[House Report 115-390]
[From the U.S. Government Publishing Office]
115th Congress } { Report
HOUSE OF REPRESENTATIVES
1st Session } { 115-390
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VETERAN URGENT ACCESS TO MENTAL HEALTHCARE ACT
_______
November 6, 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. 918]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred
the bill (H.R. 918) to amend title 38, United States Code, to
direct the Secretary of Veterans Affairs to furnish mental
health care to certain former members of the Armed Forces who
are not otherwise eligible to receive such care, and for other
purposes, having considered the same, report favorably thereon
with an amendment and recommend that the bill as amended do
pass.
CONTENTS
Page
Purpose and Summary.............................................. 4
Background and Need for Legislation.............................. 4
Hearings......................................................... 6
Subcommittee Consideration....................................... 6
Committee Consideration.......................................... 6
Committee Votes.................................................. 6
Committee Oversight Findings..................................... 7
Statement of General Performance Goals and Objectives............ 7
New Budget Authority, Entitlement Authority, and Tax Expenditures 7
Earmarks and Tax and Tariff Benefits............................. 7
Committee Cost Estimate.......................................... 7
Congressional Budget Office Cost Estimate........................ 7
Federal Mandates Statement....................................... 11
Advisory Committee Statement..................................... 11
Statement of Constitutional Authority............................ 11
Applicability to Legislative Branch.............................. 11
Statement on Duplication of Federal Programs..................... 11
Disclosure of Directed Rulemaking................................ 11
Section-by-Section Analysis of the Legislation................... 11
Changes in Existing Law Made by the Bill as Reported............. 13
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Veteran Urgent Access to Mental
Healthcare Act''.
SEC. 2. EXPANSION OF MENTAL HEALTH CARE FOR CERTAIN FORMER MEMBERS OF
THE ARMED FORCES.
(a) In General.--Chapter 17 of title 38, United States Code, is
amended by inserting after section 1720H the following new section:
``Sec. 1720I. Expansion of mental health care for certain former
members of the Armed Forces
``(a) In General.--The Secretary shall furnish to former members of
the Armed Forces described in subsection (b)--
``(1) an initial mental health assessment; and
``(2) the mental health care services authorized under this
chapter that the Secretary determines are required to treat the
mental health care needs of the former member, including risk
of suicide or harming others.
``(b) Former Members of the Armed Forces Described.--A former member
of the Armed Forces described in this subsection is an individual who
meets the following criteria:
``(1) The individual is a former member of the Armed Forces,
including the reserve components, who--
``(A) served in the active military, naval, or air
service, and was discharged or released therefrom under
a condition that is not honorable except--
``(i) dishonorable; or
``(ii) bad conduct discharge;
``(B) has applied for a character of service
determination and such determination has not been made;
and
``(C) is not otherwise eligible to enroll in the
health care system established by section 1705 of this
title by reason of such discharge or release not
meeting the requirements of section 101(2) of this
title.
``(2) While serving in the Armed Forces--
``(A) the former member was deployed in a theater of
combat operations or an area at a time during which
hostilities occurred in that area;
``(B) participated in or experienced such combat
operations or hostilities, including by controlling an
unmanned aerial vehicle from a location other than such
theater or area; or
``(C) was the victim of a physical assault of a
sexual nature, battery of a sexual nature, or sexual
harassment (as defined in section 1720D(f) of this
title).
``(c) Non-Department Care.--(1) In furnishing mental health care
services to an individual under this section, the Secretary may provide
such mental health care services at a non-Department facility if--
``(A) in the judgment of a mental health professional
employed by the Department, the receipt of mental health care
services by that individual in facilities of the Department
would be clinically inadvisable; or
``(B) facilities of the Department are not capable of
furnishing such mental health care services to that individual
economically because of geographical inaccessibility.
``(2) The Secretary shall carry out paragraph (1) pursuant to section
1703 of this title or any other provision of law authorizing the
Secretary to enter into contracts or agreements to furnish hospital
care and medical services to veterans at non-Department facilities.
``(d) Setting and Referrals.--In furnishing mental health care
services to an individual under this section, the Secretary shall--
``(1) seek to ensure that such mental health care services
are furnished in a setting that is therapeutically appropriate,
taking into account the circumstances that resulted in the need
for such mental health care services; and
``(2) provide referral services to assist former members who
are not eligible for services under this chapter to obtain
services from sources outside the Department.
``(e) Information.--The Secretary shall provide information on the
mental health care services available under this section. Efforts by
the Secretary to provide such information--
``(1) shall include availability of a toll-free telephone
number (commonly referred to as an 800 number);
``(2) shall ensure that information about the mental health
care services available under this section--
``(A) is revised and updated as appropriate;
``(B) is made available and visibly posted at
appropriate facilities of the Department; and
``(C) is made available to State veteran agencies and
through appropriate public information services; and
``(3) shall include coordination with the Secretary of
Defense seeking to ensure that members of the Armed Forces and
individuals who are being separated from active military,
naval, or air service are provided appropriate information
about programs, requirements, and procedures for applying for
mental health care services under this section.
``(f) Annual Reports.--Each year, the Secretary shall submit to
Congress an annual report on the mental health care services provided
pursuant to this section. Each report shall include data for the year
covered by the report with respect to each of the following:
``(1) The number of individuals who received mental health
care services under subsection (a), disaggregated by the number
of men who received such services and the number of women who
received such services.
``(2) Such other information as the Secretary considers
appropriate.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 17 of title 38, United States Code, is amended by inserting
after the item relating to section 1720H the following new item:
``1720I. Expansion of mental health care for certain former members of
the Armed Forces.''.
SEC. 3. EXTENSION OF REQUIREMENT FOR COLLECTION OF FEES FOR HOUSING
LOANS GUARANTEED BY SECRETARY OFVETERANS AFFAIRS.
Section 3729(b)(2) of title 38, United States Code, is amended--
(1) in subparagraph (A)--
(A) in clause (iii), by striking ``September 30,
2024'' and inserting ``September 30, 2025''; and
(B) in clause (iv), by striking ``September 30,
2024'' and inserting ``September 30, 2025'';
(2) in subparagraph (B)--
(A) in clause (i), by striking ``September 30, 2024''
and inserting ``September 30, 2025''; and
(B) in clause (ii), by striking ``September 30,
2024'' and inserting ``September 30, 2025'';
(3) in subparagraph (C)--
(A) in clause (i), by striking ``September 30, 2024''
and inserting ``September 30, 2025''; and
(B) in clause (ii), by striking ``September 30,
2024'' and inserting ``September 30, 2025''; and
(4) in subparagraph (D)--
(A) in clause (i), by striking ``September 30, 2024''
and inserting ``September 30, 2025''; and
(B) in clause (ii), by striking ``September 30,
2024'' and inserting ``September 30, 2025''.
SEC. 4. CHARACTER OF SERVICE DETERMINATIONS.
(a) In General.--Chapter 53 of title 38, United States Code, is
amended by inserting after section 5303A the following new section:
``Sec. 5303B. Character of service determinations
``(a) Determination.--The Secretary shall establish a process by
which an individual who served in the Armed Forces and was discharged
or dismissed therefrom may seek a determination from the Secretary with
respect to whether such discharge or release was under a condition that
bars the right of such individual to a benefit under the laws
administered by the Secretary based upon the period of service from
which discharged or dismissed.
``(b) Provision of Information.--If the Secretary determines under
subsection (a) that an individual is barred to a benefit under the laws
administered by the Secretary, the Secretary shall provide to such
individual information regarding the ability of the individual to
address such condition, including pursuant to section 5303 of this
title and chapter 79 of title 10.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item relating to section
5303A the following new item:
``5303B. Character of service determinations.''.
Purpose and Summary
Representative Mike Coffman of Colorado introduced H.R.
918, the Veteran Urgent Access to Mental Healthcare Act, on
February 7, 2017.
H.R. 918, as amended, would: (1) require the Department of
Veterans Affairs (VA) to provide mental health care to certain
former servicemembers who would otherwise be ineligible for
such care because they were discharged from military service
under conditions that were other than honorable (OTH); (2)
extend the requirement to collect fees for certain housing
loans made, insured, or guaranteed by VA; and, (3) require VA
to establish a character of service determination process.
Background and Need for Legislation
Section 2. Expansion of mental health care for certain former members
of the Armed Forces
Veteran status and eligibility for VA benefits and services
generally require an individual to be discharged or released
under conditions other than dishonorable.\1\ Individuals with
OTH discharges may or may not be eligible to enroll in the VA
healthcare system and/or to receive care through the Veterans
Health Administration for conditions other than those incurred
in or aggravated in service in the Armed Forces depending on
the outcome of a character of service review by the Veterans
Benefits Administration.\2\
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\1\Other Than Honorable Discharges--Impact on Eligibility for VA
Health Care Benefits. Health Benefits Resources. https://www.va.gov/
healthbenefits/resources/publications/IB10-
448_other_than_honorable_discharges5_17.pdf Accessed July 20, 2017.
\2\United States Cong. House Committee on Veterans' Affairs
Subcommittee on Health. Legislative Hearing. March 29, 2017. 115th
Cong. 1st sess. Washington: GPO, 2017 (statement from Jennifer S. Lee,
Deputy Under Secretary for Health for Policy and Services, Veterans
Health Administration, U.S. Department of Veterans Affairs).
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According to the Vietnam Veterans of America, ``the use of
less-than-honorable administrative discharges has grown
significantly for recent generations of veterans.''\3\ VA
currently estimates that there are approximately 505,000 former
servicemembers with OTH discharges.\4\ Recently, stakeholders--
including many veterans service organizations--began noting a
connection between combat stress and conditions prevalent among
servicemembers and OTH discharges. For example, the Wounded
Warrior Project testified that, ``in our experience, many
veterans suffering from post-traumatic stress disorder,
traumatic brain injury, or military sexual trauma have received
[OTH] discharges for behavioral problems rooted in the same
circumstances that led to those [discharges].''\5\ The Wounded
Warrior Project also noted that veterans with OTH discharges
are at a greater risk for homelessness, substance use disorder,
incarceration, untreated physical and mental conditions.\6\
Furthermore, VA data has shown that the rate of death by
suicide among those who do not use VA care--like those with OTH
discharges who may be barred from such care--is increasing at a
significantly greater rate than that among veterans who use VA
care.\7\
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\3\United States Cong. House Committee on Veterans' Affairs
Subcommittee on Health. Legislative Hearing. March 29, 2017. 115th
Cong. 1st sess. Washington: GPO, 2017 (statement from Kristofer
Goldsmith, Assistant Director for Policy and Government Affairs,
Vietnam Veterans of America).
\4\Emergent Mental Health Care for Former Service Members. VA Fact
Sheet. June 2017.
\5\United States Cong. House Committee on Veterans' Affairs
Subcommittee on Health. Legislative Hearing. March 29, 2017. 115th
Cong. 1st sess. Washington: GPO, 2017 (statement from Michael S.
Linnington, LTG (ret), U.S. Army, Chief Executive Officer, Wounded
Warrior Project).
\6\Ibid.
\7\Emergent Mental Health Care for Former Service Members. VA Fact
Sheet. June 2017.
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Section 2 of the bill would require VA to provide an
initial mental health assessment and subsequent mental health
services that are required to meet the mental healthcare needs
of former servicemembers who would otherwise be ineligible for
such services because they were discharged from military
service under OTH conditions. Individuals would be eligible for
such care if they have applied for a character of service
determination, deployed or participated in a theater of combat
operations, or were the victim of military sexual assault.
These services could be provided at either VA medical
facilities or at community facilities at VA's expense. Section
2 of the bill would further require VA to submit an annual
report to Congress on the mental healthcare services provided
pursuant to this authority.
Section 3. Extension of requirement for collection of fees for housing
loans guaranteed by Secretary of Veterans Affairs
Under VA's home loan guaranty program, VA may guarantee a
loan made to eligible servicemembers, veterans, reservists, and
certain un-remarried surviving spouses for the purchase or
refinancing of a house, condominium, or manufactured home.
Section 3729(b)(2) of title 38, U.S.C., sets forth a loan fee
table that lists funding fees associated with such loans. These
funding fees are expressed as a percentage of the loan amount
for different types of loans. Under current law, the higher
rates will expire on September 30, 2024.
Section 3 of the bill would extend through September 30,
2025, VA's authority to collect certain funding fees by
amending the fee schedule set forth in section 3729(b)(2) of
title 38, U.S.C.
Section 4. Character of service determinations
Under current procedures, an individual's character of
service is only adjudicated if he/she applies for a specific VA
benefit, like disability compensation.\8\ Therefore, the
majority of those with OTH discharges do not know whether or
not they are eligible to receive VA healthcare services because
their eligibility for such services has never been adjudicated
by VA.\9\
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\8\Ibid.
\9\United States Cong. House Committee on Veterans' Affairs
Subcommittee on Health. Legislative Hearing. March 29, 2017. 115th
Cong. 1st sess. Washington: GPO, 2017 (statement from Swords to
Plowshares, a Veteran Rights Organization, with the assistance of the
Veterans Legal Clinic at Harvard Law School).
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Section 4 of the bill would require VA to establish a
character of service determination process to determine whether
or not an individual's discharge or release from military
service was under a condition that bars such an individual from
accessing VA benefits and services.
Hearings
There were no full Committee hearings held on H.R. 918, as
amended.
On March 29, 2017, the Subcommittee on Health conducted a
legislative hearing on a number of bills, including H.R. 918.
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. 918 to
be reported favorably to the Full Committee by voice vote.
Committee Consideration
On July 19, 2017, the Full Committee met in open markup
session, a quorum being present, and ordered H.R. 918, as
amended, to be reported favorably to the House of
Representatives by voice vote. During consideration of the
bill, the following amendments were considered and agreed to by
voice vote:
An Amendment in the Nature of a Substitute to H.R.
918 offered by Representative Mike Coffman of Colorado.
An Amendment to the Amendment in the Nature of a
Substitute to H.R. 918 offered by Representative Beto
O'Rourke of Texas.
An Amendment to the Amendment in the Nature of a
Substitute to H.R. 918 offered by Representative
Jenniffer Gonzalez-Colon of Puerto Rico.
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. 918, as
amended, reported to the House. A motion by Representative Tim
Walz of Minnesota--the Ranking Member of the Committee on
Veterans' Affairs--to report H.R. 918, as amended, favorably to
the House of Representatives was agreed to by voice vote.
Committee Oversight Findings
In compliance with clause 3(c)(1) of rule XIII and clause
(2)(b)(1) of rule X of the Rules of the House of
Representatives, the Committee's oversight findings and
recommendations are reflected in the descriptive portions of
this report.
Statement of General Performance Goals and Objectives
In accordance with clause 3(c)(4) of rule XIII of the Rules
of the House of Representatives, the Committee's performance
goals and objectives are to provide mental health care to
certain former servicemembers who would otherwise be ineligible
for such care because they were discharged from military
service under conditions that were OTH.
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. 918, 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.
918, 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. 918, 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, September 28, 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. 918, the Veteran
Urgent Access to Mental Healthcare 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,
Director.
Enclosure.
H.R. 918--Veteran Urgent Access to Mental Healthcare Act
Summary: H.R. 918 would change the fees charged to veterans
who obtain loans guaranteed by the Department of Veterans
Affairs (VA). CBO estimates that enacting the bill would
increase direct spending by $688 million over the 2026-2027
period. Because enacting the bill would affect direct spending,
pay-as-you-go procedures apply. Enacting the bill would not
affect revenues.
The bill also would require VA to provide an initial mental
health assessment and subsequent mental health care to certain
former service members who are currently not eligible for such
care. CBO estimates that implementing that provision would cost
$15 million over the 2017-2022 period, assuming appropriation
of the necessary amounts.
CBO estimates that enacting H.R. 918 would not increase net
direct spending or on-budget deficits in any of the four
consecutive 10-year periods beginning in 2028.
H.R. 918 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA)
and would impose no costs on state, local, or tribal
governments.
Estimated cost to the Federal Government: The estimated
budgetary effects of H.R. 918 are shown in the following table.
The costs of this legislation fall within budget function 700
(veterans benefits and services).
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By fiscal year, in millions of dollars--
-------------------------------------------------------------------------------------------------------------------
2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2017-2022 2017-2027
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INCREASES IN DIRECT SPENDING
Estimated Budget Authority.......... 0 0 0 0 0 0 0 0 0 340 348 0 688
Estimated Outlays................... 0 0 0 0 0 0 0 0 0 340 348 0 688
INCREASES IN SPENDING SUBJECT TO APPROPRIATION
Estimated Authorization Level....... 0 4 3 3 3 3 n.a. n.a. n.a. n.a. n.a. 16 n.a.
Estimated Outlays................... 0 3 3 3 3 3 n.a. n.a. n.a. n.a. n.a. 15 n.a.
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Note: n.a. = not applicable.
Basis of estimate: For this estimate, CBO assumes that H.R.
918 will be enacted near the beginning of fiscal year 2018 and
that the estimated amounts will be appropriated each year.
Estimated outlays are based on historical spending patterns for
the affected programs.
Direct spending
Under its Home Loan program, VA guarantees mortgages made
to veterans. Those guarantees enable veterans to get better
loan terms, such as lower interest rates or smaller down
payments. The loan guarantee provides lenders a payment of up
to 25 percent of the outstanding balances (subject to some
limitations on the original loan amounts) in the event that a
veteran defaults on a guaranteed loan. Section 3 would decrease
some of the fees that VA charges veterans for providing those
guarantees. Those fees lower the subsidy cost of the guarantees
by partially offsetting the costs of subsequent defaults.\1\
The subsidy cost of VA loan guarantees are paid from mandatory
appropriations. Hence, by increasing the subsidy cost, lowering
those fees would increase direct spending.
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\1\Under the Federal Credit Reform Act of 1990, the subsidy cost of
a loan guarantee is the net present value of estimated payments by the
government to cover defaults and delinquencies, interest subsidies, or
other expenses, offset by any payments to the government, including
origination fees, other fees, penalties, and recoveries on defaulted
loans. Such subsidy costs are calculated by discounting those expected
cash flows using the rate on Treasury securities of comparable
maturity. The resulting estimated subsidy costs are recorded in the
budget when the loans are disbursed.
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Under current law, the up-front fee varies on the basis of
the size of the down payment and whether the veteran has
previously used the loan-guarantee benefit. Borrowers who are
members of the reserve component pay an additional fee of 0.25
percent of the loan amount. Veterans who receive compensation
for service-connected disabilities areexempt from paying the
fee. The fees that would be affected by section 3 are currently set as
follows:
2.15 percent of the loan amount for loans
with no down payment on the first use of the guarantee
benefit,
3.30 percent of the loan amount for loans
with no down payment on subsequent uses of the
guarantee benefit,
1.50 percent of the loan amount for loans
with a 5 percent down payment, and
0.75 percent of the loan amount for loans
with a 10 percent down payment.
Those fees are scheduled to decline on October 1, 2027, to
1.40 percent, 1.25 percent, 0.75 percent, and 0.50 percent,
respectively.
Under section 3, that scheduled fee reduction would occur
two years earlier, on September 30, 2025. Reducing the fees
from their current level would decrease collections by VA,
thereby increasing the subsidy cost of the loan guarantees.
Based on data from VA regarding the number and initial
principal value of the loans it guarantees each year, CBO
estimates that enacting section 3 would increase direct
spending by $688 million over the 2026-2027 period.
Spending subject to appropriation
Under current law, former service members are eligible for
VA health care benefits if they separated from military service
with an honorable discharge or a discharge characterized as
``General, Under Honorable Conditions.'' Individuals whose
discharges are characterized as ``Under Other Than Honorable
Conditions (OTH),'' Bad Conduct, or Dishonorable are generally
not eligible for those benefits. Section 2 would require VA to
provide an initial health assessment and any necessary mental
health services to former service members who received an OTH
discharge and have requested an upgrade of that status, if they
were deployed to a theater of combat operations, participated
in combat operations or hostilities, or experienced sexual
trauma. That period of special eligibility would end once the
Department of Defense (DoD) has made a determination on the
veteran's request to have the character of their discharge
changed.
On the basis of data from DoD and VA, CBO estimates that
roughly 340 additional former service members would use medical
services through VA each year under this provision. On average,
costs at VA for the first year of treatment for mental health
conditions is about $10,000 (including costs for the initial
mental health assessments). In total, CBO estimates that
implementing this section would cost $15 million over the 2017-
2022 period.
Pay-As-You-Go considerations: The Statutory Pay-As-You-Go
Act of 2010 establishes budget-reporting and enforcement
procedures for legislation affecting direct spending or
revenues. The net changes in outlays that are subject to those
pay-as-you-go procedures are shown in the following table.
CBO ESTIMATE OF PAY-AS-YOU-GO EFFECTS FOR H.R. 918, THE VETERAN URGENT ACCESS TO MENTAL HEALTHCARE ACT, AS ORDERED REPORTED BY THE HOUSE COMMITTEE ON
VETERANS' AFFAIRS ON JULY 19, 2017
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By fiscal year, in millions of dollars--
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2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2017-2022 2017-2027
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NET INCREASE OR DECREASE (-) IN THE DEFICIT
Statutory Pay-As-You-Go Impact............ 0 0 0 0 0 0 0 0 0 340 348 0 688
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Increase in long-term direct spending and deficits: CBO
estimates that enacting the legislation would not increase net
direct spending or on-budget deficits in any of the four
consecutive 10-year periods beginning in 2028.
Intergovernmental and private-sector impact: H.R. 918
contains no intergovernmental or private-sector mandates as
defined in UMRA and would impose no costs on state, local, or
tribal governments.
Previous CBO estimates: The language in H.R. 918, the
Veteran Urgent Access to Mental Healthcare Act that affects
loan guarantee fees is similar to language in the following
bills that were ordered reported by the House Committee on
Veterans' Affairs on July 19, 2017:
H.R. 95, the Veterans' Access to Child Care
Act, and
H.R. 3262, the Grow Our Own Directive:
Physician Assistant Employment and Education Act of
2017.
However, CBO's estimate of the loan guarantee fees in H.R.
918 differs from those in the above mentioned bills because of
different proposed extension periods and the enactment of S.
114, the VA Choice and Quality Employment Act of 2017, on
August 12, 2017.
When H.R. 918 was ordered reported on July 19, 2017, the
loan fees were scheduled to decline on September 30, 2024. S.
114, the VA Choice and Quality Employment Act of 2017 (Public
Law 115-46), which was enacted on August 12, 2017, postponed
the date on which those fees would decline to September 30,
2027. Compared with the law prior to enactment of that act,
section 3 would have postponed the date on which the fees would
have declined by one year. Thus, absent the enactment of S.
114, section 3 would have reduced direct spending by $332
million in 2025, CBO estimates.
Estimate prepared by: Federal Costs: Ann E. Futrell and
David Newman; Impact on State, Local, and Tribal Governments:
Jon Sperl; Impact on the Private Sector: Paige Piper/Bach.
Estimate approved by: H. Samuel Papenfuss, Deputy Assistant
Director for Budget Analysis.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates regarding H.R. 918, 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.
918, as amended.
Statement of Constitutional Authority
Pursuant to Article I, section 8 of the United States
Constitution, H.R. 918, 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. 918, 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. 918, 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. 918, 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 H.R.
918, as amended, as the ``Veteran Urgent Access to Mental
Healthcare Act.''
Section 2. Expansion of mental health care for certain former members
of the Armed Forces
Section 2(a) of the bill would amend subchapter II of
chapter 17 of title 38 to of title 38 U.S.C. to add at the end
the new section, Sec. 1720I. Expansion of mental health care
for certain former members of the Armed Forces.''
The new subsection 1720I(a) would require that the
Secretary furnish to former members of the Armed Forces
described in subsection (b): (1) an initial mental health
assessment; and, (2) any subsequent mental health services that
are required to meet their mental health care needs, including
services that address risk of suicide or harming others.
The new subsection 1720I(b) would define former members of
the Armed Services to mean individuals who: (1) served in the
active duty military, naval, or air service, as well as the
reserve component, and were discharged or released under a
less-than-honorable condition, but not dishonorable or a bad
conduct discharge, who have applied for a character of service
determination that has not yet been made, and, are not
otherwise eligible to enroll in the VHA health care system; (2)
were deployed or participated in a theater of combat
operations; or, (3) were the victims of military sexual
assault.
The new subsection 1720I(c) would allow the Secretary to
furnish such care at a non-VA facility if the VA provider
determines that furnishing the care within VA would be
clinically inadvisable or a VA facility is not capable of
providing the services. This subsection would also require the
Secretary to enter into any necessary contracts or agreements
to furnish this care at non-VA facilities.
The new subsection 1720I (d) would require the Secretary
to: (1) seek to ensure that such mental health care services
are furnished in a setting that is therapeutically appropriate,
taking into account the circumstances that resulted in the need
for such services; and, (2) provide referral services to assist
former members who are not eligible for services under this
chapter to obtain services from sources outside VA.
The new subsection 1720I (e) would require that the
Secretary provide information on the mental health care
services available under this section, to include ensuring: (1)
the availability of a toll-free phone number; (2) that the
information available is revised and updated as needed, visible
at VA facilities, and is made available to State veteran
agencies; and, (3) produced in coordination with DOD to ensure
that separating servicemembers receive it.
The new subsection 1720I (f) would require that the
Secretary submit to Congress an annual report on the mental
health care services provided pursuit to this section, to
include: (1) the number of men and the number of women,
respectively, who received services; and, (2) any other
information the Secretary considers appropriate.
Section 2(b) of the bill would amend the table of sections
at the beginning of chapter 17 of title 38 by inserting
``1720I. Expansion of mental health care for certain former
members of the Armed Forces'' following the item relating to
section 1720H.
Section 3. Extension of requirement for collection of fees for housing
loans guaranteed by Secretary of Veterans Affairs
Section 3 of the bill would amend section 3729(b)(2) of
title 38, U.S.C. clause (iii) in subparagraph (A) by striking
``September 30, 2024'' and inserting ``September 30, 2025;''
clause (iv) in subparagraph (A) by striking ``September 30,
2024'' and inserting ``September 30, 2025;'' clause (i) in
subparagraph (B) by striking ``September 30, 2024'' and
inserting ``September 30, 2025;'' clause (ii) in subparagraph
(B) by striking ``September 30, 2024'' and inserting
``September 30, 2025;'' clause (i) in subparagraph (C) by
striking ``September 30, 2024'' and inserting ``September 30,
2025;'' clause (ii) in subparagraph (C) by striking ``September
30, 2024'' and inserting ``September 30, 2025;'' clause (i) in
subparagraph (D) by striking ``September 30, 2024'' and
inserting ``September 30, 2025;'' and, clause (ii) in
subparagraph (D) by striking ``September 30, 2024'' and
inserting ``September 30, 2025.''
Section 4. Character of service determination
Section 4(a) of the bill would amend chapter 53 of title
38, U.S.C., by inserting after section 5303A the new section,
``Sec. 5303B. Character of service determinations.''
The new subsection 5303B(a) would require that the
Secretary establish a process by which an individual who was
discharged from the Armed Services can seek a determination
from the Secretary with respect to whether that discharge was
under a condition that bars him or her from receiving a benefit
under the laws administered by the Secretary.
The new section 5303B(a) would require that if the
Secretary determines under subsection 5303B(a) that an
individual is barred from receiving a benefit, the Secretary
shall provide to such individual information regarding the
ability of the individual to address such condition, including
pursuant to section 5303 of this title and chapter 79 of title
10.
Section 4(b) of the bill would amend the table of sections
at the beginning of chapter 53 of title 38 by inserting
``5303B. Character of service determinations.''
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 italics, and existing law in which no
change is proposed is shown in roman):
TITLE 38, UNITED STATES CODE
* * * * * * *
PART II--GENERAL BENEFITS
* * * * * * *
CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE
SUBCHAPTER I--GENERAL
Sec.
1701. Definitions.
* * * * * * *
SUBCHAPTER II--HOSPITAL, NURSING HOME, OR DOMICILIARY CARE AND MEDICAL
TREATMENT
* * * * * * *
1720I. Expansion of mental health care for certain former members of the
Armed Forces.
* * * * * * *
SUBCHAPTER II--HOSPITAL, NURSING HOME, OR DOMICILIARY CARE AND MEDICAL
TREATMENT
* * * * * * *
Sec. 1720I. Expansion of mental health care for certain former members
of the Armed Forces
(a) In General.--The Secretary shall furnish to former
members of the Armed Forces described in subsection (b)--
(1) an initial mental health assessment; and
(2) the mental health care services authorized under
this chapter that the Secretary determines are required
to treat the mental health care needs of the former
member, including risk of suicide or harming others.
(b) Former Members of the Armed Forces Described.--A former
member of the Armed Forces described in this subsection is an
individual who meets the following criteria:
(1) The individual is a former member of the Armed
Forces, including the reserve components, who--
(A) served in the active military, naval, or
air service, and was discharged or released
therefrom under a condition that is not
honorable except--
(i) dishonorable; or
(ii) bad conduct discharge;
(B) has applied for a character of service
determination and such determination has not
been made; and
(C) is not otherwise eligible to enroll in
the health care system established by section
1705 of this title by reason of such discharge
or release not meeting the requirements of
section 101(2) of this title.
(2) While serving in the Armed Forces--
(A) the former member was deployed in a
theater of combat operations or an area at a
time during which hostilities occurred in that
area;
(B) participated in or experienced such
combat operations or hostilities, including by
controlling an unmanned aerial vehicle from a
location other than such theater or area; or
(C) was the victim of a physical assault of a
sexual nature, battery of a sexual nature, or
sexual harassment (as defined in section
1720D(f) of this title).
(c) Non-Department Care.--(1) In furnishing mental health
care services to an individual under this section, the
Secretary may provide such mental health care services at a
non-Department facility if--
(A) in the judgment of a mental health professional
employed by the Department, the receipt of mental
health care services by that individual in facilities
of the Department would be clinically inadvisable; or
(B) facilities of the Department are not capable of
furnishing such mental health care services to that
individual economically because of geographical
inaccessibility.
(2) The Secretary shall carry out paragraph (1) pursuant to
section 1703 of this title or any other provision of law
authorizing the Secretary to enter into contracts or agreements
to furnish hospital care and medical services to veterans at
non-Department facilities.
(d) Setting and Referrals.--In furnishing mental health care
services to an individual under this section, the Secretary
shall--
(1) seek to ensure that such mental health care
services are furnished in a setting that is
therapeutically appropriate, taking into account the
circumstances that resulted in the need for such mental
health care services; and
(2) provide referral services to assist former
members who are not eligible for services under this
chapter to obtain services from sources outside the
Department.
(e) Information.--The Secretary shall provide information on
the mental health care services available under this section.
Efforts by the Secretary to provide such information--
(1) shall include availability of a toll-free
telephone number (commonly referred to as an 800
number);
(2) shall ensure that information about the mental
health care services available under this section--
(A) is revised and updated as appropriate;
(B) is made available and visibly posted at
appropriate facilities of the Department; and
(C) is made available to State veteran
agencies and through appropriate public
information services; and
(3) shall include coordination with the Secretary of
Defense seeking to ensure that members of the Armed
Forces and individuals who are being separated from
active military, naval, or air service are provided
appropriate information about programs, requirements,
and procedures for applying for mental health care
services under this section.
(f) Annual Reports.--Each year, the Secretary shall submit to
Congress an annual report on the mental health care services
provided pursuant to this section. Each report shall include
data for the year covered by the report with respect to each of
the following:
(1) The number of individuals who received mental
health care services under subsection (a),
disaggregated by the number of men who received such
services and the number of women who received such
services.
(2) Such other information as the Secretary considers
appropriate.
* * * * * * *
PART III--READJUSTMENT AND RELATED BENEFITS
* * * * * * *
CHAPTER 37--HOUSING AND SMALL BUSINESS LOANS
* * * * * * *
Sec. 3729. Loan fee
(a) Requirement of Fee.--(1) Except as provided in subsection
(c), a fee shall be collected from each person obtaining a
housing loan guaranteed, insured, or made under this chapter,
and each person assuming a loan to which section 3714 of this
title applies. No such loan may be guaranteed, insured, made,
or assumed until the fee payable under this section has been
remitted to the Secretary.
(2) The fee may be included in the loan and paid from the
proceeds thereof.
(b) Determination of Fee.--(1) The amount of the fee shall be
determined from the loan fee table in paragraph (2). The fee is
expressed as a percentage of the total amount of the loan
guaranteed, insured, or made, or, in the case of a loan
assumption, the unpaid principal balance of the loan on the
date of the transfer of the property.
(2) The loan fee table referred to in paragraph (1) is as
follows:
LOAN FEE TABLE
------------------------------------------------------------------------
Active duty
Type of loan veteran Reservist Other obligor
------------------------------------------------------------------------
(A)(i) Initial 2.00 2.75 NA
loan
described in
section
3710(a) to
purchase or
construct a
dwelling with
0-down, or
any other
initial loan
described in
section
3710(a) other
than with 5-
down or 10-
down (closed
before
January 1,
2004)
(A)(ii) 2.20 2.40 NA
Initial loan
described in
section
3710(a) to
purchase or
construct a
dwelling with
0-down, or
any other
initial loan
described in
section
3710(a) other
than with 5-
down or 10-
down (closed
on or after
January 1,
2004, and
before
October 1,
2004)
(A)(iii) 2.15 2.40 NA
Initial loan
described in
section
3710(a) to
purchase or
construct a
dwelling with
0-down, or
any other
initial loan
described in
section
3710(a) other
than with 5-
down or 10-
down (closed
on or after
October 1,
2004, and
before
September 30,
[2024] 2025 )
(A)(iv) 1.40 1.65 NA
Initial loan
described in
section
3710(a) to
purchase or
construct a
dwelling with
0-down, or
any other
initial loan
described in
section
3710(a) other
than with 5-
down or 10-
down (closed
on or after
September 30,
[2024] 2025 )
(B)(i) 3.30 3.30 NA
Subsequent
loan
described in
section
3710(a) to
purchase or
construct a
dwelling with
0-down, or
any other
subsequent
loan
described in
section
3710(a)
(closed
before
September 30,
[2024] 2025 )
(B)(ii) 1.25 1.25 NA
Subsequent
loan
described in
section
3710(a) to
purchase or
construct a
dwelling with
0-down, or
any other
subsequent
loan
described in
section
3710(a)
(closed on or
after
September 30,
[2024] 2025 )
(C)(i) Loan 1.50 1.75 NA
described in
section
3710(a) to
purchase or
construct a
dwelling with
5-down
(closed
before
September 30,
[2024] 2025 )
(C)(ii) Loan 0.75 1.00 NA
described in
section
3710(a) to
purchase or
construct a
dwelling with
5-down
(closed on or
after
September 30,
[2024] 2025 )
(D)(i) Initial 1.25 1.50 NA
loan
described in
section
3710(a) to
purchase or
construct a
dwelling with
10-down
(closed
before
September 30,
[2024] 2025 )
(D)(ii) 0.50 0.75 NA
Initial loan
described in
section
3710(a) to
purchase or
construct a
dwelling with
10-down
(closed on or
after
September 30,
[2024] 2025 )
(E) Interest 0.50 0.50 NA
rate
reduction
refinancing
loan
(F) Direct 1.00 1.00 NA
loan under
section 3711
(G) 1.00 1.00 NA
Manufactured
home loan
under section
3712 (other
than an
interest rate
reduction
refinancing
loan)
(H) Loan to 1.25 1.25 NA
Native
American
veteran under
section 3762
(other than
an interest
rate
reduction
refinancing
loan)
(I) Loan 0.50 0.50 0.50
assumption
under section
3714
(J) Loan under 2.25 2.25 2.25
section
3733(a)
------------------------------------------------------------------------
(3) Any reference to a section in the ``Type of loan'' column
in the loan fee table in paragraph (2) refers to a section of
this title.
(4) For the purposes of paragraph (2):
(A) The term ``active duty veteran'' means any
veteran eligible for the benefits of this chapter other
than a Reservist.
(B) The term ``Reservist'' means a veteran described
in section 3701 (b)(5)(A) of this title who is eligible
under section 3702(a)(2)(E) of this title.
(C) The term ``other obligor'' means a person who is
not a veteran, as defined in section 101 of this title
or other provision of this chapter.
(D) The term ``initial loan'' means a loan to a
veteran guaranteed under section 3710 or made under
section 3711 of this title if the veteran has never
obtained a loan guaranteed under section 3710 or made
under section 3711 of this title.
(E) The term ``subsequent loan'' means a loan to a
veteran, other than an interest rate reduction
refinancing loan, guaranteed under section 3710 or made
under section 3711 of this title if the veteran has
previously obtained a loan guaranteed under section
3710 or made under section 3711 of this title.
(F) The term ``interest rate reduction refinancing
loan'' means a loan described in section 3710(a)(8),
3710(a)(9)(B)(i), 3710(a)(11), 3712(a)(1)(F), or
3762(h) of this title.
(G) The term ``0-down'' means a downpayment, if any,
of less than 5 percent of the total purchase price or
construction cost of the dwelling.
(H) The term ``5-down'' means a downpayment of at
least 5 percent or more, but less than 10 percent, of
the total purchase price or construction cost of the
dwelling.
(I) The term ``10-down'' means a downpayment of 10
percent or more of the total purchase price or
construction cost of the dwelling.
(c) Waiver of Fee.--(1) A fee may not be collected under this
section from a veteran who is receiving compensation (or who,
but for the receipt of retirement pay or active service pay,
would be entitled to receive compensation) or from a surviving
spouse of any veteran (including a person who died in the
active military, naval, or air service) who died from a
service-connected disability.
(2)(A) A veteran described in subparagraph (B) shall be
treated as receiving compensation for purposes of this
subsection as of the date of the rating described in such
subparagraph without regard to whether an effective date of the
award of compensation is established as of that date.
(B) A veteran described in this subparagraph is a veteran who
is rated eligible to receive compensation--
(i) as the result of a pre-discharge disability
examination and rating; or
(ii) based on a pre-discharge review of existing
medical evidence (including service medical and
treatment records) that results in the issuance of a
memorandum rating.
* * * * * * *
PART IV--GENERAL ADMINISTRATIVE PROVISIONS
* * * * * * *
CHAPTER 53--SPECIAL PROVISIONS RELATING TO BENEFITS
Sec.
5301. Nonassignability and exempt status of benefits.
* * * * * * *
5303B. Character of service determinations.
* * * * * * *
Sec. 5303B. Character of service determinations
(a) Determination.--The Secretary shall establish a process
by which an individual who served in the Armed Forces and was
discharged or dismissed therefrom may seek a determination from
the Secretary with respect to whether such discharge or release
was under a condition that bars the right of such individual to
a benefit under the laws administered by the Secretary based
upon the period of service from which discharged or dismissed.
(b) Provision of Information.--If the Secretary determines
under subsection (a) that an individual is barred to a benefit
under the laws administered by the Secretary, the Secretary
shall provide to such individual information regarding the
ability of the individual to address such condition, including
pursuant to section 5303 of this title and chapter 79 of title
10.
* * * * * * *
[all]