[House Report 115-685]
[From the U.S. Government Publishing Office]


115th Congress    }                                    {       Report
                        HOUSE OF REPRESENTATIVES
 2d Session       }                                    {      115-685

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



 
        IMPROVING OVERSIGHT OF WOMEN VETERANS' CARE ACT OF 2017

                                _______
                                

  May 18, 2018.--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. 4334]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 4334) to provide for certain reporting 
requirements relating to medical care for women veterans 
provided by the Department of Veterans Affairs and through 
contracts entered into by the Secretary of Veterans Affairs 
with non-Department medical providers, and for other purposes, 
having considered the same, report favorably thereon without 
amendment and recommend that the bill do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     2
Background and Need for Legislation..............................     2
Hearings.........................................................     2
Subcommittee Consideration.......................................     3
Committee Consideration..........................................     3
Committee Votes..................................................     3
Committee Oversight Findings.....................................     3
Statement of General Performance Goals and Objectives............     3
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
Statement of Constitutional Authority............................     5
Applicability to Legislative Branch..............................     5
Statement on Duplication of Federal Programs.....................     5
Disclosure of Directed Rulemaking................................     5
Section-by-Section Analysis of the Legislation...................     5
Changes in Existing Law Made by the Bill as Reported.............     6

                          PURPOSE AND SUMMARY

    H.R. 4334, the ``Improving Oversight of Women Veterans' 
Care Act of 2017,'' would (1) require the Department of 
Veterans Affairs to submit to Congress an annual report on the 
accessibility of covered gender-specific medical care furnished 
to female veterans under contracts with non-VA providers, (2) 
require VA Medical Centers (VAMC) to submit quarterly reports 
on compliance with environment of care standards for women 
veterans and (3) report to Congress, no later than 180 days 
after enactment, on the Department's plan to strengthen such 
care standards for women veterans at VA facilities. 
Representative Louis Correa of California introduced H.R. 4334 
on November 9, 2017.

                  BACKGROUND AND NEED FOR LEGISLATION

    The Veterans Health Care Act of 1992 (P.L. 102-585) 
authorized VA to provide gender-specific services for eligible 
women veterans. That authority has become increasingly 
important in recent years as the number of women veterans 
continues to rise and reach critical levels. VA has responded 
to the growing number of women veterans by targeting programs 
and facilities to meet their unique health care needs.\1\
---------------------------------------------------------------------------
    \1\Women Veterans Report: The Past, Present, and Future of Women 
Veterans. National Center for Veterans Analysis and Statistics, 
Department of Veterans Affairs, Washington, DC. February 2017
---------------------------------------------------------------------------
    However, while significant gains have also been made at VA 
medical facilities to ensure privacy and safety for women 
veterans and to ensure timely access to gender-specific care in 
the community when it is not available at VA medical 
facilities, the provision of care to women veterans continues 
to be an area of concern for veteran advocates, who call for 
increased oversight and attention to these issues.\2\
---------------------------------------------------------------------------
    \2\Veterans of Foreign Wars. (2016). In Their Words: Evaluating VA 
Health Care and Benefits for Women Veterans [PDF File].
---------------------------------------------------------------------------
    Section 2 of the bill would require VA to submit an annual 
report to congress on access to (1) mammograms, (2) maternity 
care, and (3) gynecological care for women veterans under 
community care networks, to include data and performance 
measures for wait times, drive times, and reasons why 
appointments could not be scheduled.
    Section 3 of the bill would require each VA Medical Center 
to submit quarterly reports on compliance with environment of 
care standards and report to Congress with a plan to strengthen 
such standards, to include (1) a description of the process 
established to verify noncompliance, and (2) a description of 
the method by which VA will ensure that all patient care areas 
are inspected as required and expand the list of items that 
facility staff inspect for compliance to align with VA's 
women's health handbook.\3\
---------------------------------------------------------------------------
    \3\United States Department of Veterans Affairs. (2017). VHA 
Directive 1330.01(1) Health Care Services For Women Veterans.
---------------------------------------------------------------------------

                                HEARINGS

    On April 17, 2018, the Subcommittee on Health conducted a 
legislative hearing on a number of bills including H.R. 4334.
    The following witnesses testified:
          The Honorable Beto O'Rourke, U.S. House of 
        Representatives, 16th District, Texas;
          The Honorable Tim Walberg, U.S. House of 
        Representatives,7th District, Michigan;
          The Honorable Neal Dunn, U.S. House of 
        Representatives, 2nd District, Florida;
          The Honorable Luis Correa, U.S. House of 
        Representatives, 46th District, California;
          The Honorable Mike Coffman, U.S. House of 
        Representatives, 6th District, Colorado;
          Louis J. Celli, Director, National Veterans Affairs 
        and Rehabilitation Division, The American Legion;
          Adrian M. Atizado, Deputy National Legislative 
        Director, Disabled American Veterans;
          Sarah S. Dean, Associate Legislative Director, 
        Paralyzed Veterans of America; and
          Kayda Keleher, Associate Director, National 
        Legislative Service, Veterans of Foreign Wars of the 
        United States.
    Statements for the record were submitted by:
          The Elizabeth Dole Foundation; The Independence Fund; 
        Veteran Cannabis Project; Wounded Warrior Project; and 
        Iraq and Afghanistan Veterans of America.

                       SUBCOMMITTEE CONSIDERATION

    There was no subcommittee consideration of H.R. 4334.

                        COMMITTEE CONSIDERATION

    On May 8, 2018, the full Committee met in open markup 
session, a quorum being present, and ordered H.R. 4334 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. 
4334 favorably to the House of Representatives was adopted 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. 4334 
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 ensure non-VA network providers 
adhere to and uphold established VA patient safety and privacy 
guidelines for women veterans, and are able to provide a timely 
and convenient alternative to VA-administered services.

   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. 4334 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. 
4334 prepared by 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. 4334 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 9, 2018.
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. 4334, the 
Improving Oversight of Women Veterans' Care Act of 2017.
    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. 4334--Improving Oversight of Women Veterans' Care Act of 2017

    H.R. 4334 would require the Department of Veterans Affairs 
(VA) to submit annual reports to the Congress about the access 
of women veterans to gender-specific health care. The bill also 
would require VA medical facilities to submit quarterly reports 
on health care standards for women veterans. On the basis of 
information from VA, CBO estimates that preparing such reports 
would cost about $300,000 a year (or the equivalent of three 
full-time employees). CBO estimates that implementing this bill 
would cost $2 million over the 2019-2023 period, assuming 
availability of appropriated amounts.
    Enacting H.R. 4334 would not affect direct spending or 
revenues; therefore, pay-as-you-go procedures do not apply.
    CBO estimates that enacting H.R. 4334 would not increase 
net direct spending or on-budget deficits in any of the four 
consecutive 10-year periods beginning in 2029.
    H.R. 4334 contains no intergovernmental or private-sector 
mandates as define in the Unfunded Mandates Reform Act.
    The CBO staff contact for this estimate is Ann E. Futrell. 
The estimate was reviewed by Leo Lex, Deputy Assistant Director 
for Budget Analysis.

                       FEDERAL MANDATES STATEMENT

    The Committee adopts as its own the estimate of Federal 
mandates regarding H.R. 4334 prepared by 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. 
4334.

                 STATEMENT OF CONSTITUTIONAL AUTHORITY

    Pursuant to Article I, section 8 of the United States 
Constitution, H.R. 4334 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. 4334 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 of 1995.

              STATEMENT ON DUPLICATION OF FEDERAL PROGRAMS

    Pursuant to clause 3(c)(5) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that no provision 
of H.R. 4334 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, 115th Cong. (2017), 
the Committee estimates that H.R. 4334 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. 4334 as the, ``Improving Oversight of Women Veterans' Care 
Act of 2017.''

Section 2. Annual Report on Veteran access to covered sex-specific 
        services under community care contracts

    Section 2(a) of the bill would direct the Under Secretary 
of Veterans Affairs to submit to Congress an annual report on 
the provision of covered gender-specific care to women veterans 
under contracts with non-VA providers. Such a report shall 
include: (1) average wait time between the veteran's preferred 
appointment date and the date on which the appointment is 
completed, (2) driving time required for veterans to attend 
appointments, and (3) reasons why appointments could not be 
scheduled with non-Department medical providers.
    Section 2(b) defines the term ``covered sex-specific 
medical care.''
    Section 3(a) would require each VA Medical Center (VAMC) to 
submit quarterly reports to the Secretary of Veterans Affairs 
on the compliance or non-compliance of the facility with the 
environment of care standard for women veterans, including the 
names and roles of those responsible for compliance at each 
facility.
    Section 3(b) would require the Secretary of Veterans 
Affairs, by no later than 180 days after enactment, to submit a 
report to Congress detailing plans to strengthen the 
environment of care standards for women veterans, including: 
(1) a description of the process established to verify that 
noncompliance information reported under section 3(a) is 
accurate and complete; and, (2) a description of the method by 
which the Secretary will (A) ensure that all patient care areas 
of each facility are inspected, as required; and, (B) expand 
the list of items that facility staff inspect for compliance 
with VA's women's health handbook.
    Section 3(c) defines the term ``environment of care 
standards for women veterans.''

         CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

    If enacted, this bill would make no changes in existing 
law.

                                  [all]