[House Report 114-191]
[From the U.S. Government Publishing Office]
114th Congress } { Report
HOUSE OF REPRESENTATIVES
1st Session } { 114-191
======================================================================
VETERANS INFORMATION MODERNIZATION ACT
_______
July 7, 2015.--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. 2256]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred
the bill (H.R. 2256) to amend title 38, United States Code, to
direct the Secretary of Veterans Affairs to submit an annual
report on the Veterans Health Administration and the furnishing
of hospital care, medical services, and nursing home care by
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.............................................. 8
Background and Need for Legislation.............................. 9
Hearings......................................................... 12
Subcommittee Consideration....................................... 13
Committee Consideration ......................................... 14
Committee Votes.................................................. 14
Committee Oversight Findings..................................... 14
Statement of General Performance Goals and Objectives............ 14
New Budget Authority, Entitlement Authority, and Tax Expenditures 15
Earmarks and Tax and Tariff Benefits............................. 15
Committee Cost Estimate.......................................... 15
Congressional Budget Office Estimate............................. 15
Federal Mandates Statement....................................... 18
Advisory Committee Statement..................................... 19
Constitutional Authority Statement............................... 19
Applicability to Legislative Branch.............................. 19
Statement on Duplication of Federal Programs..................... 19
Disclosure of Directed Rulemaking................................ 19
Section-by-Section Analysis of the Legislation................... 19
Changes in Existing Law Made by the Bill as Reported............. 25
Amendment in the Nature of a Substitute
The amendments are as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited a the ``Veterans Information Modernization
Act''.
SEC. 2. ANNUAL REPORT ON VETERANS HEALTH ADMINISTRATION AND FURNISHING
OF HOSPITAL CARE, MEDICAL SERVICES, AND NURSING
HOME CARE.
(a) In General.--Subchapter II of chapter 73 of title 38, United
States Code, is amended by adding at the end the following new section:
``Sec. 7330B. Annual report on Veterans Health Administration and
furnishing of hospital care, medical services, and
nursing home care
``(a) Report Required.--Not later than March 1 of each year, the
Secretary shall submit to the Committees on Veterans' Affairs of the
Senate and House of Representatives a report on the furnishing of
hospital care, medical services, and nursing home care under the laws
administered by the Secretary and on the administration of the
provision of such care and services by the Veterans Health
Administration during the calendar year preceding the calendar year
during which the report is submitted.
``(b) Contents of Report.--Each report required by subsection (a)
shall include each of the following for the year covered by the report:
``(1) An evaluation of the effectiveness of the Veterans
Health Administration program in increasing the access of
veterans eligible for hospital care, medical services, and
nursing home care furnished by the Secretary to such care.
``(2) An evaluation of the effectiveness of the Veterans
Health Administration in improving the quality of health care
provided to such veterans, without increasing the costs
incurred by the Government or such veterans, which includes the
relevant information for each medical center and Veterans
Integrated Service Network of the Department set forth
separately.
``(3) An assessment of--
``(A) the workload of physicians and other employees
of the Veterans Health Administration;
``(B) patient demographics and utilization rates;
``(C) physician compensation;
``(D) the productivity of physicians and other
employees of the Veterans Health Administration;
``(E) the percentage of hospital care, medical
services, and nursing home care provided to such
veterans in Department facilities and in non-Department
facilities and any changes in such percentages compared
to the year preceding the year covered by the report;
``(F) pharmaceutical prices; and
``(G) third party health billings owed to the
Department, including the total amount of such billings
and the total amounts collected, set forth separately
for claims greater than $1000 and for claims equal to
or less than $1000.
``(c) Definitions.--In this section, the terms `hospital care',
`medical services', `nursing home care', and `non-Department
facilities' have the meanings given such terms in section 1701 of this
title.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item relating to section
7330A the following new item:
``7330B. Annual report on Veterans Health Administration and furnishing
of hospital care, medical services, and nursing home care.''.
SEC. 3. EXPANSION OF DEFINITION OF HOMELESS VETERAN FOR PURPOSES OF
BENEFITS UNDER THE LAWS ADMINISTERED BY THE
SECRETARY OF VETERANS AFFAIRS.
Section 2002(1) of title 38, United States Code, is amended by
inserting ``or (b)'' after ``section 103(a)''.
SEC. 4. IDENTIFICATION AND TRACKING OF BIOLOGICAL IMPLANTS USED IN
DEPARTMENT OF VETERANS AFFAIRS MEDICAL FACILITIES.
(a) In General.--Subchapter II of chapter 73 of title 38, United
States Code, as amended by section 2, is further amended by adding at
the end the following new section:
``Sec. 7330C. Identification and tracking of biological implants
``(a) Standard Identification System for Biological Implants.--(1)
The Secretary shall adopt the unique device identification system
developed for medical devices by the Food and Drug Administration
pursuant to section 519(f) of the Federal Food, Drug, and Cosmetic Act
(21 U.S.C. 360i(f)), or implement a comparable standard identification
system, for use in identifying biological implants intended for use in
medical procedures conducted in medical facilities of the Department.
``(2) In adopting or implementing a standard identification system
for biological implants under paragraph (1), the Secretary shall permit
a vendor to use any of the accredited entities identified by the Food
and Drug Administration as an issuing agency pursuant to section
830.100 of title 21, Code of Federal Regulations, or any successor
regulation.
``(b) Biological Implant Tracking System.--(1) The Secretary shall
implement a system for tracking the biological implants referred to in
subsection (a) from human donor or animal source to implantation.
``(2) The tracking system implemented under paragraph (1) shall be
compatible with the identification system adopted or implemented under
subsection (a).
``(3) The Secretary shall implement inventory controls compatible
with the tracking system implemented under paragraph (1) so that all
patients who have received, in a medical facility of the Department, a
biological implant subject to a recall can be notified of the recall,
if based on the evaluation of appropriate medical personnel of the
Department of the risks and benefits, the Secretary determines such
notification is appropriate.
``(c) Consistency With Food and Drug Administration Regulations.--To
the extent that a conflict arises between this section and a provision
of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 301 et seq.) or
sections 351 or 361 of the Public Health Service Act (42 U.S.C. 262)
(including any regulations issued under such Acts), the provision the
Federal Food, Drug, and Cosmetic Act or Public Health Service Act
(including any regulations issued under such Acts) shall apply.
``(d) Definition of Biological Implant.--In this section, the term
`biological implant' means any animal or human cell, tissue, or
cellular or tissue-based product--
``(1) under the meaning given the term human cells, tissues,
or cellular or tissue-based products in section 1271.3 of title
21, Code of Federal Regulations, or any successor regulation;
or
``(2) that is regulated as a device under section 201(h) of
the Federal Food, Drug, and Cosmetic Act.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter, as amended by section 2, is further amended by inserting
after the item relating to section 7330B, as added by section 2, the
following new item:
``7330C. Identification and tracking of biological implants.''.
(c) Implementation Deadlines.--
(1) Standard identification system.--
(A) In general.--With respect to biological implants
described in paragraph (1) of subsection (d) of section
7330C of title 38, United States Code, as added by
subsection (a), the Secretary of Veterans Affairs shall
adopt or implement a standard identification system for
biological implants, as required by subsection (a) of
such section, by not later than the date that is 180
days after the date of the enactment of this Act.
(B) Implants regulated as devices.--With respect to
biological implants described in paragraph (2) of
subsection (d) of such section, the Secretary of
Veterans Affairs shall adopt or implement such standard
identification system in compliance with the compliance
dates established by the Food and Drug Administration
pursuant to section 519(f) of the Federal Food, Drug,
and Cosmetic Act (21 U.S.C. 360i(f)).
(2) Tracking system.--The Secretary of Veterans Affairs shall
implement the biological implant tracking system required by
section 7330C(b), as added by subsection (a), by not later than
the date that is 180 days after the date of the enactment of
this Act.
(d) Reporting Requirement.--
(1) In general.--If the biological implant tracking system
required by section 7330C(b) of title 38, United States Code,
as added by subsection (a), is not operational by the date that
is 180 days after the date of the enactment of this Act, the
Secretary of Veterans Affairs shall submit to the Committees on
Veterans' Affairs of the Senate and House of Representatives a
written explanation for why the system is not operational for
each month until such time as the system is operational.
(2) Elements.--Each explanation submitted under paragraph (1)
shall include a description of the following:
(A) Each impediment to the implementation of the
system described in such paragraph.
(B) Steps being taken to remediate each such
impediment.
(C) Target dates for a solution to each such
impediment.
SEC. 5. PROCUREMENT OF BIOLOGICAL IMPLANTS USED IN DEPARTMENT OF
VETERANS AFFAIRS MEDICAL FACILITIES.
(a) Procurement.--
(1) In general.--Subchapter II of chapter 81 of such title is
amended by adding at the end the following new section:
``Sec. 8129. Procurement of biological implants
``(a) In General.--(1) The Secretary may procure biological implants
of human origin only from vendors that meet the following conditions:
``(A) The vendor uses the standard identification system
adopted or implemented by the Secretary under section 7330C(a)
of this title and has safeguards to ensure that a distinct
identity code has been in place at each step of distribution of
each biological implant from its donor.
``(B) The vendor is registered as required by the Food and
Drug Administration under subpart B of part 1271 of title 21,
Code of Federal Regulations, or any successor regulation, and
in the case of a vendor that uses a tissue distribution
intermediary or a tissue processor, the vendor provides
assurances that the tissue distribution intermediary or tissue
processor is registered as required by the Food and Drug
Administration.
``(C) The vendor ensures that donor eligibility
determinations and such other records as the Secretary may
require accompany each biological implant at all times,
regardless of the country of origin of the donor of the
biological material.
``(D) The vendor agrees to cooperate with all biological
implant recalls conducted on the vendor's own initiative, on
the initiative of the original product manufacturer used by the
vendor, by the request of the Food and Drug Administration, or
by a statutory order of the Food and Drug Administration.
``(E) The vendor agrees to notify the Secretary of any
adverse event or reaction report it provides to the Food and
Drug Administration, as required by section 1271.350 of title
21, Code of Federal Regulations, or any successor regulation,
or any successor regulation, or of any warning letter from the
Food and Drug Administration issued to the vendor or a tissue
processor or tissue distribution intermediary it uses by not
later than 60 days after the vendor receives such report or
warning letter.
``(F) The vendor agrees to retain all records associated with
the procurement of a biological implant by the Department for
at least 10 years after the date of the procurement of the
biological implant.
``(G) The vendor provides assurances that the biological
implants provided by the vendor are acquired only from tissue
processors that maintain active accreditation with the American
Association of Tissue Banks or a similar national accreditation
specific to biological implants.
``(2) The Secretary may procure biological implants of non-human
origin only from vendors that meet the following conditions:
``(A) The vendor uses the standard identification system
adopted or implemented by the Secretary under section 7330C(a)
of this title.
``(B) The vendor is a registered establishment as required by
the Food and Drug Administration under sections 807.20 and
807.40 of title 21, Code of Federal Regulations, or any
successor regulation, (or is not required to register pursuant
to section 807.65(a) of such title) and in the case of a vendor
that is not the original product manufacturer of such implants
the vendor provides assurances that the original product
manufacturer is registered as required by the Food and Drug
Administration.
``(C) The vendor agrees to cooperate with all biological
implant recalls conducted on the vendor's own initiative, on
the initiative of the original product manufacturer used by the
vendor, by the request of the Food and Drug Administration, or
by a statutory order of the Food and Drug Administration.
``(D) The vendor agrees to notify the Secretary of any
adverse event report it provides to the Food and Drug
Administration as required in part 803 of title 21, Code of
Federal Regulations, or any warning letter from the Food and
Drug Administration issued to the vendor or the original
product manufacturer it uses by not later than 60 days after
the vendor receives such report or warning letter.
``(E) The vendor agrees to retain all records associated with
the procurement of a biological implant by the Department for
at least 10 years after the date of the procurement of the
biological implant.
``(3)(A) The Secretary shall procure biological implants under the
Federal Supply Schedules of the General Services Administration unless
such implants are not available under such Schedules.
``(B) With respect to biological implants listed on the Federal
Supply Schedules, the Secretary shall accommodate reasonable vendor
requests to undertake outreach efforts to educate medical professionals
of the Department about the use and efficacy of such biological
implants.
``(C) In the case of biological implants that are unavailable for
procurement under the Federal Supply Schedules, the Secretary shall
procure such implants using competitive procedures in accordance with
applicable law and the Federal Acquisition Regulation.
``(4) Section 8123 of this title shall not apply to the procurement
of biological implants.
``(b) Penalties.--In addition to any applicable penalty under any
other provision of law, any procurement employee of the Department who
is found responsible for a biological implant procurement transaction
with intent to avoid or with reckless disregard of the requirements of
this section shall be ineligible to hold a certificate of appointment
as a contracting officer or to serve as the representative of an
ordering officer, contracting officer, or purchase card holder.
``(c) Definitions.--In this section:
``(1) The term `biological implant' shall have the meaning
given such term in section 7330C(d) of this title.
``(2) The term `distinct identity code' means a code that--
``(A) relates a biological implant to the human donor
of the implant and to all records pertaining to the
implant;
``(B) includes information designed to facilitate
effective tracking, using such code, from the donor to
the recipient and from the recipient to the donor; and
``(C) satisfies the requirements of section 1271.290
of title 21, Code of Federal Regulations, or any
successor regulation.
``(3) The term `tissue distribution intermediary' means an
agency that acquires and stores human tissue for further
distribution and performs no other tissue banking functions.
``(4) The term `tissue processor' means an entity processing
human tissue for use in biological implants including
activities performed on tissue other than donor screening,
donor testing, tissue recovery and collection functions,
storage, or distribution.''.
(2) Clerical amendment.--The table of sections at the
beginning of such chapter is amended by adding at the end of
the items relating to such subchapter the following new item:
``8129. Procurement of biological implants.''.
(b) Effective Date.--Section 8129 of title 38, United States Code, as
added by subsection (a), shall take effect on the date that is 180 days
after the date on which the tracking system required under subsection
(b) of section 7330C of such title, as added by section 4(a) is
implemented.
(c) Special Rule for Cryopreserved Products.--During the three-year
period beginning on the effective date of section 8129 of title 38,
United States Code, as added by subsection (a), biological implants
produced and labeled before that date may be procured by the Department
of Veterans Affairs without relabeling under the standard
identification system adopted or implemented under section 7330C of
such title, as added by section 4(a).
SEC. 6. EXTENSION OF ROUNDING DOWN OF PERCENTAGE INCREASES OF RATES OF
CERTAIN EDUCATIONAL ASSISTANCE.
(a) Montgomery GI Bill.--Section 3015(h)(2) of title 38, United
States Code, is amended--
(1) by striking ``fiscal year 2014'' and inserting ``fiscal
year 2020''; and
(2) by striking ``fiscal year 2013'' and inserting ``fiscal
year 2019''.
(b) Survivors and Dependents Educational Assistance.--Section 3564(b)
of such title is amended--
(1) by striking ``fiscal year 2014'' and inserting ``fiscal
year 2020''; and
(2) by striking ``fiscal year 2013'' and inserting ``fiscal
year 2019''.
SEC. 7. VETERANS EXPEDITED RECOVERY COMMISSION.
(a) Establishment.--There is established the Veterans Expedited
Recovery Commission (in this section referred to as the
``Commission'').
(b) Duties.--The Commission shall perform the following duties:
(1) Examine the efficacy of the evidence-based therapy model
used by the Secretary of Veterans Affairs for treating mental
health illnesses of veterans and identify areas to improve
wellness-based outcomes.
(2) Conduct a patient-centered survey within each of the
Veterans Integrated Service Networks to examine--
(A) the experience of veterans with the Department of
Veterans Affairs when seeking medical assistance for
mental health issues through the health care system of
the Department;
(B) the experience of veterans with non-Department
medical facilities and health professionals for
treating mental health issues;
(C) the preferences of veterans regarding available
treatments for mental health issues and which methods
the veterans believe to be most effective;
(D) the experience, if any, of veterans with respect
to the complementary alternative treatment therapies
described in subparagraphs (A) through (I) in paragraph
(3);
(E) the prevalence of prescribing prescription
medication among veterans seeking treatment through the
health care system of the Department as remedies for
addressing mental health issues; and
(F) the outreach efforts of the Secretary regarding
the availability of benefits and treatments for
veterans for addressing mental health issues, including
by identifying ways to reduce barriers to and gaps in
such benefits and treatments.
(3) Examine available research on complementary alternative
treatment therapies for mental health issues and identify what
benefits could be made with the inclusion of such treatments
for veterans, including with respect to--
(A) music therapy;
(B) equine therapy;
(C) training and caring for service dogs;
(D) yoga therapy;
(E) acupuncture therapy;
(F) meditation therapy;
(G) outdoor sports therapy;
(H) hyperbaric oxygen therapy;
(I) accelerated resolution therapy; and
(J) other therapies the Commission determines
appropriate.
(4) Study the potential increase of claims relating to mental
health issues submitted to the Secretary by veterans who served
in Operation Enduring Freedom, Operation Iraqi Freedom, or
Operation New Dawn, including an assessment of the resources
available within the Department to ensure that quality health
care demands relating to such claims can be delivered in a
timely manner.
(c) Membership.--
(1) Number and appointment.--
(A) In general.--The Commission shall be composed of
10 members, appointed as follows:
(i) Two members appointed by the Speaker of
the House of Representatives, at least one of
whom shall be a veteran.
(ii) Two members appointed by the Minority
Leader of the House of Representatives, at
least one of whom shall be a veteran.
(iii) Two members appointed by the Majority
Leader of the Senate, at least one of whom
shall be a veteran.
(iv) Two members appointed by the Minority
Leader of the Senate, at least one of whom
shall be a veteran.
(v) Two members appointed by the President,
at least one of whom shall be a veteran.
(B) Qualifications.--Members of the Commission shall
be--
(i) individuals who are of recognized
standing and distinction within the medical
community with a background in treating mental
health;
(ii) individuals with experience working with
the military and veteran population; and
(iii) individuals who do not have a financial
interest in any of the complementary
alternative treatments reviewed by the
Commission.
(2) Chairman.--The President shall designate a member of the
Commission to be the chairman.
(3) Period of appointment.--Members of the Commission shall
be appointed for the life of the Commission.
(4) Vacancy.--A vacancy in the Commission shall be filled in
the manner in which the original appointment was made.
(5) Appointment deadline.--The appointment of members of the
Commission in this section shall be made not later than 90 days
after the date of the enactment of this Act.
(d) Powers of Commission.--
(1) Meeting.--
(A) Initial meeting.--The Commission shall hold its
first meeting not later than 30 days after a majority
of members are appointed to the Commission.
(B) Meeting.--The Commission shall regularly meet at
the call of the Chairman. Such meetings may be carried
out through the use of telephonic or other appropriate
telecommunication technology if the Commission
determines that such technology will allow the members
to communicate simultaneously.
(2) Hearing.--The Commission may hold such hearings, sit and
act at such times and places, take such testimony, and receive
evidence as the Commission considers advisable to carry out the
responsibilities of the Commission.
(3) Information from federal agencies.--The Commission may
secure directly from any department or agency of the Federal
Government such information as the Commission considers
necessary to carry out the duties of the Commission.
(4) Information from nongovernmental organizations.--In
carrying out subsection (b), the Commission may seek guidance
through consultation with foundations, veterans service
organizations, nonprofit groups, faith-based organizations,
private and public institutions of higher education, and other
organizations as the Commission determines appropriate.
(5) Commission records.--The Commission shall keep an
accurate and complete record of the actions and meetings of the
Commission. Such record shall be made available for public
inspection and the Comptroller General of the United States may
audit and examine such record.
(6) Personnel matters.--Upon request of the chairman of the
Commission, the head of any department or agency of the Federal
Government may detail, on a reimbursable basis, any personnel
of that department or agency to assist the Commission in
carrying out the duties of the Commission.
(7) Compensation of members; travel expenses.--Each member
shall serve without pay, except that each member shall receive
travel expenses to perform the duties of the Commission under
subsection (b), including per diem in lieu of subsistence, at
rates authorized under subchapter I of chapter 57 of title 5,
United States Code.
(8) Staff.--The Chairman, in accordance with rules agreed
upon by the Commission, may appoint and fix the compensation of
a staff director and such other personnel as may be necessary
to enable the Commission to carry out its functions, without
regard to the provisions of title 5, United States Code,
governing appointments in the competitive service, without
regard to the provision of chapter 51 and subchapter III of
chapter 53 of such title relating to classification and General
Schedule pay rates, except that no rate of pay fixed under this
subsection may exceed the equivalent of that payable for a
position at a level IV of the Executive Schedule under section
5316 of title 5, United States Code.
(9) Personnel as federal employees.--
(A) In general.--The executive director and any
personnel of the Commission are employees under section
2105 of title 5, United States Code, for purpose of
chapters 63, 81, 83, 84, 85, 87, 89, and 90 of such
title.
(B) Members of the commission.--Subparagraph (A)
shall not be construed to apply to members of the
Commission.
(10) Contracting.--The Commission may, to such extent and in
such amounts as are provided in appropriations Acts, enter into
contracts to enable the Commission to discharge the duties of
the Commission under this section.
(11) Expert and consultant service.--The Commission may
procure the services of experts and consultants in accordance
with section 3109 of title 5, United States Code, at rates not
to exceed the daily rate paid to a person occupying a position
at level IV of the Executive Schedule under section 5315 of
title 5, United States Code.
(12) Postal service.--The Commission may use the United
States mails in the same manner and under the same conditions
as departments and agencies of the United States.
(13) Physical facilities and equipment.--Upon the request of
the Commission, the Administrator of General Services shall
provide to the Commission, on a reimbursable basis, the
administrative support services necessary for the Commission to
carry out its responsibilities under this section. These
administrative services may include human resource management,
budget, leasing, accounting, and payroll services.
(e) Report.--
(1) Interim reports.--
(A) In general.--Not later than 60 days after the
date on which the Commission first meets, and each 30-
day period thereafter ending on the date on which the
Commission submits the final report under paragraph
(2), the Commission shall submit to the Committees on
Veterans' Affairs of the House of Representatives and
the Senate and the President a report detailing the
level of cooperation the Secretary of Veterans Affairs
(and the heads of other departments or agencies of the
Federal Government) has provided to the Commission.
(B) Other reports.--In carrying out the duties
pursuant to subsection (b), at times that the
Commission determines appropriate, the Commission shall
submit to the Committees on Veterans' Affairs of the
House of Representatives and the Senate and any other
appropriate entities an interim report with respect to
the findings identified by the Commission.
(2) Final report.--Not later than 18 months after the first
meeting of the Commission, the Commission shall submit to the
Committees on Veterans' Affairs of the House of Representatives
and the Senate, the President, and the Secretary of Veterans
Affairs a final report on the findings of the Commission. Such
report shall include the following:
(A) Recommendations to implement in a feasible,
timely, and cost-effective manner the solutions and
remedies identified within the findings of the
Commission pursuant to subsection (b).
(B) An analysis of the evidence-based therapy model
used by the Secretary of Veterans Affairs for treating
veterans with mental health care issues, and an
examination of the prevalence and efficacy of
prescription drugs as a means for treatment.
(C) The findings of the patient-centered survey
conducted within each of the Veterans Integrated
Service Networks pursuant to subsection (b)(2).
(D) An examination of complementary alternative
treatments described in subsection (b)(3) and the
potential benefits of incorporating such treatments in
the therapy model used by the Secretary for treating
veterans with mental health issues.
(3) Plan.--Not later than 90 days after the date on which the
Commission submits the final report under subsection (b), the
Secretary of Veterans Affairs shall submit to the Committees on
Veterans' Affairs of the House of Representatives and the
Senate a report on the following:
(A) An action plan for implementing the
recommendations established by the Commission on such
solutions and remedies for improving wellness-based
outcomes for veterans with mental health care issues.
(B) A feasible timeframe on when complementary
alternative treatments described in subsection (b)(3)
can be implemented Department-wide.
(C) With respect to each recommendation established
by the Commission, including regarding any
complementary alternative treatment, that the Secretary
determines is not appropriate or feasible to implement,
a justification for each such determination and an
alternative solution to improve the efficacy of the
therapy model used by the Secretary for treating
veterans with mental health issues.
(f) Termination of Commission.--The Commission shall terminate 30
days after the Commission submits the final report under subsection
(e)(2).
Amend the title so as to read:
A bill to amend title 38, United States Code, to direct the
Secretary of Veterans Affairs to submit an annual report on the
Veterans Health Administration, to provide for the
identification and tracking of biological implants used in
Department of Veterans Affairs facilities, and for other
purposes.
Purpose and Summary
H.R. 2256, as amended, the ``Veterans Information
Modernization Act,'' was ordered to be favorably reported to
the full House on May 21, 2015 by voice vote. In addition to
H.R. 2256, introduced on May 12, 2015, by Representative Dan
Benishek of Michigan, the Chairman of the Subcommittee on
Health of the Committee on Veterans' Affairs, the amended
version of the bill reflects the Committee's consideration of
three other bills introduced during the 114th Congress: H.R.
627, introduced by Representative Janice Hahn of California on
January 30, 2015; H.R. 1016, introduced by Representative David
P. Roe of Tennessee on February 20, 2015; and H.R. 271,
introduced by Representative Gus Bilirakis of Florida on
January 12, 2015.
H.R. 2256, as amended, would require the Department of
Veterans Affairs (VA) to submit an annual report to Congress
regarding the provision of hospital care, medical services, and
nursing home care by the VA health care system for the prior
calendar year. It would amend VA's definition of a homeless
veteran to include a veteran or veteran's family who is fleeing
domestic or dating violence, sexual assault, stalking, or other
dangerous or life-threatening conditions in the individual's or
family's current housing situation, has no other residence, and
lacks the resources or support networks to obtain other
permanent housing. It would require VA to implement a standard
identification protocol for biological implants that is
consistent with the Food and Drug Administration's (FDA's)
Unique Identification System and to procure biological implants
only through competitive procurement processes from vendors who
maintain a 10 year record retention policy and who procure
their human tissue from properly accredited sources. The bill
would also round down, to the nearest whole dollar, any
increases to the Montgomery GI Bill and Survivors' and
Dependents' Educational Assistance Program by the cost-of-
living-adjustment. Finally, the bill would establish the
Veterans Expedited Recovery Commission to study, survey, and
evaluate VA's ability to effectively treat veterans with mental
health issues and direct VA, upon a report by the Commission,
to submit an action plan and a timeframe for implementing
complementary and alternative treatments.
Background and Need for Legislation
Section 2--Annual report on Veterans Health Administration and
furnishing of hospital care, medical services, and nursing home
care
Since the wait time manipulation scandal at the Phoenix VA
Health Care System sparked a system-wide review of veteran
access to care in 2014, there has been a renewed focus on the
cost of care provided to veteran patients by the VA health care
system. On December 10, 2014, the Congressional Budget Office
(CBO) released a report entitled, ``Comparing the Costs of the
Veterans' Health Care System with Private-Sector Costs.'' The
purpose of the report was to examine how the costs of health
care provided by the Veterans Health Administration (VHA)
compare to the costs of care provided in the private sector. In
the report, CBO concluded that, ``limited evidence and
substantial uncertainty make it difficult to reach firm
conclusions about those relative costs or about whether it
would be cheaper to expand veterans' access to health care in
the future through VHA facilities or the private sector.''
On January 28, 2015, Matthew S. Goldberg, the Deputy
Assistant Director of the CBO's National Security Division,
testified before the Subcommittee on Health regarding the
report and CBO's findings. In his testimony, Mr. Goldberg
stated that, ``[a]mong the many analytical challenges in
conducting [studies regarding VA benefits and services] are the
problems CBO sometimes encounters in obtaining appropriate data
from VHA[.]'' He stated that, ``VA, which runs VHA, has
provided limited data to the Congress and the public about its
costs and operational performance,'' and that, ``if it was
provided on a regular and systemic basis, could help inform
policymakers about the efficiency and cost-effectiveness of
VHA's services.''
Similar statements were made in other testimony provided
during the hearing. Carl Blake, Associate Executive Director
for Government Relations for the Paralyzed Veterans of America,
speaking on behalf of the co-authors of the Independent Budget
(IB), testified that, ``the IB co-authors believe that VHA
should be far more forthcoming with data that allows for a
thorough examination of the timeliness and quality of its
services and the capacities VA maintains to meet these
requirements.'' Likewise, Louis Celli, Jr., Director of the
Veterans Affairs & Rehabilitation Division of the American
Legion, testified that, ``CBO needs more data in order to make
recommendations or be able to come to any credible
conclusion.''
To address these calls for greater reporting of data
regarding health care, increased transparency, and improved
data collection that would allow for greater cost comparisons
between VA and the private sector, Section 2 of the bill would
require VA to submit an annual report to Congress regarding the
provision of hospital care, medical services, and nursing home
care by the VA health care system. The report would include,
for the prior calendar year, data regarding access to care,
quality of care, workload, patient demographics and
utilization, physician compensation, productivity, non-VA care,
and pharmaceutical prices.
This reporting requirement is similar to the annual report
that the Department of Defense publishes pursuant to Section
717 of the National Defense Authorization Act for FY 1996
(Public Law 104-106). That report contains information on the
Tricare program including data regarding population,
demographics, workload, costs, and trends for both direct and
purchased care.
Section 3--Expansion of definition of homeless veteran for purposes of
benefits under the laws administered by the Secretary of
Veterans Affairs
Section 2002 of title 38, U.S.C., defines a ``homeless
veteran'' as ``a veteran who is homeless (as that term is
defined in section 103(a) of the McKinney-Vento Homeless
Assistance Act (42 U.S.C. 11302(a))).'' However, in 2009, the
definition of homelessness under the McKinney-Vento Homeless
Assistance Act was amended to include section 103(b), which
defines as homeless an individual or family who is fleeing
their current residence due to domestic or sexual violence or
some other life-threatening condition. Because VA's definition
of homelessness refers only to section 103(a), veterans who are
fleeing their current home due to domestic violence, sexual
violence, or other life-threatening conditions are not
considered homeless per VA's current statutory definition of
that term.
Section 3 of the bill would correct this by amending VA's
definition of a homeless veteran to include section 103(b) of
the McKinney-Vento Homeless Assistance Act. Under this
definition, a veteran or veteran's family who is fleeing
domestic or dating violence, sexual assault, stalking, or other
dangerous or life-threatening conditions in the individual's or
family's current housing situation and has no other residence
and lacks the resources or support networks to obtain other
permanent housing would be considered a ``homeless'' veteran.
Section 4--Identification and tracking of biological implants used in
Department of Veterans Affairs medical facilities
Currently, there is no requirement in title 38, U.S.C., for
VA to identify and track biological implants intended for use
in VA Medical facilities. Subcommittee on Oversight and
Investigations hearings revealed significant risk to veteran
health and safety involving possibly contaminated products and
the inability of VA to reliably identify veterans with implants
in the event of recall.\1\
---------------------------------------------------------------------------
\1\See, House Committee on Veterans' Affairs, Subcommittee on
Oversight and Investigations Hearing, ``Vendors in the OR--VA's Failed
Oversight of Surgical Implants,'' dated January 15, 2014 and House
Committee on Veterans' Affairs, Subcommittee on Oversight and
Investigations Hearing, ``VA & Human Tissue: Improvements Needed for
Veterans Safety,'' dated April 2, 2014.
---------------------------------------------------------------------------
Section 4 of the bill would require VA to implement a
standard identification system for biological implants and a
tracking system that would allow the tracking of such implants
from human or animal source to implantation in a veteran/
patient. Section 4 of the bill would also contain definitions,
reporting requirements, implementation deadlines, and a
provision regarding consistency with FDA regulations.
Section 5--Procurement of biological implants used in Department of
Veterans Affairs medical facilities
To ensure the ability to track and trace biological
implants, section 5 would require that VA procure them only
from vendors who use the standard identification system adopted
under section 4 by VA. Section 5 of the bill would also impose
additional requirements to foster patient safety, including
that VA procure biological implants from vendors who: (1)
registered with the FDA, (2) agreed to recordkeeping
requirements, (3) agreed to cooperate with recalls, (4) agreed
to notify VA in the event of adverse event or FDA warning
letter, and (5) maintained accreditation from the American
Association of Tissue Banks or by a similar national
accreditation specific to biological implants.
To promote competition and provide for multiple sources for
procuring biological implants, section 5 would further require
VA to procure biological implants from vendors on the Federal
Supply Schedule unless they are unavailable thereon. Section 5
would require that VA accommodate reasonable requests from
vendors to educate VA medical professionals about the efficacy
of their products and eliminate the option for VA to procure
biological implants under the sole source authority of section
8123 of title 38, U.S.C. Subcommittee on Oversight and
Investigations hearings indicated that the authority of section
8123 of title 38 U.S.C., was prone to abuse because sole source
justifications were often missing or poorly documented. Section
5 would not eliminate sole source justification for procurement
of biological implants when necessary in accordance with the
Federal Acquisition Regulation and the Veterans Affairs
Acquisition Regulation.
Section 6--Extension of rounding down of percentage increases of rates
of certain educational assistance
Section 3015(h)(2) and 3564(b) of title 38, U.S.C.,
requires that any increase in educational assistance rates
under the Montgomery GI Bill and the Survivors' and Dependents'
Educational Assistance Program be rounded down to the next
lower whole dollar amount. However, this authority expires at
the end of fiscal year 2014.
Section 6 of the bill would extend this authority through
the end of fiscal year 2019. Any increase in educational
assistance rates under the Montgomery GI Bill and the
Survivors' and Dependents' Educational Assistance Program made
after fiscal year 2019 would be rounded to the nearest whole
dollar.
Section 7--Veterans Expedited Recovery Commission
The National Institutes of Health's National Center for
Complementary and Alternative Medicine defines complementary
and alternative medicine (CAM) as a group of diverse medical
and health care systems, practices, and products that are not
generally considered part of conventional medicine. The term
''Complementary'' refers to the use of CAM together with
conventional medicine, such as using meditation in addition to
traditional psychotherapy to treat post-traumatic stress
disorder (PTSD). ``Alternative'' refers to use of CAM in place
of conventional medicine, such as using meditation in place of
traditional psychotherapy to treat PTSD.
The use of CAM has grown significantly in VA over the past
decade. In a 2012 survey completed by the NIH, 96 percent of
post-traumatic stress disorder (PTSD) programs surveyed
reported the use of at least one CAM therapy and 88 percent
offered CAM therapies other than those commonly part of
treatment (i.e. guided imagery, progressive muscle relaxation,
and stress management-relaxation therapies). Though the use of
CAM therapies has become increasingly widespread among VA
medical facilities in recent years and demand for CAM services
among veteran patients using the VA health care system is
increasing, CAM is not uniformly offered to veterans across the
system.
In an attempt to remedy this, section 7 would establish the
Veterans Expedited Recovery Commission to study, survey, and
evaluate VA's ability to effectively treat veterans with mental
health issues. Following a report by the Commission, VA would
be directed to submit an action plan for implementing
recommendations and a timeframe for implementing complementary
and alternative treatments, or else it must provide a
justification for a determination that a recommendation is not
appropriate and an alternative solution to improve the efficacy
of VA's therapy model.
Hearings
There were no full Committee hearings held on H.R. 2256, as
amended. On March 19, 2015, the Subcommittee on Oversight and
Investigations conducted a legislative hearing on H.R. 571,
H.R. 593, H.R. 1015, H.R. 1016, H.R. 1017, H.R. 1128, and H.R.
1129.
The following witnesses testified:
Meghan Flanz, the Director of the Office of
Accountability Review for the Department of Veterans
Affairs; Diane Zumatto, the National Legislative
Director for AMVETS; Frank Wilton, the Chief Executive
Officer for the American Association of Tissue Banks;
and, Daimon E. Geopfert, the National Leader, Security
and Privacy Consulting for McGladrey, LLP. Ms. Flanz
was accompanied by Michael Icardi, M.D., the National
Director of Pathology and Laboratory Medicine Services
for the Veterans Health Administration of the U.S.
Department of Veterans Affairs; Stanley Lowe, the
Deputy Assistant Secretary for Information Security and
Chief Information Security Officer for the U.S.
Department of Veteran Affairs; and, Dennis Milsten,
CCM, the Associate Executive Director for the Office of
Operations of the Office of Construction and Facilities
Management for the U.S. Department of Veterans Affairs.
A Statement for the record was submitted by:
The American Legion.
On April 23, 2015, the Subcommittee on Health
conducted a legislative hearing on: draft legislation
to improve reproductive treatment provided to certain
disabled veterans; draft legislation to direct VA to
submit an annual report on the Veterans Health
Administration; H.R. 271; H.R. 627; H.R. 1369; H.R.
1575; and H.R. 1769.
The following witnesses testified:
The Honorable Gus Bilirakis of Florida; the Honorable
Janice Hahn of California; the Honorable Jackie
Walorski of Indiana; Blake Ortner, the Deputy
Government Relations Director of the Paralyzed Veterans
of America; Louis J. Celli, Jr., the Director of the
National Veterans Affairs and Rehabilitation Division
for the American Legion; John Rowan, the National
President of the Vietnam Veterans of America; Adrian
Atizado, the Assistant National Legislative Director
for the Disabled American Veterans; and, Rajiv Jain,
M.D., the Assistant Deputy Under Secretary for Health
for Patient Care Services for the Veterans Health
Administration of the U.S. Department of Veterans
Affairs. Dr. Jain was accompanied by Janet Murphy, the
Acting Deputy Under Secretary for Health for Operations
and Management for the Veterans Health Administration
of the U.S. Department of Veterans Affairs, and
Jennifer Gray, Attorney for the Office of the General
Counsel of the U.S. Department of Veterans Affairs.
Statements for the Record were submitted by:
The Honorable Corrine Brown of Florida, the Ranking
Member of the Full Committee; the American Health Care
Association; the American Society for Reproductive
Medicine; Concerned Veterans for America; RESOLVE:
National Infertility Association; Veterans of Foreign
Wars of the United States; and, Wounded Warrior
Project.
Subcommittee Consideration
On April 21, 2015, the Subcommittee on Oversight and
Investigations met in an open markup session, a quorum being
present, and ordered H.R. 571, as amended, H.R. 1015, as
amended, H.R. 1016, as amended, and H.R. 1017, as amended, to
be reported favorably to the full Committee by voice vote.
During consideration of H.R. 1016, the following amendment
was considered and agreed to by voice vote:
An amendment in the nature of a substitute offered by
Mr. Roe of Tennessee that increased the record
retention requirement from 5 years to 10 years, removed
the inspection and audit requirement as the FDA is
already required to conduct such investigations, and
made other technical changes.
The Subcommittee on Health met in an open markup session on
May 15, 2015, a quorum being present, and ordered H.R. 271,
H.R. 627, H.R. 1575, H.R. 1769, and H.R. 2256, to be reported
favorably to the full Committee by voice vote.
Committee Consideration
On May 21, 2015, the Full Committee met in an open markup
session, a quorum being present, and ordered H.R. 2256, as
amended, to be reported favorably to the House of
Representatives by voice vote.
During consideration of H.R. 2256, as amended, the
following amendment was considered and agreed to by voice vote:
An amendment in the nature of a substitute offered by
Dr. Benishek of Michigan which combined the contents of
H.R. 2256, as introduced; H.R. 271; H.R. 627; and, H.R.
1016 and inserted a provision that would round down, to
the nearest whole dollar, any increases to the
Montgomery GI Bill and Dependents Educational
Assistance Program by the cost of living adjustment.
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.
There were no recorded votes taken on amendments or in
connection with ordering H.R. 2256, as amended, reported to the
House. A motion by Ranking Member Corrine Brown of Florida to
report H.R. 2256, as amended, favorably to the House of
Representatives was agreed to by voice vote.
Committee Oversight Findings
In compliance with clause 3(c)(1) of rule XIII and clause
(2)(b)(1) of rule X of the Rules of the House of
Representatives, the Committee's oversight findings and
recommendations are reflected in the descriptive portions of
this report.
Statement of General Performance Goals and Objectives
In accordance with clause 3(c)(4) of rule XIII of the Rules
of the House of Representatives, the Committee's performance
goals and objectives are 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. 2256, 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.
2256, 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. 2256, 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, June 23, 2015.
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. 2256, the Veterans
Information Modernization Act.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Anne E.
Futrell.
Sincerely,
Keith Hall.
Enclosure.
H.R. 2256--Veterans Information Modernization Act
Summary: H.R. 2256 would establish a tracking system for
biological implants, create a commission to assess mental
health care at the Department of Veterans Affairs (VA), expand
the definition of homeless veterans for purpose of certain
programs and benefits offered by VA, and require VA to submit
an annual report to the Congress. In total, CBO estimates that
implementing this bill would increase costs to VA by $9 million
over the 2016-2020 period, assuming appropriation of the
necessary amounts.
In addition, CBO estimates that enacting the bill would
decrease direct spending by $9 million over the 2016-2025
period by adjusting the monthly payments for VA educational
benefits; therefore, pay-as-you-go procedures apply to the
bill. Enacting H.R. 2256 would not affect revenues.
H.R. 2256 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA)
and would not affect the budgets of state, local, or tribal
governments.
Estimated cost to the Federal Government: The estimated
budgetary effect of H.R. 2256 is shown in the following table.
The costs of this legislation fall within budget function 700
(veterans benefits and services).
----------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
-------------------------------------------------------
2016 2017 2018 2019 2020 2016-2020
----------------------------------------------------------------------------------------------------------------
CHANGES IN SPENDING SUBJECT TO APPROPRIATION
Commission on Mental Health Care:
Estimated Authorization Level....................... 2 2 0 0 0 4
Estimated Outlays................................... 2 2 * * 0 4
Tracking of Biological Implants:
Estimated Authorization Level....................... 1 1 1 * * 3
Estimated Outlays................................... 1 1 1 * * 3
Annual Report:
Estimated Authorization Level....................... * * * * * 2
Estimated Outlays................................... * * * * * 2
Total:
Estimated Authorization Level................... 3 3 1 1 1 9
Estimated Outlays............................... 3 3 1 1 1 9
CHANGES IN DIRECT SPENDING
Estimated Budget Authority.............................. 0 -1 -1 -1 -1 -4
Estimated Outlays....................................... 0 -1 -1 -1 -1 -4
----------------------------------------------------------------------------------------------------------------
Notes: In addition to, in the effects shown here, enacting H.R. 2256 would have effects on direct spending
beyond 2020. CBO estimates that, in total, direct spending would decrease by $9 million over the 2016-2025
period.
* = less than $500,000.
Basis of estimate: For this estimate, CBO assumes that the
legislation will be enacted near the beginning of fiscal year
2016, that estimated amounts will be appropriated for each
year, and that outlays will follow historical spending patterns
for similar and existing programs.
Spending subject to appropriation
CBO estimates that, in total, implementing H.R. 2256 would
cost $9 million over the 2016-2020 period, assuming
appropriation of the necessary amounts.
Commission on Mental Health Care. Section 7 would establish
the Veterans Expedited Recovery Commission. The commission--
consisting of 10 voting members--would examine the treatment of
mental health at VA. Members of the commission would serve
without pay; however, they would receive travel reimbursement
and per diem. The staff director and support staff would
receive compensation (not to exceed the salary of senior
political officials). The commission also would be authorized
to hire contractors and experts to provide additional guidance
and recommendations. The commission would be required to
conduct a nationwide survey and to submit a final report of its
findings within a year and a half from its first meeting.
Based on an examination of other government commissions, we
expect this commission would require five full-time employees
(including a staff director) with an average salary of $200,000
(including benefits) and five part-time contractors at an
average salary of $40,000. We also estimate annual costs
totaling $4,000 per member for per diem, $1,000 per member for
travel, and $30,000 for rent. Based on costs of similar
surveys, we estimate that a nationwide survey would cost $1
million per year. In total, CBO estimates that establishing the
commission would cost $4 million over the 2016-2020 period.
Tracking of Biological Implants. Within 180 days after
enactment, sections 4 and 5 would require VA to establish and
implement a tracking system for biological implants (i.e. human
cells, tissue, or cellular or tissue-based product) used in
medical procedures at VA medical facilities. The bill would
allow VA to use the existing unique device identification
system administered by the U.S. Food and Drug Administration.
By ensuring that surgical implants are labeled with unique
device identifiers, the tracking system would help VA to notify
patients in cases of device recalls and potentially reduce
medical errors.
Over the 2010-2013 period, VA planned and initiated the
development of the Veterans Implant Tracking and Alert System
(VITAS). That system was intended to document the provenance of
surgical implants, allowing VA to identify and locate patients
with implants in the event of a recall. However, in 2013, VA
stopped developing VITAS prior to the completion of the
registry, because of coordination issues with VA's record
system for patients. According to VA, such efforts required
three full-time staff at $1 million per year. We expect
comparable resources and costs to further develop and expand
the biological implant tracking system over the next three
years. In total, CBO estimates discretionary costs of $3
million over the 2016-2020 period to develop and implement a
device tracking system.
Annual Report. Section 2 would require VA to submit an
annual report to the Congress on the following information:
Effectiveness of VA health care and long-term
care,
Workload and compensation of VA employees,
Demographics of the veterans enrolled and using
the VA health care system,
Usage rates of the VA health care system, and
Pharmaceutical prices.
The report would include data for each VA health care
region and medical center. Currently, VA gathers and reports on
some of that data. CBO expects that about five full-time-
equivalent staff would be necessary to coordinate and prepare a
comprehensive report with facility level data on an annual
basis. CBO estimates implementing this section would cost $2
million over the 2016-2020 period.
Definition of Homeless Veterans. Section 3 would expand the
definition of homeless veterans to include veterans who are
fleeing or attempting to flee domestic violence, dating
violence, sexual assault, stalking, or other life threatening
conditions. That change would make veterans who are victims of
such conditions eligible for services provided to homeless
veterans by VA. In 2015, about $344 million was appropriated
for those services.
The Bureau of Justice Statistics reports that less than
half of 1 percent of the U.S. population in 2012 were victims
of domestic abuse. Most of those individuals (80 percent) were
female and about 20 percent sought support from government or
private-sector agencies. Because about 10 percent of veterans
are female, CBO expects that the number of veterans who would
be newly eligible for homeless benefits under this provision
would be quite small (about 20 people a year). Therefore, CBO
estimates that implementing this section would cost less than
$500,000 over the 2016-2020 period.
Direct spending
Under current law, the rates of certain monthly benefits
paid under the Montgomery G.I. Bill and Survivors' and
Dependents' Educational Assistance programs are increased
annually by specified economic indices. Section 6 of H.R. 2256
would extend through fiscal year 2019 two provisions of law
that require those increases to be rounded down to the next
lower whole dollar. Those provisions expired at the end of
fiscal year 2013. Based on projections of the number of
beneficiaries and payments made each year, and assuming that
the rounding is not retroactive, CBO estimates that enacting
section 6 would reduce direct spending by $9 million over the
2016-2025 period.
Pay-As-You-Go considerations: The Statutory Pay-As-You-Go
Act of 2010 establishes budget-reporting and enforcement
procedures for legislation affecting direct spending or
revenues. H.R. 2256 would modify a program that provides
educational benefits to veterans. The changes in outlays that
are subject to those pay-as-you-go procedures are shown in the
following table.
CBO ESTIMATE OF PAY-AS-YOU-GO EFFECTS FOR H.R. 2256 AS ORDERED REPORTED BY THE HOUSE COMMITTEE ON VETERANS' AFFAIRS ON MAY 21, 2015
--------------------------------------------------------------------------------------------------------------------------------------------------------
By Fiscal Year, in millions of dollars--
-------------------------------------------------------------------------------------------------------
2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2015-2020 2015-2025
--------------------------------------------------------------------------------------------------------------------------------------------------------
NET DECREASE (-) IN THE DEFICIT
Statutory Pay-As-You-Go Impact.................. 0 0 -1 -1 -1 -1 -1 -1 -1 -1 -1 -4 -9
--------------------------------------------------------------------------------------------------------------------------------------------------------
Intergovernmental and private-sector impact: H.R. 2256
contains no intergovernmental or private-sector mandates as
defined in UMRA and would not affect the budgets of state,
local, or tribal governments.
Estimate prepared by: Federal Costs: Ann E. Futrell and
David Newman; Impact on State, Local, and Tribal Governments:
Jon Sperl; Impact on the Private Sector: Paige Piper/Bach.
Estimate approved by: H. Samuel Papenfuss, Deputy Assistant
Director for Budget Analysis.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates regarding H.R. 2256, 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.
2256, 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.
Statement on Duplication of Federal Programs
Pursuant to section 3(g) of H. Res. 5, 114th Cong. (2015),
the Committee finds that no provision of H.R. 2256, as amended,
establishes or reauthorizes a program of the Federal Government
known to be duplicative of another Federal program, a program
that was included in any report from the Government
Accountability Office to Congress pursuant to section 21 of
Public Law 111-139, or a program related to a program
identified in the most recent Catalog of Federal Domestic
Assistance.
Disclosure of Directed Rulemaking
Pursuant to section 3(i) of H. Res. 5, 114th Cong. (2015),
the Committee estimates that H.R. 2256, as amended, does not
require any directed rulemakings.
Section-by-Section Analysis of the Legislation
Section 1. Short title
Section 1 of the bill would provide the short title of H.R.
2256, as amended, as the ``Veterans Information Modernization
Act.''
Section 2. Annual report on Veterans Health Administration and
furnishing of hospital care, medical services, and nursing home
care
Section 2(a) of the bill would amend Subchapter II of
chapter 73 of title 38 U.S.C., by creating a new subsection
7330B. This section would require VA to submit annual reports
to the Committees on Veterans' Affairs of the House and Senate
regarding the furnishing of hospital care, medical services,
and nursing home care under the laws administered by VA and on
the administration of the provision of such care and services
by VHA during the preceding calendar year. The report must
contain evaluations of: (1) the effectiveness of VHA in
increasing access to hospital care, medical services, and
nursing home care for eligible veterans; (2) the effectiveness
of VHA in improving the quality of care provided to veterans
without increasing costs incurred by the Federal government or
by veterans; (3) the workload of physicians and other VHA
employees; (4) patient demographics and utilization rates; (5)
physician compensation; (6) productivity of physicians and
other VHA employees; (7) the percentage of hospital care,
medical services, and nursing home care provided to veterans in
VA facilities and in non-VA facilities, as well as any changes
in such percentages compared to the preceding year; (8)
pharmaceutical prices; and (9) third party billings owed to VA,
including the total amount of such billings and the total
amounts collected separated by claims greater than, equal to,
or less than one thousand dollars. The report would also
include relevant information for each VA medical center and
Veterans Integrated Service Network. Finally, this section
would define the terms ``hospital care,'' ``medical care,'' and
``non-Department facilities'' as having the same meanings given
to such terms in section 1701 of title 38 U.S.C.
Section 2(b) of the bill would amend the table of sections
at the beginning of Subchapter II of chapter 73 of title 38
U.S.C., by inserting the item relating to section 7330B after
section 7330A.
Section 3. Expansion of definition of homeless veteran for purposes of
benefits under the laws administrated by the Secretary of
Veterans Affairs
Section 3 of the bill would amend section 2002(1) of title
38 U.S.C., by inserting ``or (b)'' after ``section 103(a).''
Section 4. Identification and tracking of biological implants used in
Department of Veterans Affairs medical facilities
Section 4(a) would add a new section, 7330C, to Subchapter
II of chapter 73 of title 38, U.S.C. This section would require
VA to adopt the unique device identification system developed
for medical devices by the Food and Drug Administration (FDA)
at Section 360i(f) of title 21, U.S.C., or implement a
comparable standard identification system, for use in
identifying biological implants intended for use at VA medical
facilities. This section would also permit a vendor of
biological implants to VA to use any of the accredited entities
identified by the FDA as an issuing agency pursuant to Section
830.100 of title 21, U.S.C. VA would be required to implement a
system for tracking biological implants from human or animal
source to implantation, and the tracking system used must be
compatible with the identification system adopted in this
section. Further, to the extent that a conflict arises with any
provision of the FDA, the FDA provision would apply. Finally,
this section would provide a definition for biological implants
to mean any animal or human cell, tissue, or cellular or
tissue-based product under the meaning given by the FDA at
Section 1271.3 of title 21, CFR, or that is regulated as a
device at section 201(h) of the Federal Food, Drug, and
Cosmetic Act.
Section 4(b) would amend the table of sections at the
beginning of chapter 73 of title 38, U.S.C., by inserting after
the item relating to section 7330B, as added by section 2 of
this bill, the following new item: ``7330C. Identification and
tracking of biological implants.''
Section 4(c) would require VA to implement the
identification system required by section 4(a) by not later
than 180 days after enactment and in compliance with dates
established by the FDA, pursuant to Section 360i(j) of title
21, U.S.C. VA would also be required to implement the
biological implant tracking system required by section 4(a)
within the same 180 day timeframe.
Section 4(d) would require that if the standard
identification system for biological implants is not
operational 180 days after enactment, then VA must submit to
the Committees on Veterans' Affairs of the House and the Senate
written explanations each month until the system is
operational. Such written explanations would require
description of the impediments to implementation, the steps
being taken to remediate each impediment, and the target dates
for solution to each impediment.
Section 5. Procurement of biological implants used in Department of
Veterans Affairs medical facilities
Section 5(a) would amend Subchapter II of chapter 81 of
title 38, U.S.C., section 2, by adding a new section, 8129.
This section would require that VA procure biological implants
of human origin only from vendors that: (1) use the standard
identification system adopted or implemented by the Secretary
under section 4(a) of this bill and have safeguards to ensure
that a distinct identity code has been in place at each step of
distribution of each biological implant from its donor; (2) are
registered with the FDA and, in the case of a vendor that uses
a tissue distribution intermediary or a tissue processor, that
provide assurances that the tissue distribution intermediary or
tissue processor is registered with the FDA; (3) ensure that
donor eligibility determinations and such other records as VA
may require accompany each biological implant at all times,
regardless of the country of origin of the donor of the
biological material; (4) agree to cooperate with all biological
implant recalls conducted on the vendor's own initiative, on
the initiative of the original product manufacturer used by the
vendor, by the request of the FDA, or by a statutory order of
the FDA; (5) agree to notify VA of any adverse event or
reaction report it is required to provide to the FDA or of any
warning letter from the FDA issued to the vendor or a tissue
processor or tissue distribution intermediary it uses by not
later than sixty days after the vendor receives such report or
warning letter; (6) agree to retain all records associated with
the procurement of a biological implant by VA for at least 10
years after the date of the procurement; and (7) provide
assurances that the biological implants provided by the vendor
are acquired only from tissue processors that maintain active
accreditation with the American Association of Tissue Banks or
a similar national accreditation specific to biological
implants.
This section would also require that VA procure biological
implants of non-human origin only from vendors that: (1) use
the standard identification system adopted or implemented by
the Secretary under section 4(a); (2) are registered
establishments as required by the FDA and, in the case of a
vendor that is not the original product manufacturer of such
implants, that provide assurances that the original product
manufacturer is registered as required by the FDA; (3) agree to
cooperate with all biological implant recalls conducted on the
vendor's own initiative, on the initiative of the original
product manufacturer used by the vendor, by the request of the
FDA, or by a statutory order of the FDA; (4) agree to notify VA
of any adverse event report it is required to provide to the
FDA or any warning letter from the FDA issued to the vendor or
the original product manufacturer it uses by not later than
sixty days after the vendor receives such report or warning
letter; and (5) agree to retain all records associated with the
procurement of a biological implant by VA for at least 10 years
after the date of the procurement.
VA would also be required to procure biological implants
under Federal Supply Schedule of the General Services
Administration unless such implants are unavailable thereon and
to accommodate reasonable vendor requests to undertake outreach
efforts to educate VA medical professionals about the use and
efficacy of such biological implants on the Federal Supply
Schedule. When biological implants are unavailable for
procurement under the Federal Supply Schedule, VA would be
required to procure them using competitive procedures in
accordance with applicable law and the Federal Acquisition
Regulation. In no case, however, would section 8123 of title
38, U.S.C., apply to the procurement of biological implants.
Additionally, VA employees who procure biological implants
with the intent to avoid, or with reckless disregard of, the
procurement provisions of this section would be ineligible to
hold a certificate of appointment as a contracting officer or
serve as a representative of an ordering officer, contracting
officer, or purchase card holder. Finally, this section would
provide definitions for ``biological implant,'' ``distinct
identity code,'' ``tissue distribution intermediary,'' and
``tissue processor.''
Section 5(b) would provide that section 5(a) would take
effect 180 days after the tracking system required by section
4(b) is implemented.
Section 5(c) would provide a special rule for cryopreserved
products that would allow, for three years after enactment,
such products to be procured by VA without relabeling them with
the standard identification system adopted or implemented under
section 4(a).
Section 6. Extension of rounding down of percentage increases of rates
of certain educational assistance
Section 6(a) would extend the rounding down of percentage
increases of Montgomery GI Bill rates by five years, from the
end of fiscal year 2014 through the endof fiscal year 2019, and
stipulate that any increase in educational assistance rates under the
Montgomery GI Bill made after fiscal year 2019 shall be rounded to the
nearest whole dollar.
Section 6(b) would extend the rounding down of percentage
increases of Survivors' and Dependents' Educational Assistance
rates by five years, from fiscal year 2014 through fiscal year
2019, and stipulate that any increase in educational assistance
rates under the Survivors' and Dependents' Educational
Assistance Program made after fiscal year 2019 shall be rounded
to the nearest whole dollar.
Section 7. Veterans expedited recovery commission
Section 7(a) would establish the Veterans Expedited
Recovery Commission (the Commission).
Section 7(b) would set out the duties of the Commission as
follows: (1) to examine the efficacy of the evidence-based
therapy model used by VA to treat mental health illnesses of
veterans and identify areas to improve wellness-based outcomes;
(2) to release a patient centered survey within each Veterans
Integrated Service Network examining (a) veteran experience
when seeking mental health care through the VA health care
system, (b) veteran experience when seeking mental health care
through non-VA facilities and providers, (c) veteran preference
regarding available mental health treatments and most effective
methods, (d) veteran experience with complementary and
alternative treatment therapies, (e) the prevalence of
prescription medication among veterans seeking mental health
care through VA, and (f) VA outreach efforts regarding the
availability of benefits and treatments for veterans addressing
mental health issues, including ways to reduce barriers to and
gaps in such benefits and treatments; (3) to examine available
research on complementary and alternative treatment therapies
for mental health issues and the identification of benefits
that could result from the inclusion of treatments including
music therapy, equine therapy, service dog training and care,
yoga therapy, acupuncture therapy, meditation therapy, outdoor
sports therapy, hyperbaric oxygen therapy, accelerated
resolution therapy, and other therapies as the Commission deems
appropriate; and, (4) to study the potential increase in claims
relating to mental health issues submitted to VA by veterans of
Operation Enduring Freedom, Operation Iraqi Freedom, or
Operation New Dawn, including an assessment of the resources
available within VA to ensure that quality health care demands
relating to such claims can be delivered in a timely manner.
Section 7(c) would require that the Commission be composed
of ten Commissioners, two appointed by the Speaker of the
House, two appointed by the Minority Leader of the House, two
appointed by the Majority Leader of the Senate, two appointed
by the Minority Leader of the Senate, and two appointed by the
President. At least one of every two Commissioners chosen by
the above named entities must be a veteran, and all
appointments would be required to be made within ninety days of
enactment. This section would also set out the qualifications
of the Commissioners to include individuals of recognized
standing and distinction within the medical community with a
background in treating mental health, individuals with
experience working with the military and veteran populations,
and individuals who do not have a financial interest in any of
the complementary alternative treatments reviewed by the
Commission. The President would be required to designate a
Commissioner to serve as Chairman, and all Commissioners would
be appointed for the life of the Commission. Vacancies in the
Commission would be filled in the manner in which the original
appointment was made.
Section 7(d) would set out the powers of the Commission,
including: (1) the requirement to hold its first meeting not
later than thirty days after a majority of Commissioners have
been appointed and regularly at the call of the Chairman,
including through the use of telecommunication technology if
the Commission determines that such technology would allow
Commissioners to communication simultaneously; (2) the
authority to hold hearings, sit, act, take testimony, and
receive evidence, at such times and places as the Commission
considers advisable to carry out its responsibilities; (3) the
authority to secure information directly from any department or
agency of the Federal government it considers necessary to
carry out its duties; (4) the authority to seek guidance
through consultation with foundations, veterans service
organizations, nonprofit groups, faith-based organizations,
private and public institutions of higher education, and other
organizations as it deems appropriate; (5) the requirement to
keep accurate and complete records of actions and meetings of
the Commission and to make such records available for public
inspection and the Comptroller General of the United States to
audit and examine; (6) upon request of the Chairman, to
authorize the head of any department or agency of the Federal
government to detail, on a reimbursable basis, any personnel of
that department or agency to assist the Commission in carrying
out its duties; (7) the authority to provide Commissioners with
travel expenses to perform their duties, including per diem in
lieu of subsistence at authorized rates, but otherwise not to
provide any pay to such Commissioners; (8) the authority for
the Chairman to fix the compensation of a staff director and
such other personnel as may be necessary to carry out the
duties of the Commission in accordance with rules agreed upon
by the Commission without regard to provisions of title 5,
U.S.C., and without regard to the provisions of chapter 51 and
subchapter III of chapter 53 of such title relating to
classification and General Schedule pay rates, except that no
rate of pay fixed under this subsection may exceed the
equivalent of that payable for a position at level IV of the
Executive Schedule under section 5316 of title 5, U.S.C; (9)
the stipulation that the executive director and any personnel
of the Commission, but not the Commissioners themselves, are
employees under section 2105 of title 5, U.S.C., for purposes
of chapters 63, 81, 83, 84, 85, 87, 89, and 90 of such title;
(10) the authority to enter into contracts to enable it to
discharge its duties to such extent and in such amounts as are
provided in appropriations acts; (11) the authority to procure
the services of experts and consultants in accordance with
section 3109 of title 5, U.S.C., at rates not to exceed the
daily rate paid to a person occupying a position at level IV of
the Executive Schedule under section 5315 of title 5, U.S.C;
(12) the authority to use the United States mail in the same
manner and under the same conditions as departments and
agencies of the United States; and (13) the authority for the
Chairman to request the General Services Administration to
provide the Commission, on a reimbursable basis, the
administrative support services--including human resources
management, budget, leasing, accounting, and payroll services--
necessary for the Commission to carry out its responsibilities.
Section 7(e) would require the Commission to submit an
interim report to the Committees on Veterans' Affairs of the
House and Senate, as well as the President, by no later than
sixty days after the date on which the Commission first meets,
and each 30-day period thereafter, detailing the level of
cooperation VA and other departments or agencies have provided
to the Commission. This section would also require the
Commission to submit to the Committees on Veterans' Affairs of
the House and Senate, and any other appropriate entities, an
interim report with respect to the findings identified by the
Commission. The Commission would also be required to submit to
the Committees on Veterans' Affairs of the House and Senate,
the President, and the VA Secretary, not later than 18 months
after the first meeting of the Commission, a final report on
the findings of the Commission to include: (1) recommendations
to implement in a feasible, timely, and cost-effective manner
the solutions and remedies identified within the findings of
the Commission; (2) an analysis of the evidence-based therapy
model used by VA for treating veterans with mental health
issues and an examination of the prevalence and efficacy of
prescription drugs as a means for treatment; (3) the findings
of the patient-centered survey conducted within each Veterans
Integrated Service Network; and (4) an examination of
complementary and alternative treatments and the potential
benefits of incorporating such treatments in the therapy model
used by VA for treating veterans with mental health issues.
Finally, this section would require VA to submit a report to
the Committees on Veterans' Affairs of the House and Senate,
not later than ninety days after the Commission submits its
final report, with the following: (1) an action plan for
implementing the recommendations established by the Commission
on such solutions and remedies for improving wellness-based
outcomes for veterans with mental health care issues; (2) a
feasible timeframe on when complementary and alternative
treatments can be implemented department-wide; and (3) a
justification and alternative solution for any recommendation
made by the Commission that VA determines is not appropriate or
feasible to implement.
Section 7(f) would require the Commission to terminate
thirty days after the Commission submits its final report.
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 II--GENERAL BENEFITS
* * * * * * *
CHAPTER 20--BENEFITS FOR HOMELESS VETERANS
* * * * * * *
Subchapter I--PURPOSE; DEFINITIONS; ADMINISTRATIVE MATTERS
* * * * * * *
Sec. 2002. Definitions
In this chapter:
(1) The term ``homeless veteran'' means a veteran who
is homeless (as that term is defined in section 103(a)
or (b) of the McKinney-Vento Homeless Assistance Act
(42 U.S.C. 11302(a))).
(2) The term ``grant and per diem provider'' means an
entity in receipt of a grant under section 2011 or 2012
of this title.
* * * * * * *
PART III--READJUSTMENT AND RELATED BENEFITS
* * * * * * *
CHAPTER 30--ALL-VOLUNTEER FORCE EDUCATIONAL ASSISTANCE PROGRAM
* * * * * * *
Subchapter II--BASIC EDUCATIONAL ASSISTANCE
* * * * * * *
Sec. 3015. Amount of basic educational assistance
(a) The amount of payment of educational assistance under
this chapter is subject to section 3032 of this title. Except
as otherwise provided in this section, in the case of an
individual entitled to an educational assistance allowance
under this chapter whose obligated period of active duty on
which such entitlement is based is three years, a basic
educational assistance allowance under this subchapter shall be
paid--
(1) for an approved program of education pursued on a
full- time basis, at the monthly rate of--
(A) for months occurring during the period
beginning on August 1, 2008, and ending on the
last day of fiscal year 2009, $1,321; and
(B) for months occurring during a subsequent
fiscal year, the amount for months occurring
during the previous fiscal year increased under
subsection (h); or
(2) at an appropriately reduced rate, as determined
under regulations which the Secretary shall prescribe,
for an approved program of education pursued on less
than a full-time basis.
(b) In the case of an individual entitled to an educational
assistance allowance under section 3011 or 3018 of this title
whose obligated period of active duty on which such entitlement
is based is two years, a basic educational assistance allowance
under this chapter shall (except as provided in the succeeding
subsections of this section)be paid--
(1) for an approved program of education pursued on a
full- time basis, at the monthly rate of--
(A) for months occurring during the period
beginning on August 1, 2008, and ending on the
last day of fiscal year 2009, $1,073; and
(B) for months occurring during a subsequent
fiscal year, the amount for months occurring
during the previous fiscal year increased under
subsection (h); or
(2) at an appropriately reduced rate, as determined
under regulations which the Secretary shall prescribe,
for an approved program of education pursued on less
than a full-time basis.
(c)(1) The amount of basic educational allowance payable
under this chapter to an individual referred to in paragraph
(2) of this subsection is the amount determined under
subsection (a) of this section.
(2) Paragraph (1) of this subsection applies to an individual
entitled to an educational assistance allowance under section
3011 of this title--
(A) whose obligated period of active duty on which
such entitlement is based is less than three years;
(B) who, beginning on the date of the commencement of
such obligated period of active duty, serves a
continuous period of active duty of not less than three
years; and
(C) who, after the completion of that continuous
period of active duty, meets one of the conditions set
forth in subsection (a)(3) of such section 3011.
(d)(1) In the case of an individual who has a skill or
specialty designated by the Secretary concerned as a skill or
specialty in which there is a critical shortage of personnel or
for which it is difficult to recruit, the Secretary concerned,
pursuant to regulations to be prescribed by the Secretary of
Defense, may, at the time the individual first becomes a member
of the Armed Forces, increase the rate of the basic educational
assistance allowance applicable to such individual to such rate
in excess of the rate prescribed under subsections (a), (b),
and (c) of this section as the Secretary of Defense considers
appropriate, but the amount of any such increase may not exceed
$950 per month.
(2) In the case of an individual who after October 7, 1997,
receives an enlistment bonus under section 308a or 308f of
title 37, receipt of that bonus does not affect the eligibility
of that individual for an increase under paragraph (1) in the
rate of the basic educational assistance allowance applicable
to that individual, and the Secretary concerned may provide
such an increase for that individual (and enter into an
agreement with that individual that the United States agrees to
make payments pursuant to such an increase) without regard to
any provision of law (enacted before, on, or after the date of
the enactment of this paragraph) that limits the authority to
make such payments.
(e)(1)(A) Except as provided in subparagraph (B) of this
paragraph and subject to paragraph (2) of this subsection, in
the case of an individual who on December 31, 1989, was
entitled to educational assistance under chapter 34 of this
title, the rate of the basic educational assistance allowance
applicable to such individual under this chapter shall be
increased by the amount equal to one-half of the educational
assistance allowance that would be applicable to such
individual under such chapter 34 (as of the time the assistance
under this chapter is provided and based on the rates in effect
on December 31, 1989) if such chapter were in effect.
(B) Notwithstanding subparagraph (A) of this paragraph, in
the case of an individual described in that subparagraph who is
pursuing a cooperative program on or after October 9, 1996, the
rate of the basic educational assistance allowance applicable
to such individual under this chapter shall be increased by the
amount equal to one-half of the educational assistance
allowance that would be applicable to such individual for
pursuit of full-time institutional training under chapter 34
(as of the time the assistance under this chapter is provided
and based on the rates in effect on December 31, 1989) if such
chapter were in effect.
(2) The number of months for which the rate of the basic
educational assistance allowance applicable to an individual is
increased under paragraph (1) of this subsection may not exceed
the number of months of entitlement to educational assistance
under chapter 34 of this title that the individual had
remaining on December 31, 1989.
(f) In the case of an individual for whom the Secretary of
Defense made contributions under section 3222(c) of this title
and who is entitled to educational assistance under section
3018A, 3018B, or 3018C of this chapter, the Secretary shall
increase the rate of the basic educational assistance allowance
applicable to such individual in excess of the rate provided
under subsection (a) of this section in a manner consistent
with, as determined by the Secretary of Defense, the agreement
entered into with such individual pursuant to the rules and
regulations issued by the Secretary of Defense under section
3222(c) of this title.
(g) In the case of an individual who has made contributions
authorized by section 3011(e) or 3012(f) of this title,
effective as of the first day of the enrollment period
following receipt of such contributions from such individual by
the Secretary concerned, the monthly amount of basic
educational assistance allowance applicable to such individual
under subsection (a), (b), or (c) shall be the monthly rate
otherwise provided for under the applicable subsection
increased by--
(1) an amount equal to $5 for each $20 contributed by
such individual under section 3011(e) or 3012(f) of
this title, as the case may be, for an approved program
of education pursued on a full-time basis; or
(2) an appropriately reduced amount based on the
amount so contributed, as determined under regulations
which the Secretary shall prescribe, for an approved
program of education pursued on less than a full-time
basis.
(h)(1) With respect to any fiscal year, the Secretary shall
provide a percentage increase in the rates payable under
subsections (a)(1) and (b)(1) equal to the percentage by
which--
(A) the average cost of undergraduate tuition in the
United States, as determined by the National Center for
Education Statistics, for the last academic year
preceding the beginning of the fiscal year for which
the increase is made, exceeds
(B) the average cost of undergraduate tuition in the
United States, as so determined, for the academic year
preceding the academic year described in subparagraph
(A).
(2) Any increase under paragraph (1) in a rate with respect
to a fiscal year after fiscal year 2004 and before [fiscal year
2014] fiscal year 2020 shall be rounded down to the next lower
whole dollar amount. Any such increase with respect to a fiscal
year after [fiscal year 2013] fiscal year 2019 shall be rounded
to the nearest whole dollar amount.
* * * * * * *
CHAPTER 35--SURVIVORS' AND DEPENDENTS' EDUCATIONAL ASSISTANCE
* * * * * * *
Subchapter VI--MISCELLANEOUS PROVISIONS
* * * * * * *
Sec. 3564. Annual adjustment of amounts of educational assistance
(a) With respect to any fiscal year, the Secretary shall
provide a percentage increase in the rates payable under
sections 3532, 3534(b), and 3542(a) of this title equal to the
percentage by which--
(1) the Consumer Price Index (all items, United
States city average) for the 12-month period ending on
the June 30 preceding the beginning of the fiscal year
for which the increase is made, exceeds
(2) such Consumer Price Index for the 12-month period
preceding the 12-month period described in paragraph
(1).
(b) Any increase under subsection (a) in a rate with respect
to a fiscal year after fiscal year 2004 and before [fiscal year
2014] fiscal year 2020 shall be rounded down to the next lower
whole dollar amount. Any such increase with respect to a fiscal
year after [fiscal year 2013] fiscal year 2019 shall be rounded
to the nearest whole dollar amount.
* * * * * * *
PART V--BOARDS, ADMINISTRATIONS, AND SERVICES
* * * * * * *
CHAPTER 73--ORGANIZATION AND FUNCTIONS
SUBCHAPTER I--ORGANIZATION
Sec.
7301. Functions of Veterans Health Administration: in general.
* * * * * * *
SUBCHAPTER II--GENERAL AUTHORITY AND ADMINISTRATION
* * * * * * *
7330B. Annual report on Veterans Health Administration and furnishing of
hospital care, medical services, and nursing home care.
7330C. Identification and tracking of biological implants.
* * * * * * *
Subchapter II--GENERAL AUTHORITY AND ADMINISTRATION
* * * * * * *
Sec. 7330B. Annual report on Veterans Health Administration and
furnishing of hospital care, medical services, and
nursing home care
(a) Report Required.--Not later than March 1 of each year,
the Secretary shall submit to the Committees on Veterans'
Affairs of the Senate and House of Representatives a report on
the furnishing of hospital care, medical services, and nursing
home care under the laws administered by the Secretary and on
the administration of the provision of such care and services
by the Veterans Health Administration during the calendar year
preceding the calendar year during which the report is
submitted.
(b) Contents of Report.--Each report required by subsection
(a) shall include each of the following for the year covered by
the report:
(1) An evaluation of the effectiveness of the
Veterans Health Administration program in increasing
the access of veterans eligible for hospital care,
medical services, and nursing home care furnished by
the Secretary to such care.
(2) An evaluation of the effectiveness of the
Veterans Health Administration in improving the quality
of health care provided to such veterans, without
increasing the costs incurred by the Government or such
veterans, which includes the relevant information for
each medical center and Veterans Integrated Service
Network of the Department set forth separately.
(3) An assessment of--
(A) the workload of physicians and other
employees of the Veterans Health
Administration;
(B) patient demographics and utilization
rates;
(C) physician compensation;
(D) the productivity of physicians and other
employees of the Veterans Health
Administration;
(E) the percentage of hospital care, medical
services, and nursing home care provided to
such veterans in Department facilities and in
non-Department facilities and any changes in
such percentages compared to the year preceding
the year covered by the report;
(F) pharmaceutical prices; and
(G) third party health billings owed to the
Department, including the total amount of such
billings and the total amounts collected, set
forth separately for claims greater than $1000
and for claims equal to or less than $1000.
(c) Definitions.--In this section, the terms ``hospital
care'', ``medical services'', ``nursing home care'', and ``non-
Department facilities'' have the meanings given such terms in
section 1701 of this title.
Sec. 7330C. Identification and tracking of biological implants
(a) Standard Identification System for Biological Implants.--
(1) The Secretary shall adopt the unique device identification
system developed for medical devices by the Food and Drug
Administration pursuant to section 519(f) of the Federal Food,
Drug, and Cosmetic Act (21 U.S.C. 360i(f)), or implement a
comparable standard identification system, for use in
identifying biological implants intended for use in medical
procedures conducted in medical facilities of the Department.
(2) In adopting or implementing a standard identification
system for biological implants under paragraph (1), the
Secretary shall permit a vendor to use any of the accredited
entities identified by the Food and Drug Administration as an
issuing agency pursuant to section 830.100 of title 21, Code of
Federal Regulations, or any successor regulation.
(b) Biological Implant Tracking System.--(1) The Secretary
shall implement a system for tracking the biological implants
referred to in subsection (a) from human donor or animal source
to implantation.
(2) The tracking system implemented under paragraph (1) shall
be compatible with the identification system adopted or
implemented under subsection (a).
(3) The Secretary shall implement inventory controls
compatible with the tracking system implemented under paragraph
(1) so that all patients who have received, in a medical
facility of the Department, a biological implant subject to a
recall can be notified of the recall, if based on the
evaluation of appropriate medical personnel of the Department
of the risks and benefits, the Secretary determines such
notification is appropriate.
(c) Consistency With Food and Drug Administration
Regulations.--To the extent that a conflict arises between this
section and a provision of the Federal Food, Drug, and Cosmetic
Act (21 U.S.C. 301 et seq.) or sections 351 or 361 of the
Public Health Service Act (42 U.S.C. 262) (including any
regulations issued under such Acts), the provision the Federal
Food, Drug, and Cosmetic Act or Public Health Service Act
(including any regulations issued under such Acts) shall apply.
(d) Definition of Biological Implant.--In this section, the
term ``biological implant'' means any animal or human cell,
tissue, or cellular or tissue-based product--
(1) under the meaning given the term human cells,
tissues, or cellular or tissue-based products in
section 1271.3 of title 21, Code of Federal
Regulations, or any successor regulation; or
(2) that is regulated as a device under section
201(h) of the Federal Food, Drug, and Cosmetic Act.
* * * * * * *
PART VI--ACQUISITION AND DISPOSITION OF PROPERTY
* * * * * * *
CHAPTER 81--ACQUISITION AND OPERATION OF HOSPITAL AND DOMICILIARY
FACILITIES; PROCUREMENT AND SUPPLY; ENHANCED-USE LEASES OF REAL
PROPERTY
SUBCHAPTER I--ACQUISITION AND OPERATION OF MEDICAL FACILITIES
Sec.
8101. Definitions.
* * * * * * *
SUBCHAPTER II--PROCUREMENT AND SUPPLY
* * * * * * *
8129. Procurement of biological implants.
* * * * * * *
Subchapter II--PROCUREMENT AND SUPPLY
* * * * * * *
Sec. 8129. Procurement of biological implants
(a) In General.--(1) The Secretary may procure biological
implants of human origin only from vendors that meet the
following conditions:
(A) The vendor uses the standard identification
system adopted or implemented by the Secretary under
section 7330C(a) of this title and has safeguards to
ensure that a distinct identity code has been in place
at each step of distribution of each biological implant
from its donor.
(B) The vendor is registered as required by the Food
and Drug Administration under subpart B of part 1271 of
title 21, Code of Federal Regulations, or any successor
regulation, and in the case of a vendor that uses a
tissue distribution intermediary or a tissue processor,
the vendor provides assurances that the tissue
distribution intermediary or tissue processor is
registered as required by the Food and Drug
Administration.
(C) The vendor ensures that donor eligibility
determinations and such other records as the Secretary
may require accompany each biological implant at all
times, regardless of the country of origin of the donor
of the biological material.
(D) The vendor agrees to cooperate with all
biological implant recalls conducted on the vendor's
own initiative, on the initiative of the original
product manufacturer used by the vendor, by the request
of the Food and Drug Administration, or by a statutory
order of the Food and Drug Administration.
(E) The vendor agrees to notify the Secretary of any
adverse event or reaction report it provides to the
Food and Drug Administration, as required by section
1271.350 of title 21, Code of Federal Regulations, or
any successor regulation, or any successor regulation,
or of any warning letter from the Food and Drug
Administration issued to the vendor or a tissue
processor or tissue distribution intermediary it uses
by not later than 60 days after the vendor receives
such report or warning letter.
(F) The vendor agrees to retain all records
associated with the procurement of a biological implant
by the Department for at least 10 years after the date
of the procurement of the biological implant.
(G) The vendor provides assurances that the
biological implants provided by the vendor are acquired
only from tissue processors that maintain active
accreditation with the American Association of Tissue
Banks or a similar national accreditation specific to
biological implants.
(2) The Secretary may procure biological implants of non-
human origin only from vendors that meet the following
conditions:
(A) The vendor uses the standard identification
system adopted or implemented by the Secretary under
section 7330C(a) of this title.
(B) The vendor is a registered establishment as
required by the Food and Drug Administration under
sections 807.20 and 807.40 of title 21, Code of Federal
Regulations, or any successor regulation, (or is not
required to register pursuant to section 807.65(a) of
such title) and in the case of a vendor that is not the
original product manufacturer of such implants the
vendor provides assurances that the original product
manufacturer is registered as required by the Food and
Drug Administration.
(C) The vendor agrees to cooperate with all
biological implant recalls conducted on the vendor's
own initiative, on the initiative of the original
product manufacturer used by the vendor, by the request
of the Food and Drug Administration, or by a statutory
order of the Food and Drug Administration.
(D) The vendor agrees to notify the Secretary of any
adverse event report it provides to the Food and Drug
Administration as required in part 803 of title 21,
Code of Federal Regulations, or any warning letter from
the Food and Drug Administration issued to the vendor
or the original product manufacturer it uses by not
later than 60 days after the vendor receives such
report or warning letter.
(E) The vendor agrees to retain all records
associated with the procurement of a biological implant
by the Department for at least 10 years after the date
of the procurement of the biological implant.
(3)(A) The Secretary shall procure biological implants under
the Federal Supply Schedules of the General Services
Administration unless such implants are not available under
such Schedules.
(B) With respect to biological implants listed on the Federal
Supply Schedules, the Secretary shall accommodate reasonable
vendor requests to undertake outreach efforts to educate
medical professionals of the Department about the use and
efficacy of such biological implants.
(C) In the case of biological implants that are unavailable
for procurement under the Federal Supply Schedules, the
Secretary shall procure such implants using competitive
procedures in accordance with applicable law and the Federal
Acquisition Regulation.
(4) Section 8123 of this title shall not apply to the
procurement of biological implants.
(b) Penalties.--In addition to any applicable penalty under
any other provision of law, any procurement employee of the
Department who is found responsible for a biological implant
procurement transaction with intent to avoid or with reckless
disregard of the requirements of this section shall be
ineligible to hold a certificate of appointment as a
contracting officer or to serve as the representative of an
ordering officer, contracting officer, or purchase card holder.
(c) Definitions.--In this section:
(1) The term ``biological implant'' shall have the
meaning given such term in section 7330C(d) of this
title.
(2) The term ``distinct identity code'' means a code
that--
(A) relates a biological implant to the human
donor of the implant and to all records
pertaining to the implant;
(B) includes information designed to
facilitate effective tracking, using such code,
from the donor to the recipient and from the
recipient to the donor; and
(C) satisfies the requirements of section
1271.290 of title 21, Code of Federal
Regulations, or any successor regulation.
(3) The term ``tissue distribution intermediary''
means an agency that acquires and stores human tissue
for further distribution and performs no other tissue
banking functions.
(4) The term ``tissue processor'' means an entity
processing human tissue for use in biological implants
including activities performed on tissue other than
donor screening, donor testing, tissue recovery and
collection functions, storage, or distribution.
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