[House Report 115-393]
[From the U.S. Government Publishing Office]
115th Congress } { Report
HOUSE OF REPRESENTATIVES
1st Session } { 115-393
======================================================================
VETERANS TRANSPLANT COVERAGE ACT OF 2017
_______
November 7, 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. 1133]
The Committee on Veterans' Affairs, to whom was referred
the bill (H.R. 1133) to amend title 38, United States Code, to
authorize the Secretary of Veterans Affairs to provide for an
operation on a live donor for purposes of conducting a
transplant procedure for a veteran, and for other purposes,
having considered the same, report favorably thereon with an
amendment and recommend that the bill as amended do pass.
CONTENTS
Page
Purpose and Summary.............................................. 2
Background and Need for Legislation.............................. 2
Hearings......................................................... 4
Subcommittee Consideration....................................... 4
Committee Consideration.......................................... 4
Committee Votes.................................................. 5
Committee Oversight Findings..................................... 5
Statement of General Performance Goals and Objectives............ 5
New Budget Authority, Entitlement Authority, and Tax Expenditures 5
Earmarks and Tax and Tariff Benefits............................. 5
Committee Cost Estimate.......................................... 5
Budget Authority and Congressional Budget Office Cost Estimate... 6
Federal Mandates Statement....................................... 6
Advisory Committee Statement..................................... 6
Statement of Constitutional Authority............................ 6
Applicability to Legislative Branch.............................. 6
Statement on Duplication of Federal Programs..................... 6
Disclosure of Directed Rulemaking................................ 7
Section-by-Section Analysis of the Legislation................... 7
Changes in Existing Law Made by the Bill, as Reported............ 7
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Veterans Transplant Coverage Act of
2017''.
SEC. 2. AUTHORIZATION TO PROVIDE FOR OPERATIONS ON LIVE DONORS FOR
PURPOSES OF CONDUCTING TRANSPLANT PROCEDURES FOR
VETERANS.
(a) In General.--Subchapter VIII of chapter 17 of title 38, United
States Code, is amended by adding at the end the following new section:
``Sec. 1788. Transplant procedures with live donors and related
services
``(a) In General.--In a case in which a veteran is eligible for a
transplant procedure from the Department, the Secretary may provide for
an operation on a live donor to carry out such procedure for such
veteran, notwithstanding that the live donor may not be eligible for
health care from the Department.
``(b) Other Services.--Subject to the availability of appropriations
for such purpose, the Secretary shall furnish to a live donor any care
or services before and after conducting the transplant procedure under
subsection (a) that may be required in connection with such procedure.
``(c) Use of Department or Non-Department Facilities.--The Secretary
may provide for the operation described in subsection (a) on a live
donor and furnish to the live donor the care and services described in
subsection (b) at a facility of the Department or at a non-Department
facility pursuant to an agreement entered into by the Secretary under
section 1703 or 8153 of this title, section 101 of the Veterans Access,
Choice, and Accountability Act of 2014 (Public Law 113-146; 38 U.S.C.
1701 note), or any other authority of the Secretary to furnish care at
non-Department facilities. The live donor shall be deemed to be an
individual eligible for hospital care and medical services at a non-
Department facility pursuant to such an agreement solely for the
purposes of receiving such operation, care, and services at the non-
Department facility.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 17 of such title is amended by inserting after the item
relating to section 1787 the following new item:
``1788. Transplant procedures with live donors and related services.''.
Purpose and Summary
H.R. 1133, as amended, the ``Veterans Transplant Coverage
Act of 2017,'' would authorize the Department of Veterans
Affairs (VA) to provide for any care or services a live donor
may require to carry out a transplant procedure--in either a VA
medical facility or a medical facility in the community--for an
eligible veteran notwithstanding that the live donor may not be
eligible for VA health care. Representative John Carter of
Texas introduced H.R. 1133 on February 16, 2017.
Background and Need for Legislation
VA has offered solid organ transplant services for eligible
veteran patients since 1962 and bone marrow transplant services
for eligible veteran patients since 1982.\1\ Through VA's
National Transplant Program, VA provides transplants primarily
through 13 VA transplant centers located in: Palo Alto,
California; Portland, Oregon; Seattle, Washington; Houston,
Texas; San Antonio, Texas; Salt Lake City, Utah; Iowa City,
Iowa; Madison, Wisconsin; Birmingham, Alabama; Nashville,
Tennessee; West Roxbury, Massachusetts; Bronx, New York;
Pittsburgh, Pennsylvania; and Richmond, Virginia.\2\
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\1\VA National Transplant Program. https://www.va.gov/health/
services/transplant/ Accessed October 30, 2017.
\2\Ibid.
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The Veterans Access, Choice, and Accountability Act of 2014
(Public Law 113-146; 128 STAT. 1754) created the Choice program
to increase access to care in the community for veteran
patients unable to receive care at VA medical facilities due to
long waiting times for VA appointments or lengthy travel
distances to VA medical facilities. Since the implementation of
the Choice program, the Committee has heard an increasing
number of complaints about the VA transplant program from
veterans who are concerned about the lengthy travel required
for many veterans to reach a VA transplant center and barriers
to receiving transplant care in the community. For example, in
2016, Charles Nelson--a 100 percent service-connected veteran
from Leander, Texas--attempted to receive a kidney transplant
through the VA health care system.\3\ Mr. Nelson's non-veteran
son, Austin, was willing and able to serve as Mr. Nelson's live
donor.\4\ Rather than travel to VA transplant centers in
Nashville, Tennessee, or Portland, Oregon, to receive his
kidney transplant, Mr. Nelson asked VA to authorize him to
receive his transplant at the University Hospital in San
Antonio via the Choice program.\5\\6\ Though his request was
approved by local VA officials in Texas, VA Central Office in
Washington, D.C. denied Mr. Nelson's request to receive his
transplant through the Choice program, arguing that because
Austin was not a veteran VA would be unable to use Choice funds
to cover the costs of his care.\7\ Though Choice is just one of
several care in the community programs that VA could have used
to cover the costs of Mr. Nelson's transplant at the University
Hospital in San Antonio, Mr. Nelson eventually received his
transplant at that facility using his Medicare benefits,
private donations, and personal savings to cover the cost of
his care.\8\
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\3\United States Cong. House Committee on Veterans' Affairs.
Legislative Hearing. October 24, 2017. 115th Cong. 1st sess.
Washington: GPO, 2017 (statement for the record Representative John
Carter).
\4\Ibid.
\5\Ibid.
\6\Fox 7, ``Leander Veteran Fighting for VA to Pay for Kidney
Transplant,'' May 24, 2016, http://www.fox7austin.com/news/local-news/
disabled-leander-veteran-fighting-to-get-va-to-pay-for-kidney-
transplant.
\7\United States Cong. House Committee on Veterans' Affairs.
Legislative Hearing. October 24, 2017. 115th Cong. 1st sess.
Washington: GPO, 2017 (statement for the record Representative John
Carter).
\8\Ibid.
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On June 29, 2016, the Journal of the American Medical
Association published an article which found that greater
distance from a VA Transplant Center was associated with a
lower likelihood of receiving a transplant and a greater
likelihood of death among certain veteran transplant
patients.\9\ Given the article's findings the Committee
believes that veterans residing far from VA transplant centers
should be given the option of receiving their transplant from
transplant centers in the community closer to the veteran's
place of residence. The Committee also believes that, wherever
possible, VA should remove barriers to transplant care in the
community for veteran patients. Consistent with those goals,
section 2 of the bill would authorize VA to provide for any
care or services a live donor may require to carry out a
transplant procedure in either a VA transplant center or
medical facility or VA community care facility for an eligible
veteran notwithstanding that the live donor may not be eligible
for VA health care.
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\9\Journal of the American Medical Association, ``Association of
Distance from a Transplant Center with Access to Waitlist Placement,
Receipt of Liver Transplantation, and Survival Among U.S. Veterans,
June 29, 2016, https://www.ncbi.nlm.nih.gov/pubmed/24668105.
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Hearings
There were no Subcommittee hearings held on H.R. 1133.
On October 24, 2017, the full Committee conducted a
legislative hearing on a number of bills including H.R. 1133.
The following witnesses testified:
The Honorable Jim Banks, U.S. House of
Representatives, 3rd District, Indiana; The Honorable
Mike Gallagher, U.S. House of Representatives, 8th
District, Wisconsin; The Honorable John R. Carter, U.S.
House of Representatives, 31st District, Texas; The
Honorable Glenn Thompson, U.S. House of
Representatives, 5th District, Pennsylvania; The
Honorable Neal P. Dunn, U.S. House of Representatives,
2nd District, Florida; The Honorable Andy Barr, U.S.
House of Representatives, 6th District, Kentucky; The
Honorable David J. Shulkin, M.D., Secretary, U.S.
Department of Veterans Affairs, who was accompanied by
Carolyn Clancy M.D., the Executive in Charge of the
Veterans Health Administration, and Laurie Zephyrin
M.D., MPH, MBA, the Acting Deputy Under Secretary for
Health for Community Care for the Veterans Health
Administration; Adrian M. Atizado, Deputy National
Legislative Director, Disabled American Veterans;
Roscoe G. Butler, Deputy Director for Health Care,
Veterans Affairs and Rehabilitation Division, The
American Legion; and, Kayda Keleher, Associate
Director, National Legislative Service, Veterans of
Foreign Wars of the United States.
Statements for the record were submitted by:
American Federation of Government Employees, AFL-CIO;
American Health Care Association; American Medical
Association; AMVETS; Concerned Veterans of America;
Fleet Reserve Association; Got Your 6; Health IT Now;
Iraq and Afghanistan Veterans of America; Military
Officers Association of America; Military Order of the
Purple Heart; National Alliance on Mental Illness;
National Guard Association of the United States; Nurses
Organization of Veterans Affairs/Association of VA
Psychologist Leaders/Association of VA Social Workers/
Veterans Healthcare Action Campaign; Paralyzed Veterans
of America; Reserve Officers Association; University of
Pittsburgh; Vietnam Veterans of America; the Wounded
Warrior Project; The American Congress of Obstetrics
and Gynecologists; the University of California,
Riverside School of Medicine; the American Society of
Transplant Surgeons; and, the National Indian Health
Board.
Subcommittee Consideration
There was no Subcommittee consideration of H.R. 1133, as
amended.
Committee Consideration
On November 2, 2017, the full Committee met in open markup
session, a quorum being present, and ordered H.R. 1133, as
amended, to be reported favorably to the House of
Representatives by voice vote. During consideration of the
bill, the following amendments were considered and agreed to by
voice vote:
An Amendment in the Nature of a Substitute to H.R.
1133 offered by Representative Brad Wenstrup of Ohio.
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. 1133,
as amended, reported to the House. A motion by Representative
Tim Walz of Minnesota, Ranking Member of the Committee on
Veterans' Affairs, to report H.R. 1133, 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 improve the provision of transplant
care to veteran patients by authorizing VA to provide for any
care or services a live donor may require to carry out a
transplant procedure in either a VA or VA community care
facility for an eligible veteran notwithstanding that the live
donor may not be eligible for VA health care.
New Budget Authority, Entitlement Authority, and Tax Expenditures
With respect to the requirement with respect to clause
3(c)(2) of rule XIII of the Rules of the House of
Representatives, the Committee has requested but not received
from the Director of the Congressional Budget Office an
estimate of new budget authority, entitlement authority, or tax
expenditures or revenues.
Earmarks and Tax and Tariff Benefits
H.R. 1133, 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
Clause 3(d)(2) of rule XIII of the Rules of the House of
Representatives requires an estimate and a comparison by the
Committee of the costs that would be incurred in carrying out
this bill. However, clause 3(d)(3)(B) of that Rule provides
that this requirement does not apply when the Committee has
included in its report a timely submitted cost estimate of the
bill prepared by the Director of the Congressional Budget
Office under section 402 of the Congressional Budget Act of
1974. The Committee has requested but not received a cost
estimate for this bill from the Director of the Congressional
Budget Office. The Committee believes, according to a
preliminary score from the Congressional Budget Office, that
enactment of H.R. 1133, as amended, could have significant
discretionary costs in the tens of millions of dollars over a 5
year period.
Budget Authority and Congressional Budget Office Cost Estimate
With respect to the requirements of clause 3(c)(2) of rule
XIII of the Rules of the House of Representatives and section
308(a) of the Congressional Budget Act of 1974 and with respect
to requirements of clause (3)(c)(3) of rule XIII of the Rules
of the House of Representatives and section 402 of the
Congressional Budget Act of 1974, the Committee has requested
but not received a cost estimate for this bill from the
Director of Congressional Budget Office. The Committee has
requested but not received from the Director of the
Congressional Budget Office a statement as to whether this bill
contains any new budget authority, spending authority, credit
authority, or an increase or decrease in revenues or tax
expenditures.
Federal Mandates Statement
With respect to the requirements of Section 423 of the
Congressional Budget and Impoundment Control Act (as amended by
Section 101(a)(2) of the Unfunded Mandate Reform Act, P.L. 104-
4), the Committee has requested but not received from the
Director of the Congressional Budget Office a statement as to
whether the provisions of the reported bill include unfunded
mandates.
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.
1133, as amended.
Statement of Constitutional Authority
Pursuant to Article I, section 8 of the United States
Constitution, H.R. 1133, 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. 1133, 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, 115th Cong. (2017),
the Committee finds that no provision of H.R. 1133, 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, 115th Cong. (2017),
the Committee estimates that H.R. 1133, as amended, contains no
directed rulemaking 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. 1133, as amended, as the ``Veterans Transplant Coverage
Act of 2017''.
Section 2. Authorization to provide for operations on live donors for
purposes on conducting transplant procedures for veterans
Section 2(a) of the bill would amend subchapter VIII of
chapter 17 of title 38 U.S.C. by adding at the end the
following new section: ``Sec. 1788. Transplant procedures with
live donors and related services.'' The new section 1788 (a)
would authorize VA, in the case in which a veteran is eligible
for a transplant procedure from VA, to provide for an operation
on a live donor to carry out the transplant procedure for the
eligible veteran notwithstanding that the live donor may not be
eligible for health care from VA. The new section 1788 (b)
would require VA, subject to the availability of appropriations
for such purpose, to furnish to a live donor any care or
services before or after conducting the transplant procedure
under section 1788(a) that may be required in connection with
such procedure. The new section 1788(c) would authorize VA to
provide for the operation described in section 1788(a) on a
live donor and furnish to the live donor the care and services
described in section 1788(b) pursuant to an agreement entered
into by VA under section 1703 or 8153 of title 38 U.S.C.,
section 101 of the Veterans Access, Choice, and Accountability
Act of 2014 (Public Law 113-146; 38 U.S.C. 1701 note), or any
other authority to provide to furnish care at non-VA
facilities. The new section 1788(c) would also require the live
donor to be deemed an individual eligible for hospital care and
medical services at a non-VA facility pursuant to such an
agreement solely for the purposes of receiving such operation,
care, and services at a non-VA facility.
Section 2(b) of the bill would amend the table of sections
at the beginning of chapter 17 of title 38 U.S.C. by inserting
after the item relating to section 1787 the following new item:
1788. Transplant procedures with live donors and related
services.''.
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.
* * * * * * *
1788. Transplant procedures with live donors and related services.
* * * * * * *
SUBCHAPTER VIII--HEALTH CARE OF PERSONS OTHER THAN VETERANS
* * * * * * *
Sec. 1788. Transplant procedures with live donors and related services
(a) In General.--In a case in which a veteran is eligible for
a transplant procedure from the Department, the Secretary may
provide for an operation on a live donor to carry out such
procedure for such veteran, notwithstanding that the live donor
may not be eligible for health care from the Department.
(b) Other Services.--Subject to the availability of
appropriations for such purpose, the Secretary shall furnish to
a live donor any care or services before and after conducting
the transplant procedure under subsection (a) that may be
required in connection with such procedure.
(c) Use of Department or Non-Department Facilities.--The
Secretary may provide for the operation described in subsection
(a) on a live donor and furnish to the live donor the care and
services described in subsection (b) at a facility of the
Department or at a non-Department facility pursuant to an
agreement entered into by the Secretary under section 1703 or
8153 of this title, section 101 of the Veterans Access, Choice,
and Accountability Act of 2014 (Public Law 113-146; 38 U.S.C.
1701 note), or any other authority of the Secretary to furnish
care at non-Department facilities. The live donor shall be
deemed to be an individual eligible for hospital care and
medical services at a non-Department facility pursuant to such
an agreement solely for the purposes of receiving such
operation, care, and services at the non-Department facility.
* * * * * * *
[all]