[House Report 114-191]
[From the U.S. Government Publishing Office]


114th Congress   }                                       {      Report
                        HOUSE OF REPRESENTATIVES
 1st Session     }                                       {     114-191

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



 
                 VETERANS INFORMATION MODERNIZATION ACT

                                _______
                                

  July 7, 2015.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

    Mr. Miller of Florida, from the Committee on Veterans' Affairs, 
                        submitted the following

                              R E P O R T

                        [To accompany H.R. 2256]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 2256) to amend title 38, United States Code, to 
direct the Secretary of Veterans Affairs to submit an annual 
report on the Veterans Health Administration and the furnishing 
of hospital care, medical services, and nursing home care by 
the Department of Veterans Affairs, having considered the same, 
report favorably thereon with amendments and recommend that the 
bill as amended do pass.

                                CONTENTS

                                                                   Page
Amendment........................................................     2
Purpose and Summary..............................................     8
Background and Need for Legislation..............................     9
Hearings.........................................................    12
Subcommittee Consideration.......................................    13
Committee Consideration .........................................    14
Committee Votes..................................................    14
Committee Oversight Findings.....................................    14
Statement of General Performance Goals and Objectives............    14
New Budget Authority, Entitlement Authority, and Tax Expenditures    15
Earmarks and Tax and Tariff Benefits.............................    15
Committee Cost Estimate..........................................    15
Congressional Budget Office Estimate.............................    15
Federal Mandates Statement.......................................    18
Advisory Committee Statement.....................................    19
Constitutional Authority Statement...............................    19
Applicability to Legislative Branch..............................    19
Statement on Duplication of Federal Programs.....................    19
Disclosure of Directed Rulemaking................................    19
Section-by-Section Analysis of the Legislation...................    19
Changes in Existing Law Made by the Bill as Reported.............    25

                Amendment in the Nature of a Substitute

    The amendments are as follows:
    Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited a the ``Veterans Information Modernization 
Act''.

SEC. 2. ANNUAL REPORT ON VETERANS HEALTH ADMINISTRATION AND FURNISHING 
                    OF HOSPITAL CARE, MEDICAL SERVICES, AND NURSING 
                    HOME CARE.

  (a) In General.--Subchapter II of chapter 73 of title 38, United 
States Code, is amended by adding at the end the following new section:

``Sec. 7330B. Annual report on Veterans Health Administration and 
                    furnishing of hospital care, medical services, and 
                    nursing home care

  ``(a) Report Required.--Not later than March 1 of each year, the 
Secretary shall submit to the Committees on Veterans' Affairs of the 
Senate and House of Representatives a report on the furnishing of 
hospital care, medical services, and nursing home care under the laws 
administered by the Secretary and on the administration of the 
provision of such care and services by the Veterans Health 
Administration during the calendar year preceding the calendar year 
during which the report is submitted.
  ``(b) Contents of Report.--Each report required by subsection (a) 
shall include each of the following for the year covered by the report:
          ``(1) An evaluation of the effectiveness of the Veterans 
        Health Administration program in increasing the access of 
        veterans eligible for hospital care, medical services, and 
        nursing home care furnished by the Secretary to such care.
          ``(2) An evaluation of the effectiveness of the Veterans 
        Health Administration in improving the quality of health care 
        provided to such veterans, without increasing the costs 
        incurred by the Government or such veterans, which includes the 
        relevant information for each medical center and Veterans 
        Integrated Service Network of the Department set forth 
        separately.
          ``(3) An assessment of--
                  ``(A) the workload of physicians and other employees 
                of the Veterans Health Administration;
                  ``(B) patient demographics and utilization rates;
                  ``(C) physician compensation;
                  ``(D) the productivity of physicians and other 
                employees of the Veterans Health Administration;
                  ``(E) the percentage of hospital care, medical 
                services, and nursing home care provided to such 
                veterans in Department facilities and in non-Department 
                facilities and any changes in such percentages compared 
                to the year preceding the year covered by the report;
                  ``(F) pharmaceutical prices; and
                  ``(G) third party health billings owed to the 
                Department, including the total amount of such billings 
                and the total amounts collected, set forth separately 
                for claims greater than $1000 and for claims equal to 
                or less than $1000.
  ``(c) Definitions.--In this section, the terms `hospital care', 
`medical services', `nursing home care', and `non-Department 
facilities' have the meanings given such terms in section 1701 of this 
title.''.
  (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item relating to section 
7330A the following new item:

``7330B. Annual report on Veterans Health Administration and furnishing 
of hospital care, medical services, and nursing home care.''.

SEC. 3. EXPANSION OF DEFINITION OF HOMELESS VETERAN FOR PURPOSES OF 
                    BENEFITS UNDER THE LAWS ADMINISTERED BY THE 
                    SECRETARY OF VETERANS AFFAIRS.

  Section 2002(1) of title 38, United States Code, is amended by 
inserting ``or (b)'' after ``section 103(a)''.

SEC. 4. IDENTIFICATION AND TRACKING OF BIOLOGICAL IMPLANTS USED IN 
                    DEPARTMENT OF VETERANS AFFAIRS MEDICAL FACILITIES.

  (a) In General.--Subchapter II of chapter 73 of title 38, United 
States Code, as amended by section 2, is further amended by adding at 
the end the following new section:

``Sec. 7330C. Identification and tracking of biological implants

  ``(a) Standard Identification System for Biological Implants.--(1) 
The Secretary shall adopt the unique device identification system 
developed for medical devices by the Food and Drug Administration 
pursuant to section 519(f) of the Federal Food, Drug, and Cosmetic Act 
(21 U.S.C. 360i(f)), or implement a comparable standard identification 
system, for use in identifying biological implants intended for use in 
medical procedures conducted in medical facilities of the Department.
  ``(2) In adopting or implementing a standard identification system 
for biological implants under paragraph (1), the Secretary shall permit 
a vendor to use any of the accredited entities identified by the Food 
and Drug Administration as an issuing agency pursuant to section 
830.100 of title 21, Code of Federal Regulations, or any successor 
regulation.
  ``(b) Biological Implant Tracking System.--(1) The Secretary shall 
implement a system for tracking the biological implants referred to in 
subsection (a) from human donor or animal source to implantation.
  ``(2) The tracking system implemented under paragraph (1) shall be 
compatible with the identification system adopted or implemented under 
subsection (a).
  ``(3) The Secretary shall implement inventory controls compatible 
with the tracking system implemented under paragraph (1) so that all 
patients who have received, in a medical facility of the Department, a 
biological implant subject to a recall can be notified of the recall, 
if based on the evaluation of appropriate medical personnel of the 
Department of the risks and benefits, the Secretary determines such 
notification is appropriate.
  ``(c) Consistency With Food and Drug Administration Regulations.--To 
the extent that a conflict arises between this section and a provision 
of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 301 et seq.) or 
sections 351 or 361 of the Public Health Service Act (42 U.S.C. 262) 
(including any regulations issued under such Acts), the provision the 
Federal Food, Drug, and Cosmetic Act or Public Health Service Act 
(including any regulations issued under such Acts) shall apply.
  ``(d) Definition of Biological Implant.--In this section, the term 
`biological implant' means any animal or human cell, tissue, or 
cellular or tissue-based product--
          ``(1) under the meaning given the term human cells, tissues, 
        or cellular or tissue-based products in section 1271.3 of title 
        21, Code of Federal Regulations, or any successor regulation; 
        or
          ``(2) that is regulated as a device under section 201(h) of 
        the Federal Food, Drug, and Cosmetic Act.''.
  (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter, as amended by section 2, is further amended by inserting 
after the item relating to section 7330B, as added by section 2, the 
following new item:

``7330C. Identification and tracking of biological implants.''.

  (c) Implementation Deadlines.--
          (1) Standard identification system.--
                  (A) In general.--With respect to biological implants 
                described in paragraph (1) of subsection (d) of section 
                7330C of title 38, United States Code, as added by 
                subsection (a), the Secretary of Veterans Affairs shall 
                adopt or implement a standard identification system for 
                biological implants, as required by subsection (a) of 
                such section, by not later than the date that is 180 
                days after the date of the enactment of this Act.
                  (B) Implants regulated as devices.--With respect to 
                biological implants described in paragraph (2) of 
                subsection (d) of such section, the Secretary of 
                Veterans Affairs shall adopt or implement such standard 
                identification system in compliance with the compliance 
                dates established by the Food and Drug Administration 
                pursuant to section 519(f) of the Federal Food, Drug, 
                and Cosmetic Act (21 U.S.C. 360i(f)).
          (2) Tracking system.--The Secretary of Veterans Affairs shall 
        implement the biological implant tracking system required by 
        section 7330C(b), as added by subsection (a), by not later than 
        the date that is 180 days after the date of the enactment of 
        this Act.
  (d) Reporting Requirement.--
          (1) In general.--If the biological implant tracking system 
        required by section 7330C(b) of title 38, United States Code, 
        as added by subsection (a), is not operational by the date that 
        is 180 days after the date of the enactment of this Act, the 
        Secretary of Veterans Affairs shall submit to the Committees on 
        Veterans' Affairs of the Senate and House of Representatives a 
        written explanation for why the system is not operational for 
        each month until such time as the system is operational.
          (2) Elements.--Each explanation submitted under paragraph (1) 
        shall include a description of the following:
                  (A) Each impediment to the implementation of the 
                system described in such paragraph.
                  (B) Steps being taken to remediate each such 
                impediment.
                  (C) Target dates for a solution to each such 
                impediment.

SEC. 5. PROCUREMENT OF BIOLOGICAL IMPLANTS USED IN DEPARTMENT OF 
                    VETERANS AFFAIRS MEDICAL FACILITIES.

  (a) Procurement.--
          (1) In general.--Subchapter II of chapter 81 of such title is 
        amended by adding at the end the following new section:

``Sec. 8129. Procurement of biological implants

  ``(a) In General.--(1) The Secretary may procure biological implants 
of human origin only from vendors that meet the following conditions:
          ``(A) The vendor uses the standard identification system 
        adopted or implemented by the Secretary under section 7330C(a) 
        of this title and has safeguards to ensure that a distinct 
        identity code has been in place at each step of distribution of 
        each biological implant from its donor.
          ``(B) The vendor is registered as required by the Food and 
        Drug Administration under subpart B of part 1271 of title 21, 
        Code of Federal Regulations, or any successor regulation, and 
        in the case of a vendor that uses a tissue distribution 
        intermediary or a tissue processor, the vendor provides 
        assurances that the tissue distribution intermediary or tissue 
        processor is registered as required by the Food and Drug 
        Administration.
          ``(C) The vendor ensures that donor eligibility 
        determinations and such other records as the Secretary may 
        require accompany each biological implant at all times, 
        regardless of the country of origin of the donor of the 
        biological material.
          ``(D) The vendor agrees to cooperate with all biological 
        implant recalls conducted on the vendor's own initiative, on 
        the initiative of the original product manufacturer used by the 
        vendor, by the request of the Food and Drug Administration, or 
        by a statutory order of the Food and Drug Administration.
          ``(E) The vendor agrees to notify the Secretary of any 
        adverse event or reaction report it provides to the Food and 
        Drug Administration, as required by section 1271.350 of title 
        21, Code of Federal Regulations, or any successor regulation, 
        or any successor regulation, or of any warning letter from the 
        Food and Drug Administration issued to the vendor or a tissue 
        processor or tissue distribution intermediary it uses by not 
        later than 60 days after the vendor receives such report or 
        warning letter.
          ``(F) The vendor agrees to retain all records associated with 
        the procurement of a biological implant by the Department for 
        at least 10 years after the date of the procurement of the 
        biological implant.
          ``(G) The vendor provides assurances that the biological 
        implants provided by the vendor are acquired only from tissue 
        processors that maintain active accreditation with the American 
        Association of Tissue Banks or a similar national accreditation 
        specific to biological implants.
  ``(2) The Secretary may procure biological implants of non-human 
origin only from vendors that meet the following conditions:
          ``(A) The vendor uses the standard identification system 
        adopted or implemented by the Secretary under section 7330C(a) 
        of this title.
          ``(B) The vendor is a registered establishment as required by 
        the Food and Drug Administration under sections 807.20 and 
        807.40 of title 21, Code of Federal Regulations, or any 
        successor regulation, (or is not required to register pursuant 
        to section 807.65(a) of such title) and in the case of a vendor 
        that is not the original product manufacturer of such implants 
        the vendor provides assurances that the original product 
        manufacturer is registered as required by the Food and Drug 
        Administration.
          ``(C) The vendor agrees to cooperate with all biological 
        implant recalls conducted on the vendor's own initiative, on 
        the initiative of the original product manufacturer used by the 
        vendor, by the request of the Food and Drug Administration, or 
        by a statutory order of the Food and Drug Administration.
          ``(D) The vendor agrees to notify the Secretary of any 
        adverse event report it provides to the Food and Drug 
        Administration as required in part 803 of title 21, Code of 
        Federal Regulations, or any warning letter from the Food and 
        Drug Administration issued to the vendor or the original 
        product manufacturer it uses by not later than 60 days after 
        the vendor receives such report or warning letter.
          ``(E) The vendor agrees to retain all records associated with 
        the procurement of a biological implant by the Department for 
        at least 10 years after the date of the procurement of the 
        biological implant.
  ``(3)(A) The Secretary shall procure biological implants under the 
Federal Supply Schedules of the General Services Administration unless 
such implants are not available under such Schedules.
  ``(B) With respect to biological implants listed on the Federal 
Supply Schedules, the Secretary shall accommodate reasonable vendor 
requests to undertake outreach efforts to educate medical professionals 
of the Department about the use and efficacy of such biological 
implants.
  ``(C) In the case of biological implants that are unavailable for 
procurement under the Federal Supply Schedules, the Secretary shall 
procure such implants using competitive procedures in accordance with 
applicable law and the Federal Acquisition Regulation.
  ``(4) Section 8123 of this title shall not apply to the procurement 
of biological implants.
  ``(b) Penalties.--In addition to any applicable penalty under any 
other provision of law, any procurement employee of the Department who 
is found responsible for a biological implant procurement transaction 
with intent to avoid or with reckless disregard of the requirements of 
this section shall be ineligible to hold a certificate of appointment 
as a contracting officer or to serve as the representative of an 
ordering officer, contracting officer, or purchase card holder.
  ``(c) Definitions.--In this section:
          ``(1) The term `biological implant' shall have the meaning 
        given such term in section 7330C(d) of this title.
          ``(2) The term `distinct identity code' means a code that--
                  ``(A) relates a biological implant to the human donor 
                of the implant and to all records pertaining to the 
                implant;
                  ``(B) includes information designed to facilitate 
                effective tracking, using such code, from the donor to 
                the recipient and from the recipient to the donor; and
                  ``(C) satisfies the requirements of section 1271.290 
                of title 21, Code of Federal Regulations, or any 
                successor regulation.
          ``(3) The term `tissue distribution intermediary' means an 
        agency that acquires and stores human tissue for further 
        distribution and performs no other tissue banking functions.
          ``(4) The term `tissue processor' means an entity processing 
        human tissue for use in biological implants including 
        activities performed on tissue other than donor screening, 
        donor testing, tissue recovery and collection functions, 
        storage, or distribution.''.
          (2) Clerical amendment.--The table of sections at the 
        beginning of such chapter is amended by adding at the end of 
        the items relating to such subchapter the following new item:

``8129. Procurement of biological implants.''.

  (b) Effective Date.--Section 8129 of title 38, United States Code, as 
added by subsection (a), shall take effect on the date that is 180 days 
after the date on which the tracking system required under subsection 
(b) of section 7330C of such title, as added by section 4(a) is 
implemented.
  (c) Special Rule for Cryopreserved Products.--During the three-year 
period beginning on the effective date of section 8129 of title 38, 
United States Code, as added by subsection (a), biological implants 
produced and labeled before that date may be procured by the Department 
of Veterans Affairs without relabeling under the standard 
identification system adopted or implemented under section 7330C of 
such title, as added by section 4(a).

SEC. 6. EXTENSION OF ROUNDING DOWN OF PERCENTAGE INCREASES OF RATES OF 
                    CERTAIN EDUCATIONAL ASSISTANCE.

  (a) Montgomery GI Bill.--Section 3015(h)(2) of title 38, United 
States Code, is amended--
          (1) by striking ``fiscal year 2014'' and inserting ``fiscal 
        year 2020''; and
          (2) by striking ``fiscal year 2013'' and inserting ``fiscal 
        year 2019''.
  (b) Survivors and Dependents Educational Assistance.--Section 3564(b) 
of such title is amended--
          (1) by striking ``fiscal year 2014'' and inserting ``fiscal 
        year 2020''; and
          (2) by striking ``fiscal year 2013'' and inserting ``fiscal 
        year 2019''.

SEC. 7. VETERANS EXPEDITED RECOVERY COMMISSION.

  (a) Establishment.--There is established the Veterans Expedited 
Recovery Commission (in this section referred to as the 
``Commission'').
  (b) Duties.--The Commission shall perform the following duties:
          (1) Examine the efficacy of the evidence-based therapy model 
        used by the Secretary of Veterans Affairs for treating mental 
        health illnesses of veterans and identify areas to improve 
        wellness-based outcomes.
          (2) Conduct a patient-centered survey within each of the 
        Veterans Integrated Service Networks to examine--
                  (A) the experience of veterans with the Department of 
                Veterans Affairs when seeking medical assistance for 
                mental health issues through the health care system of 
                the Department;
                  (B) the experience of veterans with non-Department 
                medical facilities and health professionals for 
                treating mental health issues;
                  (C) the preferences of veterans regarding available 
                treatments for mental health issues and which methods 
                the veterans believe to be most effective;
                  (D) the experience, if any, of veterans with respect 
                to the complementary alternative treatment therapies 
                described in subparagraphs (A) through (I) in paragraph 
                (3);
                  (E) the prevalence of prescribing prescription 
                medication among veterans seeking treatment through the 
                health care system of the Department as remedies for 
                addressing mental health issues; and
                  (F) the outreach efforts of the Secretary regarding 
                the availability of benefits and treatments for 
                veterans for addressing mental health issues, including 
                by identifying ways to reduce barriers to and gaps in 
                such benefits and treatments.
          (3) Examine available research on complementary alternative 
        treatment therapies for mental health issues and identify what 
        benefits could be made with the inclusion of such treatments 
        for veterans, including with respect to--
                  (A) music therapy;
                  (B) equine therapy;
                  (C) training and caring for service dogs;
                  (D) yoga therapy;
                  (E) acupuncture therapy;
                  (F) meditation therapy;
                  (G) outdoor sports therapy;
                  (H) hyperbaric oxygen therapy;
                  (I) accelerated resolution therapy; and
                  (J) other therapies the Commission determines 
                appropriate.
          (4) Study the potential increase of claims relating to mental 
        health issues submitted to the Secretary by veterans who served 
        in Operation Enduring Freedom, Operation Iraqi Freedom, or 
        Operation New Dawn, including an assessment of the resources 
        available within the Department to ensure that quality health 
        care demands relating to such claims can be delivered in a 
        timely manner.
  (c) Membership.--
          (1) Number and appointment.--
                  (A) In general.--The Commission shall be composed of 
                10 members, appointed as follows:
                          (i) Two members appointed by the Speaker of 
                        the House of Representatives, at least one of 
                        whom shall be a veteran.
                          (ii) Two members appointed by the Minority 
                        Leader of the House of Representatives, at 
                        least one of whom shall be a veteran.
                          (iii) Two members appointed by the Majority 
                        Leader of the Senate, at least one of whom 
                        shall be a veteran.
                          (iv) Two members appointed by the Minority 
                        Leader of the Senate, at least one of whom 
                        shall be a veteran.
                          (v) Two members appointed by the President, 
                        at least one of whom shall be a veteran.
                  (B) Qualifications.--Members of the Commission shall 
                be--
                          (i) individuals who are of recognized 
                        standing and distinction within the medical 
                        community with a background in treating mental 
                        health;
                          (ii) individuals with experience working with 
                        the military and veteran population; and
                          (iii) individuals who do not have a financial 
                        interest in any of the complementary 
                        alternative treatments reviewed by the 
                        Commission.
          (2) Chairman.--The President shall designate a member of the 
        Commission to be the chairman.
          (3) Period of appointment.--Members of the Commission shall 
        be appointed for the life of the Commission.
          (4) Vacancy.--A vacancy in the Commission shall be filled in 
        the manner in which the original appointment was made.
          (5) Appointment deadline.--The appointment of members of the 
        Commission in this section shall be made not later than 90 days 
        after the date of the enactment of this Act.
  (d) Powers of Commission.--
          (1) Meeting.--
                  (A) Initial meeting.--The Commission shall hold its 
                first meeting not later than 30 days after a majority 
                of members are appointed to the Commission.
                  (B) Meeting.--The Commission shall regularly meet at 
                the call of the Chairman. Such meetings may be carried 
                out through the use of telephonic or other appropriate 
                telecommunication technology if the Commission 
                determines that such technology will allow the members 
                to communicate simultaneously.
          (2) Hearing.--The Commission may hold such hearings, sit and 
        act at such times and places, take such testimony, and receive 
        evidence as the Commission considers advisable to carry out the 
        responsibilities of the Commission.
          (3) Information from federal agencies.--The Commission may 
        secure directly from any department or agency of the Federal 
        Government such information as the Commission considers 
        necessary to carry out the duties of the Commission.
          (4) Information from nongovernmental organizations.--In 
        carrying out subsection (b), the Commission may seek guidance 
        through consultation with foundations, veterans service 
        organizations, nonprofit groups, faith-based organizations, 
        private and public institutions of higher education, and other 
        organizations as the Commission determines appropriate.
          (5) Commission records.--The Commission shall keep an 
        accurate and complete record of the actions and meetings of the 
        Commission. Such record shall be made available for public 
        inspection and the Comptroller General of the United States may 
        audit and examine such record.
          (6) Personnel matters.--Upon request of the chairman of the 
        Commission, the head of any department or agency of the Federal 
        Government may detail, on a reimbursable basis, any personnel 
        of that department or agency to assist the Commission in 
        carrying out the duties of the Commission.
          (7) Compensation of members; travel expenses.--Each member 
        shall serve without pay, except that each member shall receive 
        travel expenses to perform the duties of the Commission under 
        subsection (b), including per diem in lieu of subsistence, at 
        rates authorized under subchapter I of chapter 57 of title 5, 
        United States Code.
          (8) Staff.--The Chairman, in accordance with rules agreed 
        upon by the Commission, may appoint and fix the compensation of 
        a staff director and such other personnel as may be necessary 
        to enable the Commission to carry out its functions, without 
        regard to the provisions of title 5, United States Code, 
        governing appointments in the competitive service, without 
        regard to the provision of chapter 51 and subchapter III of 
        chapter 53 of such title relating to classification and General 
        Schedule pay rates, except that no rate of pay fixed under this 
        subsection may exceed the equivalent of that payable for a 
        position at a level IV of the Executive Schedule under section 
        5316 of title 5, United States Code.
          (9) Personnel as federal employees.--
                  (A) In general.--The executive director and any 
                personnel of the Commission are employees under section 
                2105 of title 5, United States Code, for purpose of 
                chapters 63, 81, 83, 84, 85, 87, 89, and 90 of such 
                title.
                  (B) Members of the commission.--Subparagraph (A) 
                shall not be construed to apply to members of the 
                Commission.
          (10) Contracting.--The Commission may, to such extent and in 
        such amounts as are provided in appropriations Acts, enter into 
        contracts to enable the Commission to discharge the duties of 
        the Commission under this section.
          (11) Expert and consultant service.--The Commission may 
        procure the services of experts and consultants in accordance 
        with section 3109 of title 5, United States Code, at rates not 
        to exceed the daily rate paid to a person occupying a position 
        at level IV of the Executive Schedule under section 5315 of 
        title 5, United States Code.
          (12) Postal service.--The Commission may use the United 
        States mails in the same manner and under the same conditions 
        as departments and agencies of the United States.
          (13) Physical facilities and equipment.--Upon the request of 
        the Commission, the Administrator of General Services shall 
        provide to the Commission, on a reimbursable basis, the 
        administrative support services necessary for the Commission to 
        carry out its responsibilities under this section. These 
        administrative services may include human resource management, 
        budget, leasing, accounting, and payroll services.
  (e) Report.--
          (1) Interim reports.--
                  (A) In general.--Not later than 60 days after the 
                date on which the Commission first meets, and each 30-
                day period thereafter ending on the date on which the 
                Commission submits the final report under paragraph 
                (2), the Commission shall submit to the Committees on 
                Veterans' Affairs of the House of Representatives and 
                the Senate and the President a report detailing the 
                level of cooperation the Secretary of Veterans Affairs 
                (and the heads of other departments or agencies of the 
                Federal Government) has provided to the Commission.
                  (B) Other reports.--In carrying out the duties 
                pursuant to subsection (b), at times that the 
                Commission determines appropriate, the Commission shall 
                submit to the Committees on Veterans' Affairs of the 
                House of Representatives and the Senate and any other 
                appropriate entities an interim report with respect to 
                the findings identified by the Commission.
          (2) Final report.--Not later than 18 months after the first 
        meeting of the Commission, the Commission shall submit to the 
        Committees on Veterans' Affairs of the House of Representatives 
        and the Senate, the President, and the Secretary of Veterans 
        Affairs a final report on the findings of the Commission. Such 
        report shall include the following:
                  (A) Recommendations to implement in a feasible, 
                timely, and cost-effective manner the solutions and 
                remedies identified within the findings of the 
                Commission pursuant to subsection (b).
                  (B) An analysis of the evidence-based therapy model 
                used by the Secretary of Veterans Affairs for treating 
                veterans with mental health care issues, and an 
                examination of the prevalence and efficacy of 
                prescription drugs as a means for treatment.
                  (C) The findings of the patient-centered survey 
                conducted within each of the Veterans Integrated 
                Service Networks pursuant to subsection (b)(2).
                  (D) An examination of complementary alternative 
                treatments described in subsection (b)(3) and the 
                potential benefits of incorporating such treatments in 
                the therapy model used by the Secretary for treating 
                veterans with mental health issues.
          (3) Plan.--Not later than 90 days after the date on which the 
        Commission submits the final report under subsection (b), the 
        Secretary of Veterans Affairs shall submit to the Committees on 
        Veterans' Affairs of the House of Representatives and the 
        Senate a report on the following:
                  (A) An action plan for implementing the 
                recommendations established by the Commission on such 
                solutions and remedies for improving wellness-based 
                outcomes for veterans with mental health care issues.
                  (B) A feasible timeframe on when complementary 
                alternative treatments described in subsection (b)(3) 
                can be implemented Department-wide.
                  (C) With respect to each recommendation established 
                by the Commission, including regarding any 
                complementary alternative treatment, that the Secretary 
                determines is not appropriate or feasible to implement, 
                a justification for each such determination and an 
                alternative solution to improve the efficacy of the 
                therapy model used by the Secretary for treating 
                veterans with mental health issues.
  (f) Termination of Commission.--The Commission shall terminate 30 
days after the Commission submits the final report under subsection 
(e)(2).

    Amend the title so as to read:
    A bill to amend title 38, United States Code, to direct the 
Secretary of Veterans Affairs to submit an annual report on the 
Veterans Health Administration, to provide for the 
identification and tracking of biological implants used in 
Department of Veterans Affairs facilities, and for other 
purposes.

                          Purpose and Summary

    H.R. 2256, as amended, the ``Veterans Information 
Modernization Act,'' was ordered to be favorably reported to 
the full House on May 21, 2015 by voice vote. In addition to 
H.R. 2256, introduced on May 12, 2015, by Representative Dan 
Benishek of Michigan, the Chairman of the Subcommittee on 
Health of the Committee on Veterans' Affairs, the amended 
version of the bill reflects the Committee's consideration of 
three other bills introduced during the 114th Congress: H.R. 
627, introduced by Representative Janice Hahn of California on 
January 30, 2015; H.R. 1016, introduced by Representative David 
P. Roe of Tennessee on February 20, 2015; and H.R. 271, 
introduced by Representative Gus Bilirakis of Florida on 
January 12, 2015.
    H.R. 2256, as amended, would require the Department of 
Veterans Affairs (VA) to submit an annual report to Congress 
regarding the provision of hospital care, medical services, and 
nursing home care by the VA health care system for the prior 
calendar year. It would amend VA's definition of a homeless 
veteran to include a veteran or veteran's family who is fleeing 
domestic or dating violence, sexual assault, stalking, or other 
dangerous or life-threatening conditions in the individual's or 
family's current housing situation, has no other residence, and 
lacks the resources or support networks to obtain other 
permanent housing. It would require VA to implement a standard 
identification protocol for biological implants that is 
consistent with the Food and Drug Administration's (FDA's) 
Unique Identification System and to procure biological implants 
only through competitive procurement processes from vendors who 
maintain a 10 year record retention policy and who procure 
their human tissue from properly accredited sources. The bill 
would also round down, to the nearest whole dollar, any 
increases to the Montgomery GI Bill and Survivors' and 
Dependents' Educational Assistance Program by the cost-of-
living-adjustment. Finally, the bill would establish the 
Veterans Expedited Recovery Commission to study, survey, and 
evaluate VA's ability to effectively treat veterans with mental 
health issues and direct VA, upon a report by the Commission, 
to submit an action plan and a timeframe for implementing 
complementary and alternative treatments.

                  Background and Need for Legislation


Section 2--Annual report on Veterans Health Administration and 
        furnishing of hospital care, medical services, and nursing home 
        care

    Since the wait time manipulation scandal at the Phoenix VA 
Health Care System sparked a system-wide review of veteran 
access to care in 2014, there has been a renewed focus on the 
cost of care provided to veteran patients by the VA health care 
system. On December 10, 2014, the Congressional Budget Office 
(CBO) released a report entitled, ``Comparing the Costs of the 
Veterans' Health Care System with Private-Sector Costs.'' The 
purpose of the report was to examine how the costs of health 
care provided by the Veterans Health Administration (VHA) 
compare to the costs of care provided in the private sector. In 
the report, CBO concluded that, ``limited evidence and 
substantial uncertainty make it difficult to reach firm 
conclusions about those relative costs or about whether it 
would be cheaper to expand veterans' access to health care in 
the future through VHA facilities or the private sector.''
    On January 28, 2015, Matthew S. Goldberg, the Deputy 
Assistant Director of the CBO's National Security Division, 
testified before the Subcommittee on Health regarding the 
report and CBO's findings. In his testimony, Mr. Goldberg 
stated that, ``[a]mong the many analytical challenges in 
conducting [studies regarding VA benefits and services] are the 
problems CBO sometimes encounters in obtaining appropriate data 
from VHA[.]'' He stated that, ``VA, which runs VHA, has 
provided limited data to the Congress and the public about its 
costs and operational performance,'' and that, ``if it was 
provided on a regular and systemic basis, could help inform 
policymakers about the efficiency and cost-effectiveness of 
VHA's services.''
    Similar statements were made in other testimony provided 
during the hearing. Carl Blake, Associate Executive Director 
for Government Relations for the Paralyzed Veterans of America, 
speaking on behalf of the co-authors of the Independent Budget 
(IB), testified that, ``the IB co-authors believe that VHA 
should be far more forthcoming with data that allows for a 
thorough examination of the timeliness and quality of its 
services and the capacities VA maintains to meet these 
requirements.'' Likewise, Louis Celli, Jr., Director of the 
Veterans Affairs & Rehabilitation Division of the American 
Legion, testified that, ``CBO needs more data in order to make 
recommendations or be able to come to any credible 
conclusion.''
    To address these calls for greater reporting of data 
regarding health care, increased transparency, and improved 
data collection that would allow for greater cost comparisons 
between VA and the private sector, Section 2 of the bill would 
require VA to submit an annual report to Congress regarding the 
provision of hospital care, medical services, and nursing home 
care by the VA health care system. The report would include, 
for the prior calendar year, data regarding access to care, 
quality of care, workload, patient demographics and 
utilization, physician compensation, productivity, non-VA care, 
and pharmaceutical prices.
    This reporting requirement is similar to the annual report 
that the Department of Defense publishes pursuant to Section 
717 of the National Defense Authorization Act for FY 1996 
(Public Law 104-106). That report contains information on the 
Tricare program including data regarding population, 
demographics, workload, costs, and trends for both direct and 
purchased care.

Section 3--Expansion of definition of homeless veteran for purposes of 
        benefits under the laws administered by the Secretary of 
        Veterans Affairs

    Section 2002 of title 38, U.S.C., defines a ``homeless 
veteran'' as ``a veteran who is homeless (as that term is 
defined in section 103(a) of the McKinney-Vento Homeless 
Assistance Act (42 U.S.C. 11302(a))).'' However, in 2009, the 
definition of homelessness under the McKinney-Vento Homeless 
Assistance Act was amended to include section 103(b), which 
defines as homeless an individual or family who is fleeing 
their current residence due to domestic or sexual violence or 
some other life-threatening condition. Because VA's definition 
of homelessness refers only to section 103(a), veterans who are 
fleeing their current home due to domestic violence, sexual 
violence, or other life-threatening conditions are not 
considered homeless per VA's current statutory definition of 
that term.
    Section 3 of the bill would correct this by amending VA's 
definition of a homeless veteran to include section 103(b) of 
the McKinney-Vento Homeless Assistance Act. Under this 
definition, a veteran or veteran's family who is fleeing 
domestic or dating violence, sexual assault, stalking, or other 
dangerous or life-threatening conditions in the individual's or 
family's current housing situation and has no other residence 
and lacks the resources or support networks to obtain other 
permanent housing would be considered a ``homeless'' veteran.

Section 4--Identification and tracking of biological implants used in 
        Department of Veterans Affairs medical facilities

    Currently, there is no requirement in title 38, U.S.C., for 
VA to identify and track biological implants intended for use 
in VA Medical facilities. Subcommittee on Oversight and 
Investigations hearings revealed significant risk to veteran 
health and safety involving possibly contaminated products and 
the inability of VA to reliably identify veterans with implants 
in the event of recall.\1\
---------------------------------------------------------------------------
    \1\See, House Committee on Veterans' Affairs, Subcommittee on 
Oversight and Investigations Hearing, ``Vendors in the OR--VA's Failed 
Oversight of Surgical Implants,'' dated January 15, 2014 and House 
Committee on Veterans' Affairs, Subcommittee on Oversight and 
Investigations Hearing, ``VA & Human Tissue: Improvements Needed for 
Veterans Safety,'' dated April 2, 2014.
---------------------------------------------------------------------------
    Section 4 of the bill would require VA to implement a 
standard identification system for biological implants and a 
tracking system that would allow the tracking of such implants 
from human or animal source to implantation in a veteran/
patient. Section 4 of the bill would also contain definitions, 
reporting requirements, implementation deadlines, and a 
provision regarding consistency with FDA regulations.

Section 5--Procurement of biological implants used in Department of 
        Veterans Affairs medical facilities

    To ensure the ability to track and trace biological 
implants, section 5 would require that VA procure them only 
from vendors who use the standard identification system adopted 
under section 4 by VA. Section 5 of the bill would also impose 
additional requirements to foster patient safety, including 
that VA procure biological implants from vendors who: (1) 
registered with the FDA, (2) agreed to recordkeeping 
requirements, (3) agreed to cooperate with recalls, (4) agreed 
to notify VA in the event of adverse event or FDA warning 
letter, and (5) maintained accreditation from the American 
Association of Tissue Banks or by a similar national 
accreditation specific to biological implants.
    To promote competition and provide for multiple sources for 
procuring biological implants, section 5 would further require 
VA to procure biological implants from vendors on the Federal 
Supply Schedule unless they are unavailable thereon. Section 5 
would require that VA accommodate reasonable requests from 
vendors to educate VA medical professionals about the efficacy 
of their products and eliminate the option for VA to procure 
biological implants under the sole source authority of section 
8123 of title 38, U.S.C. Subcommittee on Oversight and 
Investigations hearings indicated that the authority of section 
8123 of title 38 U.S.C., was prone to abuse because sole source 
justifications were often missing or poorly documented. Section 
5 would not eliminate sole source justification for procurement 
of biological implants when necessary in accordance with the 
Federal Acquisition Regulation and the Veterans Affairs 
Acquisition Regulation.

Section 6--Extension of rounding down of percentage increases of rates 
        of certain educational assistance

    Section 3015(h)(2) and 3564(b) of title 38, U.S.C., 
requires that any increase in educational assistance rates 
under the Montgomery GI Bill and the Survivors' and Dependents' 
Educational Assistance Program be rounded down to the next 
lower whole dollar amount. However, this authority expires at 
the end of fiscal year 2014.
    Section 6 of the bill would extend this authority through 
the end of fiscal year 2019. Any increase in educational 
assistance rates under the Montgomery GI Bill and the 
Survivors' and Dependents' Educational Assistance Program made 
after fiscal year 2019 would be rounded to the nearest whole 
dollar.

Section 7--Veterans Expedited Recovery Commission

    The National Institutes of Health's National Center for 
Complementary and Alternative Medicine defines complementary 
and alternative medicine (CAM) as a group of diverse medical 
and health care systems, practices, and products that are not 
generally considered part of conventional medicine. The term 
''Complementary'' refers to the use of CAM together with 
conventional medicine, such as using meditation in addition to 
traditional psychotherapy to treat post-traumatic stress 
disorder (PTSD). ``Alternative'' refers to use of CAM in place 
of conventional medicine, such as using meditation in place of 
traditional psychotherapy to treat PTSD.
    The use of CAM has grown significantly in VA over the past 
decade. In a 2012 survey completed by the NIH, 96 percent of 
post-traumatic stress disorder (PTSD) programs surveyed 
reported the use of at least one CAM therapy and 88 percent 
offered CAM therapies other than those commonly part of 
treatment (i.e. guided imagery, progressive muscle relaxation, 
and stress management-relaxation therapies). Though the use of 
CAM therapies has become increasingly widespread among VA 
medical facilities in recent years and demand for CAM services 
among veteran patients using the VA health care system is 
increasing, CAM is not uniformly offered to veterans across the 
system.
    In an attempt to remedy this, section 7 would establish the 
Veterans Expedited Recovery Commission to study, survey, and 
evaluate VA's ability to effectively treat veterans with mental 
health issues. Following a report by the Commission, VA would 
be directed to submit an action plan for implementing 
recommendations and a timeframe for implementing complementary 
and alternative treatments, or else it must provide a 
justification for a determination that a recommendation is not 
appropriate and an alternative solution to improve the efficacy 
of VA's therapy model.

                                Hearings

    There were no full Committee hearings held on H.R. 2256, as 
amended. On March 19, 2015, the Subcommittee on Oversight and 
Investigations conducted a legislative hearing on H.R. 571, 
H.R. 593, H.R. 1015, H.R. 1016, H.R. 1017, H.R. 1128, and H.R. 
1129.
    The following witnesses testified:
          Meghan Flanz, the Director of the Office of 
        Accountability Review for the Department of Veterans 
        Affairs; Diane Zumatto, the National Legislative 
        Director for AMVETS; Frank Wilton, the Chief Executive 
        Officer for the American Association of Tissue Banks; 
        and, Daimon E. Geopfert, the National Leader, Security 
        and Privacy Consulting for McGladrey, LLP. Ms. Flanz 
        was accompanied by Michael Icardi, M.D., the National 
        Director of Pathology and Laboratory Medicine Services 
        for the Veterans Health Administration of the U.S. 
        Department of Veterans Affairs; Stanley Lowe, the 
        Deputy Assistant Secretary for Information Security and 
        Chief Information Security Officer for the U.S. 
        Department of Veteran Affairs; and, Dennis Milsten, 
        CCM, the Associate Executive Director for the Office of 
        Operations of the Office of Construction and Facilities 
        Management for the U.S. Department of Veterans Affairs.
    A Statement for the record was submitted by:
          The American Legion.
          On April 23, 2015, the Subcommittee on Health 
        conducted a legislative hearing on: draft legislation 
        to improve reproductive treatment provided to certain 
        disabled veterans; draft legislation to direct VA to 
        submit an annual report on the Veterans Health 
        Administration; H.R. 271; H.R. 627; H.R. 1369; H.R. 
        1575; and H.R. 1769.
    The following witnesses testified:
          The Honorable Gus Bilirakis of Florida; the Honorable 
        Janice Hahn of California; the Honorable Jackie 
        Walorski of Indiana; Blake Ortner, the Deputy 
        Government Relations Director of the Paralyzed Veterans 
        of America; Louis J. Celli, Jr., the Director of the 
        National Veterans Affairs and Rehabilitation Division 
        for the American Legion; John Rowan, the National 
        President of the Vietnam Veterans of America; Adrian 
        Atizado, the Assistant National Legislative Director 
        for the Disabled American Veterans; and, Rajiv Jain, 
        M.D., the Assistant Deputy Under Secretary for Health 
        for Patient Care Services for the Veterans Health 
        Administration of the U.S. Department of Veterans 
        Affairs. Dr. Jain was accompanied by Janet Murphy, the 
        Acting Deputy Under Secretary for Health for Operations 
        and Management for the Veterans Health Administration 
        of the U.S. Department of Veterans Affairs, and 
        Jennifer Gray, Attorney for the Office of the General 
        Counsel of the U.S. Department of Veterans Affairs.
    Statements for the Record were submitted by:
          The Honorable Corrine Brown of Florida, the Ranking 
        Member of the Full Committee; the American Health Care 
        Association; the American Society for Reproductive 
        Medicine; Concerned Veterans for America; RESOLVE: 
        National Infertility Association; Veterans of Foreign 
        Wars of the United States; and, Wounded Warrior 
        Project.

                       Subcommittee Consideration

    On April 21, 2015, the Subcommittee on Oversight and 
Investigations met in an open markup session, a quorum being 
present, and ordered H.R. 571, as amended, H.R. 1015, as 
amended, H.R. 1016, as amended, and H.R. 1017, as amended, to 
be reported favorably to the full Committee by voice vote.
    During consideration of H.R. 1016, the following amendment 
was considered and agreed to by voice vote:
          An amendment in the nature of a substitute offered by 
        Mr. Roe of Tennessee that increased the record 
        retention requirement from 5 years to 10 years, removed 
        the inspection and audit requirement as the FDA is 
        already required to conduct such investigations, and 
        made other technical changes.
    The Subcommittee on Health met in an open markup session on 
May 15, 2015, a quorum being present, and ordered H.R. 271, 
H.R. 627, H.R. 1575, H.R. 1769, and H.R. 2256, to be reported 
favorably to the full Committee by voice vote.

                        Committee Consideration

    On May 21, 2015, the Full Committee met in an open markup 
session, a quorum being present, and ordered H.R. 2256, as 
amended, to be reported favorably to the House of 
Representatives by voice vote.
    During consideration of H.R. 2256, as amended, the 
following amendment was considered and agreed to by voice vote:
          An amendment in the nature of a substitute offered by 
        Dr. Benishek of Michigan which combined the contents of 
        H.R. 2256, as introduced; H.R. 271; H.R. 627; and, H.R. 
        1016 and inserted a provision that would round down, to 
        the nearest whole dollar, any increases to the 
        Montgomery GI Bill and Dependents Educational 
        Assistance Program by the cost of living adjustment.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list the record votes 
on the motion to report the legislation and amendments thereto. 
There were no recorded votes taken on amendments or in 
connection with ordering H.R. 2256, as amended, reported to the 
House. A motion by Ranking Member Corrine Brown of Florida to 
report H.R. 2256, as amended, favorably to the House of 
Representatives was agreed to by voice vote.

                      Committee Oversight Findings

    In compliance with clause 3(c)(1) of rule XIII and clause 
(2)(b)(1) of rule X of the Rules of the House of 
Representatives, the Committee's oversight findings and 
recommendations are reflected in the descriptive portions of 
this report.

         Statement of General Performance Goals and Objectives

    In accordance with clause 3(c)(4) of rule XIII of the Rules 
of the House of Representatives, the Committee's performance 
goals and objectives are reflected in the descriptive portions 
of this report.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee adopts as its 
own the estimate of new budget authority, entitlement 
authority, or tax expenditures or revenues contained in the 
cost estimate prepared by the Director of the Congressional 
Budget Office pursuant to section 402 of the Congressional 
Budget Act of 1974.

                  Earmarks and Tax and Tariff Benefits

    H.R. 2256, as amended, does not contain any Congressional 
earmarks, limited tax benefits, or limited tariff benefits as 
defined in clause 9 of rule XXI of the Rules of the House of 
Representatives.

                        Committee Cost Estimate

    The Committee adopts as its own the cost estimate on H.R. 
2256, as amended, prepared by the Director of the Congressional 
Budget Office pursuant to section 402 of the Congressional 
Budget Act of 1974.

               Congressional Budget Office Cost Estimate

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
for H.R. 2256, as amended, provided by the Congressional Budget 
Office pursuant to section 402 of the Congressional Budget Act 
of 1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                     Washington, DC, June 23, 2015.
Hon. Jeff Miller,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 2256, the Veterans 
Information Modernization Act.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Anne E. 
Futrell.
            Sincerely,
                                                        Keith Hall.
    Enclosure.

H.R. 2256--Veterans Information Modernization Act

    Summary: H.R. 2256 would establish a tracking system for 
biological implants, create a commission to assess mental 
health care at the Department of Veterans Affairs (VA), expand 
the definition of homeless veterans for purpose of certain 
programs and benefits offered by VA, and require VA to submit 
an annual report to the Congress. In total, CBO estimates that 
implementing this bill would increase costs to VA by $9 million 
over the 2016-2020 period, assuming appropriation of the 
necessary amounts.
    In addition, CBO estimates that enacting the bill would 
decrease direct spending by $9 million over the 2016-2025 
period by adjusting the monthly payments for VA educational 
benefits; therefore, pay-as-you-go procedures apply to the 
bill. Enacting H.R. 2256 would not affect revenues.
    H.R. 2256 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA) 
and would not affect the budgets of state, local, or tribal 
governments.
    Estimated cost to the Federal Government: The estimated 
budgetary effect of H.R. 2256 is shown in the following table. 
The costs of this legislation fall within budget function 700 
(veterans benefits and services).

----------------------------------------------------------------------------------------------------------------
                                                                 By fiscal year, in millions of dollars--
                                                         -------------------------------------------------------
                                                            2016     2017     2018     2019     2020   2016-2020
----------------------------------------------------------------------------------------------------------------
                                  CHANGES IN SPENDING SUBJECT TO APPROPRIATION
 
Commission on Mental Health Care:
    Estimated Authorization Level.......................        2        2        0        0        0         4
    Estimated Outlays...................................        2        2        *        *        0         4
Tracking of Biological Implants:
    Estimated Authorization Level.......................        1        1        1        *        *         3
    Estimated Outlays...................................        1        1        1        *        *         3
Annual Report:
    Estimated Authorization Level.......................        *        *        *        *        *         2
    Estimated Outlays...................................        *        *        *        *        *         2
    Total:
        Estimated Authorization Level...................        3        3        1        1        1         9
        Estimated Outlays...............................        3        3        1        1        1         9
 
                                           CHANGES IN DIRECT SPENDING
 
Estimated Budget Authority..............................        0       -1       -1       -1       -1        -4
Estimated Outlays.......................................        0       -1       -1       -1       -1        -4
----------------------------------------------------------------------------------------------------------------
Notes: In addition to, in the effects shown here, enacting H.R. 2256 would have effects on direct spending
  beyond 2020. CBO estimates that, in total, direct spending would decrease by $9 million over the 2016-2025
  period.
* = less than $500,000.

    Basis of estimate: For this estimate, CBO assumes that the 
legislation will be enacted near the beginning of fiscal year 
2016, that estimated amounts will be appropriated for each 
year, and that outlays will follow historical spending patterns 
for similar and existing programs.

Spending subject to appropriation

    CBO estimates that, in total, implementing H.R. 2256 would 
cost $9 million over the 2016-2020 period, assuming 
appropriation of the necessary amounts.
    Commission on Mental Health Care. Section 7 would establish 
the Veterans Expedited Recovery Commission. The commission--
consisting of 10 voting members--would examine the treatment of 
mental health at VA. Members of the commission would serve 
without pay; however, they would receive travel reimbursement 
and per diem. The staff director and support staff would 
receive compensation (not to exceed the salary of senior 
political officials). The commission also would be authorized 
to hire contractors and experts to provide additional guidance 
and recommendations. The commission would be required to 
conduct a nationwide survey and to submit a final report of its 
findings within a year and a half from its first meeting.
    Based on an examination of other government commissions, we 
expect this commission would require five full-time employees 
(including a staff director) with an average salary of $200,000 
(including benefits) and five part-time contractors at an 
average salary of $40,000. We also estimate annual costs 
totaling $4,000 per member for per diem, $1,000 per member for 
travel, and $30,000 for rent. Based on costs of similar 
surveys, we estimate that a nationwide survey would cost $1 
million per year. In total, CBO estimates that establishing the 
commission would cost $4 million over the 2016-2020 period.
    Tracking of Biological Implants. Within 180 days after 
enactment, sections 4 and 5 would require VA to establish and 
implement a tracking system for biological implants (i.e. human 
cells, tissue, or cellular or tissue-based product) used in 
medical procedures at VA medical facilities. The bill would 
allow VA to use the existing unique device identification 
system administered by the U.S. Food and Drug Administration. 
By ensuring that surgical implants are labeled with unique 
device identifiers, the tracking system would help VA to notify 
patients in cases of device recalls and potentially reduce 
medical errors.
    Over the 2010-2013 period, VA planned and initiated the 
development of the Veterans Implant Tracking and Alert System 
(VITAS). That system was intended to document the provenance of 
surgical implants, allowing VA to identify and locate patients 
with implants in the event of a recall. However, in 2013, VA 
stopped developing VITAS prior to the completion of the 
registry, because of coordination issues with VA's record 
system for patients. According to VA, such efforts required 
three full-time staff at $1 million per year. We expect 
comparable resources and costs to further develop and expand 
the biological implant tracking system over the next three 
years. In total, CBO estimates discretionary costs of $3 
million over the 2016-2020 period to develop and implement a 
device tracking system.
    Annual Report. Section 2 would require VA to submit an 
annual report to the Congress on the following information:
      Effectiveness of VA health care and long-term 
care,
      Workload and compensation of VA employees,
      Demographics of the veterans enrolled and using 
the VA health care system,
      Usage rates of the VA health care system, and
     Pharmaceutical prices.
    The report would include data for each VA health care 
region and medical center. Currently, VA gathers and reports on 
some of that data. CBO expects that about five full-time-
equivalent staff would be necessary to coordinate and prepare a 
comprehensive report with facility level data on an annual 
basis. CBO estimates implementing this section would cost $2 
million over the 2016-2020 period.
    Definition of Homeless Veterans. Section 3 would expand the 
definition of homeless veterans to include veterans who are 
fleeing or attempting to flee domestic violence, dating 
violence, sexual assault, stalking, or other life threatening 
conditions. That change would make veterans who are victims of 
such conditions eligible for services provided to homeless 
veterans by VA. In 2015, about $344 million was appropriated 
for those services.
    The Bureau of Justice Statistics reports that less than 
half of 1 percent of the U.S. population in 2012 were victims 
of domestic abuse. Most of those individuals (80 percent) were 
female and about 20 percent sought support from government or 
private-sector agencies. Because about 10 percent of veterans 
are female, CBO expects that the number of veterans who would 
be newly eligible for homeless benefits under this provision 
would be quite small (about 20 people a year). Therefore, CBO 
estimates that implementing this section would cost less than 
$500,000 over the 2016-2020 period.

Direct spending

    Under current law, the rates of certain monthly benefits 
paid under the Montgomery G.I. Bill and Survivors' and 
Dependents' Educational Assistance programs are increased 
annually by specified economic indices. Section 6 of H.R. 2256 
would extend through fiscal year 2019 two provisions of law 
that require those increases to be rounded down to the next 
lower whole dollar. Those provisions expired at the end of 
fiscal year 2013. Based on projections of the number of 
beneficiaries and payments made each year, and assuming that 
the rounding is not retroactive, CBO estimates that enacting 
section 6 would reduce direct spending by $9 million over the 
2016-2025 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. H.R. 2256 would modify a program that provides 
educational benefits to veterans. The changes in outlays that 
are subject to those pay-as-you-go procedures are shown in the 
following table.

           CBO ESTIMATE OF PAY-AS-YOU-GO EFFECTS FOR H.R. 2256 AS ORDERED REPORTED BY THE HOUSE COMMITTEE ON VETERANS' AFFAIRS ON MAY 21, 2015
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                 By Fiscal Year, in millions of dollars--
                                                 -------------------------------------------------------------------------------------------------------
                                                   2015   2016   2017   2018   2019   2020   2021    2022    2023    2024    2025   2015-2020  2015-2025
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                             NET DECREASE (-) IN THE DEFICIT
 
Statutory Pay-As-You-Go Impact..................      0      0     -1     -1     -1     -1      -1      -1      -1      -1      -1        -4         -9
--------------------------------------------------------------------------------------------------------------------------------------------------------

    Intergovernmental and private-sector impact: H.R. 2256 
contains no intergovernmental or private-sector mandates as 
defined in UMRA and would not affect the budgets of state, 
local, or tribal governments.
    Estimate prepared by: Federal Costs: Ann E. Futrell and 
David Newman; Impact on State, Local, and Tribal Governments: 
Jon Sperl; Impact on the Private Sector: Paige Piper/Bach.
    Estimate approved by: H. Samuel Papenfuss, Deputy Assistant 
Director for Budget Analysis.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates regarding H.R. 2256, as amended, prepared by the 
Director of the Congressional Budget Office pursuant to section 
423 of the Unfunded Mandates Reform Act.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act would be created by H.R. 
2256, as amended.

                 Statement of Constitutional Authority

    Pursuant to Article I, section 8 of the United States 
Constitution, the reported bill is authorized by Congress' 
power to ``provide for the common Defense and general Welfare 
of the United States.''

                  Applicability to Legislative Branch

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

              Statement on Duplication of Federal Programs

    Pursuant to section 3(g) of H. Res. 5, 114th Cong. (2015), 
the Committee finds that no provision of H.R. 2256, as amended, 
establishes or reauthorizes a program of the Federal Government 
known to be duplicative of another Federal program, a program 
that was included in any report from the Government 
Accountability Office to Congress pursuant to section 21 of 
Public Law 111-139, or a program related to a program 
identified in the most recent Catalog of Federal Domestic 
Assistance.

                   Disclosure of Directed Rulemaking

    Pursuant to section 3(i) of H. Res. 5, 114th Cong. (2015), 
the Committee estimates that H.R. 2256, as amended, does not 
require any directed rulemakings.

             Section-by-Section Analysis of the Legislation


Section 1. Short title

    Section 1 of the bill would provide the short title of H.R. 
2256, as amended, as the ``Veterans Information Modernization 
Act.''

Section 2. Annual report on Veterans Health Administration and 
        furnishing of hospital care, medical services, and nursing home 
        care

    Section 2(a) of the bill would amend Subchapter II of 
chapter 73 of title 38 U.S.C., by creating a new subsection 
7330B. This section would require VA to submit annual reports 
to the Committees on Veterans' Affairs of the House and Senate 
regarding the furnishing of hospital care, medical services, 
and nursing home care under the laws administered by VA and on 
the administration of the provision of such care and services 
by VHA during the preceding calendar year. The report must 
contain evaluations of: (1) the effectiveness of VHA in 
increasing access to hospital care, medical services, and 
nursing home care for eligible veterans; (2) the effectiveness 
of VHA in improving the quality of care provided to veterans 
without increasing costs incurred by the Federal government or 
by veterans; (3) the workload of physicians and other VHA 
employees; (4) patient demographics and utilization rates; (5) 
physician compensation; (6) productivity of physicians and 
other VHA employees; (7) the percentage of hospital care, 
medical services, and nursing home care provided to veterans in 
VA facilities and in non-VA facilities, as well as any changes 
in such percentages compared to the preceding year; (8) 
pharmaceutical prices; and (9) third party billings owed to VA, 
including the total amount of such billings and the total 
amounts collected separated by claims greater than, equal to, 
or less than one thousand dollars. The report would also 
include relevant information for each VA medical center and 
Veterans Integrated Service Network. Finally, this section 
would define the terms ``hospital care,'' ``medical care,'' and 
``non-Department facilities'' as having the same meanings given 
to such terms in section 1701 of title 38 U.S.C.
    Section 2(b) of the bill would amend the table of sections 
at the beginning of Subchapter II of chapter 73 of title 38 
U.S.C., by inserting the item relating to section 7330B after 
section 7330A.

Section 3. Expansion of definition of homeless veteran for purposes of 
        benefits under the laws administrated by the Secretary of 
        Veterans Affairs

    Section 3 of the bill would amend section 2002(1) of title 
38 U.S.C., by inserting ``or (b)'' after ``section 103(a).''

Section 4. Identification and tracking of biological implants used in 
        Department of Veterans Affairs medical facilities

    Section 4(a) would add a new section, 7330C, to Subchapter 
II of chapter 73 of title 38, U.S.C. This section would require 
VA to adopt the unique device identification system developed 
for medical devices by the Food and Drug Administration (FDA) 
at Section 360i(f) of title 21, U.S.C., or implement a 
comparable standard identification system, for use in 
identifying biological implants intended for use at VA medical 
facilities. This section would also permit a vendor of 
biological implants to VA to use any of the accredited entities 
identified by the FDA as an issuing agency pursuant to Section 
830.100 of title 21, U.S.C. VA would be required to implement a 
system for tracking biological implants from human or animal 
source to implantation, and the tracking system used must be 
compatible with the identification system adopted in this 
section. Further, to the extent that a conflict arises with any 
provision of the FDA, the FDA provision would apply. Finally, 
this section would provide a definition for biological implants 
to mean any animal or human cell, tissue, or cellular or 
tissue-based product under the meaning given by the FDA at 
Section 1271.3 of title 21, CFR, or that is regulated as a 
device at section 201(h) of the Federal Food, Drug, and 
Cosmetic Act.
    Section 4(b) would amend the table of sections at the 
beginning of chapter 73 of title 38, U.S.C., by inserting after 
the item relating to section 7330B, as added by section 2 of 
this bill, the following new item: ``7330C. Identification and 
tracking of biological implants.''
    Section 4(c) would require VA to implement the 
identification system required by section 4(a) by not later 
than 180 days after enactment and in compliance with dates 
established by the FDA, pursuant to Section 360i(j) of title 
21, U.S.C. VA would also be required to implement the 
biological implant tracking system required by section 4(a) 
within the same 180 day timeframe.
    Section 4(d) would require that if the standard 
identification system for biological implants is not 
operational 180 days after enactment, then VA must submit to 
the Committees on Veterans' Affairs of the House and the Senate 
written explanations each month until the system is 
operational. Such written explanations would require 
description of the impediments to implementation, the steps 
being taken to remediate each impediment, and the target dates 
for solution to each impediment.

Section 5. Procurement of biological implants used in Department of 
        Veterans Affairs medical facilities

    Section 5(a) would amend Subchapter II of chapter 81 of 
title 38, U.S.C., section 2, by adding a new section, 8129. 
This section would require that VA procure biological implants 
of human origin only from vendors that: (1) use the standard 
identification system adopted or implemented by the Secretary 
under section 4(a) of this bill and have safeguards to ensure 
that a distinct identity code has been in place at each step of 
distribution of each biological implant from its donor; (2) are 
registered with the FDA and, in the case of a vendor that uses 
a tissue distribution intermediary or a tissue processor, that 
provide assurances that the tissue distribution intermediary or 
tissue processor is registered with the FDA; (3) ensure that 
donor eligibility determinations and such other records as VA 
may require accompany each biological implant at all times, 
regardless of the country of origin of the donor of the 
biological material; (4) agree to cooperate with all biological 
implant recalls conducted on the vendor's own initiative, on 
the initiative of the original product manufacturer used by the 
vendor, by the request of the FDA, or by a statutory order of 
the FDA; (5) agree to notify VA of any adverse event or 
reaction report it is required to provide to the FDA or of any 
warning letter from the FDA issued to the vendor or a tissue 
processor or tissue distribution intermediary it uses by not 
later than sixty days after the vendor receives such report or 
warning letter; (6) agree to retain all records associated with 
the procurement of a biological implant by VA for at least 10 
years after the date of the procurement; and (7) provide 
assurances that the biological implants provided by the vendor 
are acquired only from tissue processors that maintain active 
accreditation with the American Association of Tissue Banks or 
a similar national accreditation specific to biological 
implants.
    This section would also require that VA procure biological 
implants of non-human origin only from vendors that: (1) use 
the standard identification system adopted or implemented by 
the Secretary under section 4(a); (2) are registered 
establishments as required by the FDA and, in the case of a 
vendor that is not the original product manufacturer of such 
implants, that provide assurances that the original product 
manufacturer is registered as required by the FDA; (3) agree to 
cooperate with all biological implant recalls conducted on the 
vendor's own initiative, on the initiative of the original 
product manufacturer used by the vendor, by the request of the 
FDA, or by a statutory order of the FDA; (4) agree to notify VA 
of any adverse event report it is required to provide to the 
FDA or any warning letter from the FDA issued to the vendor or 
the original product manufacturer it uses by not later than 
sixty days after the vendor receives such report or warning 
letter; and (5) agree to retain all records associated with the 
procurement of a biological implant by VA for at least 10 years 
after the date of the procurement.
    VA would also be required to procure biological implants 
under Federal Supply Schedule of the General Services 
Administration unless such implants are unavailable thereon and 
to accommodate reasonable vendor requests to undertake outreach 
efforts to educate VA medical professionals about the use and 
efficacy of such biological implants on the Federal Supply 
Schedule. When biological implants are unavailable for 
procurement under the Federal Supply Schedule, VA would be 
required to procure them using competitive procedures in 
accordance with applicable law and the Federal Acquisition 
Regulation. In no case, however, would section 8123 of title 
38, U.S.C., apply to the procurement of biological implants.
    Additionally, VA employees who procure biological implants 
with the intent to avoid, or with reckless disregard of, the 
procurement provisions of this section would be ineligible to 
hold a certificate of appointment as a contracting officer or 
serve as a representative of an ordering officer, contracting 
officer, or purchase card holder. Finally, this section would 
provide definitions for ``biological implant,'' ``distinct 
identity code,'' ``tissue distribution intermediary,'' and 
``tissue processor.''
    Section 5(b) would provide that section 5(a) would take 
effect 180 days after the tracking system required by section 
4(b) is implemented.
    Section 5(c) would provide a special rule for cryopreserved 
products that would allow, for three years after enactment, 
such products to be procured by VA without relabeling them with 
the standard identification system adopted or implemented under 
section 4(a).

Section 6. Extension of rounding down of percentage increases of rates 
        of certain educational assistance

    Section 6(a) would extend the rounding down of percentage 
increases of Montgomery GI Bill rates by five years, from the 
end of fiscal year 2014 through the endof fiscal year 2019, and 
stipulate that any increase in educational assistance rates under the 
Montgomery GI Bill made after fiscal year 2019 shall be rounded to the 
nearest whole dollar.
    Section 6(b) would extend the rounding down of percentage 
increases of Survivors' and Dependents' Educational Assistance 
rates by five years, from fiscal year 2014 through fiscal year 
2019, and stipulate that any increase in educational assistance 
rates under the Survivors' and Dependents' Educational 
Assistance Program made after fiscal year 2019 shall be rounded 
to the nearest whole dollar.

Section 7. Veterans expedited recovery commission

    Section 7(a) would establish the Veterans Expedited 
Recovery Commission (the Commission).
    Section 7(b) would set out the duties of the Commission as 
follows: (1) to examine the efficacy of the evidence-based 
therapy model used by VA to treat mental health illnesses of 
veterans and identify areas to improve wellness-based outcomes; 
(2) to release a patient centered survey within each Veterans 
Integrated Service Network examining (a) veteran experience 
when seeking mental health care through the VA health care 
system, (b) veteran experience when seeking mental health care 
through non-VA facilities and providers, (c) veteran preference 
regarding available mental health treatments and most effective 
methods, (d) veteran experience with complementary and 
alternative treatment therapies, (e) the prevalence of 
prescription medication among veterans seeking mental health 
care through VA, and (f) VA outreach efforts regarding the 
availability of benefits and treatments for veterans addressing 
mental health issues, including ways to reduce barriers to and 
gaps in such benefits and treatments; (3) to examine available 
research on complementary and alternative treatment therapies 
for mental health issues and the identification of benefits 
that could result from the inclusion of treatments including 
music therapy, equine therapy, service dog training and care, 
yoga therapy, acupuncture therapy, meditation therapy, outdoor 
sports therapy, hyperbaric oxygen therapy, accelerated 
resolution therapy, and other therapies as the Commission deems 
appropriate; and, (4) to study the potential increase in claims 
relating to mental health issues submitted to VA by veterans of 
Operation Enduring Freedom, Operation Iraqi Freedom, or 
Operation New Dawn, including an assessment of the resources 
available within VA to ensure that quality health care demands 
relating to such claims can be delivered in a timely manner.
    Section 7(c) would require that the Commission be composed 
of ten Commissioners, two appointed by the Speaker of the 
House, two appointed by the Minority Leader of the House, two 
appointed by the Majority Leader of the Senate, two appointed 
by the Minority Leader of the Senate, and two appointed by the 
President. At least one of every two Commissioners chosen by 
the above named entities must be a veteran, and all 
appointments would be required to be made within ninety days of 
enactment. This section would also set out the qualifications 
of the Commissioners to include individuals of recognized 
standing and distinction within the medical community with a 
background in treating mental health, individuals with 
experience working with the military and veteran populations, 
and individuals who do not have a financial interest in any of 
the complementary alternative treatments reviewed by the 
Commission. The President would be required to designate a 
Commissioner to serve as Chairman, and all Commissioners would 
be appointed for the life of the Commission. Vacancies in the 
Commission would be filled in the manner in which the original 
appointment was made.
    Section 7(d) would set out the powers of the Commission, 
including: (1) the requirement to hold its first meeting not 
later than thirty days after a majority of Commissioners have 
been appointed and regularly at the call of the Chairman, 
including through the use of telecommunication technology if 
the Commission determines that such technology would allow 
Commissioners to communication simultaneously; (2) the 
authority to hold hearings, sit, act, take testimony, and 
receive evidence, at such times and places as the Commission 
considers advisable to carry out its responsibilities; (3) the 
authority to secure information directly from any department or 
agency of the Federal government it considers necessary to 
carry out its duties; (4) the authority to seek guidance 
through consultation with foundations, veterans service 
organizations, nonprofit groups, faith-based organizations, 
private and public institutions of higher education, and other 
organizations as it deems appropriate; (5) the requirement to 
keep accurate and complete records of actions and meetings of 
the Commission and to make such records available for public 
inspection and the Comptroller General of the United States to 
audit and examine; (6) upon request of the Chairman, to 
authorize the head of any department or agency of the Federal 
government to detail, on a reimbursable basis, any personnel of 
that department or agency to assist the Commission in carrying 
out its duties; (7) the authority to provide Commissioners with 
travel expenses to perform their duties, including per diem in 
lieu of subsistence at authorized rates, but otherwise not to 
provide any pay to such Commissioners; (8) the authority for 
the Chairman to fix the compensation of a staff director and 
such other personnel as may be necessary to carry out the 
duties of the Commission in accordance with rules agreed upon 
by the Commission without regard to provisions of title 5, 
U.S.C., and without regard to the provisions of chapter 51 and 
subchapter III of chapter 53 of such title relating to 
classification and General Schedule pay rates, except that no 
rate of pay fixed under this subsection may exceed the 
equivalent of that payable for a position at level IV of the 
Executive Schedule under section 5316 of title 5, U.S.C; (9) 
the stipulation that the executive director and any personnel 
of the Commission, but not the Commissioners themselves, are 
employees under section 2105 of title 5, U.S.C., for purposes 
of chapters 63, 81, 83, 84, 85, 87, 89, and 90 of such title; 
(10) the authority to enter into contracts to enable it to 
discharge its duties to such extent and in such amounts as are 
provided in appropriations acts; (11) the authority to procure 
the services of experts and consultants in accordance with 
section 3109 of title 5, U.S.C., at rates not to exceed the 
daily rate paid to a person occupying a position at level IV of 
the Executive Schedule under section 5315 of title 5, U.S.C; 
(12) the authority to use the United States mail in the same 
manner and under the same conditions as departments and 
agencies of the United States; and (13) the authority for the 
Chairman to request the General Services Administration to 
provide the Commission, on a reimbursable basis, the 
administrative support services--including human resources 
management, budget, leasing, accounting, and payroll services--
necessary for the Commission to carry out its responsibilities.
    Section 7(e) would require the Commission to submit an 
interim report to the Committees on Veterans' Affairs of the 
House and Senate, as well as the President, by no later than 
sixty days after the date on which the Commission first meets, 
and each 30-day period thereafter, detailing the level of 
cooperation VA and other departments or agencies have provided 
to the Commission. This section would also require the 
Commission to submit to the Committees on Veterans' Affairs of 
the House and Senate, and any other appropriate entities, an 
interim report with respect to the findings identified by the 
Commission. The Commission would also be required to submit to 
the Committees on Veterans' Affairs of the House and Senate, 
the President, and the VA Secretary, not later than 18 months 
after the first meeting of the Commission, a final report on 
the findings of the Commission to include: (1) recommendations 
to implement in a feasible, timely, and cost-effective manner 
the solutions and remedies identified within the findings of 
the Commission; (2) an analysis of the evidence-based therapy 
model used by VA for treating veterans with mental health 
issues and an examination of the prevalence and efficacy of 
prescription drugs as a means for treatment; (3) the findings 
of the patient-centered survey conducted within each Veterans 
Integrated Service Network; and (4) an examination of 
complementary and alternative treatments and the potential 
benefits of incorporating such treatments in the therapy model 
used by VA for treating veterans with mental health issues. 
Finally, this section would require VA to submit a report to 
the Committees on Veterans' Affairs of the House and Senate, 
not later than ninety days after the Commission submits its 
final report, with the following: (1) an action plan for 
implementing the recommendations established by the Commission 
on such solutions and remedies for improving wellness-based 
outcomes for veterans with mental health care issues; (2) a 
feasible timeframe on when complementary and alternative 
treatments can be implemented department-wide; and (3) a 
justification and alternative solution for any recommendation 
made by the Commission that VA determines is not appropriate or 
feasible to implement.
    Section 7(f) would require the Commission to terminate 
thirty days after the Commission submits its final report.

         Changes in Existing Law Made by the Bill, as Reported

    In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italic, existing law in which no change is 
proposed is shown in roman):

                      TITLE 38, UNITED STATES CODE




           *       *       *       *       *       *       *
PART II--GENERAL BENEFITS

           *       *       *       *       *       *       *


CHAPTER 20--BENEFITS FOR HOMELESS VETERANS

           *       *       *       *       *       *       *



Subchapter I--PURPOSE; DEFINITIONS; ADMINISTRATIVE MATTERS

           *       *       *       *       *       *       *


Sec. 2002. Definitions

   In this chapter:
          (1) The term ``homeless veteran'' means a veteran who 
        is homeless (as that term is defined in section 103(a) 
        or (b) of the McKinney-Vento Homeless Assistance Act 
        (42 U.S.C. 11302(a))).
          (2) The term ``grant and per diem provider'' means an 
        entity in receipt of a grant under section 2011 or 2012 
        of this title.

           *       *       *       *       *       *       *


PART III--READJUSTMENT AND RELATED BENEFITS

           *       *       *       *       *       *       *


CHAPTER 30--ALL-VOLUNTEER FORCE EDUCATIONAL ASSISTANCE PROGRAM

           *       *       *       *       *       *       *



Subchapter II--BASIC EDUCATIONAL ASSISTANCE

           *       *       *       *       *       *       *


Sec. 3015. Amount of basic educational assistance

  (a) The amount of payment of educational assistance under 
this chapter is subject to section 3032 of this title. Except 
as otherwise provided in this section, in the case of an 
individual entitled to an educational assistance allowance 
under this chapter whose obligated period of active duty on 
which such entitlement is based is three years, a basic 
educational assistance allowance under this subchapter shall be 
paid--
          (1) for an approved program of education pursued on a 
        full- time basis, at the monthly rate of--
                  (A) for months occurring during the period 
                beginning on August 1, 2008, and ending on the 
                last day of fiscal year 2009, $1,321; and
                  (B) for months occurring during a subsequent 
                fiscal year, the amount for months occurring 
                during the previous fiscal year increased under 
                subsection (h); or
          (2) at an appropriately reduced rate, as determined 
        under regulations which the Secretary shall prescribe, 
        for an approved program of education pursued on less 
        than a full-time basis.
  (b) In the case of an individual entitled to an educational 
assistance allowance under section 3011 or 3018 of this title 
whose obligated period of active duty on which such entitlement 
is based is two years, a basic educational assistance allowance 
under this chapter shall (except as provided in the succeeding 
subsections of this section)be paid--
          (1) for an approved program of education pursued on a 
        full- time basis, at the monthly rate of--
                  (A) for months occurring during the period 
                beginning on August 1, 2008, and ending on the 
                last day of fiscal year 2009, $1,073; and
                  (B) for months occurring during a subsequent 
                fiscal year, the amount for months occurring 
                during the previous fiscal year increased under 
                subsection (h); or
          (2) at an appropriately reduced rate, as determined 
        under regulations which the Secretary shall prescribe, 
        for an approved program of education pursued on less 
        than a full-time basis.
  (c)(1) The amount of basic educational allowance payable 
under this chapter to an individual referred to in paragraph 
(2) of this subsection is the amount determined under 
subsection (a) of this section.
  (2) Paragraph (1) of this subsection applies to an individual 
entitled to an educational assistance allowance under section 
3011 of this title--
          (A) whose obligated period of active duty on which 
        such entitlement is based is less than three years;
          (B) who, beginning on the date of the commencement of 
        such obligated period of active duty, serves a 
        continuous period of active duty of not less than three 
        years; and
          (C) who, after the completion of that continuous 
        period of active duty, meets one of the conditions set 
        forth in subsection (a)(3) of such section 3011.
  (d)(1) In the case of an individual who has a skill or 
specialty designated by the Secretary concerned as a skill or 
specialty in which there is a critical shortage of personnel or 
for which it is difficult to recruit, the Secretary concerned, 
pursuant to regulations to be prescribed by the Secretary of 
Defense, may, at the time the individual first becomes a member 
of the Armed Forces, increase the rate of the basic educational 
assistance allowance applicable to such individual to such rate 
in excess of the rate prescribed under subsections (a), (b), 
and (c) of this section as the Secretary of Defense considers 
appropriate, but the amount of any such increase may not exceed 
$950 per month.
  (2) In the case of an individual who after October 7, 1997, 
receives an enlistment bonus under section 308a or 308f of 
title 37, receipt of that bonus does not affect the eligibility 
of that individual for an increase under paragraph (1) in the 
rate of the basic educational assistance allowance applicable 
to that individual, and the Secretary concerned may provide 
such an increase for that individual (and enter into an 
agreement with that individual that the United States agrees to 
make payments pursuant to such an increase) without regard to 
any provision of law (enacted before, on, or after the date of 
the enactment of this paragraph) that limits the authority to 
make such payments.
  (e)(1)(A) Except as provided in subparagraph (B) of this 
paragraph and subject to paragraph (2) of this subsection, in 
the case of an individual who on December 31, 1989, was 
entitled to educational assistance under chapter 34 of this 
title, the rate of the basic educational assistance allowance 
applicable to such individual under this chapter shall be 
increased by the amount equal to one-half of the educational 
assistance allowance that would be applicable to such 
individual under such chapter 34 (as of the time the assistance 
under this chapter is provided and based on the rates in effect 
on December 31, 1989) if such chapter were in effect.
  (B) Notwithstanding subparagraph (A) of this paragraph, in 
the case of an individual described in that subparagraph who is 
pursuing a cooperative program on or after October 9, 1996, the 
rate of the basic educational assistance allowance applicable 
to such individual under this chapter shall be increased by the 
amount equal to one-half of the educational assistance 
allowance that would be applicable to such individual for 
pursuit of full-time institutional training under chapter 34 
(as of the time the assistance under this chapter is provided 
and based on the rates in effect on December 31, 1989) if such 
chapter were in effect.
  (2) The number of months for which the rate of the basic 
educational assistance allowance applicable to an individual is 
increased under paragraph (1) of this subsection may not exceed 
the number of months of entitlement to educational assistance 
under chapter 34 of this title that the individual had 
remaining on December 31, 1989.
  (f) In the case of an individual for whom the Secretary of 
Defense made contributions under section 3222(c) of this title 
and who is entitled to educational assistance under section 
3018A, 3018B, or 3018C of this chapter, the Secretary shall 
increase the rate of the basic educational assistance allowance 
applicable to such individual in excess of the rate provided 
under subsection (a) of this section in a manner consistent 
with, as determined by the Secretary of Defense, the agreement 
entered into with such individual pursuant to the rules and 
regulations issued by the Secretary of Defense under section 
3222(c) of this title.
  (g) In the case of an individual who has made contributions 
authorized by section 3011(e) or 3012(f) of this title, 
effective as of the first day of the enrollment period 
following receipt of such contributions from such individual by 
the Secretary concerned, the monthly amount of basic 
educational assistance allowance applicable to such individual 
under subsection (a), (b), or (c) shall be the monthly rate 
otherwise provided for under the applicable subsection 
increased by--
          (1) an amount equal to $5 for each $20 contributed by 
        such individual under section 3011(e) or 3012(f) of 
        this title, as the case may be, for an approved program 
        of education pursued on a full-time basis; or
          (2) an appropriately reduced amount based on the 
        amount so contributed, as determined under regulations 
        which the Secretary shall prescribe, for an approved 
        program of education pursued on less than a full-time 
        basis.
  (h)(1) With respect to any fiscal year, the Secretary shall 
provide a percentage increase in the rates payable under 
subsections (a)(1) and (b)(1) equal to the percentage by 
which--
          (A) the average cost of undergraduate tuition in the 
        United States, as determined by the National Center for 
        Education Statistics, for the last academic year 
        preceding the beginning of the fiscal year for which 
        the increase is made, exceeds
          (B) the average cost of undergraduate tuition in the 
        United States, as so determined, for the academic year 
        preceding the academic year described in subparagraph 
        (A).
  (2) Any increase under paragraph (1) in a rate with respect 
to a fiscal year after fiscal year 2004 and before [fiscal year 
2014] fiscal year 2020 shall be rounded down to the next lower 
whole dollar amount. Any such increase with respect to a fiscal 
year after [fiscal year 2013] fiscal year 2019 shall be rounded 
to the nearest whole dollar amount.

           *       *       *       *       *       *       *


CHAPTER 35--SURVIVORS' AND DEPENDENTS' EDUCATIONAL ASSISTANCE

           *       *       *       *       *       *       *



Subchapter VI--MISCELLANEOUS PROVISIONS

           *       *       *       *       *       *       *


Sec. 3564. Annual adjustment of amounts of educational assistance

  (a) With respect to any fiscal year, the Secretary shall 
provide a percentage increase in the rates payable under 
sections 3532, 3534(b), and 3542(a) of this title equal to the 
percentage by which--
          (1) the Consumer Price Index (all items, United 
        States city average) for the 12-month period ending on 
        the June 30 preceding the beginning of the fiscal year 
        for which the increase is made, exceeds
          (2) such Consumer Price Index for the 12-month period 
        preceding the 12-month period described in paragraph 
        (1).
  (b) Any increase under subsection (a) in a rate with respect 
to a fiscal year after fiscal year 2004 and before [fiscal year 
2014] fiscal year 2020 shall be rounded down to the next lower 
whole dollar amount. Any such increase with respect to a fiscal 
year after [fiscal year 2013] fiscal year 2019 shall be rounded 
to the nearest whole dollar amount.

           *       *       *       *       *       *       *


PART V--BOARDS, ADMINISTRATIONS, AND SERVICES

           *       *       *       *       *       *       *


                 CHAPTER 73--ORGANIZATION AND FUNCTIONS


                       SUBCHAPTER I--ORGANIZATION

Sec.
7301. Functions of Veterans Health Administration: in general.
     * * * * * * *

           SUBCHAPTER II--GENERAL AUTHORITY AND ADMINISTRATION

     * * * * * * *
7330B. Annual report on Veterans Health Administration and furnishing of 
          hospital care, medical services, and nursing home care.
7330C. Identification and tracking of biological implants.

           *       *       *       *       *       *       *


Subchapter II--GENERAL AUTHORITY AND ADMINISTRATION

           *       *       *       *       *       *       *


Sec. 7330B. Annual report on Veterans Health Administration and 
                    furnishing of hospital care, medical services, and 
                    nursing home care

  (a) Report Required.--Not later than March 1 of each year, 
the Secretary shall submit to the Committees on Veterans' 
Affairs of the Senate and House of Representatives a report on 
the furnishing of hospital care, medical services, and nursing 
home care under the laws administered by the Secretary and on 
the administration of the provision of such care and services 
by the Veterans Health Administration during the calendar year 
preceding the calendar year during which the report is 
submitted.
  (b) Contents of Report.--Each report required by subsection 
(a) shall include each of the following for the year covered by 
the report:
          (1) An evaluation of the effectiveness of the 
        Veterans Health Administration program in increasing 
        the access of veterans eligible for hospital care, 
        medical services, and nursing home care furnished by 
        the Secretary to such care.
          (2) An evaluation of the effectiveness of the 
        Veterans Health Administration in improving the quality 
        of health care provided to such veterans, without 
        increasing the costs incurred by the Government or such 
        veterans, which includes the relevant information for 
        each medical center and Veterans Integrated Service 
        Network of the Department set forth separately.
          (3) An assessment of--
                  (A) the workload of physicians and other 
                employees of the Veterans Health 
                Administration;
                  (B) patient demographics and utilization 
                rates;
                  (C) physician compensation;
                  (D) the productivity of physicians and other 
                employees of the Veterans Health 
                Administration;
                  (E) the percentage of hospital care, medical 
                services, and nursing home care provided to 
                such veterans in Department facilities and in 
                non-Department facilities and any changes in 
                such percentages compared to the year preceding 
                the year covered by the report;
                  (F) pharmaceutical prices; and
                  (G) third party health billings owed to the 
                Department, including the total amount of such 
                billings and the total amounts collected, set 
                forth separately for claims greater than $1000 
                and for claims equal to or less than $1000.
  (c) Definitions.--In this section, the terms ``hospital 
care'', ``medical services'', ``nursing home care'', and ``non-
Department facilities'' have the meanings given such terms in 
section 1701 of this title.

Sec. 7330C. Identification and tracking of biological implants

  (a) Standard Identification System for Biological Implants.--
(1) The Secretary shall adopt the unique device identification 
system developed for medical devices by the Food and Drug 
Administration pursuant to section 519(f) of the Federal Food, 
Drug, and Cosmetic Act (21 U.S.C. 360i(f)), or implement a 
comparable standard identification system, for use in 
identifying biological implants intended for use in medical 
procedures conducted in medical facilities of the Department.
  (2) In adopting or implementing a standard identification 
system for biological implants under paragraph (1), the 
Secretary shall permit a vendor to use any of the accredited 
entities identified by the Food and Drug Administration as an 
issuing agency pursuant to section 830.100 of title 21, Code of 
Federal Regulations, or any successor regulation.
  (b) Biological Implant Tracking System.--(1) The Secretary 
shall implement a system for tracking the biological implants 
referred to in subsection (a) from human donor or animal source 
to implantation.
  (2) The tracking system implemented under paragraph (1) shall 
be compatible with the identification system adopted or 
implemented under subsection (a).
  (3) The Secretary shall implement inventory controls 
compatible with the tracking system implemented under paragraph 
(1) so that all patients who have received, in a medical 
facility of the Department, a biological implant subject to a 
recall can be notified of the recall, if based on the 
evaluation of appropriate medical personnel of the Department 
of the risks and benefits, the Secretary determines such 
notification is appropriate.
  (c) Consistency With Food and Drug Administration 
Regulations.--To the extent that a conflict arises between this 
section and a provision of the Federal Food, Drug, and Cosmetic 
Act (21 U.S.C. 301 et seq.) or sections 351 or 361 of the 
Public Health Service Act (42 U.S.C. 262) (including any 
regulations issued under such Acts), the provision the Federal 
Food, Drug, and Cosmetic Act or Public Health Service Act 
(including any regulations issued under such Acts) shall apply.
  (d) Definition of Biological Implant.--In this section, the 
term ``biological implant'' means any animal or human cell, 
tissue, or cellular or tissue-based product--
          (1) under the meaning given the term human cells, 
        tissues, or cellular or tissue-based products in 
        section 1271.3 of title 21, Code of Federal 
        Regulations, or any successor regulation; or
          (2) that is regulated as a device under section 
        201(h) of the Federal Food, Drug, and Cosmetic Act.

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PART VI--ACQUISITION AND DISPOSITION OF PROPERTY

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   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.
8101. Definitions.
     * * * * * * *

                  SUBCHAPTER II--PROCUREMENT AND SUPPLY

     * * * * * * *
8129. Procurement of biological implants.

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Subchapter II--PROCUREMENT AND SUPPLY

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Sec. 8129. Procurement of biological implants

  (a) In General.--(1) The Secretary may procure biological 
implants of human origin only from vendors that meet the 
following conditions:
          (A) The vendor uses the standard identification 
        system adopted or implemented by the Secretary under 
        section 7330C(a) of this title and has safeguards to 
        ensure that a distinct identity code has been in place 
        at each step of distribution of each biological implant 
        from its donor.
          (B) The vendor is registered as required by the Food 
        and Drug Administration under subpart B of part 1271 of 
        title 21, Code of Federal Regulations, or any successor 
        regulation, and in the case of a vendor that uses a 
        tissue distribution intermediary or a tissue processor, 
        the vendor provides assurances that the tissue 
        distribution intermediary or tissue processor is 
        registered as required by the Food and Drug 
        Administration.
          (C) The vendor ensures that donor eligibility 
        determinations and such other records as the Secretary 
        may require accompany each biological implant at all 
        times, regardless of the country of origin of the donor 
        of the biological material.
          (D) The vendor agrees to cooperate with all 
        biological implant recalls conducted on the vendor's 
        own initiative, on the initiative of the original 
        product manufacturer used by the vendor, by the request 
        of the Food and Drug Administration, or by a statutory 
        order of the Food and Drug Administration.
          (E) The vendor agrees to notify the Secretary of any 
        adverse event or reaction report it provides to the 
        Food and Drug Administration, as required by section 
        1271.350 of title 21, Code of Federal Regulations, or 
        any successor regulation, or any successor regulation, 
        or of any warning letter from the Food and Drug 
        Administration issued to the vendor or a tissue 
        processor or tissue distribution intermediary it uses 
        by not later than 60 days after the vendor receives 
        such report or warning letter.
          (F) The vendor agrees to retain all records 
        associated with the procurement of a biological implant 
        by the Department for at least 10 years after the date 
        of the procurement of the biological implant.
          (G) The vendor provides assurances that the 
        biological implants provided by the vendor are acquired 
        only from tissue processors that maintain active 
        accreditation with the American Association of Tissue 
        Banks or a similar national accreditation specific to 
        biological implants.
  (2) The Secretary may procure biological implants of non-
human origin only from vendors that meet the following 
conditions:
          (A) The vendor uses the standard identification 
        system adopted or implemented by the Secretary under 
        section 7330C(a) of this title.
          (B) The vendor is a registered establishment as 
        required by the Food and Drug Administration under 
        sections 807.20 and 807.40 of title 21, Code of Federal 
        Regulations, or any successor regulation, (or is not 
        required to register pursuant to section 807.65(a) of 
        such title) and in the case of a vendor that is not the 
        original product manufacturer of such implants the 
        vendor provides assurances that the original product 
        manufacturer is registered as required by the Food and 
        Drug Administration.
          (C) The vendor agrees to cooperate with all 
        biological implant recalls conducted on the vendor's 
        own initiative, on the initiative of the original 
        product manufacturer used by the vendor, by the request 
        of the Food and Drug Administration, or by a statutory 
        order of the Food and Drug Administration.
          (D) The vendor agrees to notify the Secretary of any 
        adverse event report it provides to the Food and Drug 
        Administration as required in part 803 of title 21, 
        Code of Federal Regulations, or any warning letter from 
        the Food and Drug Administration issued to the vendor 
        or the original product manufacturer it uses by not 
        later than 60 days after the vendor receives such 
        report or warning letter.
          (E) The vendor agrees to retain all records 
        associated with the procurement of a biological implant 
        by the Department for at least 10 years after the date 
        of the procurement of the biological implant.
  (3)(A) The Secretary shall procure biological implants under 
the Federal Supply Schedules of the General Services 
Administration unless such implants are not available under 
such Schedules.
  (B) With respect to biological implants listed on the Federal 
Supply Schedules, the Secretary shall accommodate reasonable 
vendor requests to undertake outreach efforts to educate 
medical professionals of the Department about the use and 
efficacy of such biological implants.
  (C) In the case of biological implants that are unavailable 
for procurement under the Federal Supply Schedules, the 
Secretary shall procure such implants using competitive 
procedures in accordance with applicable law and the Federal 
Acquisition Regulation.
  (4) Section 8123 of this title shall not apply to the 
procurement of biological implants.
  (b) Penalties.--In addition to any applicable penalty under 
any other provision of law, any procurement employee of the 
Department who is found responsible for a biological implant 
procurement transaction with intent to avoid or with reckless 
disregard of the requirements of this section shall be 
ineligible to hold a certificate of appointment as a 
contracting officer or to serve as the representative of an 
ordering officer, contracting officer, or purchase card holder.
  (c) Definitions.--In this section:
          (1) The term ``biological implant'' shall have the 
        meaning given such term in section 7330C(d) of this 
        title.
          (2) The term ``distinct identity code'' means a code 
        that--
                  (A) relates a biological implant to the human 
                donor of the implant and to all records 
                pertaining to the implant;
                  (B) includes information designed to 
                facilitate effective tracking, using such code, 
                from the donor to the recipient and from the 
                recipient to the donor; and
                  (C) satisfies the requirements of section 
                1271.290 of title 21, Code of Federal 
                Regulations, or any successor regulation.
          (3) The term ``tissue distribution intermediary'' 
        means an agency that acquires and stores human tissue 
        for further distribution and performs no other tissue 
        banking functions.
          (4) The term ``tissue processor'' means an entity 
        processing human tissue for use in biological implants 
        including activities performed on tissue other than 
        donor screening, donor testing, tissue recovery and 
        collection functions, storage, or distribution.

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