[House Report 112-235]
[From the U.S. Government Publishing Office]
112th Congress Report
HOUSE OF REPRESENTATIVES
1st Session 112-235
======================================================================
VETERANS SEXUAL ASSAULT PREVENTION AND HEALTH CARE ENHANCEMENT ACT
_______
October 5, 2011.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Miller of Florida, from the Committee on Veterans' Affairs,
submitted the following
R E P O R T
[To accompany H.R. 2074]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred the
bill (H.R. 2074) to amend title 38, United States Code, to
require a comprehensive policy on reporting and tracking sexual
assault incidents and other safety incidents that occur at
medical facilities of the Department of Veterans Affairs,
having considered the same, report favorably thereon with
amendments and recommend that the bill as amended do pass.
CONTENTS
Page
Amendment........................................................ 2
Purpose and Summary.............................................. 5
Background and Need for Legislation.............................. 6
Hearings......................................................... 11
Subcommittee Consideration....................................... 11
Committee Consideration.......................................... 11
Committee Votes.................................................. 12
Committee Oversight Findings..................................... 12
Statement of General Performance Goals and Objectives............ 12
New Budget Authority, Entitlement Authority, and Tax Expenditures 12
Earmarks and Tax and Tariff Benefits............................. 13
Committee Cost Estimate.......................................... 13
Congressional Budget Office Estimate............................. 13
Federal Mandates Statement....................................... 14
Advisory Committee Statement..................................... 14
Statement of Constitutional Authority............................ 14
Applicability to Legislative Branch.............................. 14
Section-by-Section Analysis of the Legislation................... 14
Changes in Existing Law Made by the Bill as Reported............. 16
Amendment
The amendments are as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Veterans Sexual Assault Prevention and
Health Care Enhancement Act''.
SEC. 2. COMPREHENSIVE POLICY ON REPORTING AND TRACKING SEXUAL ASSAULT
INCIDENTS AND OTHER SAFETY INCIDENTS.
(a) Policy.--Subchapter I of chapter 17 of title 38, United States
Code, is amended by adding at the end the following:
``Sec. 1709. Comprehensive policy on reporting and tracking sexual
assault incidents and other safety incidents
``(a) Policy Required.--Not later than March 1, 2012, the Secretary
of Veterans Affairs shall develop and implement a centralized and
comprehensive policy on the reporting and tracking of sexual assault
incidents and other safety incidents that occur at each medical
facility of the Department, including--
``(1) suspected, alleged, attempted, or confirmed cases of
sexual assault, regardless of whether such assaults lead to
prosecution or conviction;
``(2) criminal and purposefully unsafe acts;
``(3) alcohol or substance abuse related acts (including by
employees of the Department); and
``(4) any kind of event involving alleged or suspected abuse
of a patient.
``(b) Scope.--The policy required by subsection (a) shall cover each
of the following:
``(1) For purposes of reporting and tracking sexual assault
incidents and other safety incidents, definitions of the
terms--
``(A) `safety incident';
``(B) `sexual assault'; and
``(C) `sexual assault incident'.
``(2) The development and use of specific risk-assessment
tools to examine any risks related to sexual assault that a
veteran may pose while being treated at a medical facility of
the Department, including clear and consistent guidance on the
collection of information related to--
``(A) the legal history of the veteran; and
``(B) the medical record of the veteran.
``(3) The mandatory training of employees of the Department
on security issues, including awareness, preparedness,
precautions, and police assistance.
``(4) The mandatory implementation, use, and regular testing
of appropriate physical security precautions and equipment,
including surveillance camera systems, computer-based panic
alarm systems, stationary panic alarms, and electronic portable
personal panic alarms.
``(5) Clear, consistent, and comprehensive criteria and
guidance with respect to an employee of the Department
communicating and reporting sexual assault incidents and other
safety incidents to--
``(A) supervisory personnel of the employee at--
``(i) a medical facility of the Department;
``(ii) an office of a Veterans Integrated
Service Network; and
``(iii) the central office of the Veterans
Health Administration; and
``(B) a law enforcement official of the Department.
``(6) Clear and consistent criteria and guidelines with
respect to an employee of the Department referring and
reporting to the Office of Inspector General of the Department
sexual assault incidents and other safety incidents that meet
the regulatory criminal threshold in accordance with section
1.201 and 1.204 of title 38, Code of Federal Regulations.
``(7) An accountable oversight system within the Veterans
Health Administration that includes--
``(A) systematic information sharing of reported
sexual assault incidents and other safety incidents
among officials of the Administration who have
programmatic responsibility; and
``(B) a centralized reporting, tracking, and
monitoring system for such incidents.
``(8) Consistent procedures and systems for law enforcement
officials of the Department with respect to investigating,
tracking, and closing reported sexual assault incidents and
other safety incidents.
``(9) Clear and consistent guidance for the clinical
management of the treatment of sexual assaults that are
reported more than 72 hours after the assault.
``(c) Updates to Policy.--The Secretary shall review and revise the
policy required by subsection (a) on a periodic basis as the Secretary
considers appropriate and in accordance with best practices.
``(d) Annual Report.--(1) Not later than 60 days after the date on
which the Secretary develops the policy required by subsection (a), and
by not later than October 1 of each year thereafter, the Secretary
shall submit to the Committee on Veterans' Affairs of the House of
Representatives and the Committee on Veterans' Affairs of the Senate a
report on the implementation of the policy.
``(2) The report under paragraph (1) shall include--
``(A) the number and type of sexual assault incidents and
other safety incidents reported by each medical facility of the
Department;
``(B) a detailed description of the implementation of the
policy required by subsection (a), including any revisions made
to such policy from the previous year; and
``(C) the effectiveness of such policy on improving the
safety and security of the medical facilities of the
Department, including the performance measures used to evaluate
such effectiveness.
``(e) Regulations.--The Secretary shall prescribe regulations to
carry out this section.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by adding after the item relating to section
1708 the following:
``1709. Comprehensive policy on reporting and tracking sexual assault
incidents and other safety incidents.''.
(c) Interim Report.--Not later than 30 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall submit
to the Committee on Veterans' Affairs of the House of Representatives
and the Committee on Veterans' Affairs of the Senate a report on the
development of the performance measures described in section
1709(d)(2)(C) of title 38, United States Code, as added by subsection
(a).
SEC. 3. INCREASED FLEXIBILITY IN ESTABLISHING PAYMENT RATES FOR NURSING
HOME CARE PROVIDED BY STATE HOMES.
(a) In General.--Section 1745(a) of title 38, United States Code, is
amended--
(1) in paragraph (1), by striking ``The Secretary shall pay
each State home for nursing home care at the rate determined
under paragraph (2)'' and inserting ``The Secretary shall enter
into a contract (or agreement under section 1720(c)(1) of this
title) with each State home for payment by the Secretary for
nursing home care provided in the home''; and
(2) by striking paragraph (2) and inserting the following new
paragraph (2):
``(2) Payment under each contract (or agreement) between the
Secretary and a State home under paragraph (1) shall be based on a
methodology, developed by the Secretary in consultation with the State
home, to adequately reimburse the State home for the care provided by
the State home under the contract (or agreement).''.
(b) Effective Date.--The amendment made by subsection (a) shall apply
to care provided on or after January 1, 2012.
SEC. 4. REHABILITATIVE SERVICES FOR VETERANS WITH TRAUMATIC BRAIN
INJURY.
(a) Rehabilitation Plans and Services.--Section 1710C of title 38,
United States Code, is amended--
(1) in subsection (a)(1), by inserting before the semicolon
the following: ``with the goal of maximizing the individual's
independence'';
(2) in subsection (b)--
(A) in paragraph (1)--
(i) by inserting ``(and sustaining
improvement in)'' after ``improving'';
(ii) by inserting ``behavioral,'' after
``cognitive,'';
(B) in paragraph (2), by inserting ``rehabilitative
services and'' before ``rehabilitative components'';
and
(C) in paragraph (3)--
(i) by striking ``treatments'' the first
place it appears and inserting ``services'';
and
(ii) by striking ``treatments and'' the
second place it appears; and
(3) by adding at the end the following new subsection:
``(h) Rehabilitative Services Defined.--For purposes of this section,
and sections 1710D and 1710E of this title, the term `rehabilitative
services' includes--
``(1) rehabilitative services, as defined in section 1701 of
this title;
``(2) treatment and services (which may be of ongoing
duration) to sustain, and prevent loss of, functional gains
that have been achieved; and
``(3) any other rehabilitative services or supports that may
contribute to maximizing an individual's independence.''
(b) Rehabilitation Services in Comprehensive Program for Long-term
Rehabilitation.--Section 1710D(a) of title 38, United States Code, is
amended--
(1) by inserting ``and rehabilitative services (as defined in
section 1710C of this title)'' after ``long-term care''; and
(2) by striking ``treatment''.
(c) Rehabilitation Services in Authority for Cooperative Agreements
for Use of Non-Department Facilities for Rehabilitation.--Section
1710E(a) of title 38, United States Code, is amended by inserting ``,
including rehabilitative services (as defined in section 1710C of this
title),'' after ``medical services''.
(d) Technical Amendment.--Section 1710C(c)(2)(S) of title 38, United
States Code, is amended by striking ``opthamologist'' and inserting
``ophthalmologist''.
SEC. 5. USE OF SERVICE DOGS ON PROPERTY OF THE DEPARTMENT OF VETERANS
AFFAIRS.
Section 901 of title 38, United States Code, is amended by adding at
the end the following new subsection:
``(f) The Secretary may not prohibit the use of service dogs in any
facility or on any property of the Department or in any facility or on
any property that receives funding from the Secretary.''.
SEC. 6. DEPARTMENT OF VETERANS AFFAIRS PILOT PROGRAM ON DOG TRAINING
THERAPY.
(a) In General.--Commencing not later than 120 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs shall
implement a three-year pilot program for the purpose of assessing the
effectiveness of using dog training activities as a component of
integrated post-deployment mental health and post-traumatic stress
disorder rehabilitation programs at Department of Veterans Affairs
medical centers to positively affect veterans with post-deployment
mental health conditions and post-traumatic stress disorder symptoms
and to produce specially trained dogs that meet criteria for becoming
service dogs for veterans with disabilities.
(b) Location of Pilot Program.--The pilot program shall be carried
out at between one and three Department of Veterans Affairs medical
centers selected by the Secretary for such purpose. In selecting
medical centers for the pilot program, the Secretary shall--
(1) ensure that each medical center selected--
(A) has an established mental health rehabilitation
program that includes a clinical focus on
rehabilitation treatment of post-deployment mental
health conditions and post-traumatic stress disorder;
and
(B) has a demonstrated capability and capacity to
incorporate service dog training activities into the
rehabilitation program; and
(2) shall review and consider using recommendations published
by Assistance Dogs International, International Guide Dog
Federation, or comparably recognized experts in the art and
science of basic dog training with regard to space, equipments,
and methodologies.
(c) Design of Pilot Program.--In carrying out the pilot program, the
Secretary shall--
(1) administer the program through the Department of Veterans
Affairs Patient Care Services Office as a collaborative effort
between the Rehabilitation Office and the Office of Mental
Health Services;
(2) ensure that the national pilot program lead of the
Patient Care Services Office has sufficient administrative
experience to oversee all pilot program sites;
(3) establish partnerships through memorandums of
understanding with Assistance Dog International organizations,
International Guide Dog Federation organizations, academic
affiliates, or organizations with equivalent credentials with
experience in teaching others to train service dogs for the
purpose of advising the Department of Veterans Affairs
regarding the design, development, and implementation of pilot
program;
(4) ensure that each pilot program site has obtained a
service dog training instructor certified by Assistance Dog
International, International Guide Dog Federation, or an
organization with equivalent credentials to oversee service dog
training activities;
(5) ensure that dogs selected for use in the program meet all
health clearance, age, and temperament criteria as outlined by
Assistance Dog International, International Guide Dog
Federation, or an organization with equivalent credentials and
the Centers for Disease Control and Prevention;
(6) consider dogs residing in animal shelters or foster homes
for participation in the program if such dogs meet the
selection criteria under this subsection; and
(7) ensure that each dog selected for the program is taught
all basic commands and behaviors essential to being accepted by
an accredited service dog training organization to be partnered
with a disabled veteran for final individualized service dog
training tailored to meet the needs of the veteran.
(d) Veteran Participation.--A veteran diagnosed with post-traumatic
stress disorder or another post-deployment mental health condition may
volunteer to participate in the pilot program required by subsection
(a) and may participate in the program if the Secretary determines that
adequate program resources are available for such veteran to
participate at the pilot program site.
(e) Hiring Preference.--In selecting service dog training instructors
for the pilot program, the Secretary shall give a preference to a
veteran who successfully completed a post-traumatic stress disorder or
other residential treatment program and who has received certification
in service dog training from an Assistance Dog International or
International Guide Dog Federation accredited program.
(f) Collection of Data.--The Secretary shall collect data on the
pilot program to determine the effectiveness of the program in
positively affecting veterans with post-traumatic stress disorder or
other post-deployment mental health conditions and the potential for
expanding the program to additional Department of Veterans Affairs
medical centers. Such data shall be collected and analyzed using valid
and reliable methodologies and instruments.
(g) Reports to Congress.--
(1) Annual reports.--Not later than one year after the date
of the commencement of the pilot program, and annually
thereafter for the duration of the pilot program, the Secretary
shall submit to Congress a report on the pilot program. Each
such report shall include--
(A) the number of veterans participating in the pilot
program;
(B) a description of the services carried out by the
Secretary under the pilot program;
(C) the effects that participating in the pilot
program has on veterans with post-traumatic stress
disorder and post-deployment mental health conditions;
(2) Final report.--At the conclusion of pilot program, the
Secretary shall submit to Congress a final report that includes
recommendations with respect to the extension or expansion of
the pilot program.
(h) Definition.--For the purposes of this section, the term ``service
dog training instructor'' means an instructor recognized by an
accredited dog organization training program who provides hands-on
training in the art and science of service dog training and handling.
Amend the title so as to read:
A bill to amend title 38, United States Code, to require a
comprehensive policy on reporting and tracking sexual assault
incidents and other safety incidents that occur at medical
facilities of the Department of Veterans Affairs, to improve
rehabilitative services for veterans with traumatic brain
injury, and for other purposes.
Purpose and Summary
H.R. 2074, the Veterans Sexual Assault Prevention Act, was
introduced by Representative Ann Marie Buerkle of New York, the
Chairwoman of the Subcommittee on Health of the Committee on
Veterans' Affairs, on June 1, 2011. In addition to H.R. 2074,
the amended version of H.R. 2074 reflects the Committee's
consideration of several bills introduced during the 112th
Congress, including: H.R. 1855, the Veterans Traumatic Brain
Injury Rehabilitative Services Act of 2011, introduced by the
Honorable Timothy J. Walz of Minnesota; H.R. 2530, to amend
title 38 United States Code (U.S.C.) to provide increased
flexibility in establishing rates for reimbursement of State
Homes by the Secretary of the Department of Veterans Affairs
(VA) for nursing home care provided to veterans, introduced by
the Honorable Michael Michaud of Maine; H.R. 1154, the Veterans
Equal Treatment for Service Dogs (VETS Dogs) Act, introduced by
the Honorable John Carter of Texas; and, H.R. 198, the Veterans
Dog Training Therapy Act, introduced by the Honorable Michael
Grimm of New York.
H.R. 2074, as amended, the Veterans Sexual Assault
Prevention and Health Care Enhancement Act, would: (1) require
VA to establish a comprehensive policy on the reporting and
tracking of sexual assault and other safety incidents at VA
medical facilities and require a report on said policy 60 days
after initial implementation and annually thereafter; (2)
require VA to enter into a contract or agreement with each
State Veterans Home (SVH) for payment of nursing home care
provided to veterans with a service-connected disability rated
at 70 percent or greater or in need of such care because of a
service-connected condition; (3) include the goal of maximizing
independence and improving behavioral and mental health
functioning within a program of individualized rehabilitation
and reintegration for veterans with traumatic brain injury
(TBI) and require rehabilitative services be included within VA
comprehensive programs of long-term care for veterans with TBI;
(4) clarify the access rights of service dogs on VA property
and in VA facilities; and, (5) direct VA to carry out a three
year pilot program in one to three VA medical centers (VAMCs)
for the purpose of assessing the effectiveness of addressing
post deployment mental health and post traumatic stress
disorder (PTSD) symptoms through service dog training therapy.
Background and Need for Legislation
Section 2--Comprehensive policy regarding sexual assault and other
safety incidents
VA operates inpatient mental health units in 111 VAMCs to
provide intensive treatment to veterans with acute mental
health needs. These are generally locked units with 24-hour
supervision intended to stabilize mentally-ill veterans for
transfer to less intensive levels of care. In some cases, the
less intensive level of care may be a VA residential program.
VA operates 237 residential programs in 104 VA medical
facilities. Designated as residential rehabilitation treatment
programs, domiciliary programs, or compensated work therapy/
transitional residence programs, VA's residential programs
provide rehabilitative and clinical care to veterans with a
variety of mental health conditions.
Serious concerns about the safety of patients in VA
residential programs were brought to the attention of the
Government Accountability Office (GAO) during an investigation
into services available to female veterans accessing VA health
care. As a result of these concerns and at the request of
Chairman Jeff Miller and Ranking Member Bob Filner, GAO
initiated an investigation into sexual assault and other safety
incidents at VA medical facilities. On June 7, 2011, GAO
published the findings of that investigation in a report
entitled, VA HEALTH CARE: Actions Needed to Prevent Sexual
Assault and Other Safety Incidents, GAO-11-530.
In analyzing VA's national police files from January 2007
through July 2010, GAO identified 284 incidents of alleged
sexual assault. Included in that total are 67 incidents of
alleged rape, 185 incidents of alleged inappropriate touching,
8 incidents of alleged forceful medical examinations, 13
incidents of alleged forced or inappropriate oral sex, and 11
other alleged sexual assaults. There were 89 allegations of
patient-on-patient sexual assaults, 85 allegations of patient-
on-employee sexual assaults, 46 allegations of employee-on-
patient sexual assaults, 28 allegations of persons-with-
unknown-affiliation-on patient sexual assaults, 15 allegations
of employee-on-employee sexual assaults, and 21 other
allegations of sexual assault involving patients, employees,
visitors, and outsiders.
GAO found that many of the sexual assault incidents
reported to the VA police were not reported to VA leadership
officials and/or the VA Office of the Inspector General (OIG),
as required by VA regulation.
GAO identified several factors that contribute to the
underreporting of sexual assault incidents including the lack
of a: (1) consistent definition of sexual assault; (2) clear
and comprehensive criteria for communicating and reporting
sexual assault incidents at each level of VA leadership; (3)
centralized reporting, tracking and monitoring system; (4)
satisfactory and operable physical security precaution system;
and, (5) proper and centralized VA leadership oversight
mechanism.
To correct these deficiencies, GAO recommended VA improve
the reporting and monitoring of sexual assault and other safety
incidents and the tools used to identify risk and address
vulnerabilities at VA facilities by: ensuring a consistent
definition for reporting purposes; clarifying expectations
about the reporting of sexual assault incidents; implementing a
centralized tracking system to monitor sexual assault
incidents; developing an automated mechanism within the VA
police reporting system, establishing guidance on legal history
discussions; ensuring effective panic alarm systems; and
requiring stakeholder input on plans for new and renovated
units and changes to physical security features in existing
units.
Section 2 of the bill would address the safety
vulnerabilities, security weaknesses, and oversight failures
identified by GAO and result in a fundamentally safer VA health
care system for VA patients and employees alike by requiring VA
to establish a comprehensive policy on reporting and tracking
sexual assault and other safety incidents at VA medical
facilities by no later than March 1, 2012. It would mandate
that the policy include the: (1) development of clear and
comprehensive criteria with respect to the reporting of sexual
assault incidents and other safety incidents for both clinical
personnel and law enforcement personnel; (2) establishment of
an accountable oversight system within VA to report and track
sexual assault incidents for all alleged or suspected forms of
abuse and unsafe acts; (3) systematic information sharing of
reported sexual assault incidents, and a centralized reporting,
tracking, and monitoring system to ensure each case is fully
investigated and victims receive appropriate treatment; (4) use
of specific ``risk assessment tools'' to examine any danger
related to sexual assault that a veteran may pose while being
treated, including clear guidance on the collection of
information relating to the legal history of the veteran; (5)
mandatory training of employees on safety awareness and
security; and, (6) establishment of physical security
precautions including appropriate surveillance and panic alarm
systems that are operable and regularly tested. It would also
require a report on said policy no later than 60 days after
implementation and by October 1 of each subsequent year.
Section 3--Increased flexibility in establishing payment rates for
nursing home care provided by State Veterans Homes
The Veterans Millennium Health Care and Benefits Act,
Public Law (P.L.) 106-117, 113 Stat. 1545, requires VA to
provide nursing home care to certain qualified veterans,
including those veterans with a service-connected disability
rated at 70 percent or greater or requiring nursing home care
because of a service-connected condition.
The VA nursing home program provides institutional long
term care for such qualified veterans in various settings
including VA owned and operated Community Living Centers,
contract purchased care in Community Nursing Homes, and State
Veterans Homes (SVHs).
SVHs are characterized by a long-standing partnership
between VA and the States to provide long-term care to veterans
through a joint cost-sharing agreement. Veterans may choose to
seek care in a SVH and, although VA may refer patients to SVHs,
it does not control eligibility criteria.
Prior to the enactment of the Veterans Benefits, Health
Care, and Information Technology Act of 2006, P.L. 109-461, 120
Stat. 3403, VA could only pay one per diem rate for care in a
SVH. This per diem amounted to approximately one-third of the
total cost of care. VA could not pay the full cost of care for
a veteran in a SVH, even if that veteran qualified for VA-paid
nursing home care under the Veterans Millenium Health Care and
Benefits Act, P.L. 106-117. However, VA would pay the full cost
of care for that veteran in a VA or community nursing home.
P.L. 109-461 included a provision requiring VA to pay SVHs
a new rate for these veterans: the lesser of a prevailing rate
determined by VA or the actual cost of care in the SVH. This
provision is known as the ``70% program.''
The 70% program was meant to provide equity of access to VA
resources for qualified veterans residing in SVHs. However,
after implementation of the 70% program, some states and
individual SVHs began reporting that it resulted in lower total
payments to SVHs because of the inability to bill other payers
for care and, therefore, was threatening their financial
viability and ability to admit the veterans who qualified under
the 70% program.
Section 3 of the bill would resolve the unintended issues
created by P.L. 109-461 by allowing for greater flexibility in
VA payments to SVHs under the 70% program by requiring VA to
enter into a contract or agreement separately with each SVH
based on the particular needs of the veteran population in a
given SVH.
Section 4--Rehabilitative services for veterans with traumatic brain
injury (TBI)
Approximately 1.3 million Operation Enduring Freedom (OEF),
Operation Iraqi Freedom (OIF), and Operation New Dawn (OND)
veterans have left active duty and become eligible for VA
health care. According to VA, as of FY 2010, 45,606 wounded
warriors have been diagnosed with TBI-related conditions.
Current law governing rehabilitative care for veterans with
TBI within VA, which is codified in sections 1710C and 1710D of
title 38, U.S.C. These sections direct VA to provide
comprehensive care in accord with individualized rehabilitation
plans to veterans with TBI. Although these sections of law do
not provide a definition of the word ``rehabilitation,'' the
phrase ``rehabilitative services'' is defined in section
1701(8) of title 38, U.S.C. for VA health-care purposes as
``such professional, counseling, and guidance services and
treatment programs as are necessary to restore, to the maximum
extent possible, the physical, mental, and psychological
functioning of an ill or disabled person.''
Concerns have been raised that VA has interpreted the law
as limited only to those services that restore function. By
limiting rehabilitative care in such a manner, individuals with
TBI may risk losing out on therapy that may prove vital in
maintaining physical, cognitive, and other progress. Further,
they may risk losing out on services necessary for a successful
reintegration into community and civilian life but which fall
outside of a strictly medical model.
Section 4 of the bill recognizes the unique responsibility
we owe to those suffering from TBI, especially those who may
experience a lifetime of cognitive and neurological impairment,
to ensure that institutional barriers do not stand in the way
of those rehabilitative services needed to achieve and maintain
maximum health and well-being. It would clarify current law to
require that VA's responsibilities in providing rehabilitative
care to veterans with TBI include the goal of maximizing
independence and improving behavioral and mental health
functioning within a program of individualized rehabilitation
and reintegration for veterans with TBI and also include
rehabilitative services within VA comprehensive programs of
long-term care for veterans with TBI. This would ensure that
rehabilitative services are directed not simply to ``improving
functioning'' but also to sustaining improvement and preventing
loss of functional gains and, further, are not limited only to
services provided by health professionals but also include
other services or supports that contribute to maximizing the
veteran's independence.
Section 5--Use of service dogs on property of the Department of
Veterans Affairs
Regulations regarding veterans and members of the public
who enter Veterans Health Administration (VHA) facilities or
properties accompanied by a guide dog are found within 38 Code
of Federal Regulations (CFR), Part 1, 1.218 (a)(11), which
states that, ``[d]ogs and other animals, except seeing-eye
dogs, shall not be brought upon property except as authorized
by the head of the facility or designee.''
This regulation was last updated in July of 1985 and does
not address the access rights of trained service dogs. Service
dogs, which are classified by VA as a prosthetic appliance and
are provided to veterans through the VA Prosthetics and Sensory
Aid Service, have a significant role in maintaining
functionality and promoting maximum independence of veterans
with disabilities. However, as a result of current regulation,
disabled veterans may be denied entrance to VA medical
facilities if accompanied by their VA-approved service dog.
There has been growing frustration among veterans and
veterans service organizations about VA's outdated regulation
and the access rights of service dogs on VA campuses.
As a result, VA issued VHA Directive 2011-013 on March 10,
2011, requiring all VHA facilities to have a written policy on
access for guide and service dogs that directs both veterans
and members of the public with disabilities who require the
assistance of a trained guide or service dog be authorized to
enter VHA facilities and property accompanied by that trained
guide or service dog consistent with the same terms and
conditions, and subject to the same regulations, that govern
the admission of members of the public to the property.
Section 5 of the bill would eliminate any inconsistencies
between VA policy and practice and better fit the needs of
today's veterans who rely on service dogs for needed aid and
assistance by amending current law to mandate that service dogs
have access to any VA facility consistent with the same terms
and conditions, and subject to the same regulations, as
generally govern the admittance of guide dogs to VA property.
Section 6--Pilot program on dog training therapy
Considerable attention has been given in recent years to
the ``invisible wounds of war'' including mental health
illnesses such as PTSD. Perhaps the most widely recognized
mental health issue affecting veterans, PTSD is a severe
anxiety disorder that can develop after exposure to a traumatic
event in which grave physical harm occurred or was threatened.
Given the prevalence of PTSD among our veteran population,
Congress has recognized the need to provide veterans seeking
treatment for mental health issues with newer and more
innovative modes of therapy. In that vein, the Conference
Report (H. Rept. 111-366) that accompanied the Consolidated
Appropriations Act, 2010 (P.L. 111-117, 123 Stat. 3034)
included the recommendation that VA ``expand its partnership
with accredited nonprofit service dog organizations where
veterans with PTSD help to train service dogs.''
Currently, there are therapy dog training programs in use
at the VA Palo Alto Health Care System in Palo Alto,
California, and the National Intrepid Center of Excellence in
Bethesda, Maryland, reporting positive and promising outcomes.
In each of the above programs, training service dogs for fellow
veterans is believed to help address symptoms associated with
post-deployment mental health issues and PTSD. Veterans
participating in the programs have demonstrated improved
emotional regulation, sleep patterns, and sense of personal
safety. They also experienced reduced levels of anxiety and
social isolation. Further, participation in the pilot enabled
them to actively instill or re-establish a sense of purpose and
meaning while also providing an opportunity to help fellow
veterans and reintegrate healthfully back into the community.
However, despite the anecdotal evidence of the therapeutic
benefit of service dog training on veterans with mental health
issues and PTSD, there is a serious dearth of scientific
research on the value of such programs.
Section 6 of the bill would enable VA to reach more
veterans with this innovative treatment model by requiring VA
to conduct a three-year pilot program for the purpose of
assessing the effectiveness of addressing post-deployment
mental health and PTSD symptoms through a therapeutic medium of
service dog training therapy. The pilot program would have the
added benefit of providing a career path to veterans who
successfully graduate from the program and are interested in
becoming certified dog trainers.
Hearings
On July 25, 2011, the Subcommittee on Health held a
legislative hearing on various bills introduced during the
112th Congress, including H.R. 2074, H.R. 1855, H.R. 2530, H.R.
1154, and H.R. 198. The following witnesses testified:
The Honorable Michael G. Grimm of New York; the Honorable
John R. Carter of Texas, the Honorable Timothy J. Walz of
Minnesota; the Honorable Larry Bucshon of Indiana; Shane
Barker, Senior Legislative Associate, National Veterans
Service, Veterans of Foreign Wars of the United States; Joy J.
Ilem, Deputy National Legislative Director, Disabled American
Veterans; Thomas J. Berger, Ph.D., Executive Director, Veterans
Health Council, Vietnam Veterans of America; Carl Blake,
National Legislative Director, Paralyzed Veterans of America;
Christina M. Roof, National Acting Legislative Director,
AMVETS; and Robert L. Jesse, M.D., Ph.D., Principal Deputy
Under Secretary for Health, Veterans Health Administration,
U.S. Department of Veterans Affairs. Individuals and
organizations submitting statements for the record included:
the Honorable Scott R. Tipton of Colorado; America's VetDogs;
National Association of State Veterans Homes; Paws for Purple
Hearts; Pets2Vets; Service Women's Action Network; VetsFirst, a
Program of United Spinal Association; and, the Wounded Warrior
Project.
Subcommittee Consideration
On July 28 2011, the Subcommittee on Health met in an open
markup session, a quorum being present, and favorably reported
the following to the Full Committee: H.R. 1154, the ``Veterans
Equal Treatment for Service Dogs Act;'' H.R. 1855, as amended,
the ``Veterans'' Traumatic Brain Injury Rehabilitative
Services' Improvements Act of 2011;'' H.R. 2074 the ``Veterans
Sexual Assault Prevention Act;'' and H.R. 2530, a bill to amend
title 38, U.S.C. to provide increased flexibility in
establishing rates for reimbursement of State homes by the
Secretary of the Department of Veterans Affairs for nursing
home care provided to veterans.
Committee Consideration
On September 8, 2011, the full Committee met in an open
markup session, a quorum being present. Ms. Buerkle offered an
amendment in the nature of a substititute to H.R. 2074 which
would combine the contents of H.R. 2074, H.R. 2530, H.R. 1855,
H.R. 1154, and H.R. 198 and insert a provision eliminating the
statutory requirement that VA reimburse any full-time board-
certified physician or dentist for expenses incurred, up to
$1,000 per year, for continuing professional education. Mr.
McNerney of California offered an amendment to the amendment in
the nature of a substitute to H.R. 2074 to strike the last
provision regarding continuing professional education. The
amendment was adopted and H.R. 2074, as amended, was reported
favorably to the House of Representatives by voice vote.
Committee Votes
Clause 3(b) of rule XIII of the Rules of the House of
Representatives requires the Committee to list the record votes
on the motion to report the legislation and amendments thereto.
The Honorable Mr. Filner of California requested a recorded
vote on adoption of the amendment to the amendment in the
nature of a substitute to H.R. 2074; the recorded vote was 11
Members voting in favor of adoption, 9 Members voting in
opposition. The following table reflects the vote:
------------------------------------------------------------------------
Name Yea/Aye Nay/No Notes
------------------------------------------------------------------------
Mr. Miller, FL, Chairman...... ............ X ............
Mr. Bilirakis, FL, Vice ............ X ............
Chairman.....................
Mr. Stearns, FL............... ............ ............ Absent
Mr. Lamborn, CO............... ............ X ............
Mr. Roe, TN................... X ............ ............
Mr. Stutzman, IN.............. ............ X ............
Mr. Flores, TX................ ............ X ............
Mr. Johnson, OH............... ............ X ............
Mr. Denham, CA................ ............ ............ Absent
Mr. Runyan, NJ................ ............ X ............
Mr. Benishek, MI.............. X ............ ............
Ms. Buerkle, NY............... ............ X ............
Mr. Huelskamp, KS............. ............ X ............
Mr. Filner, CA................ X ............ ............
Ms. Brown, FL................. ............ ............ Absent
Mr. Reyes, TX................. ............ ............ Absent
Mr. Michaud, ME............... X ............ ............
Ms. Sanchez, CA............... X ............ ............
Mr. Braley, IA................ X ............ ............
Mr. McNerney, CA.............. X ............ ............
Mr. Donnelly, IN.............. X ............ ............
Mr. Walz, MN.................. X ............ ............
Mr. Barrow, GA................ X ............ ............
Mr. Carnahan, MO.............. X ............ ............
-----------------------------------------
Total..................... 11 9 ............
------------------------------------------------------------------------
A motion by the Honorable Gus Bilirakis of Florida to order
H.R. 2074, as amended, reported 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 reflected in the descriptive portions
of this report.
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. 2074, 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.
2074, 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. 2074, 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 23, 2011.
Hon. Jeff Miller,
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. 2074, the Veterans
Sexual Assault Prevention and Health Care Enhancement 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,
Douglas W. Elmendorf.
Enclosure.
H.R. 2074--Veterans Sexual Assault Prevention and Health Care
Enhancement Act
H.R. 2074 would require the Department of Veterans Affairs
(VA) to develop a comprehensive policy for tracking and
reporting sexual assault incidents and make other changes to
health care services. In total, CBO estimates that implementing
the bill would have discretionary costs of $1 million over the
2012-2016 period, assuming the availability of appropriated
funds. Enacting this legislation would not affect direct
spending or revenues; therefore, pay-as-you-go procedures do
not apply.
Section 2 would require VA to prepare and implement a
comprehensive policy on tracking and reporting sexual assault
incidents and other safety incidents. VA has already begun to
address most of the requirements of this section. It has
established a multidisciplinary workgroup to assess the actions
necessary to prevent sexual assault incidents and improve
response to reported incidents. CBO estimates that the costs
associated with preparing and distributing the required annual
reports would amount to less than $500,000 over the 2012-2016
period, assuming the availability of appropriated funds.
Section 6 would require VA to establish a pilot program
through which veterans diagnosed with post-traumatic stress
disorder or other mental health conditions would train service
dogs for use by disabled veterans. The pilot program would
operate for three years in one to three VA medical centers and
require one certified dog trainer at each facility. Based on a
similar program at the VA facility in Palo Alto, California,
CBO estimates that each facility would train five service dogs
every two years. CBO estimates that running the pilot program
would cost $1 million over the 2012-2016 period, assuming
appropriation of the necessary amounts.
H.R. 2074 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act. States
that provide nursing home care to eligible veterans would be
required to comply with a new payment structure in order to
receive federal reimbursement. Any costs to those governments
would be incurred voluntarily as a condition of federal
assistance.
The CBO staff contact for this estimate is Ann E. Futrell.
The estimate was approved by Theresa Gullo, Deputy Assistant
Director for Budget Analysis.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates regarding H.R. 2074, 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.
2074, as amended.
Statement of Constitutional Authority
Pursuant to Article I, section 8 of the United States
Constitution, the reported bill 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 the legislation 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.
Section-by-Section Analysis of the Legislation
Section 1. Short title
This section provides the short title of H.R. 2074, as
amended, as the ``Veterans Sexual Assault Prevention and Health
Care Enhancement Act.''
Section 2. Comprehensive policy on reporting and tracking sexual
assault incidents and other safety incidents
Section 2(a) of the bill would amend Subchapter I of
chapter 17 of title 38, U.S.C., to require a comprehensive
policy on the reporting and tracking of sexual assault
incidents and other safety incidents by not later than March 1,
2012.
Section 2(b) of the bill would amend the table of sections
at the beginning of chapter 17 of title 38, U.S.C., to include
an item relating to the creation of section 1709 in Section
2(a) of the bill.
Section 2(c) of the bill would require VA to submit an
interim report on the development of performance measures added
by subsection 2(a) of the bill to the Committee on Veterans'
Affairs of both the House of Representatives and the Senate,
not later than 30 days after the date of enactment of this Act.
Section 3. Increased flexibility in establishing payment rates for
nursing home care provided by state homes
Section 3(a) of the bill would amend section 1745(a) of
title 38, U.S.C., by striking the requirement that VA pay each
State home for nursing home care at a prescribed rate and
inserting a requirement for VA to enter into a contract (or
agreement under section 1720 of the same title) with each State
home for payment by VA for nursing home care provided in the
home and by inserting a paragraph requiring payment under each
contract to be based on methodology to adequately reimburse the
State home for the care provided under the contract.
Section 3(b) of the bill would require the amendment under
subsection (a) of the bill to apply to care provided on or
after January 1, 2012.
Section 4. Rehabilitative services for Veterans with Traumatic Brain
Injury
Section 4(a) of the bill would amend section 1710C of title
38, U.S.C., to include the goal of maximizing independence
within an individualized plan for the rehabilitation and
reintegration of veterans with TBI, include rehabilitation
objectives for sustaining improvement in cognitive, behavioral,
and vocational functioning, and defining rehabilitative
services as those treatment and services (which may be of on-
going duration) which sustain, and prevent loss of, functional
gains that have been achieved, and any other rehabilitative
services or supports that may contribute to maximizing
independence.
Section 4(b) of the bill would amend section 1710D of title
38, U.S.C., to include rehabilitation services within
comprehensive programs for long-term rehabilitation of eligible
veterans with TBI.
Section 4(c) of the bill would amend section 1710E(a) of
title 38, United U.S.C., to include rehabilitation services
within cooperative agreements for the use of non-Department
facilities for neurorehabilitation amd recovery programs for
eligible veterans with TBI.
Section 4(d) of the bill would amend 1710C(c)(2)(S) of
title 38, U.S.C., to strike ``opthamologist'' and insert
``ophthalmologist'' in its place.
Section 5. Use of service dogs on property of the Department of
Veterans Affairs
Section 5 of the bill would amend section 901 of title 38,
U.S.C., by adding a new subsection declaring that VA may not
prohibit the use of service dogs in any facility or on any
property of the Department or in any facility or on any
property that receives VA funding.
Section 6. Department of Veterans Affairs Pilot Program on dog training
therapy
Section 6(a) of the bill would require VA to implement a
pilot program on dog training therapy no later than 120 days
after enactment of the Act for the purpose of assessing the
effectiveness of using dog-training activities as a component
of integrated post-deployment mental health and PTSD
rehabilitation programs.
Section 6(b) of the bill would require the pilot described
in Section 2(a) be carried out in at least one but not more
than three VAMCs who meet certain criteria.
Section 6(c) of the bill would set out the parameters for
the design of the pilot program.
Section 6(d) of the bill would define an eligible veteran
as a veteran with PTSD or another post-deployment mental health
issue who willingly volunteers to participate in the pilot
program.
Section 6(e) of the bill would create a hiring preference
for service dog training instructors who are veterans and who
have successfully completed PTSD or other residential treatment
programs and received adequate dog training certification.
Section 6(f) of the bill would require VA to collect data
to determine the effectiveness of the pilot program.
Section 6(g) of the bill would require a yearly report to
Congress on the pilot program.
Section 6(h) of the bill would define a ``service dog
training instructor'' as an instructor recognized by an
accredited dog organization training program who provides
hands-on training in the art and science of service dog
training and handling.
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 italic, existing law in which no change is
proposed is shown in roman):
TITLE 38, UNITED STATES CODE
* * * * * * *
PART I--GENERAL PROVISIONS
* * * * * * *
CHAPTER 9--SECURITY AND LAW ENFORCEMENT ON PROPERTY UNDER THE
JURISDICTION OF THE DEPARTMENT
* * * * * * *
Sec. 901. Authority to prescribe rules for conduct and penalties for
violations
(a) * * *
* * * * * * *
(f) The Secretary may not prohibit the use of service dogs in
any facility or on any property of the Department or in any
facility or on any property that receives funding from the
Secretary.
* * * * * * *
PART II--GENERAL BENEFITS
* * * * * * *
CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE
SUBCHAPTER I--GENERAL
Sec.
1701. Definitions.
* * * * * * *
1709. Comprehensive policy on reporting and tracking sexual assault
incidents and other safety incidents.
* * * * * * *
SUBCHAPTER I--GENERAL
* * * * * * *
Sec. 1709. Comprehensive policy on reporting and tracking sexual
assault incidents and other safety incidents
(a) Policy Required.--Not later than March 1, 2012, the
Secretary of Veterans Affairs shall develop and implement a
centralized and comprehensive policy on the reporting and
tracking of sexual assault incidents and other safety incidents
that occur at each medical facility of the Department,
including--
(1) suspected, alleged, attempted, or confirmed cases
of sexual assault, regardless of whether such assaults
lead to prosecution or conviction;
(2) criminal and purposefully unsafe acts;
(3) alcohol or substance abuse related acts
(including by employees of the Department); and
(4) any kind of event involving alleged or suspected
abuse of a patient.
(b) Scope.--The policy required by subsection (a) shall cover
each of the following:
(1) For purposes of reporting and tracking sexual
assault incidents and other safety incidents,
definitions of the terms--
(A) ``safety incident'';
(B) ``sexual assault''; and
(C) ``sexual assault incident''.
(2) The development and use of specific risk-
assessment tools to examine any risks related to sexual
assault that a veteran may pose while being treated at
a medical facility of the Department, including clear
and consistent guidance on the collection of
information related to--
(A) the legal history of the veteran; and
(B) the medical record of the veteran.
(3) The mandatory training of employees of the
Department on security issues, including awareness,
preparedness, precautions, and police assistance.
(4) The mandatory implementation, use, and regular
testing of appropriate physical security precautions
and equipment, including surveillance camera systems,
computer-based panic alarm systems, stationary panic
alarms, and electronic portable personal panic alarms.
(5) Clear, consistent, and comprehensive criteria and
guidance with respect to an employee of the Department
communicating and reporting sexual assault incidents
and other safety incidents to--
(A) supervisory personnel of the employee
at--
(i) a medical facility of the
Department;
(ii) an office of a Veterans
Integrated Service Network; and
(iii) the central office of the
Veterans Health Administration; and
(B) a law enforcement official of the
Department.
(6) Clear and consistent criteria and guidelines with
respect to an employee of the Department referring and
reporting to the Office of Inspector General of the
Department sexual assault incidents and other safety
incidents that meet the regulatory criminal threshold
in accordance with section 1.201 and 1.204 of title 38,
Code of Federal Regulations.
(7) An accountable oversight system within the
Veterans Health Administration that includes--
(A) systematic information sharing of
reported sexual assault incidents and other
safety incidents among officials of the
Administration who have programmatic
responsibility; and
(B) a centralized reporting, tracking, and
monitoring system for such incidents.
(8) Consistent procedures and systems for law
enforcement officials of the Department with respect to
investigating, tracking, and closing reported sexual
assault incidents and other safety incidents.
(9) Clear and consistent guidance for the clinical
management of the treatment of sexual assaults that are
reported more than 72 hours after the assault.
(c) Updates to Policy.--The Secretary shall review and revise
the policy required by subsection (a) on a periodic basis as
the Secretary considers appropriate and in accordance with best
practices.
(d) Annual Report.--(1) Not later than 60 days after the date
on which the Secretary develops the policy required by
subsection (a), and by not later than October 1 of each year
thereafter, the Secretary shall submit to the Committee on
Veterans' Affairs of the House of Representatives and the
Committee on Veterans' Affairs of the Senate a report on the
implementation of the policy.
(2) The report under paragraph (1) shall include--
(A) the number and type of sexual assault incidents
and other safety incidents reported by each medical
facility of the Department;
(B) a detailed description of the implementation of
the policy required by subsection (a), including any
revisions made to such policy from the previous year;
and
(C) the effectiveness of such policy on improving the
safety and security of the medical facilities of the
Department, including the performance measures used to
evaluate such effectiveness.
(e) Regulations.--The Secretary shall prescribe regulations
to carry out this section.
SUBCHAPTER II--HOSPITAL, NURSING HOME, OR DOMICILIARY CARE AND MEDICAL
TREATMENT
* * * * * * *
Sec. 1710C. Traumatic brain injury: plans for rehabilitation and
reintegration into the community
(a) Plan Required.--The Secretary shall, for each individual
who is a veteran or member of the Armed Forces who receives
inpatient or outpatient rehabilitative hospital care or medical
services provided by the Department for a traumatic brain
injury--
(1) develop an individualized plan for the
rehabilitation and reintegration of the individual into
the community with the goal of maximizing the
individual's independence; and
* * * * * * *
(b) Contents of Plan.--Each plan developed under subsection
(a) shall include, for the individual covered by such plan, the
following:
(1) Rehabilitation objectives for improving (and
sustaining improvement in) the physical, cognitive,
behavioral, and vocational functioning of the
individual with the goal of maximizing the independence
and reintegration of such individual into the
community.
(2) Access, as warranted, to all appropriate
rehabilitative services and rehabilitative components
of the traumatic brain injury continuum of care, and
where appropriate, to long-term care services.
(3) A description of specific rehabilitative
[treatments] services and other services to achieve the
objectives described in paragraph (1), which shall set
forth the type, frequency, duration, and location of
such [treatments and] services.
* * * * * * *
(c) Comprehensive Assessment.--(1) * * *
(2) The comprehensive assessment required under paragraph (1)
with respect to an individual is a comprehensive assessment of
the matters set forth in that paragraph by a team, composed by
the Secretary for purposes of the assessment, of individuals
with expertise in traumatic brain injury, including any of the
following:
(A) * * *
* * * * * * *
(S) An [opthamologist] ophthalmologist.
* * * * * * *
(h) Rehabilitative Services Defined.--For purposes of this
section, and sections 1710D and 1710E of this title, the term
``rehabilitative services'' includes--
(1) rehabilitative services, as defined in section
1701 of this title;
(2) treatment and services (which may be of ongoing
duration) to sustain, and prevent loss of, functional
gains that have been achieved; and
(3) any other rehabilitative services or supports
that may contribute to maximizing an individual's
independence.
Sec. 1710D. Traumatic brain injury: comprehensive program for long-
term rehabilitation
(a) Comprehensive Program.--In developing plans for the
rehabilitation and reintegration of individuals with traumatic
brain injury under section 1710C of this title, the Secretary
shall develop and carry out a comprehensive program of long-
term care and rehabilitative services (as defined in section
1710C of this title) for post-acute traumatic brain injury
rehabilitation that includes residential, community, and home-
based components utilizing interdisciplinary [treatment] teams.
* * * * * * *
Sec. 1710E. Traumatic brain injury: use of non-Department facilities
for rehabilitation
(a) Cooperative Agreements.--The Secretary, in implementing
and carrying out a plan developed under section 1710C of this
title, may provide hospital care and medical services,
including rehabilitative services (as defined in section 1710C
of this title), through cooperative agreements with appropriate
public or private entities that have established long-term
neurobehavioral rehabilitation and recovery programs.
* * * * * * *
SUBCHAPTER V--PAYMENTS TO STATE HOMES
* * * * * * *
Sec. 1745. Nursing home care and medications for veterans with
service-connected disabilities
(a)(1) [The Secretary shall pay each State home for nursing
home care at the rate determined under paragraph (2)] The
Secretary shall enter into a contract (or agreement under
section 1720(c)(1) of this title) with each State home for
payment by the Secretary for nursing home care provided in the
home, in any case in which such care is provided to any veteran
as follows:
(A) * * *
* * * * * * *
[(2) The rate determined under this paragraph with respect to
a State home is the lesser of--
[(A) the applicable or prevailing rate payable in the
geographic area in which the State home is located, as
determined by the Secretary, for nursing home care
furnished in a non- Department nursing home (as that
term is defined in section 1720(e)(2) of this title);
or
[(B) a rate not to exceed the daily cost of care, as
determined by the Secretary, following a report to the
Secretary by the director of the State home.]
(2) Payment under each contract (or agreement) between the
Secretary and a State home under paragraph (1) shall be based
on a methodology, developed by the Secretary in consultation
with the State home, to adequately reimburse the State home for
the care provided by the State home under the contract (or
agreement).
* * * * * * *