[Senate Report 111-288]
[From the U.S. Government Publishing Office]
Calendar No. 559
111th Congress Report
SENATE
2d Session 111-288
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A BILL TO EXTEND THE TEMPORARY AUTHORITY FOR THE PERFORMANCE OF MEDICAL
DISABILITY EXAMINATIONS BY CONTRACT PHYSICIANS FOR THE DEPARTMENT OF
VETERANS AFFAIRS
_______
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
[To accompany S. 3609]
The Committee on Veterans' Affairs (hereinafter, ``the
Committee''), to which was referred the bill (S. 3609), to
extend the temporary authority for the performance of medical
disability examinations by contract providers for the
Department of Veterans Affairs (hereinafter, ``VA''), having
considered the same, reports favorably thereon, and recommends
that the bill do pass without amendment.
Introduction
On July 19, 2010, Committee Chairman Daniel K. Akaka
introduced S. 3609, to extend the temporary authority for the
performance of medical disability examinations by contract
providers for VA.
Committee Meeting
The Committee met in open session on August 5, 2010, to
consider, among other legislation, S. 3609. The Committee
voted, without dissent, to report favorably S. 3609.
Summary of S. 3609 as Reported
S. 3609 as reported (hereinafter, ``the Committee bill'')
would extend the temporary authority for the performance of
medical disability examinations by contract providers for VA.
Background and Discussion
In order to determine the type and severity of disabilities
of veterans filing for VA compensation or pension benefits, VA
often requires thorough medical disability examinations.
Because these examinations form the basis of disability
ratings, their accurate and timely completion is essential. In
recent years, the demand for medical disability examinations
has increased beyond the number of requests that the current
in-house system was designed to accommodate. This rise in
demand is due to an increase in the complexity of disability
claims, an increase in the number of disabilities claimed by
veterans, and changes in eligibility requirements for
disability benefits.
Background. In 1996, in Public Law 104-275, the Veterans'
Benefits Improvements Act of 1996, VA was authorized to carry
out a pilot program of contract disability examinations through
ten VA regional offices using amounts available for payment of
compensation and pensions. During the initial pilot program,
one contractor performed all contract examinations at the ten
selected regional offices.
The pilot was deemed a success, with general satisfaction
reported from all stakeholders. According to the VA Claims
Processing Task Force's 2001 report to the Secretary of
Veterans Affairs: ``The quality of [contract] examinations has
been reported to exceed a 99 percent adequacy rate, and the
Task Force found high approval from Regional Office employees.
Reported medical examination timeliness was within contract
compliance with positive feedback in customer service
surveys.''
Subsequently, in 2003, in Public Law 108-183, the Veterans
Benefits Act of 2003, VA was given additional, time-limited
authority to contract for disability examinations using other
appropriated funds. That initial authority was extended until
December 31, 2010, by Public Law 110-389, the Veterans'
Benefits Improvement Act of 2008. VA continues to report high
demand for compensation and pension examinations and
satisfaction with the contracted examinations.
Committee Bill. The Committee bill would extend VA's
authority, through December 31, 2012, to use appropriated funds
for the purpose of contracting with non-VA providers to conduct
disability examinations. The examinations would be conducted
pursuant to contracts entered into and administered by the
Under Secretary for Benefits. The Committee notes that the
authority to contract for disability examinations through the
ten regional offices, using amounts available for payment of
compensation and pension, is an ongoing authority with no time
limitation.
Committee Bill Cost Estimate
In compliance with paragraph 11(a) of rule XXVI of the
Standing Rules of the Senate, the Committee, based on
information supplied by the CBO, estimates that enactment of
the Committee bill would, relative to current law, increase
discretionary spending by $58 million over the 2011-2013
period, assuming appropriation of the necessary amounts.
Enacting S. 3609 would not affect direct spending or revenues.
S. 3609 contains no intergovernmental and private-sector
mandates as defined in the Unfunded Mandates Reform Act.
The cost estimate provided by CBO, setting forth a detailed
breakdown of costs, follows:
Congressional Budget Office,
Washington, DC, August 12, 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. 3609, a bill to
extend the temporary authority for the performance of medical
disability examinations by contract physicians for the
Department of Veterans Affairs.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Dwayne M.
Wright.
Sincerely,
Douglas W. Elmendorf,
Director.
Enclosure.
S. 3609--A bill to extend the temporary authority for the performance
of medical disability examinations by contract physicians for
the Department of Veterans Affairs
S. 3609 would extend by two years the authority for the
Department of Veterans Affairs (VA) to use contract physicians
to perform medical disability examinations. Under current law,
that authority expires on December 31, 2010. Based on
information from VA, CBO estimates that, in 2010, VA will use
the current authority to have about 36,000 exams completed by
contract physicians at a cost of about $800 per exam. CBO
further estimates that if the authority is extended for two
years, VA would use contract physicians to complete about
72,000 additional examinations.
In the absence of such authority, VA physicians who would
otherwise be providing other types of health care to veterans
will perform the exams, at no additional cost to VA. Thus, CBO
estimates that implementing S. 3609 would cost $58 million over
the 2011-2013 period, assuming appropriation of the necessary
amounts. Enacting S. 3609 would not affect direct spending or
revenues; therefore, pay-as-you-go procedures do not apply.
S. 3609 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act and
would not affect the budgets of state, local, or tribal
governments.
The CBO staff contact for this estimate is Dwayne M.
Wright. The estimate was 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(b) 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, by voice vote, without objection, ordered to
report S. 3609, a bill to extend the temporary authority for
the performance of medical disability examinations by contract
providers for the Department of Veterans Affairs.
Agency Report
On August 6, 2010, the Secretary of Veterans Affairs
submitted the views of the Department on S. 3609--a bill to
extend VA's authority to contract for medical disability
examinations. Below are excerpts from the Secretary's letter:
The Secretary of Veterans Affairs,
Washington, DC, August 6, 2010.
Hon. Daniel K. Akaka,
Chairman,
Committee on Veterans' Affairs,
U.S. Senate, Washington, DC.
Dear Mr. Chairman: This is in response to your request for
the views of the Department of Veterans Affairs (VA) on section
3609, 111th Congress, a bill to extend the temporary authority
for the performance of medical disability examinations by
contract physicians for VA. VA supports this bill, which is
virtually identical to section 104 of VA's legislative proposal
for Fiscal Year 2011 as provided to Congress on May 26, 2010.
Section 704(a) of the Veterans Benefits Act of 2003, Public
Law 108-183, authorizes VA to provide for the conduct of VA
compensation and pension examinations by persons other than VA
employees, by using appropriated funds other than mandatory
funds, appropriated for the payment of compensation and pension
benefits. In accordance with section 704(b) of that act, VA
exercises this authority pursuant to contracts with private
entities. However, under section 704(c), as amended by section
105 of the Veterans' Benefits Improvement Act of 2008, Public
Law 110-389, this authority will expire on December 31, 2010.
This bill would extend to December 31, 2012, VA's authority
to contract for compensation and pension examinations.
Extending this authority is essential to VA's objective of
ensuring the timely adjudication of disability claims and would
allow the Veterans Health Administration to focus its resources
on providing needed health care to Veterans. The demand for
medical disability examinations has increased, largely due to
an increase in the complexity of disability claims, an increase
in the number of disabilities for which Veterans claim
benefits, and changes in eligibility requirements for
disability benefits. Extending the authority to provide
examinations to Veterans through non-VA medical providers would
improve patient care and accelerate benefit delivery.
We anticipate no benefit costs or savings because this
flexibility impacts only the timeliness of rating decisions. As
this provision would only extend VA's current authority to
effectively utilize supplemental and other discretionary
appropriated funds as available for examinations, we estimate
that enactment of this bill would have no significant financial
impact.
The Office of Management and Budget has advised that there
is no objection to the submission of this report from the
standpoint of the Administration's program.
Sincerely,
Eric K. Shinseki.
* * * * * * *
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).
VETERANS BENEFITS ACT OF 2003
(Public Law 108-183; 38 U.S.C. 5101 note)
* * * * * * *
TITLE VII. OTHER MATTERS
* * * * * * *
SEC. 704. TEMPORARY AUTHORITY FOR PERFORMANCE OF MEDICAL DISABILITIES
EXAMINATIONS BY CONTRACT PHYSICIANS.
(a) * * *
(b) * * *
(c) Expiration.--The authority in subsection (a) shall
expire on [December 31, 2010] December 31, 2012. No examination
may be carried out under the authority provided in that
subsection after that date.
(d) * * *
* * * * * * *