[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\
---------------------------------------------------------------------------
    \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.
---------------------------------------------------------------------------
    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




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PART III--READJUSTMENT AND RELATED BENEFITS

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  CHAPTER 39--AUTOMOBILES AND ADAPTIVE EQUIPMENT FOR CERTAIN DISABLED 
VETERANS AND MEMBERS OF THE ARMED FORCES

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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.

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PART V--BOARDS, ADMINISTRATIONS, AND SERVICES

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         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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