[House Report 116-72]
[From the U.S. Government Publishing Office]


116th Congress    }                                    {        Report
                        HOUSE OF REPRESENTATIVES
 1st Session      }                                    {        116-72

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



 
                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.
---------------------------------------------------------------------------
    \1\ VA National Suicide Data Report 2005-2016, Office of Mental 
Health and Suicide Prevention, U.S. Department of Veterans Affairs, 
September 2018.
---------------------------------------------------------------------------
    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\
---------------------------------------------------------------------------
    \2\ Executive Order on a National Roadmap to Empower Veterans and 
End Suicide, The White House, March 5, 2019.
---------------------------------------------------------------------------
    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.

                                  [all]