[House Report 115-147]
[From the U.S. Government Publishing Office]
115th Congress } { Report
HOUSE OF REPRESENTATIVES
1st Session } { 115-147
======================================================================
NO HERO LEFT UNTREATED ACT
_______
May 23, 2017.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Roe of Tennessee, from the Committee on Veterans' Affairs,
submitted the following
R E P O R T
[To accompany H.R. 1162]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred
the bill (H.R. 1162) to direct the Secretary of Veterans
Affairs to carry out a pilot program to provide access to
magnetic EEG/EKG-guided resonance therapy to veterans, having
considered the same, reports favorably thereon without
amendment and recommends that the bill do pass.
CONTENTS
Page
Purpose and Summary.............................................. 2
Background and Need for Legislation.............................. 2
Hearings Subcommittee............................................ 3
Consideration.................................................... 3
Committee Consideration.......................................... 3
Committee Votes.................................................. 4
Committee Correspondence......................................... 4
Committee Oversight Findings..................................... 4
Statement of General Performance Goals and Objectives............ 4
New Budget Authority, Entitlement Authority, and Tax Expenditures 4
Earmarks and Tax and Tariff Benefits............................. 4
Committee Cost Estimate.......................................... 4
Congressional Budget Office Estimate............................. 4
Federal Mandates Statement....................................... 5
Advisory Committee Statement..................................... 5
Constitutional Authority Statement............................... 5
Applicability to Legislative Branch.............................. 6
Statement on Duplication of Federal Programs..................... 6
Disclosure of Directed Rulemaking................................ 6
Section-by-Section Analysis of the Legislation................... 6
Changes in Existing Law Made by the Bill as Reported............. 7
PURPOSE AND SUMMARY
Representative Stephen Knight of California introduced H.R.
1162, the No Hero Left Untreated Act, on February 16, 2017.
H.R. 1162 would require the Department of Veterans Affairs (VA)
to carry out a one-year pilot program at no more than two VA
medical facilities to provide access to electroencephalogram/
electrocardiogram-guided magnetic resonance therapy (MRT)
technology to veterans with post-traumatic stress disorder
(PTSD), traumatic brain injury (TBI), military sexual trauma
(MST), chronic pain, or opiate addiction.
BACKGROUND AND NEED FOR LEGISLATION
Section 3. Magnetic EEG/EKG-Guided Resonance Therapy
A 2016 VA report titled, Suicide Among Veterans and Other
Americans 2001-2014, found that the rate of mental health
conditions or substance use disorders among Veterans Health
Administration (VHA) patients has been steadily increasing
throughout the 21st century, rising from about twenty-seven
percent in 2001 to over forty percent in 2014.\1\ During the
same time, the number of prescriptions for opioids written by
VA providers has increased 259 percent.\2\ The same report also
found a high rate of suicide among veterans, with approximately
20 veteran suicides per day.\3\ Given these alarming
statistics--which have occurred alongside significant increases
in VA's mental health budget and programming--the Committee
believes there is a demonstrated need to explore new and
innovative treatments for veterans with mental health
conditions or chronic pain.
---------------------------------------------------------------------------
\1\Suicide Among Veterans and Other Americans 2001-2014. http://
www.mentalhealth.va.gov/docs/2016suicidedatareport.pdf.
\2\The Center for Investigative Reporting, VA's Opiate Overload
Feeds Veterans' Addictions, Overdose Deaths, Sep. 28, 2013, http://
cironline.org/reports/vas-opiate-overload-feeds-veterans-addictions-
overdose-deaths-5261
\3\Ibid.
---------------------------------------------------------------------------
Magnetic Resonant Therapy (MRT) is one such promising
treatment. MRT uses quantitative electroencephalogram (EEG)/
electrocardiogram (EKG) technology to identify dysfunctional
areas of the brain in patients suffering from mental health
conditions and then repeatedly applying magnetic stimulation to
help restore proper brain function in those areas. MRT
technology has been approved by the Food and Drug
Administration to treat depression, and has been successfully
used to treat conditions like PTSD and TBI. A 2015 study found
that, after two weeks of MRT treatment, participating veterans
experienced an average 47.4 percent reduction in symptom
severity. After four weeks of MRT treatment, veteran
participants reported an average reduction in symptom severity
of 64 percent.\4\ No adverse events, including worsening of
patients symptoms, were reported during studies.\5\ The
Committee believes that more veterans should have access to MRT
treatment given the promising results that the treatment has
produced thus far.
---------------------------------------------------------------------------
\4\Taghva, Alexander, M.D., et al. Biometrics-Guided Magnetic E-
Resonance Therapy (MeRT) in Post-Traumatic Stress Disorder: A
Randomized, Double-Blind, Sham Controlled Trial.N.p., Nov. 2015.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4727473/.
\5\Taghva, Alexander, M.D., et al. Biometrics-Guided Magnetic E-
Resonance Therapy (MeRT) in Post-Traumatic Stress Disorder.
---------------------------------------------------------------------------
Section 3 of the bill would require VA to carry out a one-
year pilot program at not more than two VA medical facilities
to provide access to MRT treatment for up to fifty veterans
with PTSD, TBI, MST, chronic pain, or opiate addiction and to
submit a report on the pilot program to the Committees on
Veterans Affairs of the House of Representatives and the Senate
90 days after the pilot's termination. The Committee believes
that such a pilot program and the ensuing report would provide
valuable information on the effectiveness of MRT and similar
technologies for veteran patients and potentially open the door
to similar innovative treatments within the VA health care
system. Section 3 of the bill would also stipulate that no
additional funds are authorized to be appropriated to carry out
the requirements of this Act.
HEARINGS
There were no full Committee hearings held on H.R. 1162.
On March 29, 2017, the Subcommittee on Health conducted a
legislative hearing on a number of bills including H.R. 1162.
The following witnesses testified:
The Honorable David. P. Roe M.D. of Tennessee; The
Honorable Jackie Walorski of Indiana; The Honorable
Doug Collins of Georgia; The Honorable Mike Coffman of
Colorado; The Honorable Stephen Knight of California;
The Honorable Ann M. Kuster of New Hampshire; Jennifer
S. Lee, M.D., the Deputy Under Secretary for Health for
Policy and 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
the General Counsel for the U.S. Department of Veterans
Affairs; Kayda Keleher, Legislative Associate for the
National Legislative Service of the Veterans of Foreign
Wars of the United States; Shurhonda Y. Love, the
Assistant National Legislative Director for the
Disabled American Veterans; and, Sarah S. Dean, the
Associate Legislative Director for the Paralyzed
Veterans of America.
Statements for the record were submitted by:
The Honorable Lee Zeldin of New York; The American
Legion; the National Association of State Veteran
Homes; Swords to Plowshares; and, the Wounded Warrior
Project.
SUBCOMMITTEE CONSIDERATION
On April 6, 2017, the Subcommittee on Health met in an open
markup session, a quorum being present, and ordered H.R. 1162
to be reported favorably to the Full Committee by voice vote.
COMMITTEE CONSIDERATION
On May 17, 2017, the Full Committee met in open markup
session, a quorum being present, and ordered H.R. 1162 to be
reported favorably to the House of Representatives by voice
vote. A motion by Representative Tim Walz of Minnesota, Ranking
Member of the Committee on Veterans' Affairs, to report H.R.
1162 favorably 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. 1162
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 create a pilot program to increase
access to MRT treatment for veterans with PTSD, TBI, MST,
chronic pain, or opiate addiction.
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. 1162 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.
1162 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. 1162 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, May 22, 2017.
Hon. Phil Roe, M.D.,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 1162, the No Hero
Left Untreated Act.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Ann E.
Futrell.
Sincerely,
Keith Hall.
Enclosure.
H.R. 1162--No Hero Left Untreated Act
H.R. 1162 would require the Department of Veterans Affairs
(VA) to establish a one-year pilot program to use Magnetic
eResonance Therapy technology (MeRT technology) to treat
veterans with post-traumatic stress disorder, traumatic brain
injury, military sexual trauma, chronic pain, and opiate
addiction. MeRT technology, a neurological treatment, was
pioneered by the Brain Treatment Center (BTC) in Southern
California, which holds proprietary rights in the treatment.
Over the past two years, the center has treated more than 400
veterans at four locations in California and Washington.
Under the bill, VA would carry out the one-year pilot
program with no more than 50 veterans in up to two medical
facilities. We anticipate that VA would contract with BTC to
offer the MeRT technology to veterans. On the basis of
information from BTC, CBO expects the average patient at VA
would undergo an initial assessment at a cost of $1,000 and at
least 20 MeRT sessions over a one-month span at a cost of
$22,000. In total, CBO estimates that implementing this bill
would cost $1 million over the 2018-2022 period; that spending
would be subject to the availability of appropriations.
Enacting the legislation would not affect direct spending
or revenues; therefore, pay-as-you-go procedures do not apply.
CBO estimates that enacting H.R. 1162 would not increase net
direct spending or on-budget deficits in any of the four
consecutive 10-year periods beginning in 2028.
H.R. 1162 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 Ann E. Futrell.
The estimate was approved by H. Samuel Papenfuss, Deputy
Assistant Director for Budget Analysis.
FEDERAL MANDATES STATEMENT
The Committee adopts as its own the estimate of Federal
mandates regarding H.R. 1162 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.
1162.
STATEMENT OF CONSTITUTIONAL AUTHORITY
Pursuant to Article I, section 8 of the United States
Constitution, H.R. 1162 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. 1162 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. 1162 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. 1162 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 the short title for
H.R. 1162, as the No Hero Left Untreated Act.
Section 2. Findings
Section 2 of the bill states the following findings: (1)
the MRT technology has successfully treated more than 400
veterans with PTSD, TBI, MST, chronic pain, and opiate
addiction; (2) that recent clinical trials and randomized,
placebo-controlled, double-blind studies have produced
promising measurable outcomes in the evolution of MRT
technology; (3) that these outcomes have resulted in escalating
demand from returning servicemembers and veterans who are
seeking access to this treatment; and (4) that Congress
recognizes the importance of initiating innovative pilot
programs that demonstrate the use and effectiveness of new
treatment options for post-traumatic stress disorder, traumatic
brain injury, military sexual trauma, chronic pain, and opiate
addiction.
Section 3. Magnetic EEG/EKG-Guided Resonance Therapy
Section 3(a) of the bill would require the Secretary to
carry out a pilot program to provide access to MRT technology
to treat veterans with PTSD, TBI, MST, chronic pain, or opiate
addiction.
Section 3(b) of the bill would require the pilot program
established by section 2(a) of the bill be carried out at not
more than two VA facilities.
Section 3(c) of the bill would prohibit the Secretary from
providing access to MRT technology to more than 50 veterans
during the pilot program.
Section 3(d) of the bill would set a duration of one year
for the pilot program established by section 2(a).
Section 3(e) of the bill would require the Secretary to
submit a report to the House and Senate Committees on Veterans'
Affairs on the pilot program established by Section 2(a) of the
bill by not later than 90 days after the date of the
termination of the pilot.
Section 3(f) of the bill would stipulate that no additional
funds are authorized to be appropriated to carry out the
requirements of Section 2 of the bill, and the requirements of
Section 2 of the bill are required to be carried out using
amounts otherwise authorized.
CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED
If enacted, this bill would make no changes in existing
law.
[all]