[House Report 116-72]
[From the U.S. Government Publishing Office]
116th Congress } { Report
HOUSE OF REPRESENTATIVES
1st Session } { 116-72
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VETERANS' CARE QUALITY TRANSPARENCY ACT
_______
May 17, 2019.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Takano, from the Committee on Veterans' Affairs,
submitted the following
R E P O R T
[To accompany H.R. 2372]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred
the bill (H.R. 2372) to direct the Comptroller General of the
United States to conduct an assessment of all memoranda of
understanding and memoranda of agreement between Under
Secretary of Health and non-Department of Veterans Affairs
entities relating to suicide prevention and mental health
services, 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.............................................. 2
Background and Need for Legislation.............................. 2
Hearings......................................................... 3
Subcommittee Consideration....................................... 4
Committee Consideration.......................................... 4
Committee Votes.................................................. 4
Committee Oversight Findings..................................... 5
Congressional Budget Office Estimate............................. 5
Committee Cost Estimate.......................................... 6
Statement of General Performance Goals and Objectives............ 6
New Budget Authority, Entitlement Authority, and Tax Expenditures 6
Earmarks and Tax and Tariff Benefits............................. 6
Federal Mandates Statement....................................... 6
Advisory Committee Statement..................................... 6
Constitutional Authority Statement............................... 7
Applicability to Legislative Branch.............................. 7
Statement on Duplication of Federal Programs..................... 7
Section-by-Section Analysis of the Legislation................... 7
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 ``Veterans' Care Quality Transparency
Act''.
SEC. 2. COMPTROLLER GENERAL ASSESSMENT OF MEMORANDA OF UNDERSTANDING
AND MEMORANDA OF AGREEMENT BETWEEN UNDER SECRETARY
OF HEALTH AND NON-DEPARTMENT OF VETERANS AFFAIRS
ENTITIES RELATING TO SUICIDE PREVENTION AND MENTAL
HEALTH SERVICES.
(a) Assessment.--Not later than 270 days after the date of the
enactment of this Act, the Comptroller General of the United States
shall conduct an assessment of the effectiveness of all memoranda of
understanding and memoranda of agreement entered into by the Under
Secretary of Veterans Affairs for Health and a non-Department of
Veterans Affairs entity relating to--
(1) suicide prevention activities and outreach; and
(2) the provision or coordination of mental health services
during the five-year period preceding the date of the enactment
of this Act.
(b) Contents of Assessment.--The assessment required by subsection
(a) shall include an assessment of--
(1) the size of the catchment area of each such entity;
(2) the staffing structures of such entities;
(3) any accreditation or licensure any such entity has
obtained in relation to the services the entity provides;
(4) any variances in the subpopulations of veterans served by
such entities;
(5) any limitations any such entity may face in carrying out
its obligations under the memorandum of understanding or
memorandum of agreement;
(6) the extent to which the Under Secretary provides
oversight and tracks outcomes of such entities;
(7) any variations in the structure or requirements of the
memoranda of understanding and memoranda of agreement;
(8) a breakdown of the percentage of such entities that
serve--
(A) women veterans;
(B) minority veterans;
(C) veterans who are over the age of 55;
(D) veterans between the ages of 18 and 34;
(E) veterans who reside in United States insular
areas; and
(F) veterans' families; and
(9) any measures taken to ensure the secure exchange of data
and information between such entities and the Department of
Veterans Affairs.
(c) Report to Congress.--Not later than 270 days after the completion
of the assessment under subsection (a), the Comptroller General shall
submit to the Committees on Veterans' Affairs of the Senate and House
of Representatives a report on the results of the assessment.
PURPOSE AND SUMMARY
H.R. 2372, as amended, would require the Comptroller
General of the United States (GAO) to conduct an assessment,
within 270 days of enactment of this Act, of the effectiveness
of all memoranda of understanding (MOU) and memoranda of
agreement (MOA) between the Undersecretary of Health at the
Department of Veterans Affairs (VA) and non-VA entities in the
past five years relating to suicide prevention and mental
health services. It also requires GAO to report to the
Committees on Veterans' Affairs of the Senate and House of
Representatives on the results of the assessment.
Representative Lauren Underwood of Illinois introduced H.R.
2372 on April 25, 2019.
BACKGROUND AND NEED FOR LEGISLATION
According to the National Suicide Data Report for 2005-
2016, approximately 20 veterans, members of the National Guard,
and reservists die by suicide each day in this country.\1\ The
Committee applauds VA's recent shift to a public health
approach for suicide prevention. Such a shift requires greater
involvement from government and policy makers and all segments
of society.
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\1\ VA National Suicide Data Report 2005-2016, Office of Mental
Health and Suicide Prevention, U.S. Department of Veterans Affairs,
September 2018.
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VA has long relied on community partners to provide
outreach to veterans regarding mental health services and
suicide prevention. The number of mental health and suicide
prevention related MOUs/MOAs have increased significantly since
2014. It is anticipated these relationships will continue to
increase in numbers after President Trump signed Executive
Order 13861 on March 5, 2019. Executive Order 13861 seeks to
establish grants to local communities ``to enable them to
increase their capacity to collaborate with each other to
integrate service delivery to veterans and to coordinate
resources for veterans.''\2\
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\2\ Executive Order on a National Roadmap to Empower Veterans and
End Suicide, The White House, March 5, 2019.
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As reliance on outside groups grow, the Committee seeks to
better understand the effectiveness of the programs and mental
health services offered by these organizations and providers.
VA must ensure it is only working with organizations that
provide quality, culturally competent, evidence-based
healthcare and services to veterans.
As part of the assessment, GAO is required to look at
several factors such as the staffing structure of the
organization, its accreditations or licensures, the level of
oversight and tracking of outcomes by VA, the secure exchange
of data and information, and a breakdown of the entity's
ability to serve unique subsets of the veteran population--
women, minorities, older and younger veteran cohorts, families,
and veterans who reside in U.S. insular areas.
HEARINGS
For the purposes of section 103(i) of H. Res. 6 of the
116th Congress--(1) the following hearings were used to develop
or consider H.R. 2372.
On April 29, 2019, the Committee on Veterans' Affairs
conducted an oversight hearing titled, ``Tragic Trends: Suicide
Prevention Among Veterans'' to explore actions the Department
of Veterans Affairs and the House Committee on Veterans'
Affairs could take to combat the epidemic of suicide within the
veteran population.
The following witnesses testified:
Shelli Avenevoli PhD, the Deputy Director of the
National Institute of Mental Health within the National
Institute of Health; Richard McKeon PhD, MPH, the Chief
of the Suicide Prevention Branch within the Substance
Abuse and Mental Health Services Administration; and
Richard Stone M.D., the Executive-in-Charge of the
Veterans Health Administration within the U.S.
Department of Veterans Affairs, who was accompanied by
Keita Franklin LCSW, PhD, the National Director of
Suicide Prevention of the Office of Mental Health and
Suicide Prevention within the U.S. Department of
Veterans Affairs.
Statements for the record were received by:
American Veterans, Disabled American Veterans, Iraq
and Afghanistan Veterans of America, The American
Legion, Vietnam Veterans of America, Wounded Warrior
Project, Center for Disease Control, Veterans of
Foreign Wars, and The Independence Fund.
On April 30, 2019, the Subcommittee on Health conducted a
legislative hearing on several bills including H.R. 2372.
The following witnesses testified:
The Honorable Earl Blumenauer, U.S. House of
Representatives; The Honorable J. Louis Correa, U.S.
House of Representatives; The Honorable Conor Lamb,
U.S. House of Representatives; The Honorable Max Rose,
U.S. House of Representatives; Keita Franklin LCSW,
PhD, the National Director of Suicide Prevention of the
Office of Mental Health and Suicide Prevention within
the U.S. Department of Veterans Affairs, who was
accompanied by Tracy Gaudet M.D., the Director of the
Office of Patient Centered Care within the U.S.
Department of Veterans Affairs and Larry Mole PharmD,
the Chief Consultant on Population Health of the U.S.
Department of Veterans Affairs; Stephanie Mullen,
Research Director for Iraq and Afghanistan Veterans of
America; Carlos Fuentes, the Director of the National
Legislative Service within Veterans of Foreign Wars;
and Joy Ilem, the National Legislative Director for
Disabled American Veterans.
No statements for the record were received.
SUBCOMMITTEE CONSIDERATON
H.R. 2372 was not considered before the Subcommittee.
COMMITTEE CONSIDERATION
On May 8, 2019, the Full Committee met in an open markup
session, a quorum being present, and reported favorably H.R.
2372, as amended, 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 substitute offered by
Representative Mark Takano of California that would require GAO
to conduct an assessment, within 270 days of enactment of this
Act, of the effectiveness of all MOU and MOA entered into by
the Undersecretary of Health and non- U.S. Department of
Veterans Affairs (VA) entities in the past five years relating
to suicide prevention and mental health services. The amendment
in a nature of a substitute to H.R. 2372 also required GAO to
report to the Committees on Veterans' Affairs of the Senate and
House of Representatives the results of the assessment.
An amendment to the amendment in the nature of a substitute
to H.R. 2372 offered by Representative Gregorio Sablan of
Northern Mariana Islands that would require GAO to report on
the percentage of such entities under MOA/MOU that serve
veterans who reside in United States insular areas.
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. 2372,
as amended, reported to the House. A motion by Ranking Member
David P. Roe of Tennessee to report H.R. 2372, as amended,
favorably to the House of Representatives was adopted 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.
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. 2372, as amended, provided by the Director of the
Congressional Budget Office pursuant to section 402 of the
Congressional Budget Act of 1974:
U.S. Congress,
Congressional Budget Office,
Washington, DC, May 16, 2019.
Hon. Mark Takano,
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. 2372, the
Veterans' Care Quality Transparency 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,
Mark P. Hadley,
(For Keith Hall, Director)
Enclosure.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
H.R. 2372 would require the Government Accountability
Office (GAO) to assess the effectiveness of all memoranda of
understanding between the Department of Veterans Affairs and
other entities related to suicide prevention and mental health
services. The bill also would require GAO to provide the
results of that assessment to the Congress not later than 18
months after the bill is enacted.
On the basis of information from GAO, CBO estimates that
preparing the report would require four full-time employees at
an average compensation of $130,000. As a result, CBO estimates
that implementing the bill would cost $1 million over the 2020-
2024 period; such spending would be subject to the availability
of appropriated funds.
The CBO staff contact for this estimate is Ann E. Futrell.
The estimate was reviewed by Theresa Gullo, Assistant Director
for Budget Analysis.
COMMITTEE COST ESTIMATE
The Committee adopts as its own the cost estimate on H.R.
2372, as amended, prepared by the Director of the Congressional
Budget Office pursuant to section 402 of the Congressional
Budget Act of 1974.
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 expand access to high quality
mental healthcare and related resources to curb the prevalence
of suicide among our nation's veterans, servicemembers,
Reservists, and members of the Coast Guard and National Guard.
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. 2372, 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.
FEDERAL MANDATES STATEMENT
The Committee adopts as its own the estimate of Federal
mandates regarding H.R. 2372, 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.
2372, as amended.
CONSTITUTIONAL AUTHORITY STATEMENT
Pursuant to Article I, section 8 of the United States
Constitution, H.R. 2372, 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. 2372, 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 clause 3(c)(5) of rule XIII of the Rules of the
House of Representatives, the Committee finds that no provision
of H.R. 2372, 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.
SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION
Section 1. Short title
Section 1 of the bill establishes the short tile of the
measure as the ``Veterans' Care Quality Transparency Act.''
Section 2. Comptroller General assessment of memoranda of understanding
and memoranda of agreement between Under Secretary of Health
and non-Department of Veterans Affairs entities relating to
suicide prevention and mental health services
Section 2 of the bill would direct the Comptroller General
of the United States, no later than 270 after enactment, to
assess all memoranda of understanding and memoranda of
agreement between Under Secretary of Health at the Department
of Veterans Affairs and non-Department of Veterans Affairs
entities relating to suicide prevention and the provision or
coordination of mental health services during the five-year
period preceding the date of enactment.
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