[House Report 114-817]
[From the U.S. Government Publishing Office]
114th Congress } { Report
HOUSE OF REPRESENTATIVES
2d Session } { 114-817
======================================================================
NO HERO LEFT UNTREATED ACT
_______
November 14, 2016.--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. 5600]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred
the bill (H.R. 5600) to direct the Secretary of Veterans
Affairs to carry out a pilot program to provide access to
magnetic EEG/EKG-guided resonance therapy technology to
veterans, having considered the same, report favorably thereon
with an amendment and recommend that the bill as amended do
pass.
CONTENTS
Page
Amendment........................................................ 2
Purpose and Summary.............................................. 2
Background and Need for Legislation.............................. 2
Hearings......................................................... 4
Subcommittee Consideration....................................... 4
Committee Consideration.......................................... 4
Committee Votes.................................................. 4
Committee Oversight Findings..................................... 4
Statement of General Performance Goals and Objectives............ 4
New Budget Authority, Entitlement Authority, and Tax Expenditures 4
Earmarks and Tax and Tariff Benefits............................. 4
Committee Cost Estimate.......................................... 5
Congressional Budget Office Estimate............................. 5
Federal Mandates Statement....................................... 6
Advisory Committee Statement..................................... 6
Constitutional Authority Statement............................... 6
Applicability to Legislative Branch.............................. 6
Statement on Duplication of Federal Programs..................... 6
Disclosure of Directed Rulemaking................................ 6
Section-by-Section Analysis of the Legislation................... 6
Changes in Existing Law Made by the Bill as Reported............. 7
AMENDMENT
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``No Hero Left Untreated Act''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) Magnetic EEG/EKG-guided Resonance Therapy technology (in
this section referred to as ``MeRT technology'') has
successfully treated more than 400 veterans with post-traumatic
stress disorder, traumatic brain injury, military sexual
trauma, chronic pain, and opiate addiction.
(2) Recent clinical trials and randomized, placebo-
controlled, double-blind studies have produced promising
measurable outcomes in the evolution of MeRT technology.
(3) These outcomes have resulted in escalating demand from
returning warriors and veterans who are seeking access to this
treatment.
(4) Congress recognizes the importance of initiating
innovative pilot programs that demonstrate the use and
effectiveness of new treatment options for post-traumatic
stress disorder, traumatic brain injury, military sexual
trauma, chronic pain, and opiate addiction.
SEC. 3. MAGNETIC EEG/EKG-GUIDED RESONANCE THERAPY TECHNOLOGY PILOT
PROGRAM.
(a) Pilot Program.--The Secretary of Veterans Affairs shall carry out
a pilot program to provide access to magnetic EEG/EKG-guided resonance
therapy technology (commonly referred to as ``MeRT technology'') to
treat larger populations of veterans suffering from post-traumatic
stress disorder, traumatic brain injury, military sexual trauma,
chronic pain, or opiate addiction.
(b) Locations.--The Secretary shall carry out the pilot program under
subsection (a) at not more than two facilities of the Department of
Veteran Affairs.
(c) Participants.--In carrying out the pilot program under subsection
(a), the Secretary may not provide access to magnetic EEG/EKG-guided
resonance therapy technology to more than 50 veterans.
(d) Duration.--The Secretary shall carry out the pilot program under
subsection (a) for a one-year period.
(e) Report.--Not later than 90 days after the date of the termination
of the pilot program under subsection (a), the Secretary shall submit
to the Committees on Veterans' Affairs of the House of Representatives
and the Senate a report on the pilot program.
(f) No Authorization of Appropriations.--No additional funds are
authorized to be appropriated to carry out the requirements of this
section. Such requirements shall be carried out using amounts otherwise
authorized.
PURPOSE AND SUMMARY
H.R. 5600, the ``No Hero Left Untreated Act,'' was
introduced by Representative Stephen Knight of California on
June 28, 2016. H.R. 5600, as amended, would require the
Department of Veterans Affairs (VA) to carry out a one-year
pilot program at no more than two VA medical facilities to
provide access to magnetic electroencephalogram/
electrocardiogram-guided resonance therapy (MeRT) technology to
veterans with post-traumatic stress disorder (PTSD), traumatic
brain injury (TBI), military sexual trauma (MST), chronic pain,
or opiate addiction.
BACKGROUND AND NEED FOR LEGISLATION
Section 3. Magnetic EEG/EKG-Guided Resonance Therapy
According to a 2016 VA report entitled, Suicide Among
Veterans and Other Americans 2001-2014, the rate of mental
health conditions or substance use disorders among Veterans
Health Administration (VHA) patients has been increasing
throughout the 21st century, rising from about twenty-seven
percent in 2001 to over forty percent in 2014.\1\ At the same
time, the number of prescriptions for opioids written by VA
providers has increased 259%.\2\ Even more troubling, the
report also found a high rate of suicide among veterans, with
approximately 20 veteran suicides per day.\3\ Given these
alarming statistics--which have occurred alongside significant
increases in VA's mental health budget and programming--the
Committee believes that there is a demonstrated need to explore
new and innovative treatments for veterans with mental health
conditions or chronic pain.
---------------------------------------------------------------------------
\1\Suicide Among Veterans and Other Americans 2001-2014. http://
www.mentalhealth.va.gov/docs/2016suicidedatareport.pdf
\2\The Center for Investigative Reporting, ``VA's Opiate Overload
Feeds Veterans' Addictions, Overdose Deaths,'' Sep. 28, 2013, http://
cironline.org/reports/vas-opiate-overload-feeds-veterans-addictions-
overdose-deaths-5261
\3\Ibid.
---------------------------------------------------------------------------
MeRT technology is one such promising treatment. MeRT uses
quantitative electroencephalogram (EEG)/ electrocardiogram
(EKG) technology to identify dysfunctional areas of the brain
in patients suffering from mental health conditions and then
repeatedly applying magnetic stimulation to help restore proper
brain function in those areas. MeRT technology has been
approved by the Food and Drug Administration to treat
depression, and has been successfully used off-label to treat
conditions like PTSD and TBI. A 2015 study found that, after
two weeks of MeRT treatment, participating veterans experienced
an average 47.4 percent reduction in symptom severity. After
four weeks of MeRT treatment, veteran participants reported an
average reduction in symptom severity of 64 percent.\4\ No
adverse events, including worsening of patients' symptoms, were
reported during studies.\5\ MeRT treatment is currently
provided through the Brain Treatment Center (BTC). With
locations in Washington State, California, and abroad, BTC has
successfully treated over four hundred veteran patients with
MeRT to-date. However, the Committee believes that more
veterans should have access to MeRT treatment given the
promising results that the treatment has produced thus far. The
Committee believes that providing veterans with access to this
technology is no different than providing veterans with
patented medications.
---------------------------------------------------------------------------
\4\Taghva, Alexander, M.D., et al. Biometrics-Guided Magnetic E-
Resonance Therapy (MeRT) in Post-Traumatic Stress Disorder: A
Randomized, Double-Blind, Sham Controlled Trial.N.p., Nov. 2015.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4727473/.
\5\Taghva, Alexander, M.D., et al. Biometrics-Guided Magnetic E-
Resonance Therapy (MeRT) in Post-Traumatic Stress Disorder.
---------------------------------------------------------------------------
As such, Section 3 of the bill would require VA to carry
out a one-year pilot program at not more than two VA medical
facilities to provide access to MeRT treatment for up to fifty
veterans with PTSD, TBI, MST, chronic pain, or opiate addiction
and to submit a report on the pilot program to the Committees
on Veterans' Affairs of the House of Representatives and the
Senate 90 days after the pilot's termination. The Committee
believes that such a pilot program and the ensuing report would
provide valuable information on the effectiveness of MeRT and
similar technologies for veteran patients and potentially open
the door to similar innovative treatments within the VA health
care system. Section 3 of the bill would also stipulate that no
additional funds are authorized to be appropriated to carry out
the requirements of this Act.
HEARINGS
There were no Full Committee or Subcommittee hearings held
on H.R. 5600, as amended.
SUBCOMMITTEE CONSIDERATION
There was no Subcommittee markup of H.R. 5600, as amended.
COMMITTEE CONSIDERATION
On September 21, 2016, the Full Committee met in open
markup session, a quorum being present, and ordered H.R. 5600,
as amended, reported favorably to the House of Representatives
by voice vote. During consideration of H.R. 5600, the following
amendment was considered and agreed to by voice vote:
An amendment in the nature of a substitute offered by
Representative Jackie Walorski of Indiana.
COMMITTEE VOTES
In compliance with clause 3(b) of rule XIII of the Rules of
the House of Representatives, there were no recorded votes
taken on amendments or in connection with ordering H.R. 5600,
as amended, reported to the House. A motion by Representative
Mark Takano of California to report H.R. 5600, 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 to create a pilot program to increase
access to MeRT treatment for veterans with PTSD, TBI, MST,
chronic pain, or opiate addiction.
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. 5600, 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.
5600, 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. 5600, 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, October 13, 2016.
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. 5600, the No Hero
Left Untreated Act.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Ann E.
Futrell.
Sincerely,
Keith Hall.
Enclosure.
H.R. 5600--No Hero Left Untreated Act
H.R. 5600 would require the Department of Veterans Affairs
(VA) to establish a one-year pilot program to treat a limited
number of veterans with post-traumatic stress disorder,
traumatic brain injury, military sexual trauma, chronic pain,
or opiate addiction by using Magnetic eResonance Therapy
technology (MeRT technology). The bill also would require VA to
report to the Congress on the results of that pilot program.
MeRT technology is a customized neurological treatment that
uses magnetic pulses to stimulate brain tissue. The Brain
Treatment Center (BTC) in Southern California developed the
MeRT technology and has proprietary rights to the treatment.
Over the 2012-2015 period, the center has treated more than 400
veterans at four locations in the state of California and the
state of Washington.
Under this proposal, VA would be required to carry out the
one-year pilot program with no more than 50 veterans in one or
two medical facilities. Because the technologuy is proprietary,
we expect that VA would contract with BTC to provide MeRT
technology to those veterans. On the basis of information from
BTC, CBO expects the average patient at VA would undergo an
initial assessment at a cost of $1,000 and at least 20 MeRT
sessions over a 30-day period at a cost of $22,000.
On that basis, CBO estimates that implementing this bill
would cost $1 million over the 2017-2021 period; that spending
would be subject to the availability of appropriated funds.
Enacting the legislation would not affect direct spending
or revenues; therefore, pay-as-you-go procedures do not apply.
CBO estimates that enacting H.R. 5600 would not increase net
direct spending or on-budget deficits in any of the four
consecutive 10-year periods beginning in 2027.
H.R. 5600 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act and
would not affect the budgets of state, local, or tribal
governments.
The CBO staff contact for this estimate is Ann E. Futrell.
The estimate was 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. 5600, 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.
5600, as amended.
STATEMENT OF CONSTITUTIONAL AUTHORITY
Pursuant to Article I, section 8 of the United States
Constitution, H.R. 5600, as amended, is authorized by Congress'
power to ``provide for the common Defense and general Welfare
of the United States.''
APPLICABILITY TO LEGISLATIVE BRANCH
The Committee finds that H.R. 5600, as amended, does not
relate to the terms and conditions of employment or access to
public services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act.
STATEMENT ON DUPLICATION OF FEDERAL PROGRAMS
Pursuant to section 3(g) of H. Res. 5, 114th Cong. (2015),
the Committee finds that no provision of H.R. 5600, 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. 5600, as amended, contains no
directed rule making that would require the Secretary to
prescribe regulations.
SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION
Section 1. Short title
Section 1 of the bill would provide the short title for
H.R. 5600, as amended, as the ``No Hero Left Untreated Act.''
Section 2. Findings.
Section 2 of the bill states the following findings: (1)
the MeRT technology has successfully treated more than 400
veterans with PTSD, TBI, MST, chronic pain, and opiate
addiction; (2) that recent clinical trials and randomized,
placebo-controlled, double-blind studies have produced
promising measurable outcomes in the evolution of MeRT
technology; (3) that these outcomes have resulted in escalating
demand from returning servicemembers and veterans who are
seeking access to this treatment; and (4) that Congress
recognizes the importance of initiating innovative pilot
programs that demonstrate the use and effectiveness of new
treatment options for post-traumatic stress disorder, traumatic
brain injury, military sexual trauma, chronic pain, and opiate
addiction.
Section 3. Magnetic EEG/EKG-Guided Resonance Therapy
Section 3(a) of the bill would require the Secretary to
carry out a pilot program to provide access to MeRT technology
to treat veterans with PTSD, TBI, MST, chronic pain, or opiate
addiction.
Section 3(b) of the bill would require the pilot program
established by section 2(a) of the bill be carried out at not
more than two VA facilities.
Section 3(c) of the bill would prohibit the Secretary from
providing access to MeRT technology to more than 50 veterans
during the pilot program.
Section 3(d) of the bill would set a duration of one year
for the pilot program established by section 2(a).
Section 3(e) of the bill would require the Secretary to
submit a report to the House and Senate Committees on Veterans'
Affairs on the pilot program established by Section 2(a) of the
bill by not later than 90 days after the date of the
termination of the pilot.
Section 3(f) of the bill would stipulate that no additional
funds are authorized to be appropriated to carry out the
requirements of Section 2 of the bill, and the requirements of
Section 2 of the bill are required to be carried out using
amounts otherwise authorized.
CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED
If enacted, this bill would make no changes in existing
law.
[all]