[House Report 115-148]
[From the U.S. Government Publishing Office]
115th Congress } { Report
HOUSE OF REPRESENTATIVES
1st Session } { 115-148
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TO AMEND TITLE 38, UNITED STATES CODE, TO IMPROVE THE PROVISION OF
ADULT DAY HEALTH CARE SERVICES FOR VETERANS
_______
May 23, 2017.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Roe of Tennessee, from the Committee on Veterans' Affairs,
submitted the following
R E P O R T
[To accompany H.R. 1005]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred
the bill (H.R. 1005) to amend title 38, United States Code, to
improve the provision of adult day health care services for
veterans, having considered the same, report favorably thereon
without amendment and recommend that the bill do pass.
CONTENTS
Page
Purpose and Summary.............................................. 2
Background and Need for Legislation.............................. 2
Hearings......................................................... 3
Subcommittee Consideration....................................... 3
Committee Consideration.......................................... 3
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.......................................... 4
Congressional Budget Office Estimate............................. 4
Federal Mandates Statement....................................... 5
Advisory Committee Statement..................................... 5
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
Purpose and Summary
H.R. 1005 was introduced by Representative Lee Zeldin of
New York on February 13, 2017.
H.R. 1005 would direct the Department of Veterans Affairs
(VA) to enter into an agreement or a contract with state
veterans homes (SVHs) to pay for adult day health care (ADHC)
for a veteran eligible for, but not receiving, nursing home
care.
Background and Need for Legislation
Section 1. Provision of adult day health care services for veterans
In 2017, approximately 9.8 million veterans--or, 46 percent
of the total veteran population--will be 65 years of age or
older.\1\ Congress has long recognized the need to ensure
appropriate and affordable geriatric and long-term care is
available to aging veterans through the VA healthcare system.
Accordingly, the Veterans Benefits, Health Care, and
Information Technology Act of 2006 (P.L. 109-416, 120 Stat.
3403) required VA to cover the cost of nursing home care in a
SVH for any veteran in need of such care due to a service-
connected disability or with a service-connected disability
rated 70 percent or more. However, there is an increasing
demand for VA to offer geriatric and long-term care programs
for veterans in non-institutional settings that would allow
aging veterans to receive the services and support they need to
remain in their homes.
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\1\United States Cong. House Committee on Veterans Affairs. U.S.
Department of Veterans Affairs Budget Request for Fiscal Year 2017.
February 10, 2016. 114th Cong. 2nd sess. Washington: GPO, 2016
(statement The Honorable Robert A. McDonald, Secretary, U.S. Department
of Veterans Affairs)
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ADHC programs--a popular alternative to nursing home care--
provide veterans in need of supportive services with
companionship, peer support, recreation, and certain health
care services.\2\ According to the Disabled American Veterans--
a proponent of increasing access to ADHC programs for
veterans--ADHC programs are, designed to promote socialization
[and] stimulation, and to maximize independence while enhancing
quality of life as well as providing comprehensive medical,
nursing, and personal care services for veterans.\3\ ADHC
programs also provide valuable respite opportunities for
caregivers. Despite these benefits, veterans currently face
barriers accessing ADHC programs due to cost, meaning some
veterans who would prefer ADHC choose instead to receive VA-
paid nursing home care.\4\ In testimony before the Subcommittee
on Health on March 29, 2017, the National Association of State
Veterans Homes claimed that, there are a number of State Homes
across the country interested in providing medical model ADHC
services; however the current basic ADHC per diem [paid to the
SVH by VA] is not nearly sufficient for most State Homes to be
cover the costs of this program.\5\ As a result, only three
SVHs out of 153 SVHs nationwide provide ADHC programs. Those
SVHs that provide ADHC programs are located in Stony Brook, New
York; Minneapolis, Minnesota; and, Hilo, Hawaii. The Committee
is supportive of increasing access to ADHC for veterans and
recognizes that such access could allow veterans who would
otherwise qualify for more costly VA-paid nursing home care the
ability to stay at home longer.
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\2\U.S. Department of Veterans Affairs. Geriatrics and Extended
Care, Adult Day Health Care, https://www.va.gov/geriatrics/guide/
longtermcare/Adult_Day_Health_Care.asp. Accessed May 11, 2017.
\3\United States Cong. House. Committee on Veterans Affairs
Subcommittee on Health. Legislative Hearing. March 29, 2017. 115th
Cong. 1st sess. Washington: GPO, 2016 (statement from Shurhonda Y.
Love, Assistant National Legislative Director, Disabled American
Veterans)
\4\United States Cong. House Committee on Veterans Affairs
Subcommittee on Health. Legislative Hearing. March 29, 2017. 115th
Cong. 1st sess. Washington: GPO, 2016 (statement for the record from
the National Association of State Veterans Homes)
\5\Ibid.
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Section 1 of the bill would require VA to enter into an
agreement or a contract with SVHs to pay for ADHC for a veteran
eligible for, but not receiving, nursing home care and
stipulates that payment under each agreement or contract must
equal 65 percent of the payment that VA would otherwise pay to
the SVH if the veteran were receiving nursing home care.
Hearings
There were no full Committee hearings held on H.R. 1005.
On March 29, 2017, the Subcommittee on Health conducted a
legislative hearing on a number of bills including H.R. 1005.
The following witnesses testified:
The Honorable David. P. Roe M.D. of Tennessee; The
Honorable Jackie Walorski of Indiana; The Honorable
Doug Collins of Georgia; The Honorable Mike Coffman of
Colorado; The Honorable Stephen Knight of California;
The Honorable Ann M. Kuster of New Hampshire; Jennifer
S. Lee, M.D., the Deputy Under Secretary for Health for
Policy and Services for the Veterans Health
Administration of the U.S. Department of Veterans
Affairs who was accompanied by Susan Blauert, the Chief
Counsel for the Health Care Law Group of the Office of
the General Counsel for the U.S. Department of Veterans
Affairs; Kayda Keleher, Legislative Associate for the
National Legislative Service of the Veterans of Foreign
Wars of the United States; Shurhonda Y. Love, the
Assistant National Legislative Director for the
Disabled American Veterans; and, Sarah S. Dean, the
Associate Legislative Director for the Paralyzed
Veterans of America.
Statements for the record were submitted by:
The Honorable Lee Zeldin of New York; the American
Legion; the National Association of State Veteran
Homes; Swords to Plowshares; and, the Wounded Warrior
Project.
Subcommittee Consideration
On April 6, 2017, the Subcommittee on Health met in an open
markup session, a quorum being present, and ordered H.R. 1005
to be reported favorably to the full Committee by voice vote.
Committee Consideration
On May 17, 2017, the full Committee met in open markup
session, a quorum being present, and ordered H.R. 1005 to be
reported favorably to the House of Representatives by voice
vote. A motion by Representative Tim Walz of Minnesota, Ranking
Member of the Committee on Veterans Affairs, to report H.R.
1005 favorably to the House of Representatives was agreed to by
voice vote.
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. 1005
reported to the House.
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 Committees 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 Committees performance
goals and objectives are to increase the provision of ADHC
programs through SVHs.
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. 1005 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.
1005 prepared by 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. 1005 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, May 22, 2017.
Hon. Phil Roe, M.D.,
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. 1005, a bill to
amend title 38, United States Code, to improve the provision of
adult day health care services for veterans.
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. 1005--A bill to amend title 38, United States Code, to improve the
provision of adult day health care services for veterans
H.R. 1005 would require the Department of Veterans Affairs
(VA) to enter into provider agreements or contracts with State
Veterans Homes (SVHs) to provide adult day health care (ADHC)
to veterans with severe service-connected disabilities (SCD) at
rates above VA's current per-diem rates; per-diem rates cover
not more than half of the cost of the care. SVHs are facilities
operated by state governments that offer nursing home care,
domiciliary care, or ADHC primarily to veterans and receive
some of their funding from the federal government. Under the
bill, VA would pay for ADHC at a higher rate equal to 65
percent of the prevailing rate for nursing home care in that
region.
Under current law, VA is required to comply with the
Federal Acquisition Regulation (FAR) for agreements and
contracts with SVHs. The FAR is an extensive and complex set of
rules governing the federal government's purchasing processes.
VA has been unable to secure agreements or contracts with any
SVH because of the contractual requirements under the FAR
(mostly related to reporting, compensation, and fringe
benefits). As a result, VA would face challenges in entering
into agreements or contracts under the bill and CBO expects
that VA would continue to pay the SVHs at the current per-diem
rate. Therefore, CBO estimates that implementing the bill would
have no budgetary effects.
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. 1005 would not increase net
direct spending or on-budget deficits in any of the four
consecutive 10-year periods beginning in 2028.
H.R. 1005 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. 1005 prepared by 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.
1005.
Statement of Constitutional Authority
Pursuant to Article I, section 8 of the United States
Constitution, H.R. 1005 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. 1005 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 of 1995.
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. 1005 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. 1005 contains no directed
rulemaking that would require the Secretary to prescribe
regulations.
Section-by-Section Analysis of the Legislation
Section 1. Provision of adult day health care services for veterans
Section 1(a) of the bill would amend section 1745 of title
38 U.S.C. by adding at the end a new subsection (d) that would:
(1) require the Secretary of Veterans Affairs to enter into
an agreement under section 1720(c)(1) of this title or a
contract with each State home for payment for adult day health
care provided to a veteran who is eligible for but not
receiving nursing home care;
(2) stipulate that payment under each agreement or contract
between the Secretary of Veterans Affairs and a State home is
required to be made at a rate equal to 65 percent of the
payment that the Secretary would pay pursuant to subsection
(a)(2) if a veteran received nursing home care under subsection
(a) rather than under paragraph (1) of this subsection; and,
(3) stipulate that payment by the Secretary of Veterans
Affairs under paragraph (1) to a State home for adult day
health care provided to a veteran described in that paragraph
constitutes payment in full to the State home for such care
furnished to that veteran. Section 1(a) of the bill would amend
section 1745 of title 38 U.S.C. by adding at the end a new
subsection (d) that would:
Section 1(a) of the bill would also amend section 1745 of
title 38 U.S.C. in the heading by inserting, adult day health
care, after home care.
Section 1(b) of the bill would amend the table of sections
at the beginning of chapter 17 of title 38 U.S.C. by striking
the item relating to section 1745 and inserting the following
new item: 1745. Nursing home care, adult day health care, and
medications for veterans with service-connected
disabilities.''.
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):
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 (new matter is
printed in italic and existing law in which no change is
proposed is shown in roman):
TITLE 38, UNITED STATES CODE
* * * * * * *
PART II--GENERAL BENEFITS
* * * * * * *
CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE
SUBCHAPTER I--GENERAL
Sec.
1701. Definitions.
* * * * * * *
SUBCHAPTER V--PAYMENTS TO STATE HOMES
* * * * * * *
[1745. Nursing home care and medications for veterans with service-
connected disabilities.]
1745. Nursing home care, adult day health care, and medications for
veterans with service-connected disabilities.
* * * * * * *
SUBCHAPTER V--PAYMENTS TO STATE HOMES
* * * * * * *
Sec. 1745. Nursing home care, adult day health care, and medications
for veterans with service-connected disabilities
(a)(1) The Secretary shall enter into a contract (or
agreement under section 1720(c)(1) of this title) with each
State home for payment by the Secretary for nursing home care
provided in the home, in any case in which such care is
provided to any veteran as follows:
(A) Any veteran in need of such care for a service-
connected disability.
(B) Any veteran who--
(i) has a service-connected disability rated
at 70 percent or more; and
(ii) is in need of such care.
(2) Payment under each contract (or agreement) between the
Secretary and a State home under paragraph (1) shall be based
on a methodology, developed by the Secretary in consultation
with the State home, to adequately reimburse the State home for
the care provided by the State home under the contract (or
agreement).
(3) Payment by the Secretary under paragraph (1) to a State
home for nursing home care provided to a veteran described in
that paragraph constitutes payment in full to the State home
for such care furnished to that veteran.
(b) The Secretary shall furnish such drugs and medicines as
may be ordered on prescription of a duly licensed physician as
specific therapy in the treatment of illness or injury to any
veteran as follows:
(1) Any veteran who--
(A) is not being provided nursing home care
for which payment is payable under subsection
(a); and
(B) is in need of such drugs and medicines
for a service-connected disability.
(2) Any veteran who--
(A) has a service-connected disability rated
at 50 percent or more;
(B) is not being provided nursing home care
for which payment is payable under subsection
(a); and
(C) is in need of such drugs and medicines.
(c) Any State home that requests payment or reimbursement for
services provided to a veteran under this section shall provide
to the Secretary such information as the Secretary considers
necessary to identify each individual veteran eligible for
payment under such section.
(d)(1) The Secretary shall enter into an agreement under
section 1720(c)(1) of this title or a contract with each State
home for payment by the Secretary for adult day health care
provided to a veteran who is eligible for, but does not
receive, nursing home care pursuant to subsection (a).
(2) Payment under each agreement or contract between the
Secretary and a State home under paragraph (1) for each veteran
who receives care under such paragraph shall be made at a rate
that is equal to 65 percent of the payment that the Secretary
would pay to the State home pursuant to subsection (a)(2) if
the veteran received nursing home care under subsection (a)
rather than under paragraph (1) of this subsection.
(3) Payment by the Secretary under paragraph (1) to a State
home for adult day health care provided to a veteran described
in that paragraph constitutes payment in full to the State home
for such care furnished to that veteran.
* * * * * * *
[all]