee program
work. During that time, the marketplace repeatedly revealed
that there was a strong need for more programs that provide
low-cost housing, including those offering supportive services
for Veterans returning to gainful employment. There were three
main reasons why organizations did not seek project financing
through the VA program, which led them to try to instead find
funding from other Federal, state, and local programs: (1) a
lack of available operating subsidies (i.e., formerly homeless
veterans cannot pay enough rent to generate sufficient project
revenue to cover operating expenses and support services); (2)
the debt repayment requirement (many local government entities
offer either low-interest, interest-only, deferred, and/or
forgivable debt products, which are more appealing to project
sponsors than the VA loan guarantee program); and (3) the large
project size requirement (large projects are difficult to site,
and there is a growing trend towards developing mixed-tenancy
projects). In addition, other sources of funding needed to
create housing are almost exclusively tied to non-transitional
housing. Persons living in transitional housing are normally
still considered homeless.
Additionally, we have concerns how the program would be
implemented, as it is not clear that the program structure
would be consistent with other existing legislation, such as
the Federal Credit Reform Act. Furthermore, the provision that
would authorize the Secretary to delegate to a State or local
government entity the authority to approve a loan might
constitute an unconstitutional delegation of Federal authority.
The statutory language should make clear that a delegation of
approval authority to a State or local government entity
remains subject to the Secretary's continuing supervision.
VA's 2011 Budget includes $4.2 billion to prevent and
reduce homelessness among Veterans--over 3.4 billion for
medical services and nearly $800 million for specific homeless
programs.
VA estimates that this bill would not create any demand for
multifamily transitional housing direct loans, but would result
in administrative expenses of $1.05 million in year one, and
$7.8 million over 10 years. If direct loans were made, they
would likely be very expensive given the anticipated terms and
conditions on the underlying loans. Therefore, it is not clear
that Federal credit assistance is the most efficient or
effective means of achieving the policy objective.
* * * * * * *
S. 3035
S. 3035, the ``Veterans Traumatic Brain Injury Care
Improvement Act of 2010,'' would require the Secretary to
submit to Congress a report on the feasibility and advisability
of establishing a Polytrauma Rehabilitation Center or
Polytrauma Network Site for VA in the northern Rockies or the
Dakotas.
VA shares the concern for providing treatment facilities
for polytrauma in this region and has already completed an
assessment of need. VA has determined that an enhanced
Polytrauma Support Clinic Team with a strong telehealth
component at the Ft. Harrison, Montana, VA facility would meet
the needs and the workload volume of Veterans with mild to
moderate traumatic brain injury (TBI) residing in the catchment
area of the Montana Health care System. It would also
facilitate access to TBI rehabilitation care for other Veterans
from the northern Rockies and the Dakotas through telehealth.
However, establishment of a Polytrauma Rehabilitation Center or
Polytrauma Network Site, which would focus on the treatment of
moderate to severe TBI, is not feasible or advisable in this
area based on the needs of the population served. Because of
the action already being taken by VA, this bill is not
necessary, and we do not support it.
The estimated cost of staffing the Polytrauma Support
Clinic Team at Ft. Harrison would be $1 million in the first
year, $6.1 million for five years, and approximately $13
million over 10 years.
Mr. Chairman, we would be pleased to provide the Committee
with more detailed information about our findings and decisions
regarding the northern Rockies and the Dakotas.
* * * * * * *
S. 3355
S. 3355, the ``Veterans One Source Act of 2010,'' would
require VA to establish and maintain an interactive Internet
Web site that provides information on the benefits, resources,
services, and opportunities provided by VA, other Federal
agencies, and other sources.
VA supports the objective of S. 3355. However, VA has
already collaborated with the Department of Defense (DOD) in
the creation of a joint eBenefits Internet portal in response
to the recommendations of the President's Commission on Care of
America's Returning Wounded Warriors (Dole-Shalala), made in
March 2007. This new Web site (www.ebenefits.va.gov) provides
Servicemembers, Veterans, family members, and care providers a
single transparent access point to online information about
benefits, services, and other resources. It provides a
consolidated catalog of links to existing information on VA,
DOD, and other Federal and state agency Web sites concerning
benefits, services, and related resources. Obtaining a Defense
Self-Service log-on account in order to access eBenefits has
recently become mandatory for all Servicemembers and allows
them to carry their eBenefits account through their life cycle
and concurrently allows VA and DOD to regularly update benefit-
related information. Because the eBenefits portal meets the
intent and nearly all of the requirements of S. 3355, VA
believes this bill is unnecessary.
Much of the information the bill would call for is
available now in the eBenefits portal. Current topics include
compensation, pension, health care, education benefits, home
loans, financial services, employment assistance, reemployment
rights, memorial benefits, Social Security benefits, DOD
programs, state benefits, and Veterans Service Organizations.
The eBenefits portal offers quick access to online application
tools and other assistance to claimants. Secure access
capabilities allow for personalization of content and services.
Self-service capabilities the eBenefits portal offers
include the ability to apply for many benefits online, to check
the status of compensation and pension claims, to apply for a
home loan certificate of eligibility, to view VA e-health
records, and to access and retrieve official military personnel
records. Access to blogs and online communities is also
provided.
In committing to the eBenefits portal, VA and DOD have
already undertaken a multi-year project that will continue to
add self-service transactional capabilities and to enlarge and
refine online access to benefits, services, resources, and
opportunities for Servicemembers, Veterans, family members, and
caregivers. Some of these features will include the ability to:
opt into the VA/DOD virtual electronic lifetime health record;
transfer Chapter 33 (Post-9/11 GI Bill) benefits to dependents;
change an address in both VA and DOD systems of records;
communicate personally via a messaging center; receive
automatic notification of benefits; view information on, and
apply for, all VA benefits; and self-select to receive state
benefit information. VA is confident that the capabilities of
the eBenefits portal will meet the objectives of S. 3355.
Funding for the eBenefits portal in FY 2010 is
approximately $7.4 million, which includes contract support,
operating costs, and FTE. VA estimates that overall operating
costs, contract support, and FTE will be $12 million in FY
2011. The estimated cost for the capabilities required by the
bill that are not included in the eBenefits portal is $1.1
million. This estimate includes costs for the following
features: an animated virtual user guide; resources for
caregivers (currently provided at a minimal level); information
on discounts for veterans; facilitation of ride sharing for
appointments; memorial notices; opportunities for volunteering;
and information on community events.
* * * * * * *
S. 2751
S. 2751 would designate the VAMC in Big Spring, Texas, as
the George H. O'Brien, Jr., Department of Veterans Affairs
Medical Center. Mr. O'Brien was awarded the Medal of Honor for
his actions in battle in Korea and, following service,
volunteered at the VAMC in Big Spring. He died in 2005. We
defer to Congress in the naming of Federal property in honor of
individuals.
* * * * * * *
SUPPLEMENTAL VIEWS OF HON. RICHARD BURR,
RANKING MEMBER
I offered the text of legislation I introduced, S. 1518,
the Caring for Camp LeJeune Veterans Act of 2009, as an
amendment to the Committee bill at the August 5, 2010, markup.
The amendment, which would give veterans and family members
exposed to contaminated drinking water at Camp LeJeune VA
health care eligibility for conditions related to the exposure,
was, regrettably, defeated on a party-line vote. At the
Committee's January 28, 2010, markup I offered the same
amendment, also defeated on a party-line vote, in favor of an
approach advanced by my colleagues in the majority which put
the onus of providing for sick Camp LeJeune family members on
the Department of Defense (DOD). I argued then that the
majority's approach would not advance because of a number of
problems, and that the Committee's action gave false hope to
sick veterans and family members. That bill has yet to advance
in the Senate, and the Senate Armed Services Committee has
signaled it has no intention of moving the majority's bill.
My colleagues in the majority continue to assert that DOD
must first take responsibility for the contamination at Camp
LeJeune, but this view ignores the fact that DOD continues to
view this issue through the prism of litigation and has no
incentive to address the plight of veterans and their families
exposed to environmental hazards while working and living on a
DOD installation. In the absence of DOD acceptance of
responsibility or formal consideration for the veterans and
their families, this Committee should recognize that VA is the
logical and desirable provider of health care. Furthermore, I
have argued that precedent exists in VA to care for veterans
and dependents suffering from the effects of harmful exposures.
No such precedent exists at DOD.
I remain committed to enacting legislation providing those
affected by the LeJeune water contamination with medical care
for any disease associated with the water contaminants. They
have waited long enough for the Congress to act. I will
continue to be vocal about their plight until we finally have
given them this small measure of recognition for what they have
endured.
Changes in Existing Law
In compliance with paragraph 12 of Rule XXVI 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 II. GENERAL BENEFITS
CHAPTER 17. HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE
SUBCHAPTER I. GENERAL
SEC.
1701. DEFINITIONS.
1702. PRESUMPTIONS: PSYCHOSIS AFTER SERVICE IN WORLD WAR II AND
FOLLOWING PERIODS OF WAR; MENTAL ILLNESS FOLLOWING
SERVICE IN THE PERSIAN GULF WAR.
1703. CONTRACTS FOR HOSPITAL CARE AND MEDICAL SERVICES IN NON-
DEPARTMENT FACILITIES.
1703A. OVERSIGHT OF MEDICAL SERVICES PROVIDED BY CONTRACTORS.
* * * * * * *
SUBCHAPTER III. MISCELLANEOUS PROVISIONS RELATING TO HOSPITAL AND
NURSING HOME CARE AND MEDICAL TREATMENT OF VETERANS
1721. POWER TO MAKE RULES AND REGULATIONS.
1722. DETERMINATION OF INABILITY TO DEFRAY NECESSARY EXPENSES; INCOME
THRESHOLDS.
1722A. COPAYMENT FOR MEDICATIONS.
1722B. COPAYMENTS: WAIVER OF COLLECTION OF COPAYMENTS FOR TELEHEALTH
AND TELEMEDICINE VISITS OF VETERANS.
* * * * * * *
Subchapter I. General
* * * * * * *
SEC. 1703. CONTRACTS FOR HOSPITAL CARE AND MEDICAL SERVICES IN NON-
DEPARTMENT FACILITIES
* * * * * * *
SEC. 1703A. OVERSIGHT OF MEDICAL SERVICES PROVIDED BY CONTRACTORS
(a) In General.--(1) The Secretary shall ensure that the
quality assessment program of the Department includes
appropriate oversight of medical services provided pursuant to
a contract entered into by the Secretary with a non-government
entity.
(2) Oversight of a medical service required by paragraph
(1) shall include, as appropriate to the service, the
following:
(A) Periodic peer reviews of such service.
(B) Periodic written evaluations of the oversight
provided by the supervisor or manager of the individual
providing the service.
(C) Such other evaluations as the Secretary
determines are appropriate.
(3) The Secretary shall ensure that sufficient data is
collected and analyzed by an employee of the Department in
order to evaluate the quality of medical services provided
pursuant to a contract entered into by the Secretary with a
non-government entity.
(b) Requirements Relating to Extension of Certain
Contracts.--Before any contracting officer of the Department
may extend or renew any contract entered into by the Secretary
with a non-government entity for the provision of medical
services, the contracting officer shall review and take into
consideration the results of the evaluations carried out under
subsection (a).
* * * * * * *
Subchapter III. Miscellaneous Provisions Relating to Hospital and
Nursing Home Care and Medical Treatment of Veterans
* * * * * * *
SEC. 1722A. COPAYMENT FOR MEDICATIONS
* * * * * * *
SEC. 1722B. COPAYMENTS: WAIVER OF COLLECTION OF COPAYMENTS FOR
TELEHEALTH AND TELEMEDICINE VISITS OF VETERANS
The Secretary may waive the imposition or collection of
copayments for telehealth and telemedicine visits of veterans
under the laws administered by the Secretary.
* * * * * * *
CHAPTER 20. BENEFITS FOR HOMELESS VETERANS
* * * * * * *
SUBCHAPTER VI. [LOAN GUARANTEE FOR] MULTIFAMILY TRANSITIONAL HOUSING
SEC.
2051. GENERAL AUTHORITY
2052. REQUIREMENTS
2053. DEFAULT
2054. AUDIT
2055. MULTIFAMILY TRANSITIONAL HOUSING LOAN PROGRAM REVOLVING FUND.
2056. PREFERENTIAL TREATMENT OF VETERANS.
* * * * * * *
Subchapter VI. [Loan Guarantee for] Multifamily Transitional Housing
SEC. 2051. GENERAL AUTHORITY
(a)(1) The [The] Secretary may guarantee the full or
partial repayment of a loan that meets the requirements of this
subchapter.
(2) The Secretary shall, utilizing funds available in the
Multifamily Transitional Housing Loan Program Revolving Fund
under section 2055 of this title, issue not more than five
loans that meet the requirements of this subchapter.
(b)(1) Not more than 15 loans may be guaranteed [under
subsection (a)] under subsection (a)(1), of which not more than
five such loans may be guaranteed during the 3-year period
beginning on the date of the enactment of this subchapter.
(2) A guarantee of a loan [under subsection (a)] under
subsection (a)(1) shall be in an amount that is not less than
the amount necessary to sell the loan in a commercial market.
(3) Not more than an aggregate amount of $100,000,000 in
loans may be guaranteed or issued under subsection (a).
(c)(1) A loan [A loan] may not be guaranteed or issued
under this subchapter unless, before closing such loan, the
Secretary has approved the loan.
(2) The Secretary may delegate approval under paragraph (1)
to a State or local government entity.
(3) Approval activity of a State or local government entity
under paragraph (2) shall be subject to the supervision of the
Secretary.
* * * * * * *
(g) Notwithstanding any other provision of law, a
multifamily transitional housing project that is funded by a
loan guaranteed or issued under this subchapter may accept
uncompensated voluntary services performed by any eligible
entity (as that term is defined in section 2011(d) of this
title) in connection with the construction, alteration, or
repair of such project.
(h) Nothing in this subchapter shall be construed to
provide for a minimum or maximum size of a multifamily
transitional housing project that may be financed with a loan
under this subchapter.
(i) The Secretary may not guarantee under subsection (a)(1)
any loan that is closed after the date of the enactment of this
subsection. The termination by this subsection of the authority
to guarantee loans under this subsection shall not affect the
validity of any loan guaranteed under this subchapter before
the date of the enactment of this subsection and is in force on
that date.
SEC. 2052. REQUIREMENTS
(a) * * *
(1) * * *
* * * * * * *
(6) The loan is subject to such terms and conditions
as the Secretary determines are reasonable, including
with respect to forbearance, deferral, and loan
forgiveness, taking into account other housing projects
with similarities in size, location, population, and
services provided.
(b) * * *
(1) * * *
(2) provides supportive services and [counselling]
counseling services (including job [counselling]
counseling) at the project site with the goal of making
such veterans self-sufficient;
* * * * * * *
(c) Such a project--
(1) may include space for neighborhood retail
services, other commercial activities, [or job training
programs] job training programs, other types of
residential units, or other uses that the Secretary
considers necessary for the sustainability of the
project; and
* * * * * * *
(d) In determining whether to guarantee or issue a loan
under this subchapter, the Secretary shall consider--
(1) * * *
(2) the extent to which needs of homeless veterans
are met in a community[, as assessed under section 107
of Public Law 102-405].
SEC. 2053. DEFAULT
(a) The Secretary shall take such steps as may be necessary
to obtain repayment on any loan that is in default and that is
guaranteed or issued under this subchapter.
* * * * * * *
(c) The Secretary may impose such penalties or require such
collateral as the Secretary considers necessary--
(1) to discourage default on a loan issued under this
subchapter; or
(2) to mitigate harm to the Department from default
on a loan issued under this subchapter.
(d) The Secretary shall administer any property coming
under the jurisdiction of the Secretary by reason of default on
a loan issued or guaranteed under this subchapter in accordance
with regulations prescribed by the Secretary for that purpose.
Such administration of property may include selling, renting,
or otherwise disposing of property as the Secretary considers
appropriate.
SEC. 2054. AUDIT
(a) During each of the first 3 years of operation of a
multifamily transitional housing project with respect to which
a loan is guaranteed or issued under this subchapter, there
shall be an annual, independent audit of such operation. Such
audit shall include a detailed statement of the operations,
activities, and accomplishments of such project during the year
covered by such audit. The party responsible for obtaining such
audit (and paying the costs therefor) shall be determined
before the Secretary issues a guarantee or loan under this
subchapter.
(b) * * *
SEC. 2055. MULTIFAMILY TRANSITIONAL HOUSING LOAN PROGRAM REVOLVING FUND
(a) Establishment.--There is established in the Treasury of
the United States a revolving fund known as the ``Department of
Veterans Affairs Multifamily Transitional Housing Loan Program
Revolving Fund'' (in this section referred to as the ``Fund'').
(b) Elements.--There shall be deposited in the Fund the
following, which shall constitute the assets of the Fund:
(1) Amounts paid into the Fund under any provision of
law or regulation established by the Secretary imposing
fees on persons or entities issued a loan under this
subchapter.
(2) All other amounts received by the Secretary
incident to operations relating to the issuance of
loans under this subchapter, including--
(A) collections of principal and interest on
loans issued by the Secretary under this
subchapter;
(B) proceeds from the sale, rental, use, or
other disposition of property acquired under
this subchapter; and
(C) penalties collected pursuant to this
subchapter.
(3) Amounts appropriated or otherwise made available
before the date of the enactment of this section for
purposes of activities under this subchapter, including
amounts appropriated for such purposes under title I of
the Department of Veterans Affairs and Housing and
Urban Development, and Independent Agencies
Appropriations Act, 2000 (Public Law 106-74; 113 Stat.
1049).
(c) Use of Funds.--The Fund shall be available to the
Secretary, without fiscal year limitation, for all operations
relating to the issuance of loans under this subchapter,
consistent with the Federal Credit Reform Act of 1990 (2 U.S.C.
661 et seq.).
SEC. 2056. PREFERENTIAL TREATMENT OF VETERANS
No provision of Federal or State law may prohibit a
multifamily transitional housing project described in section
2052(b) of this title from offering preferential treatment to
veterans.
* * * * * * *
PART VI. ACQUISITION AND DISPOSITION OF PROPERTY
* * * * * * *
CHAPTER 81. ACQUISITION AND OPERATION OF HOSPITAL AND DOMICILIARY
FACILITIES; PROCUREMENT AND SUPPLY; ENHANCED-USE LEASES OF REAL
PROPERTY
* * * * * * *
Subchapter I. Acquisition and Operation of Medical Facilities
* * * * * * *
SEC. 8104. CONGRESSIONAL APPROVAL OF CERTAIN MEDICAL FACILITY
ACQUISITIONS
(a)(1) * * *
* * * * * * *
(d)(1) Except as provided in paragraph (2), in any case [In
any case] in which the Secretary proposes that funds be used
for a purpose other than the purpose for which such funds were
appropriated, the Secretary shall promptly notify each
committee, in writing, of the particulars involved and the
reasons why such funds were not used for the purpose for which
appropriated.
(2) In any fiscal year, unobligated amounts in the
Construction, Major Projects account that are a direct result
of bid savings from a major medical facility project may only
be obligated for other major medical facility projects
authorized for that fiscal year or a previous fiscal year.
* * * * * * *