[House Report 114-709]
[From the U.S. Government Publishing Office]
114th Congress } { Report
HOUSE OF REPRESENTATIVES
2d Session } { 114-709
======================================================================
VETERANS MOBILITY SAFETY ACT OF 2016
_______
September 6, 2016.--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. 3471]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred
the bill (H.R. 3471) to amend title 38, United States Code, to
make certain improvements in the provision of automobiles and
adaptive equipment by the Department of Veterans Affairs,
having considered the same, report favorably thereon with an
amendment and recommend that the bill as amended do pass.
CONTENTS
Page
Amendment........................................................ 2
Purpose and Summary.............................................. 4
Background and Need for Legislation.............................. 4
Hearings......................................................... 6
Subcommittee Consideration....................................... 7
Committee Consideration.......................................... 7
Committee Votes.................................................. 7
Committee Oversight Findings..................................... 7
Statement of General Performance Goals and Objectives............ 7
New Budget Authority, Entitlement Authority, and Tax Expenditures 8
Earmarks and Tax and Tariff Benefits............................. 8
Committee Cost Estimate.......................................... 8
Congressional Budget Office Estimate............................. 8
Federal Mandates Statement....................................... 9
Advisory Committee Statement..................................... 10
Constitutional Authority Statement............................... 10
Applicability to Legislative Branch.............................. 10
Statement on Duplication of Federal Programs..................... 10
Disclosure of Directed Rulemaking................................ 10
Section-by-Section Analysis of the Legislation................... 10
Changes in Existing Law Made by the Bill as Reported............. 12
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
Amendment in the Nature of a Substitute
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Veterans Mobility Safety Act of
2016''.
SEC. 2. PERSONAL SELECTIONS OF AUTOMOBILES AND ADAPTIVE EQUIPMENT.
Section 3903(b) of title 38, United States Code, is amended--
(1) by striking ``Except'' and inserting ``(1) Except''; and
(2) by adding at the end the following new paragraph:
``(2) The Secretary shall ensure that to the extent practicable an
eligible person who is provided an automobile or other conveyance under
this chapter is given the opportunity to make personal selections
relating to such automobile or other conveyance.''.
SEC. 3. COMPREHENSIVE POLICY FOR THE AUTOMOBILES ADAPTIVE EQUIPMENT
PROGRAM.
(a) Comprehensive Policy.--The Secretary of Veterans Affairs shall
develop a comprehensive policy regarding quality standards for
providers who provide modification services to veterans under the
automobile adaptive equipment program.
(b) Scope.--The policy developed under subsection (a) shall cover
each of the following:
(1) The Department of Veterans Affairs-wide management of the
automobile adaptive equipment program.
(2) The development of standards for safety and quality of
equipment and installation of equipment through the automobile
adaptive equipment program, including with respect to the
defined differentiations in levels of modification complexity.
(3) The consistent application of standards for safety and
quality of both equipment and installation throughout the
Department.
(4) The certification of a provider by a third party
organization or manufacturer if the Secretary designates the
quality standards of such organization or manufacturer as
meeting or exceeding the standards developed under this
section.
(5) The education and training of personnel of the Department
who administer the automobile adaptive equipment program.
(6) The compliance of the provider with the Americans with
Disabilities Act of 1990 (42 U.S.C. 12101 et seq.) when
furnishing automobile adaptive equipment at the facility of the
provider.
(7) The allowance, where technically appropriate, for
veterans to receive modifications at their residence or
location of choice.
(c) Updates.--Not later than one year after the date of the enactment
of this Act, the Secretary shall update Veterans Health Administration
Handbook 1173.4, or any successor handbook or directive, in accordance
with the policy developed under subsection (a). Not less frequently
than once every six years thereafter, the Secretary shall update such
handbook, or any successor handbook or directive.
(d) Consultation.--The Secretary shall develop the policy under
subsection (a), and revise such policy under subsection (c), in
consultation with veterans service organizations, the National Highway
Transportation Administration, industry representatives, manufacturers
of automobile adaptive equipment, and other entities with expertise in
installing, repairing, replacing, or manufacturing mobility equipment
or developing mobility accreditation standards for automobile adaptive
equipment.
(e) Conflicts.--In developing and implementing the policy under
subsection (a), the Secretary shall--
(1) minimize the possibility of conflicts of interest, to the
extent practicable; and
(2) establish procedures that ensure against the use of a
certifying entity referred to in subsection (b)(4) that has a
financial conflict of interest regarding the certification of
an eligible provider.
(f) Biennial Report.--
(1) In general.--Not later than one year after the date on
which the Secretary updates Veterans Health Administration
Handbook 1173.4, or any successor handbook or directive, under
subsection (c), and biennially thereafter through 2022, the
Secretary shall submit to the Committees on Veterans' Affairs
of the House of Representatives and the Senate a report on the
implementation and facility compliance with the policy
developed under subsection (a).
(2) Contents.--The report required by paragraph (1) shall
include the following:
(A) A description of the implementation plan for the
policy developed under subsection (a) and any revisions
to such policy under subsection (c).
(B) A description of the performance measures used to
determine the effectiveness of such policy in ensuring
the safety of veterans enrolled in the automobile
adaptive equipment program.
(C) An assessment of safety issues due to improper
installations based on a survey of recipients of
adaptive equipment from the Department.
(D) An assessment of the adequacy of the adaptive
equipment services of the Department based on a survey
of recipients of adaptive equipment from the
Department.
(E) An assessment of the training provided to the
personnel of the Department with respect to
administering the program.
(F) An assessment of the certified providers of the
Department of adaptive equipment with respect to
meeting the minimum standards developed under
subsection (b)(2).
(g) Definitions.--In this section:
(1) The term ``automobile adaptive equipment program'' means
the program administered by the Secretary of Veterans Affairs
pursuant to chapter 39 of title 38, United States Code.
(2) The term ``veterans service organization'' means any
organization recognized by the Secretary for the representation
of veterans under section 5902 of title 38, United States Code.
SEC. 4. APPOINTMENT OF LICENSED HEARING AID SPECIALISTS IN VETERANS
HEALTH ADMINISTRATION.
(a) Licensed Hearing Aid Specialists.--
(1) Appointment.--Section 7401(3) of title 38, United States
Code, is amended by inserting ``licensed hearing aid
specialists,'' after ``Audiologists,''.
(2) Qualifications.--Section 7402(b)(14) of such title is
amended by inserting ``, hearing aid specialist'' after
``dental technologist''.
(b) Requirements.--With respect to appointing hearing aid specialists
under sections 7401 and 7402 of title 38, United States Code, as
amended by subsection (a), and providing services furnished by such
specialists, the Secretary shall ensure that--
(1) a hearing aid specialist may only perform hearing
services consistent with the hearing aid specialist's State
license related to the practice of fitting and dispensing
hearing aids without excluding other qualified professionals,
including audiologists, from rendering services in overlapping
practice areas;
(2) services provided to veterans by hearing aid specialists
shall be provided as part of the non-medical treatment plan
developed by an audiologist; and
(3) the medical facilities of the Department of Veterans
Affairs provide to veterans access to the full range of
professional services provided by an audiologist.
(c) Consultation.--In determining the qualifications required for
hearing aid specialists and in carrying out subsection (b), the
Secretary shall consult with veterans service organizations,
audiologists, otolaryngologists, hearing aid specialists, and other
stakeholder and industry groups as the Secretary determines
appropriate.
(d) Annual Report.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, and annually thereafter during the
five-year period beginning on the date of the enactment of this
Act, the Secretary of Veterans Affairs shall submit to Congress
a report on the following:
(A) Timely access of veterans to hearing health
services through the Department of Veterans Affairs.
(B) Contracting policies of the Department with
respect to providing hearing health services to
veterans in facilities that are not facilities of the
Department.
(2) Timely access to services.--Each report shall, with
respect to the matter specified in paragraph (1)(A) for the
one-year period preceding the submittal of such report, include
the following:
(A) The staffing levels of audiologists, hearing aid
specialists, and health technicians in audiology in the
Veterans Health Administration.
(B) A description of the metrics used by the
Secretary in measuring performance with respect to
appointments and care relating to hearing health.
(C) The average time that a veteran waits to receive
an appointment, beginning on the date on which the
veteran makes the request, for the following:
(i) A disability rating evaluation for a
hearing-related disability.
(ii) A hearing aid evaluation.
(iii) Dispensing of hearing aids.
(iv) Any follow-up hearing health
appointment.
(D) The percentage of veterans whose total wait time
for appointments described in subparagraph (C),
including an initial and follow-up appointment, if
applicable, is more than 30 days.
(3) Contracting policies.--Each report shall, with respect to
the matter specified in paragraph (1)(B) for the one-year
period preceding the submittal of such report, include the
following:
(A) The number of veterans that the Secretary refers
to non-Department audiologists for hearing health care
appointments.
(B) The number of veterans that the Secretary refers
to non-Department hearing aid specialists for follow-up
appointments for a hearing aid evaluation, the
dispensing of hearing aids, or any other purpose
relating to hearing health.
Purpose and Summary
H.R. 3471, the ``Veterans Mobility Safety Act of 2015,''
was introduced by Representative Jackie Walorski of Indiana on
September 10, 2015. H.R. 3471, as amended, was ordered to be
favorably reported to the full House on May 18, 2016, by voice
vote. This legislation would direct the Department of Veterans
Affairs (VA) to develop a comprehensive policy regarding
quality standards for providers who dispense modification
services to veterans under the Automobile Adaptive Equipment
Program. The bill would also authorize VA to hire and prescribe
qualifications for hiring hearing aid specialists.
Background and Need for Legislation
Section 2. Personal selections of automobile and adaptive equipment
Section 3902 of title 38, U.S.C, authorizes VA to provide
automobile adaptive equipment to certain disabled veterans.
Through the Automobile Adaptive Equipment (AAE) program, VA
provides equipment as well as training to eligible veterans to
allow them to safely operate a motor vehicle. To be eligible
for this program, a veteran must meet at least one of the
following criteria: (1) be service-connected for the loss or
loss of use of one or both feet or hands; (2) have service-
connected ankylosis (stiffening or immobility of a joint) in
one or both knees or hips; or (3) be service-connected for
permanent impairment of vision of both eyes that have a central
acuity of 20/200. Non-service-connected veterans are eligible
for equipment or modifications to allow ingress and egress from
a vehicle only. In recognition of the individual needs of the
eligible veterans participating in the AAE program, Section 2
of the bill would direct VA to ensure that an eligible disabled
veteran who has been provided with an automobile or other
conveyance is given the opportunity to make personal selections
relating to that automobile or other conveyance.
Section 3. Comprehensive policy for the Automobile Adaptive Equipment
Program
The AAE program is governed by Veterans Health
Administration (VHA) Handbook 1173.4, which was released on
October 30, 2000. Though the Handbook was scheduled for
recertification on or before the last working day of July 2005,
it has not been updated since it was released. Notably, the
Handbook does not contain certification requirements for
automobile equipment dealers or prescribe qualification
standards that dealers or installers must meet to ensure
safety. VA's AAE program website encourages veterans to
research automobile adaptive equipment dealers who are
registered through the National Highway Traffic Safety
Administration (NHTSA) and to file a formal complaint with the
NHTSA if the veteran has concerns about the safety of the
vehicle modification or installation.\1\ However, in recent
years, the Committee has received an increasing number of
reports regarding quality and safety concerns from veterans
receiving services through the AAE program. Improperly
installed automobile adaptive equipment carries risks for
veterans as well as for the wider driving public. In a
statement for the record provided by the National Mobility
Equipment Dealers Association (NMEDA) before the Subcommittee
on Health, ``[q]uality concerns [with the VA AAE program] range
from poor customer service to faulty wiring to chronically
unreliable power, steering, and braking systems.''\2\ According
to NMEDA, ``[s]uch poor quality installations have very real
safety implications and can result in automobile accidents,
vehicle fires, injuries, or worse.''\3\
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\1\Automobile Adaptive Equipment (AAE) & Vehicle Modifications
Program, Frequently Asked Questions, http://www.prosthetics.va.gov/
psas/FAQ-AAE.asp
\2\Statement for the Record provided by the National Mobility
Equipment Dealers Association before the Subcommittee on Health,
November 17, 2015, https://veterans.house.gov/hearings/legislative-
hearing-1
\3\Ibid.
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Section 3 of the bill would require VA--in consultation
with veterans service organizations, the NHTSA, industry
representatives, manufacturers of automobile adaptive
equipment, and other entities with relevant expertise--to
develop a comprehensive policy regarding quality standards for
providers who provide modification services to veterans under
the AAE program. Section 3 of the bill would also require VA to
update the VHA Handbook 1173.4 to reflect the new comprehensive
policy and to submit biennial reports on implementation and
compliance. The Committee is aware many veterans receive
installations and/or modifications through the AAE program at
their place of residence. The Committee intends for VA to
preserve access to residential installations and service, where
appropriate, when developing and implementing standards
pursuant to this Section. The Committee would also support VA
differentiating between complex vehicle modifications that
involve changes to the structure or controls of a vehicle and
less complex modifications. Further, the Committee expects VA
to take all appropriate steps to minimize the potential for
conflicts of interest, particularly if a third party
organization who stands to unreasonably gain from designating
quality standards high enough so that only the organization
itself can certify providers of modification equipment is
selected as a certifying body. Though, of note, the Committee
does not believe that the certification of providers by any one
third party organization denotes that the organization itself
has a conflict of interest.
Section 4. Appointment of licensed hearing aid specialists in Veterans
Health Administration
Currently, hearing health services are provided in VA
medical facilities by audiologists and audiology health
technicians who assess and treat hearing loss and evaluate and
issue hearing aids for veteran patients. If a hearing aid is in
need of repair, it is either repaired by an audiologist or an
audiology health technician at a VA medical center or is sent
to the Denver Acquisitions and Logistics Center. On February
20, 2014, the VA Inspector General (IG) released an audit of
VA's hearing aid services, which found that VA was not timely
in issuing new hearing aids to veterans or in meeting its 5-day
timeliness goal to complete repair services.\4\ According to
the IG, during the 6-month period ending in September 2012, VA
issued 30% of its hearing aids to veterans more than 30 days
from the estimated receipt date from their vendors and VA took
17 to 24 days to complete hearing aid repair services. These
findings are consistent with anecdotal reports heard by the
Committee and by individual Members of Congress from their
veteran constituents.
---------------------------------------------------------------------------
\4\February 20, 2014, VA Office of the Inspector General, ``Audit
of VA's Hearing Aid Services, http://www.va.gov/oig/pubs/VAOIG-12-
02910-80.pdf.
---------------------------------------------------------------------------
To address concerns regarding timely access to hearing
health services through VA providers, Section 4 of the bill
would authorize VA to hire hearing aid specialists and to work
in consultation with veterans service organizations,
audiologists, otolaryngologists (ear, nose, and throat--or
ENT--physicians), and other stakeholder and industry groups to
prescribe qualifications for hearing aid specialists. Section 4
would further stipulate that a VA hearing aid specialist may
only perform services consistent with his/her State licensure
and in accordance with a treatment plan developed by an
audiologist. It would further stipulate that VA medical
facilities must ensure that veterans are given access to the
full range of professional services provided by an audiologist.
Finally, Section 4 of the bill would require VA to submit an
annual report on whether veterans receive timely access to
hearing health services through VA and on VA's policies with
respect to providing hearing health services through community
providers.
Hearings
There were no full Committee hearings held on H.R. 3471, as
amended. On November 17, 2015, the Subcommittee on Health
conducted a legislative hearing on various bills introduced
during the 114th Congress, including H.R. 3471. The following
witnesses testified:
The Honorable Lee Zeldin of New York; The Honorable
Mike Bost of Illinois; The Honorable Ann Kuster of New
Hampshire; The Honorable Elise Stefanik of New York;
The Honorable Jackie Walorski of Indiana; Diane M.
Zumatto, National Legislative Director for AMVETS;
Shurhonda Y. Love, Assistant National Legislative
Director for the Disabled American Veterans; Fred S.
Sganga, Legislative Officer for the National
Association of State Veteran Homes; Maureen McCarthy
M.D., Assistant Deputy Under Secretary for Health for
Patient Care Services for the Veterans Health
Administration of the U.S. Department of Veterans
Affairs who was accompanied by Susan Blauert, the Chief
Counsel for the Health Care Law Group of the Office of
General Counsel of the U.S. Department of Veterans
Affairs.
Statements for the record were submitted by:
The American Legion; the American Psychiatric
Association; Easter Seals; The Elizabeth Dole
Foundation; The National Association of Mental Illness;
Veterans Affairs Physician Assistant Association;
Veterans of Foreign Wars of the United States; and the
Wounded Warrior Project.
Subcommittee Consideration
On April 29, 2016, the Subcommittee on Health met in open
markup session, a quorum being present, and ordered H.R. 3471,
as amended, favorably forwarded to the full Committee by voice
vote. During consideration of H.R. 3471, as amended, the
following amendment in the nature of a substitute was
considered and agreed to by voice vote:
An Amendment in the Nature of a Substitute offered by
Representative Dan Benishek of Michigan.
A motion by Representative Julia Brownley of Florida to
favorably forward the bill, as amended, to the full Committee
was agreed to by voice vote.
Committee Consideration
On May 18, 2016, the Full Committee met in open markup
session, a quorum being present, and ordered H.R. 3471, as
amended, favorably reported to the House of Representatives by
voice vote. During consideration of H.R. 3471, as amended, the
following amendment in the nature of a substitute was
considered and agreed to by voice vote:
An Amendment in the Nature of a Substitute offered by
Representative Jackie Walorski of Indiana.
A motion by Representative Corrine Brown of Florida to
favorably report H.R. 3471, as amended, to the House of
Representatives was agreed to by voice vote.
Committee Votes
In compliance with clause 3(b) of rule XIII of the Rules of
the House of Representatives, there were no recorded votes
taken on amendments or in connection with ordering H.R. 3471,
as amended, reported to the House.
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 to require VA to develop a
comprehensive policy regarding quality standards for providers
under the AAE program and authorize VA to hire and prescribe
qualifications for hiring hearing aid specialists.
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. 3471, 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.
3471, 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. 3471, 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, August 2, 2016.
Hon. Jeff Miller,
Chairman, Committee on Veterans' Affairs,
U.S. House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 3471, the Veterans
Mobility Safety Act of 2016.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Dwayne M.
Wright.
Sincerely,
Mark P. Hadley
(For Keith Hall, Director).
Enclosure.
H.R. 3471--Veterans Mobility Safety Act of 2016
H.R. 3471 would modify a program administered by the
Department of Veterans Affairs (VA) that assists eligible
veterans with purchasing automobiles and having those vehicles
adapted to accommodate the veterans' disabilities. The bill
also would authorize VA to employ hearing aid specialists and
would require VA to prepare an annual report documenting the
access of veterans to hearing health services sponsored by VA.
In total, CBO estimates that implementing H.R. 3471 would cost
less than $500,000 over the 2017-2021 period; that spending
would be subject to appropriation of the necessary amounts.
Enacting H.R. 3471 would not affect direct spending or
revenues; therefore, pay-as-you-go procedures do not apply.
Section 2 would require VA to ensure that eligible veterans
have the opportunity to choose a certified, licensed provider
for purchasing an automobile or installing adaptive equipment.
On the basis of information from VA about current practice
related to personal selections for automobiles and adaptive
equipment, CBO believes that section 2 would codify current
practice and, therefore, have no budgetary effect.
Section 3 would require VA to develop a comprehensive
policy regarding quality standards for providers who make
modifications to vehicles under the adaptive equipment program
for automobiles. Section 3 also would require VA to provide
biennial reports to the Congress on the implementation of that
policy. CBO estimates that implementing section 3 would
increase costs by less than $500,000 over the 2017-2021 period.
Section 4 would specifically authorize VA to hire licensed
hearing aid specialists and would require VA to provide
veterans access to the full range of audiology services at its
medical facilities. VA currently employs about 320 audiology
health technicians (also known as audiology assistants). Some
of those technicians are already licensed as hearing aid
specialists based on their education and experience; the
remainder could potentially qualify on the basis of their
experience. CBO expects that, rather than hiring licensed
hearing aid specialists, VA would allow the existing audiology
health technicians who are not licensed to remain employed with
the agency as technicians until they meet the requirements to
be a hearing aid specialist. VA also employs 1,100 audiologists
and offers their services at 400 medical facilities. On that
basis, we do not anticipate that VA would hire additional
audiologists under this proposal.
Section 4 also would require VA to submit annual reports
detailing VA's activities in providing hearing health services
at VA medical facilities and through contracting with private-
sector facilities. CBO estimates that preparing those reports
would cost less than $500,000 over the 2017-2021 period.
CBO estimates that enacting H.R. 3471 would not increase
net direct spending or on-budget deficits in any of the four
consecutive 10-year periods beginning in 2027.
H.R. 3471 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act and
would not affect the budgets of state, local, or tribal
governments.
The CBO staff contact for this estimate is Dwayne M.
Wright. The estimate was approved by Theresa Gullo, Assistant
Director for Budget Analysis.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates regarding H.R. 3471, 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.
3471, as amended.
Statement of Constitutional Authority
Pursuant to Article I, section 8 of the United States
Constitution, H.R. 3471, as amended, 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 H.R. 3471, as amended, 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. 3471, 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. 3471, as amended, contains no
directed rulemaking that would require the Secretary to
prescribe regulations.
Section-by-Section Analysis of the Legislation
Section 1. Short title
Section 1 of the bill would provide a short title of the
``Veterans Mobility Safety Act of 2016.''
Section 2. Personal sections of automobiles and adaptive equipment
Section 2 of the bill would amend title 38, U.S.C., to
require that the Secretary ensure that a veteran who receives
an automobile or other conveyance under this chapter is given
the opportunity to make personal choices relating to the
automobile or conveyance received to the extent practicable.
Section 3. Comprehensive policy for the automobiles adaptive equipment
program
Section 3(a) of the bill would require the Secretary to
develop a comprehensive policy regarding quality standards for
those who provide modification services to veterans under the
AAE program.
Section 3(b) of the bill would require that the policy
developed under subsection (a) include: (1) VA-wide management
of the AAE program; (2) the development of standards for the
safety and quality of the equipment and its installation,
including with respect to the defined differentiations in
levels of modification complexity; (3) the consistent
application of safety and quality standards for the equipment
and its installation; (4) the certification of a provider by a
third party organization or manufacturer, if the Secretary
designates the quality standards of such organization or
manufacturer as meeting or exceeding the standards developed
under this section; (5) the education and training of VA
personnel who administer the program; (6) the compliance of
providers with the Americans with Disabilities Act of 1990 when
furnishing automobile adaptive equipment at the providers'
facilities; and (7) the allowance (where appropriate) for
veterans to receive modifications at their residence or
location of choice.
Section 3(c) of the bill would require that within one year
of the enactment of this act, the Secretary update VHA Handbook
1173.4, or any successor handbook or directive, in accordance
with the policy developed under subsection (a). This Section
would require that the Secretary update Handbook 1173.4, or any
successor handbook or directive, at least every six years
thereafter.
Section 3(d) of the bill would require that the Secretary
develop the policy under subsection (a), and revise such policy
under subsection (c), in consultation with veteran service
organizations, the NHTSA, industry representatives,
manufacturers of automobile adaptive equipment, and other
entities with relevant expertise.
Section 3(e) of the bill would require that, in developing
and implementing the policy under subsection (a), the Secretary
minimize the possibility of conflicts of interest to the extent
practicable, and establish procedures that ensure against the
use of a certifying entity referred to in subsection (b)(4)
that has a financial conflict of interest regarding the
certification of an eligible provider.
Section 3(f) of the bill would require that no later than
one year after the Secretary's update of VHA Handbook 1173.4
under subsection (c), and biennially thereafter through 2022,
the Secretary submit to the Committees on Veterans' Affairs of
the House and Senate a report on the implementation and
facility compliance with the policy developed under subsection
(a). This Section would also require that the report include:
(1) a description of the implementation plan for the policy
developed under subsection (a) and any revisions to such
policy; (2) a description of the performance measures used to
determine the effectiveness of such policy in ensuring the
safety of veterans enrolled in the program; (3) an assessment
of safety issues due to improper installations based on a
survey of recipients of adaptive equipment from VA; (4) an
assessment of the adequacy of VA's adaptive equipment services
based on such survey; (5) an assessment of the training
provided to the VA personnel administering the program; and (6)
an assessment of VA's certified providers of adaptive equipment
with respect to meeting the minimum standards developed under
subsection (b).
Section 3(g) of the bill would define the term ``automobile
adaptive equipment program'' to mean the program administered
by VA pursuant to chapter 39 of title 38, U.S.C., and the term
``veteran service organization'' to mean any organization
recognized by VA for the representation of veterans under
section 5902 of title 38, U.S.C.
Section 4. Appointment of licensed hearing aid specialists in Veterans
Health Administration
Section 4(a) of the bill would amend section 7401(3) of
title 38, U.S.C., to authorize VA to hire licensed hearing aid
specialists. This Section would also amend section 7402(b)(14)
of title 38, U.S.C., to authorize VA to prescribe
qualifications for hearing aid specialists.
Section 4(b) of the bill would require that, with respect
to appointing hearing aid specialists under title 38, U.S.C.,
as amended by subsection (a), and providing services furnished
by such specialists, the Secretary ensure that: (1) a hearing
aid specialist may only perform hearing services consistent
with the hearing aid specialist's state license related to the
practice of fitting and dispensing hearing aids without
excluding qualified professionals, including audiologists, from
rendering services in overlapping practice areas; (2) services
provided to veterans by hearing aid specialists be provided as
part of a non-medical treatment plan developed by an
audiologist; and (3) VA medical facilities provide veterans
with access to the full range of professional services provided
by an audiologist.
Section 4(c) of the bill would require that, in determining
the qualifications required for hearing aid specialists and in
carrying out subsection (b), the Secretary consult with veteran
service organizations, audiologists, otolaryngologists, hearing
aid specialists, and other stakeholders and industry groups as
the Secretary determines appropriate.
Section 4(d) of the bill would require that, within one
year of the enactment of this act and annually for five years
thereafter, the Secretary submit to Congress a report on timely
access of veterans to hearing health services through VA, and
VA contracting policies with respect to providing hearing
health services to veterans in facilities that are not VA
facilities. This Section would require that each report
include: (1) the staffing levels of audiologists, hearing aid
specialists, and health technicians in audiology in VHA; (2) a
description of metrics used by VA in measuring performance with
respect to appointments and care relating to hearing health;
(3) the average time that a veteran waits to receive a hearing
health-related appointment, beginning on the date on which the
veteran makes the request; and (4) the percentage of veterans
whose total wait time for appointments described in
subparagraph (c), including an initial and follow-up
appointment, is more than 30 days. Section 4(d) would further
require each report to include the number of veterans that VA
refers to non-VA audiologists for hearing health care
appointments, as well as the number of veterans that the
Secretary refers to non-VA hearing aid specialists for follow-
up appointments for a hearing aid evaluation, the dispensing of
hearing aids, or any other purpose relating to hearing health.
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):
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, and existing law in which no
change is proposed is shown in roman):
TITLE 38, UNITED STATES CODE
* * * * * * *
PART III--READJUSTMENT AND RELATED BENEFITS
* * * * * * *
CHAPTER 39--AUTOMOBILES AND ADAPTIVE EQUIPMENT FOR CERTAIN DISABLED
VETERANS AND MEMBERS OF THE ARMED FORCES
* * * * * * *
Sec. 3903. Limitations on assistance; special training courses
(a)(1) Except as provided in paragraph (2), no eligible
person shall be entitled to receive more than one automobile or
other conveyance under the provisions of this chapter, and no
payment shall be made under this chapter for the repair,
maintenance, or replacement of an automobile or other
conveyance.
(2) The Secretary may provide or assist in providing an
eligible person with a second automobile or other conveyance
under this chapter if--
(A) the Secretary receives satisfactory evidence that
the automobile or other conveyance previously purchased
with assistance under this chapter was destroyed--
(i) as a result of a natural or other
disaster, as determined by the Secretary; and
(ii) through no fault of the eligible person;
and
(B) the eligible person does not otherwise receive
from a property insurer compensation for the loss.
(b) [Except] (1) Except as provided in subsection (d) of
section 3902 of this title, no eligible person shall be
provided an automobile or other conveyance under this chapter
until it is established to the satisfaction of the Secretary,
in accordance with regulations the Secretary shall prescribe,
that the eligible person will be able to operate the automobile
or other conveyance in a manner consistent with such person's
own safety and the safety of others and will satisfy the
applicable standards of licensure to operate the automobile or
other conveyance established by the State of such person's
residency or other proper licensing authority.
(2) The Secretary shall ensure that to the extent practicable
an eligible person who is provided an automobile or other
conveyance under this chapter is given the opportunity to make
personal selections relating to such automobile or other
conveyance.
(c)(1) An eligible person shall not be entitled to adaptive
equipment under this chapter for more than two automobiles or
other conveyances at any one time or (except as provided in
paragraph (2) of this subsection) during any four-year period.
(2) In a case in which the four-year limitation in paragraph
(1) of this subsection precludes an eligible person from being
entitled to adaptive equipment under this chapter, if the
Secretary determines that, due to circumstances beyond the
control of such person, one of the automobiles or other
conveyances for which adaptive equipment was provided to such
person during the applicable four-year period is no longer
available for the use of such person, the Secretary may provide
adaptive equipment to such person for an additional automobile
or other conveyance during such period. Provision of adaptive
equipment under this paragraph is within the discretion of the
Secretary. Any action to provide adaptive equipment under this
paragraph shall be made pursuant to regulations which the
Secretary shall prescribe.
(d) Adaptive equipment shall not be provided under this
chapter unless it conforms to minimum standards of safety and
quality prescribed by the Secretary.
(e)(1) The Secretary shall provide, directly or by contract,
for the conduct of special driver training courses at every
hospital and, where appropriate, at regional offices and other
medical facilities, of the Department to instruct such eligible
person to operate the type of automobile or other conveyance
such person wishes to obtain with assistance under this
chapter, and may make such courses available to any veteran,
eligible for care under chapter 17 of this title or member of
the Armed Forces, who is determined by the Secretary to need
the special training provided in such courses even though such
veteran or member is not eligible for the assistance provided
under this chapter.
(2) The Secretary is authorized to obtain insurance on
automobiles and other conveyances used in conducting the
special driver training courses provided under this subsection
and to obtain, at Government expense, personal liability and
property damage insurance for all persons taking such courses
without regard to whether such persons are taking the course on
an in-patient or out-patient basis.
(3) Notwithstanding any other provision of law, the Secretary
may obtain, by purchase, lease, gift, or otherwise, any
automobile, motor vehicle, or other conveyance deemed necessary
to carry out the purposes of this subsection, and may sell,
assign, transfer, or convey any such automobile, vehicle, or
conveyance to which the Department obtains title for such price
and upon such terms as the Secretary deems appropriate; and any
proceeds received from any such disposition shall be credited
to the applicable Department appropriation.
* * * * * * *
PART V--BOARDS, ADMINISTRATIONS, AND SERVICES
* * * * * * *
CHAPTER 74--VETERANS HEALTH ADMINISTRATION - PERSONNEL
SUBCHAPTER I--APPOINTMENTS
Sec. 7401. Appointments in Veterans Health Administration
There may be appointed by the Secretary such personnel as
the Secretary may find necessary for the health care of
veterans (in addition to those in the Office of the Under
Secretary for Health appointed under section 7306 of this
title), as follows:
(1) Physicians, dentists, podiatrists, chiropractors,
optometrists, registered nurses, physician assistants,
and expanded-function dental auxiliaries.
(2) Scientific and professional personnel, such as
microbiologists, chemists, and biostatisticians.
(3) Audiologists, licensed hearing aid specialists,
speech pathologists, and audiologist-speech
pathologists, biomedical engineers, certified or
registered respiratory therapists, dietitians, licensed
physical therapists, licensed practical or vocational
nurses, nurse assistants, medical instrument
technicians, medical records administrators or
specialists, medical records technicians, medical
technologists, dental hygienists, dental assistants,
nuclear medicine technologists, occupational
therapists, occupational therapy assistants,
kinesiotherapists, orthotist-prosthetists, pharmacists,
pharmacy technicians, physical therapy assistants,
prosthetic representatives, psychologists, diagnostic
radiologic technologists, therapeutic radiologic
technologists, social workers, marriage and family
therapists, licensed professional mental health
counselors, blind rehabilitation specialists, blind
rehabilitation outpatient specialists, and such other
classes of health care occupations as the Secretary
considers necessary for the recruitment and retention
needs of the Department subject to the following
requirements:
(A) Such other classes of health care
occupations--
(i) are not occupations relating to
administrative, clerical, or physical
plant maintenance and protective
services;
(ii) would otherwise receive basic
pay in accordance with the General
Schedule under section 5332 of title 5;
(iii) provide, as determined by the
Secretary, direct patient care services
or services incident to direct patient
services; and
(iv) would not otherwise be available
to provide medical care or treatment
for veterans.
(B) Not later than 45 days before the
Secretary appoints any personnel for a class of
health care occupations that is not
specifically listed in this paragraph, the
Secretary shall submit to the Committee on
Veterans' Affairs of the Senate, the Committee
on Veterans' Affairs of the House of
Representatives, and the Office of Management
and Budget notice of such appointment.
(C) Before submitting notice under
subparagraph (B), the Secretary shall solicit
comments from any labor organization
representing employees in such class and
include such comments in such notice.
Sec. 7402. Qualifications of appointees
(a) To be eligible for appointment to the positions in the
Administration covered by subsection (b), a person must have
the applicable qualifications set forth in that subsection.
(b)(1) Physician.--To be eligible to be appointed to a
physician position, a person must--
(A) hold the degree of doctor of medicine or of
doctor of osteopathy from a college or university
approved by the Secretary,
(B) have completed an internship satisfactory to the
Secretary, and
(C) be licensed to practice medicine, surgery, or
osteopathy in a State.
(2) Dentist.--To be eligible to be appointed to a dentist
position, a person must--
(A) hold the degree of doctor of dental surgery or
dental medicine from a college or university approved
by the Secretary, and
(B) be licensed to practice dentistry in a State.
(3) Nurse.--To be eligible to be appointed to a nurse
position, a person must--
(A) have successfully completed a full course of
nursing in a recognized school of nursing, approved by
the Secretary, and
(B) be registered as a graduate nurse in a State.
(4) Director of a Hospital, Domiciliary, Center, or
Outpatient Clinic.--To be eligible to be appointed to a
director position, a person must have such business and
administrative experience and qualifications as the Secretary
shall prescribe.
(5) Podiatrist.--To be eligible to be appointed to a
podiatrist position, a person must--
(A) hold the degree of doctor of podiatric medicine,
or its equivalent, from a school of podiatric medicine
approved by the Secretary, and
(B) be licensed to practice podiatry in a State.
(6) Optometrist.--To be eligible to be appointed to an
optometrist position, a person must--
(A) hold the degree of doctor of optometry, or its
equivalent, from a school of optometry approved by the
Secretary, and
(B) be licensed to practice optometry in a State.
(7) Pharmacist.--To be eligible to be appointed to a
pharmacist position, a person must--
(A) hold the degree of bachelor of science in
pharmacy, or its equivalent, from a school of pharmacy,
approved by the Secretary, and
(B) be registered as a pharmacist in a State.
(8) Psychologist.--To be eligible to be appointed to a
psychologist position, a person must--
(A) hold a doctoral degree in psychology from a
college or university approved by the Secretary,
(B) have completed study for such degree in a
specialty area of psychology and an internship which
are satisfactory to the Secretary, and
(C) be licensed or certified as a psychologist in a
State, except that the Secretary may waive the
requirement of licensure or certification for an
individual psychologist for a period not to exceed two
years on the condition that that psychologist provide
patient care only under the direct supervision of a
psychologist who is so licensed or certified.
(9) Social Worker.--To be eligible to be appointed to a
social worker position, a person must--
(A) hold a master's degree in social work from a
college or university approved by the Secretary; and
(B) be licensed or certified to independently
practice social work in a State, except that the
Secretary may waive the requirement of licensure or
certification for an individual social worker for a
reasonable period of time recommended by the Under
Secretary for Health.
(10) Marriage and Family Therapist.--To be eligible to be
appointed to a marriage and family therapist position, a person
must--
(A) hold a master's degree in marriage and family
therapy, or a comparable degree in mental health, from
a college or university approved by the Secretary; and
(B) be licensed or certified to independently
practice marriage and family therapy in a State, except
that the Secretary may waive the requirement of
licensure or certification for an individual marriage
and family therapist for a reasonable period of time
recommended by the Under Secretary for Health.
(11) Licensed Professional Mental Health Counselor.--To be
eligible to be appointed to a licensed professional mental
health counselor position, a person must--
(A) hold a master's degree in mental health
counseling, or a related field, from a college or
university approved by the Secretary; and
(B) be licensed or certified to independently
practice mental health counseling.
(12) Chiropractor.--To be eligible to be appointed to a
chiropractor position, a person must--
(A) hold the degree of doctor of chiropractic, or its
equivalent, from a college of chiropractic approved by
the Secretary; and
(B) be licensed to practice chiropractic in a State.
(13) Peer Specialist.--To be eligible to be appointed to a
peer specialist position, a person must--
(A) be a veteran who has recovered or is recovering
from a mental health condition; and
(B) be certified by--
(i) a not-for-profit entity engaged in peer
specialist training as having met such criteria
as the Secretary shall establish for a peer
specialist position; or
(ii) a State as having satisfied relevant
State requirements for a peer specialist
position.
(14) Other Health-Care Positions.--To be appointed as a
physician assistant, expanded-function dental auxiliary,
certified or registered respiratory therapist, licensed
physical therapist, licensed practical or vocational nurse,
occupational therapist, dietitian, microbiologist, chemist,
biostatistician, medical technologist, dental technologist,
hearing aid specialist, or other position, a person must have
such medical, dental, scientific, or technical qualifications
as the Secretary shall prescribe.
(c) Except as provided in section 7407(a) of this title, a
person may not be appointed in the Administration to a position
listed in section 7401(1) of this title unless the person is a
citizen of the United States.
(d) A person may not be appointed under section 7401(1) of
this title to serve in the Administration in any direct
patient-care capacity unless the Under Secretary for Health
determines that the person possesses such basic proficiency in
spoken and written English as will permit such degree of
communication with patients and other health-care personnel as
will enable the person to carry out the person's health-care
responsibilities satisfactorily. Any determination by the Under
Secretary for Health under this subsection shall be in
accordance with regulations which the Secretary shall
prescribe.
(e) A person may not serve as Chief of Staff of a Department
health-care facility if the person is not serving on a full-
time basis.
(f) A person may not be employed in a position under
subsection (b) (other than under paragraph (4) of that
subsection) if--
(1) the person is or has been licensed, registered,
or certified (as applicable to such position) in more
than one State; and
(2) either--
(A) any of those States has terminated such
license, registration, or certification for
cause; or
(B) the person has voluntarily relinquished
such license, registration, or certification in
any of those States after being notified in
writing by that State of potential termination
for cause.
(g) The Secretary may enter into contracts with not-for-
profit entities to provide--
(1) peer specialist training to veterans; and
(2) certification for veterans under subsection
(b)(13)(B)(i).
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