[Senate Report 111-175]
[From the U.S. Government Publishing Office]
Calendar No. 360
111th Congress Report
SENATE
2d Session 111-175
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HOMELESS VETERANS AND OTHER VETERANS HEALTH CARE AUTHORITIES OF 2010
_______
April 29, 2010.--Ordered to be printed
_______
Mr. Akaka, from the Committee on Veterans' Affairs,
submitted the following
R E P O R T
[To accompany S. 1237]
The Committee on Veterans' Affairs (hereinafter, ``the
Committee''), to which was referred the bill (S. 1237), to
amend title 38, United States Code, to expand the grant program
for homeless veterans with special needs to include male
homeless veterans with minor dependents and to establish a
grant program for reintegration of homeless women veterans and
homeless veterans with children, and for other purposes,
reports favorably thereon with an amendment in the nature of a
substitute, and an amendment to the title, and recommends that
the bill, as amended, do pass.
Introduction
On June 9, 2009, Senator Murray introduced S. 1237, the
proposed ``Homeless Women Veterans and Homeless Veterans with
Children Act of 2009.'' S. 1237, as introduced, would expand
the grant program for homeless veterans with special needs to
include male homeless veterans with minor dependents and would
establish a grant program for reintegration of homeless women
veterans and homeless veterans with children. Senators Baucus,
Byrd, Johnson, Merkley, Reed and Specter are cosponsors.
Earlier, on May 21, 2009, Senator Collins introduced
S. 1155, to amend title 38, United States Code (hereinafter
``U.S.C.''), to establish the position of Director of Physician
Assistant Services within the office of the Under Secretary of
Veterans Affairs for Health. Senators Burris, Feingold, Harkin,
Inouye and Tester are cosponsors.
On June 8, 2009, Senator Murray introduced S. 1204, the
proposed ``Chiropractic Care Available to All Veterans Act of
2009.'' S. 1204 would amend the Department of Veterans Affairs
Health Care Programs Enhancement Act of 2001 to require the
provision of chiropractic care and services to veterans at all
Department of Veterans Affairs medical centers. Senators
Begich, Brown, Brownback, Burris, Grassley, Isakson, Lincoln,
and Whitehouse are cosponsors.
On June 18, 2009, Senator McConnell introduced S. 1302, the
proposed ``Veterans Health Care Improvement Act of 2009.'' This
bill would provide for the introduction of pay-for-performance
compensation mechanisms into contracts of the Department of
Veterans Affairs with community-based outpatient clinics for
the provision of health care services.
On July 9, 2009, Senator Wyden introduced S. 1427, the
proposed ``Department of Veterans Affairs Hospital Quality
Report Card Act of 2009.'' S. 1427 would establish a Hospital
Quality Report Card Initiative to report on health care quality
in Department of Veterans Affairs Medical Centers. Senator
Johanns is a cosponsor.
On July 21, 2009, Senator Klobuchar introduced S. 1483, to
designate the Department of Veterans Affairs outpatient clinic
in Alexandria, Minnesota, as the ``Max J. Beilke Department of
Veterans Affairs Outpatient Clinic.'' Senator Franken is a
cosponsor.
On July 29, 2009, Senator Pryor introduced S. 1531, the
proposed ``Department of Veterans Affairs Reorganization Act of
2009.'' S. 1531 would establish within the Department of
Veterans Affairs the position of Assistant Secretary for
Acquisition, Logistics, and Construction.
On July 30, 2009, Senator Reed introduced S. 1547, the
proposed ``Zero Tolerance for Veterans Homelessness Act of
2009.'' S. 1547 would enhance and expand the assistance
provided by the Department of Veterans Affairs and the
Department of Housing and Urban Development to homeless
veterans and veterans at risk of homelessness. Senators Baucus,
Begich, Bond, Burris, Byrd, Cantwell, Durbin, Johnson, Kerry,
Lautenberg, Leahy, Lincoln, Merkley, Mikulski, Murray, Specter,
Tester, Udall of New Mexico, and Whitehouse are cosponsors.
On October 14, 2009, Senator Bayh introduced S. 1779, the
proposed ``Health Care for Veterans Exposed to Chemical Hazards
Act of 2009.'' S. 1779 would provide health care to veterans
exposed in the line of duty to occupational and environmental
health chemical hazards. Senators Byrd, Dorgan, Lugar, Merkley,
Rockefeller, Specter, and Wyden are cosponsors.
On October 21, 2009, the Committee held a hearing on the
above referenced bills and other pending health and benefits
legislation. Testimony was offered by: Gerald M. Cross, MD,
FAAFP, Acting Under Secretary for Health, Veterans Health
Administration, Department of Veterans Affairs; Robert Jackson,
Assistant Director, National Legislative Service, Veterans of
Foreign Wars; Ian de Planque, Assistant Director for Claims
Service, The American Legion; John Driscoll, President and CEO,
National Coalition for Homeless Veterans; Rick McMichael, DC,
President, American Chiropractic Association; and William Fenn,
Ph.D., PA, Vice President, American Academy of Physician
Assistants.
Committee Meeting
After carefully reviewing the testimony from the forgoing
hearing, the Committee met in open session on January 28, 2010,
to consider, among other legislation, an amended version of
S. 1237, consisting of S. 1237 as introduced, provisions
derived from other legislation noted above, and freestanding
provisions adopted as amendments at the Committee meeting. The
Committee voted unanimously to report favorably S. 1237, as
amended.
Summary of S. 1237 as Reported
S. 1237, as reported (hereinafter, ``the Committee bill''),
would provide for enhancements to services for homeless
veterans, make expansions to the Department of Veterans Affairs
(hereinafter, ``VA'') health care and services and would amend
the title of the original bill.
TITLE I--HOMELESS VETERANS MATTERS
Section 101 would enhance VA's homeless veterans'
Comprehensive Services Program by broadening the pool of
potential applicants to those who propose to use mixed
financing to provide supportive housing.
Section 102 would establish a grant program for
reintegration of homeless women veterans and homeless veterans
with children into the labor force.
Section 103 would expand the number of eligible providers
of programs for homeless veterans with special needs and for
purposes of eligibility, classify male homeless veterans with
minor dependants as homeless veterans with special needs
Section 104 would establish a program within VA to prevent
veteran homelessness.
Section 105 would require VA, the Department of Housing and
Urban Development (hereinafter, ``HUD'') and the Interagency
Council on Homelessness to establish a method for accurately
counting the number of homeless veterans nationwide, as well as
tracking demographic information and type of assistance
received.
Section 106 would authorize the phase-in of up to 60,000
HUD and VA Supported Housing Program (hereinafter, ``HUD-
VASH'') vouchers by 2013 and describe the types of help VA case
managers are expected to provide homeless veterans receiving
rental assistance.
Section 107 would create the position of Special Assistant
for Veterans Affairs within HUD who would ensure that veterans
have access to HUD's housing and homelessness assistance
programs and also serve as a liaison with VA.
Section 108 would require the Secretary of VA to develop a
comprehensive plan within one year of the bill's enactment for
ending homelessness among veterans.
TITLE II--TOXIC SUBSTANCES EXPOSURE
Section 201 would extend eligibility to health care for
veterans with disabilities who served in the Persian Gulf War.
TITLE III--HEALTH CARE MATTERS
Section 301 would establish within VA an Assistant
Secretary for Acquisition, Logistics, and Construction and
increase the authorized number of Deputy Assistant Secretaries.
Section 302 would establish a Director of Physician
Assistant Services within the Veterans Health Administration
(hereinafter, ``VHA") Office of Patient Care Services.
Section 303 would require VA to establish a Medical Center
Report Card to ensure public view of performance comparisons
between VA facilities and between VA and non-VA sites.
Section 304 would require VA to submit to Congress a report
on the advisability and feasibility of pay-for-performance
mechanisms in VA health care contracts at Community Based
Outpatient Clinics (hereinafter ``CBOCs'').
Section 305 would direct VA to enable State veterans' homes
to admit parents who had a child die while serving in the Armed
Forces.
Section 306 would provide for the automatic enrollment of
eligible demobilizing members of the National Guard and Reserve
in health care and dental care programs of the Department of
Veterans Affairs.
Section 307 would require VA to develop, implement, and
fund a comprehensive policy on the provision of chiropractic
services.
Section 308 would designate the VA outpatient clinic in
Alexandria, Minnesota, as the ``Max J. Beilke Department of
Veterans Affairs Outpatient Clinic.''
TITLE IV--OTHER MATTERS
Section 401 would direct unobligated funds appropriated for
medical services in fiscal years 2009 and 2010 and carried over
into subsequent fiscal years to be available for purposes of
carrying out provisions contained in the Committee bill.
Background and Discussion
TITLE I--HOMELESS VETERANS MATTERS
Sec. 101. Enhancement of comprehensive service programs.
Section 101 of the Committee bill, which is derived from
S. 1547, would enhance VA's homeless veterans' Comprehensive
Service Programs by broadening the pool of potential applicants
for that program to those entities who propose to use mixed
financing to provide supportive housing and make other changes
designed to improve the overall program.
Background. Public Law 102-590, the Homeless Veterans
Comprehensive Service Programs Act of 1992, established VA's
Homeless Providers Grant and Per Diem Program (hereinafter,
``GPD.'') The purpose of the grant program was to assist public
and nonprofit private entities in establishing new programs and
service centers to furnish supportive services and housing for
homeless veterans through grants that may be used to acquire,
renovate or alter facilities. The purpose of the per diem
program was to provide per diem payments, or in-kind assistance
in lieu of per diem payments, to eligible entities which
established programs after November 10, 1992, that provide
supportive services and housing for homeless veterans.
Over the years since it was established, the GPD has
changed as more is learned about the needs of homeless
veterans. In testimony before the Committee on October 21,
2009, the National Coalition for Homeless Veterans stated that,
``[f]or years service providers have suggested a system that
reflects the actual cost of providing services to veterans with
multiple barriers to recovery rather than a `per diem' rate
based on reimbursements paid to state veterans' homes.'' They
believe that, as successful as the GPD has been, it would be
more so with less restrictions.
Section 2011 of title 38 sets forth the authority,
criteria, and various requirements for VA's grant program so as
to achieve its intended purpose to furnish and expand or modify
existing programs for furnishing, outreach, rehabilitation
services, vocational counseling and training, and transitional
housing assistance for homeless veterans. The law requires the
Secretary to establish criteria and requirements for grants
awarded under this section. Eligible entities for these grants
are restricted to public or nonprofit private entities with the
capacity to administer the grant effectively. An eligible
entity must also demonstrate that adequate financial support
will be available to carry out the project for which the grants
is sought consistent with the plans, specifications, and
schedule submitted by the applicant. An eligible entity must
also agree to meet, as well as have the capacity to meet, the
applicable criteria and requirements established by the
Secretary. Currently, the specifications as to the kinds of
projects for which the grants are available do not include new
construction of facilities. In addition, the grants may not be
used to support operational costs and the amount of the grant
may not exceed 65 percent of the estimated cost of the project
concerned.
VA's Advisory Committee on Homeless Veterans (hereinafter,
``Advisory Committee'') established pursuant to section 2066 of
title 38, provides advice and makes recommendations to the
Secretary of VA on the provision of benefits and services to
homeless veterans. In the Advisory Committee's 2005 Report, it
first recommended that the authorization for appropriations for
the GPD be increased to $200 million. Although that amount has
been increased over the last five years and currently is $150
million, raising the amount to $200 million would better allow
for continued growth in the program. The GPD has proven to be a
vital part of VA's services for homeless veterans. In response
to this Advisory Committee recommendation, VA stated that it
believes that increased funding for GPD ``should be deliberate
and systematic to provide the support systems and
administration infrastructure that are necessary to manage the
program with appropriate levels of oversight and assurance of
quality of care.''
Committee Bill. Section 101 of the Committee bill would
amend subchapter II of chapter 20 of title 38 to make a number
of improvements. It would amend section 2011(b)(1)(A), the
provision which sets forth the criteria for grants, to include
new construction of facilities as a type of program for which
the grants are available. It would amend section 2011(c), the
provision which sets forth funding limitations on grantees so
as to specify that the Secretary may not deny an application
from an entity under this program solely on the basis that the
entity proposes to use other funding sources as long as such
entity has oversight and site control over the project. In
connection with this change, the Committee bill would add a
definition of a ``private nonprofit organization.'' It is the
Committee's expectation that these changes will modernize the
GPD to allow for the utilization of innovative project funding
strategies--including the use of low-income housing tax credits
and matching funds from other government sources to facilitate
and hasten project development.
With respect to the issue of the per diem payments, the
Committee bill, in a freestanding provision, would require the
Secretary of VA to study the method of reimbursing GPD
community providers for their program expenses and report to
Congress, within one year, VA's recommendations for revising
the payment system. The Committee believes that since VA plans
to continue to develop the GPD, long term commitment to funding
and modifying the program appropriately is critical to service
providers and the veterans they assist. As these programs are
improved and increased, VA needs to look more closely at the
effectiveness of how it makes payments and reimbursements and
to whom reimbursements are made.
The Committee bill would amend section 2013 of title 38 by
increasing the annual GPD authorization to $200 million in FY
2010 and to such sums as necessary for each of fiscal years
2011 through 2014. The Committee believes this will help VA's
goal to assist every eligible homeless veteran willing to
accept services.
Finally, the Committee bill would require the Secretary to
ensure that not less than five percent of the aggregate of the
grant amounts awarded under section 2011 of title 38 is awarded
to eligible entities located in rural areas. While the issues
of homeless tend to be associated with urban areas, the
Committee believes that it is important to address the needs of
veterans who may live in very rural or remote areas and are at
risk of homelessness.
Sec. 102. Grant program for workforce reintegration of homeless women
veterans and homeless veterans with children.
Section 102 of the Committee bill, which is derived from
S. 1237, would establish a grant program for reintegration of
homeless women veterans and homeless veterans with children
into the labor force.
Background. Women veterans represent an increasing
proportion of the total veteran population. The percentage of
women veterans is nearing eight percent and expected to rise
substantially over the next two decades. While VA is an
institution originally designed for and focused on serving male
veterans, the significant increase in the number of women
veterans indicate a crucial need for VA to adapt its programs
to address this new demographic. For example, although the
majority of homeless veterans programs are designed for male
veterans, more than five percent of veterans requesting
assistance from VA and community-based homeless veteran service
providers are women. More than 10 percent of these women have
dependent children. In addition, there are reports of a
significant number of male homeless veterans who have dependent
children as well.
Currently, under section 2021 of title 38, the Secretary of
Labor is required to conduct, directly or through grant or
contract, Homeless Veterans Reintegration Programs (hereinafter
``HVRP''). These are programs the Secretary determines are
appropriate to provide job training, counseling, and placement
services (including job readiness, literacy and skills
training) to expedite the reintegration of homeless veterans
into the labor force. HVRP is administered through the
Assistant Secretary of Labor for Veterans' Employment and
Training (hereinafter ``VETS''.) Since women veterans have
represented a very small percentage of the veteran population
for decades, most of the current programs are designed for and
provide services to male homeless veterans. The Committee's
intent is to increase the availability of programs which focus
efforts toward the growing and underserved populations of women
veterans and veterans with dependent children.
Committee Bill. Section 102 of the Committee bill would
amend Subchapter III of chapter 20 of title 38 by adding a new
section 2021A, entitled ``Grant program for the reintegration
of homeless women veterans and homeless veterans with
children.'' This grant program would differ from the current
HVRP grants in that it would be strictly a grant program and
would focus specifically on providing services that will assist
in the reintegration into the labor force of homeless women
veterans and homeless veterans with children. Like the current
HVRP grants, services under this new grant program would
include job training, counseling, and job placement services,
including job readiness, literacy, and skills training.
Importantly, it would also include child care services to serve
most effectively the target population.
This new grant program would also be administered through
the Assistant Secretary of VETS and would require that
information be collected which is appropriate to monitor and
evaluate the use of the amounts granted, including data on
results or outcomes of the services provided to each homeless
veteran under the new program. The Committee believes that
monitoring the program in this way will provide proper feedback
to ensure the program is accomplishing its intent or identify
unforeseen issues that may require alterations to the program.
While homelessness is often associated with urban areas,
there are homeless veterans in rural areas as well. With the
increased number of National Guard and Reserve members
deploying as part of Operation Enduring Freedom/Operation Iraqi
Freedom (hereinafter ``OEF/OIF'') which subsequently qualifies
them for veteran status, the number of rural veterans is
increasing. In order to ensure that this population has access
to homeless veterans programs, section 102 would further
require that at least five percent of the aggregate of the
grant amounts awarded under this new grant program in each
fiscal year be awarded to eligible programs and facilities
located in rural areas.
Section 102 would authorize appropriations of $10 million
for each of fiscal years 2010 through 2014 for this new
program. This amount would be in addition to any amounts
authorized to be appropriated for the current programs under
section 2021. The funds appropriated to carry out this new
grant program would remain available until expended and funds
obligated in any fiscal year to carry out this program would be
able to be expended in that fiscal year or the succeeding
fiscal year.
Section 2012(d) of existing title 38 requires the Secretary
of Labor to submit a report to Congress every two years on the
progress of the programs conducted under section 2021. Section
102 of the Committee bill would require that report to include
an evaluation of this new grant program for the reintegration
of homeless women veterans and homeless veterans with children.
This section of the report would also be required to include an
evaluation of the services furnished to homeless women veterans
and homeless veterans with children, as well as an analysis of
the information collected and used to monitor the program
mentioned. The Committee believes that this feedback will be
helpful in determining if this grant program is meeting its
purpose and will be helpful to identify trends as changes occur
in the demographics of the homeless veteran population.
Sec. 103. Expansion of grant program for homeless veterans with special
needs.
Section 103 of the Committee bill, which is derived from
S. 1237, would expand the number of eligible providers of
programs for homeless veterans with special needs and include
male homeless veterans who have care of minor dependants as
homeless veterans with special needs.
Background. Under section 2061 of title 38, VA operates a
program of grants to encourage development of programs for
homeless veterans with special needs. Current law provides that
these special needs grants can only be awarded to VA health
care facilities and to providers receiving grant and per diem
payments under VA's Comprehensive Service Programs. Homeless
veterans with special needs eligible for these programs are
defined as homeless veterans who are 1) women, including women
who have care of minor dependents; 2) frail elderly; 3)
terminally ill; or 4) chronically mentally ill.
Committee Bill. Subsection 103(a) of the Committee bill
would expand the number of eligible providers who may receive
VA grants for programs to assist homeless veterans with special
needs to those entities eligible to receive grant and per diem
payments, but who may not be doing so. Thus, these grants would
no longer be limited to existing VA health care facilities and
current grant and per diem providers, but will allow those
eligible but not in receipt of grant and per diem payments to
apply to the grant program for homeless veterans with special
needs.
Subsection 103(b) would expand the definition of homeless
veterans with special needs to include veterans who have care
of minor dependents as well regardless of gender.
Sec. 104. Program on prevention of veteran homelessness.
Subsection 104 of the Committee bill, which is derived from
S. 1547, would require the Secretary of VA to establish a
program to prevent veteran homelessness.
Background. In January 2010, VA estimated that 131,000
veterans were homeless on any given night. In March 2010, this
estimate was revised downward to 107,000, although perhaps
twice as many experience homelessness at some point during the
course of a year. In addition, statistics show that about one-
third of the adult homeless population has served their country
in the armed services. This means that veterans are often at
greater risk of becoming homeless. Some commentators suggest
that some reasons for this may be that when they leave the
military, they discover that the skills they have honed in
their military service can be difficult to transfer to jobs in
the private sector. Others may struggle with physical or mental
wounds of war. Still others return to communities that lack
safe, affordable housing.
Committee Bill. Section 104 of the Committee bill would
amend subchapter VII of chapter 20 of title 38 to add a new
section 2067, ``Prevention of veteran homelessness.'' This new
section would create a homelessness prevention program that
would enable VA to keep at-risk veterans in stable housing and
offer increased assistance to veterans who have fallen into
homelessness. Specifically, VA could provide, directly or in
conjunction with an existing program, short-term rental
assistance, housing relocation and stabilization services,
services to resolve personal credit issues, payments for
security deposits or utility costs, assistance for moving
costs, and referral services to programs of another department
or agency of the Federal Government. These up-front expenses
can be a major obstacle that puts low-income or unemployed
veterans at risk of becoming homeless. These homelessness
prevention and rapid re-housing techniques have been
successfully used in many communities to reduce family
homelessness significantly. This new authority would give VA
the opportunity to put these strategies into practice to assist
veterans who have been identified as homeless or are at
imminent risk of becoming homeless.
It is not the Committee's intent to duplicate available
services that are already effective and successful or to permit
a veteran to ``double dip'' by receiving the same assistance
from a variety of sources. The language of this section would
require the Secretary of VA to provide assistance only to the
extent that it is not duplicating a supportive service provided
to the veteran by an eligible entity receiving financial
assistance under section 2044 of title 38 or by any other
Federal, State, or local entity.
The program established by this section is also not
intended to be long term support for the veterans identified as
homeless or those who are at imminent risk of becoming
homeless. Likewise, it should not be viewed as a slush fund for
these veterans. It is the Committee's intent to give the
Secretary the authority to protect the program from abuse by
allowing the Secretary to establish a limit on the number of
times that a particular veteran may receive assistance under
the program within a fiscal year.
The Committee bill would authorize $50,000,000 to be
appropriated to carry out this program for each of fiscal years
2010 through 2014. It would also add this new program to the
oversight and coordination responsibilities of the homeless
veterans program coordinators under Section 2003(a) of title
38.
Not later than 180 days after the date of establishment of
this program, the Secretary of VA would be required to submit a
report on its operation to the Congress. This report would be
required to include the types and sources of assistance
provided under the program, as well as an assessment of the
effectiveness of the services provided. This would allow
Congress to determine the effectiveness of the program and
evaluate the need for any necessary changes.
Sec. 105. Homeless Veterans Management Information System.
Section 105 of the Committee bill, which is derived from
S. 1547, would require VA, HUD, and the Interagency Council on
Homelessness to establish a method for accurately counting the
number of homeless veterans nationwide, as well as tracking
demographic information and type of assistance received.
Background. According to the annual VA Community
Homelessness Assessment, Local Education, and Networking Groups
Reports, approximately 131,000 veterans are homeless on any
given night. However, this is an estimate. There have been few
systematic, national efforts to count the homeless and
particularly the number of homeless veterans. In 1996, the
National Survey of Homeless Assistance Providers and Clients
estimated that veterans comprised 23 percent of the homeless
population. In 2005, HUD began organizing comprehensive,
national counts of homeless persons, but does not capture data
specific to homeless veterans.
Committee Bill. Section 105 of the Committee bill would
require the Secretary, in consultation with Special Assistant
for Veterans Affairs of HUD (as established in Section 107 of
the Committee bill) and the United States Interagency Council
on Homelessness, to establish a method for the collection and
aggregation of data on homeless veterans participating in VA
and HUD programs. The method for the collection of data would
be required to ensure that each veteran is only counted once to
avoid inflation of the number of homeless veterans. The data
collected would include, among other things, information on
age, race, sex, disability status,
marital status, income, employment history, and whether the
veteran is a parent. These data would be collected and
aggregated
annually.
It is the Committee's intent to establish a method that
provides accurate data regarding the number of homeless
veterans nationwide. Having reliable and accurate data assist
in making better assessments about the need for and
implementation of comprehensive and supportive services for
homeless veterans. The Committee does not intend to burden
homeless program providers with an overwhelming system that
would capture data about homeless veterans that is redundant
but rather would incorporate any new data pertaining to
veterans with data already collected for the greater homeless
population.
Sec. 106. Rental assistance for veterans through Department of Housing
and Urban Development.
Section 106 of the Committee bill, which is derived from
S. 1547, would authorize additional housing vouchers through
the HUD-VASH program.
Background. HUD-VASH is a cooperative partnership between
HUD and VA that provides long-term case management, supportive
services, and permanent housing support for eligible homeless
veterans. The HUD-VASH program began in 1992 under a memorandum
of agreement between the two departments. Congress codified the
HUD-VASH program in Public Law 107-95, the Homeless Veterans
Comprehensive Assistance Act of 2001. That Act also authorized
HUD to allocate 500 additional HUD-VASH vouchers in each of
fiscal years 2003 through 2006. Public Law 109--461, the
Veterans Benefits, Health Care, and Information Technology Act
of 2006 authorized HUD to allocate 500 HUD-VASH vouchers in
fiscal year 2007 and increase the amount in increments of 500
per fiscal year up to 2,500 in fiscal year 2011.
The HUD-VASH program is explicitly designed to provide
permanent supportive housing to the most vulnerable homeless
veterans. To be eligible, a veteran must be must be homeless,
eligible for VA health care, and need and participate in case
management services in order to obtain and sustain permanent
independent community housing. Eligible homeless veterans
receive VA provided case management and supportive services to
promote stability and recovery from physical and mental health,
substance use, and functional concerns contributing to or
resulting from of homelessness. The program goals include
promoting maximal veteran recovery and independence in order to
enable the veteran and his family to sustain permanent housing
in the community. The case manager and the veteran set goals
related to housing, income, employment and treatment with the
ultimate goal of having the veteran fully reintegrate back into
the community. To achieve this goal the case manager works on
employment and educational goals with the veteran so that the
veteran can be more self sufficient. There is also an annual
review by the Public Housing Authority (hereinafter, ``PHA'')
that evaluates income eligibility and, when the veteran exceeds
income eligibility, both VA and local PHAs assist the veteran
with transitioning to alternative more independent living
arrangements.
Comprehensive evaluation of the HUD-VASH program conducted
by the Department of Veterans Affairs' Northeast Program
Evaluation Center found that HUD-VASH significantly reduces
days of homelessness for veterans with mental and addictive
disorders, who are among those considered chronically homeless.
According to an analysis of data by the National Alliance to
End Homelessness, about 63,000 veterans can be classified as
chronically homeless. In the efforts to end homelessness among
veterans, Congress appropriated funding in 2008 and 2009 for,
and HUD currently provides, 20,000 ``Housing Choice'' Section 8
vouchers designated for HUD-VASH to participating PHAs to
assist with rent payment. This influx of HUD-VASH is a good
start, but it will not meet the needs of all homeless veterans.
Committee Bill. Section 106 of the Committee bill would
authorize the phase-in of up to 60,000 HUD-VASH vouchers by
2013. It would call for not more than 30,000 vouchers for
rental assistance to be outstanding during FY 2010, not more
than 40,000 during FY 2011, not more than 50,000 during FY
2012, and not more than 60,000 during FY 2013 and each fiscal
year thereafter.
The Committee bill would define what qualifies as a
``public housing agency'' and also would require the Secretary
to ensure homeless veteran case managers provide appropriate
supportive services. It describes the types of help VA case
managers would be expected to provide homeless veterans
receiving rental assistance to include medical care to help to
achieve an end to chronic homelessness.
Sec. 107. Special Assistant for Veterans Affairs in Office of Secretary
of Housing and Urban Development.
Section 107 of the Committee bill, which is also derived
from S. 1547, would establish the position of Special Assistant
for Veterans Affairs within the Office of the Secretary of
Housing and Urban Development.
Background. Currently, within HUD's Office of Community
Planning and Development, the Deputy Assistant Secretary for
Special Needs oversees efforts to confront the housing and
service needs of homeless persons, including veterans and their
families. These efforts include addressing the needs of
homeless veterans and their families. Homelessness for any
American is difficult but for an individual who has answered
the call to duty it is simply unacceptable. There are many
challenges that veterans face which can lead to homelessness
such as health concerns, including mental health problems,
economic issues, and a lack of access to safe housing. HUD
provides housing and services to homeless veterans through
HUD's targeted programs for special needs populations, as well
as through other mainstream HUD resources.
HUD administers a variety of housing programs that can
assist veterans. These include the Housing Choice Voucher
Program, Public Housing, HOME Investment Partnerships, and the
Community Development Block Grant program. These programs, by
statute, provide great flexibility so that communities can use
these federal resources to meet their particular local needs,
including the needs of their veterans.
While these efforts are commendable, the Committee believes
that HUD should have an individual who is responsible for
addressing the needs of homeless veterans only. This would
ensure appropriate visibility for the needs of this
disproportionately large segment of the homeless population.
Committee Bill. The Committee bill would amend section 3533
of title 42, U.S.C., to require the Secretary of HUD to appoint
an individual to be the Special Assistant for Veterans Affairs.
This individual would be charged with ensuring that veterans
have access to all housing and homeless assistance offered by
all programs carried out by HUD. In addition, the new Special
Assistant would coordinate all programs and activities within
the agency as they pertain to veterans.
Sec. 108. Plan to end veteran homelessness.
Section 108 of the Committee bill, which is derived from
S. 1547, would require the Secretary of Veterans Affairs to
develop a comprehensive plan within one year of the bill's
enactment for ending veterans' homelessness.
Background. At VA's Homeless Veteran Summit: Ending
Homelessness among Veterans in Five Years, which was held on
November 3, 2009, Secretary Shinseki announced VA's plans to
establish new programs and enhance existing successful efforts
designed to end homelessness among Veterans over the next five
years. No specifics of the plan were addressed, but many of the
references made were to programs contained in this Committee
bill. The Committee believes that reducing the number of
homeless veterans is going to require efforts made by providers
on many levels and on many fronts. But more importantly, this
will require a well thought out plan. There are many entities
providing services to homeless veterans. Available programs
need to be identified and assessed so that duplicative services
are not created and inefficiencies are corrected or eliminated.
Committee Bill. Section 108 of the Committee bill would
require the Secretary of VA to submit to Congress a
comprehensive plan to end homelessness. This plan would include
an analysis of all Federal Government agencies and department
level programs which are designed to prevent homelessness among
veterans and assist those veterans who are homeless. It would
also include an evaluation of whether and how partnerships
between these programs contribute to the Secretary's plan to
end homelessness among veterans. Both this analysis of programs
and evaluation of partnerships would provide support for
recommendations for improving the current programs available,
creating partnerships between such programs, or eliminating
ineffective programs. If new programs are recommended, they
should include cost estimates. The Secretary can include any
other information he feels is necessary. The plan should
include a time line for its implementation.
The Committee believes that better articulation of issues
surrounding the plan to end veteran homelessness in five years
is called for. At the time of the Committee's January 28, 2010,
markup, the Administration had yet to submit its views on
legislation (S. 1547) that was largely incorporated into the
Committee bill. Also, in response to questions asked at a March
24, 2010, Committee hearing, a VA witness testified that no
legislative action was necessary to bring about the Secretary's
plan to end homelessness among veterans. Finally, the Committee
has yet to receive answers regarding how the Administration's
proposed Fiscal Year 2011 budget request for homeless veterans'
programs is contingent on legislative authorizations under the
Committee's purview. To better assist in the effort to end
homelessness among veterans, Congress needs transparency in
order to avoid advancing duplicative programs and also ensure
that necessary funding authorizations are enacted. The
Committee urges the Administration to be more forthcoming on
these matters going forward.
TITLE II--TOXIC SUBSTANCES EXPOSURE
Sec. 201. Extension of eligibility for heath care for veterans with
disabilities who served in Persian Gulf War notwithstanding
lack of evidence to conclude such disabilities are associated
with such service.
Section 201 of the Committee bill, which is derived from
S. 1779, would extend eligibility for VA health care until
December 31, 2012, in the case of certain veterans who served
in Southwest Asia during the Persian Gulf War.
Background. Under prior law, VA had been authorized, by
section 1710 of title 38 to provide health care for a veteran
for any illness if the veteran served in the Southwest Theater
of operations during the Persian Gulf War and was exposed to a
toxic substance, radiation, or other conditions. This authority
applied even if there was insufficient medical evidence to
conclude that such illness was attributable to such military
service. This authority expired on December 31, 2002.
Since the authority expired, veterans who have been
exposed to an environmental hazard during military service are
not eligible for VA health care for a disability which may be
associated with such exposure, unless they are service-
connected for the disability, apply for VA health care within
five years of discharge or meet one of the other eligibility
criteria set forth in section 1710. As a result, some veterans
who may have been exposed to environmental hazards do not
currently have access to VA health care for disabilities which
have not yet been associated with such exposures. This
potentially includes veterans who provided security at the
Qarmat Ali water treatment plant in Iraq during the spring and
summer of 2003. During the Committee's October 8, 2009, hearing
on VA/DOD response to certain military exposures, Dr. Herman
Gibbs, an epidemiologist, testified that ``the symptoms
reported by the soldiers who served at Qarmat Ali are
consistent with significant exposure to sodium dichromate.''
Committee Bill. Section 201 of the Committee bill would
extend eligibility for VA health care for certain veterans who
served on active duty in the Southwest Asia Theater of
operations during the Persian Gulf War. Such veterans are those
who were exposed to a toxic substance, radiation, or other
occupational or environmental hazards and have disabilities
which have not been demonstrated to be associated with such
service.
Eligibility for health care under this provision would
begin on the date of enactment of the Committee bill and end on
December 31, 2012.
Section 201 would also provide a technical amendment to
section (a)(2)(F) of section 1710 by deleting the term
``conditions'' and insert ``occupational or environmental
hazards'' in order to more clearly reflect the intent of the
provision. By using the term ``occupational or environmental
hazards'', the Committee intends that generally accepted
guidelines such as those of the Department of Defense
(hereinafter ``DOD'') military exposure guidelines for the
assessment of the significance of field exposures to
occupational and environmental health chemical hazards,
standards promulgated by the Occupational Safety and Health
Administration or the Environmental Protection Agency would be
taken into consideration. The Committee believes that the use
of such terminology is more precise than the term
``conditions.''
TITLE III -- HEALTH CARE MATTERS
Sec. 301. Increase in the number of authorized Assistant Secretaries
and Deputy Assistant Secretaries.
Section 301 of the Committee bill, which is derived from
S. 1531, would establish the position of Assistant Secretary
for Acquisition, Logistics, and Construction (hereinafter ``AS/
AL&C'') within VA.
It would also provide for the establishment of eight additional
Deputy Assistant Secretary (hereinafter, ``DAS'') positions
within the Department.
Background. VA is one of the largest and most multifaceted
agencies within the federal government. With nearly 250,000
employees, a budget of over $125 billion, and major facilities
spread across the country, its operations are complex and
varied. It has responsibility for delivery of heath care;
compensation, pension, education, burial and other benefits;
and memorials for those who have served in uniform.
By law, all federal agencies are required to have four
Chief Officers: a Chief Financial Officer (hereinafter,
``CFO''), a Chief Information Officer, a Chief Human Capital
Officer, and a Chief Acquisition Officer (hereinafter,
``CAO''). The CAO position was established most recently by
title IX of Public Law 108-136, the National Defense
Authorization Act for Fiscal Year 2004. At the present time, VA
has designated the Assistant Secretary for Management to serve
as both the CFO and the CAO.
The management of acquisition and logistics has evolved
into a complex and specialized profession with highly
complicated and sophisticated facets. Both the Government
Accountability Office (hereinafter, ``GAO'') and VA's Inspector
General have identified a number of best practices and major
management challenges that result when responsibilities for
acquisition and logistics are combined with other duties.
The GAO specifically identified as a weakness situations
where the CAO has other duties not related to acquisitions. VA
remedied this by establishing an Office of Acquisition,
Logistics, and Construction in October 2008. But VA does not
have a senior level, assistant secretary to lead that office.
In an agency of this size, with programs so diverse and in so
many cases having complex requirements, such as building major
medical facilities, and purchasing almost 15 billion dollars in
goods and services annually, the need for an Assistant
Secretary with an exclusive focus on acquisition is warranted.
Finally, the number of DAS positions within VA is limited
by law. Section 308(d)(1) of title 38 provides that the number
of DAS positions within VA may not exceed 19. As originally
enacted, the 1989 law establishing VA as a Department--as
opposed to an agency--provided for 18 DAS positions; in 2002,
Public Law 107-287 expanded the number of DAS positions by one.
Over time, VA has found that the number of DAS positions
capped by law limits the Department's ability to conduct best
conduct business practices in the 21st century and that more
DAS positions would support a comprehensive and improved
mechanism for delivery of services and benefits to our Nation's
veterans. According to VA, two additional DAS positions would
be within the newly established AS/AL&C office and five would
be within the Office of Information and Technology. One DAS
would support the Office of Asset Enterprise Management.
Committee Bill. The Committee bill would establish a new
position for an AS/AL&C within the Department. The Committee
believes that by creating this new position with primary
responsibility for acquisition and logistics, the Department
may be better able to make consistent and sound business
decisions and would elevate the importance of critical
functions within the agency.
In addition, as part of on-going efforts to transform VA
into a 21st century operation, VA has recently reorganized the
construction functions within the Department by creating an
Office of Construction and Facilities Management which at
present reports directly to the Deputy Secretary. Since a large
part of the construction process involves acquisition of
services, consolidating responsibilities for this activity
under the new AS/AL&C seems to offer an opportunity for better
management practices and streamlined operations.
Finally, the Committee bill would increase the maximum
number of DAS positions within VA from 19 to 27. This would
give VA more flexibility--and a cost neutral option--to meet
best practices' needs.
Sec. 302. Establishment of Director of Physician Assistant Services in
Veterans Health Administration.
Section 302 of the Committee bill, which is derived from
S. 1155, would establish a Director of Physician Assistant
Services within the VHA Office of Patient Care Services.
Background. Currently there is a Physician Assistant
(hereinafter ``PA'') Advisor to the Under Secretary of Health,
a position that is both part-time and field-based, authorized
under the Veterans Benefits and Health Care Improvement Act of
2000, Public Law 106-419. The Physician Assistant Advisor
reports to the Chief Consultant for Primary Care.
There are nearly 1,900 PAs presently employed by VA, making
it the largest single employer of PAs. The American Academy of
Physician Assistants estimates that in 2008 over 257 million
patient visits were made to PAs nationally and about 332
million medications were prescribed or recommended by PAs.
William Fenn, Vice President of the American Academy of
Physician Assistants testified before the Committee on October
21, 2009, that PAs are fully integrated into the health care
systems of the Armed Forces and nearly all other public and
private systems. Fenn highlighted that PAs are fully integrated
into many public and private health care systems in many cases
due to a Director of PA Services being employed by these
systems. Such institutions include the Cleveland Clinic, the
Geisinger Clinic, the University of Texas M.D. Anderson Cancer
Center, and New Orleans' Ochsner Clinic Foundation. PAs serve
on the frontlines of Iraq and Afghanistan, providing medical
care to members of the Armed Forces and at all levels of
medical facilities in the military. They also play a key role
in providing medical care in medically underserved communities
and, in many of these communities, they serve as the only
health care professional available.
VA has continually had difficulties recruiting and
retaining qualified personnel such as physicians and nurses, as
well as PAs. The Independent Budget (hereinafter, ``IB'') for
fiscal year 2011, a document co-authored by AMVETS, Disabled
American Veterans, Paralyzed Veterans of America, and the
Veterans of Foreign Wars, and supported by numerous other
veterans service organizations, found a five year average
turnover rate of PAs of 14 percent, with an average loss of 125
PAs a year. Additionally, in the final quarter of 2009, there
was a loss of 98 PAs due to retirements and resignations. Fenn
also stated in his October 21 testimony that VA is not
competitive with the private sector for new PA graduates, and
approximately 40 percent of PAs currently employed by VA are
eligible for retirement in the next five years. Furthermore,
according to the IB, although overall PA positions have
increased in VA by 19 percent over the past 5 years, the
percentage of mid-level PA providers has declined by 30
percent.
Considering the large scope of care provided by PAs, the
population of PAs in VHA, and that VA is in need of non-
physician care providers to address the growing patient
population, the Committee believes it is reasonable to afford
PAs representation comparable to these other groups of
providers. As such, establishing a full-time PA presence at the
VA Central Office would both improve recruitment and retention
of such providers and ensure PAs across all VA facilities are
properly managed and utilized and providing sufficient and
quality care to veterans.
Committee Bill. Section 302 of the Committee bill would
amend section 7306 (a) of title 38 by inserting a new paragraph
(9) to establish a Director of Physician Assistant Services
within the VHA Office of Patient Care Services. The Director of
Physician Assistant Services would report to the Chief Patient
Care Services Officer on all matters relating to education and
training, employment, appropriate utilization, and optimal
participation of physician assistants within the programs and
initiatives of VHA, which conforms to the reporting structure
for most program directors and service chief consultants in the
VA.
Subsection (b) of section 302 of the Committee bill would
require new paragraph (9) of section 7306(a) to be implemented
no later than 120 days after the date of enactment of the
legislation.
The Committee intends that the Director of Physician
Assistant Services operate under conditions similar to other
program directors and service chief consultants in VHA,
including parallel placement within the VA organizational
structure and parallel pay authority.
Sec. 303. Department of Veterans Affairs Medical Center Quality Report
Card Initiative.
Section 303 of the Committee bill, which is derived from
S. 1427, would require VA to establish a Medical Center Report
Card to ensure public view of performance comparisons between
VA facilities and between VA and non-VA sites.
Background. VHA issued a Hospital Quality Report Card in
both 2008 and 2009 in response to the House Appropriations
Committee Report (No. 110-186) accompanying the Consolidated
Appropriations Act of 2008 (Public Law 110-161). That report
card was a facility-level report comprised of quality and
safety data of VA medical facilities. It detailed the quality
of care provided in inpatient and outpatient settings and
within specific patient populations, in addition to patient
satisfaction and outcomes. Raw data from these reports were
published online on Data.gov to provide veterans and the
general public with access to performance data of VA medical
facilities.
Committee Bill. Section 303 of the Committee bill would
amend subchapter I of chapter 17 of title 38 by inserting a new
section 1706A entitled ``Management of health care: Medical
Center Quality Report Card Initiative'' which would consist of
seven subsections.
Subsection (a) of proposed new section 1706A would require
the Secretary to establish and implement the Medical Center
Quality Report Card initiative no later than 18 months after
the enactment of the Committee bill.
Subsection (b) of proposed new section 1706A consists of
the following seven paragraphs as follows:
Paragraph (1) of subsection (b) has three subparagraphs.
Subparagraph (A) would require quality and performance data of
VA facilities to be posted on the Hospital Compare Web site of
the Centers for Medicare and Medicaid Services, no less
frequently than twice a year. The parameters for quality would
include effectiveness, safety, timeliness, efficiency, patient-
centeredness, patient satisfaction, satisfaction of health
professionals employed at Department medical centers, and the
equity of care provided to various patient populations.
Subparagraphs (B) and (C) would require the Secretary to
include quality measures that are common to the health care
industry in addition to those listed above and to conduct focus
groups to identify other sets of data that would be of interest
to veterans.
Paragraph (2) of subsection (b) would provide the Secretary
with flexibility in making data available in order to ensure
the quality measures reflect quality and safety trends and the
priorities of veterans' health care. The Secretary would be
authorized to provide supplemental information to that which is
required, or information in lieu of the required information,
as long as the Secretary, 15 days before the date on which the
information is made public, explains and certifies to the
Committees on Veterans' Affairs of the Senate and the House of
Representatives that the additional or substituted information
is more appropriate.
Paragraph (3) of subsection (b) would authorize the
Secretary to make risk adjustments to such quality measures to
account for differences relating to facility and patient
characteristics, but would be required to make the unadjusted
data available as well.
Paragraph (4) of subsection (b) would authorize the
Secretary to verify the publication of the data to ensure
validity and accuracy.
Paragraph (5) of subsection (b) would require the Secretary
to disclose the methodology, nature, and scope for the
publication of the data to any relevant organizations and to
each Department facility that is the subject of such data,
prior to making the data available to the public.
Paragraph (6) of subsection (b) would require the Secretary
to submit a copy of each set of data made available to the
public to the Committees on Veterans' Affairs of the Senate and
the House of Representatives. Also, this data would be required
to be made available to the public in both electronic and non-
electronic formats and in language that can be understood by
non-health care professionals and individuals with low-
functional health literacy. The Secretary would be required to
provide the data in such a form that comparisons can easily be
made between facilities. The Secretary would also be required
to develop a way to disseminate the data in a non-electronic
format to the public upon request.
Paragraph (7) of subsection (b) would require the Secretary
to acknowledge in a notice or disclaimer the analytical
methodologies, limitations on, and appropriate uses of the
information sources used for the publication of the data.
Subsection (c) of proposed new section 1706A would require
the Secretary annually to compare quality measures submitted by
each Department facility with those submitted in prior years to
identify possible false or artificial improvements.
Subsection (d) of proposed new section 1706A would require
the Secretary to develop and implement safeguards against the
unauthorized use or dissemination of Department facility data
and to ensure individually identifiable patient data is not
released to the public.
Subsection (e) of proposed new section 1706A would require
the Secretary to periodically submit a report to Congress on
the effectiveness of the initiative and, if necessary, a
description of other measures that could be taken to ensure the
purposes of the initiative is met. Each report would be
required to be made available to the public.
Subsection (f) of proposed new section 1706A defines the
term ``Department medical center.''
Subsection (g) of proposed new section 1706A authorizes the
appropriation of sums as may be necessary to carry out this
initiative for each fiscal year over the period of 2010 through
2018.
The Committee intends for this initiative to build upon
VHA's current program and create a more comprehensive and
accessible comparison of quality and performance of VHA
facilities. The Medical Center Quality Report Card would allow
for a more thorough comparison between VA facilities and
between VA and non-VA facilities. The Committee places a high
priority on quality management in veterans' health care and
believes this initiative will better assist veterans and
consumers, health care providers, and policymakers.
Sec. 304. Report on pay-for-performance compensation under health care
services contracts.
Section 304 of the Committee bill, which is derived from
S. 1302, would require VA to submit to the Committees on
Veterans' Affairs of the Senate and the House of
Representatives a report on the advisability and feasibility of
pay-for-performance mechanisms in VA health care contracts at
Community Based Outpatient Clinics.
Background. VA Directive 1663, issued in August 2006,
allows VA medical centers to purchase non-VA care from
affiliated medical schools, groups, hospitals, and other
providers, through contracts or fee-for-service care. These
contracts are generally allowed when a VA facility cannot
provide a clinical service; VA cannot recruit a needed
clinician; it is not in VA's best interest to provide such
service; only a portion of a clinician's time is needed; it is
determined that it is necessary to compete with the private
sector for certain highly paid subspecialists; or it is cost-
effective to share a service or space with another entity
rather than to develop a capacity within VA.
Throughout VHA, many VA CBOCs deliver health care on a
contract-basis. CBOCs typically are associated with VA medical
centers and refer patients to those facilities when needed. In
FY 2009, VA operated 783 CBOCs, 206 of which were operated by
contract.
Mary A. Curtis, Psychiatric Clinical Nurse Specialist and
Clinical Application Coordinator at the Boise VA Medical
Center, testified on behalf of American Federation of
Government Employees at the September 20, 2009, Committee
hearing on health care contracts stating that VA contract care
is over-utilized and under-scrutinized by many VA medical
facilities in both rural and urban areas. She further commented
that contract care makes VA less able to control costs, quality
of care, provider qualifications, and medical privacy, or to
even ensure care is delivered in a timely manner. She said many
medical center directors seeking short term fixes for patient
overloads and staff shortages tend to use contracts without
considering better options for both veterans and the VA health
care system.
The IB for Fiscal Year 2011 supports VA health care
contracts when VA facilities are not capable of providing
necessary care to veterans. The IB stated, however, that VA
does not track such care, its related costs, outcomes, or
veteran satisfaction levels.
Committee Bill. Section 304 of the Committee bill would
require the Secretary to submit a report on pay-for-performance
compensation mechanisms, where providers are rewarded for
meeting pre-established targets for delivery of health care
services, in VA health care contracts at CBOCs. The Committee
believes that pay-for-performance mechanisms in a workplace
would allow for employees to attain increased levels of
compensation by reaching specific targets.
Subsection (a) would require the Secretary to submit a
report to the Committees on Veterans' Affairs of the Senate and
the House of Representatives which would be required to include
information on VA's use of pay-for-performance mechanisms in
contracts for health care services at CBOCs. This report would
be required to be submitted not later than 180 days after the
enactment of this section of the Committee bill.
Subsection (b) would outline the elements to be included in
the report. Such requirements would include an assessment of
the feasibility and advisability of using pay-for-performance
compensation mechanisms in VA health care contracts with CBOCs.
It would also require information on the number of CBOCs
operating under pay-for-performance compensation mechanisms at
the date of enactment of this legislation, and the impact this
mechanism has had in providing incentives to provide high
quality care and to better ensure patient satisfaction.
Subsection (c) would require the Secretary to incorporate
the views and experiences of representatives of at least two
private health care systems that have utilized pay-for-
performance compensation mechanisms in the operation of medical
clinics to determine if such mechanisms had an effect on the
delivery of quality, timely, medical care in the private
sector.
Sec. 305. Expansion of State home care for parents of veterans who died
while serving in the Armed Forces.
Section 305 of the Committee bill, which is derived from an
amendment offered by Senator Ensign on July 14, 2009, to the
National Defense Appropriations Act for FY 2010 [Senate
Amendment 1521], would direct VA to modify a current regulation
so as to enable State veterans' homes to admit the parent of a
child who died while serving in the Armed Forces.
Background. Under section 51.210 (d) of title 38, Code of
Federal Regulations (hereinafter CFR), State veterans' homes
(hereinafter, ``State homes'') must allot at least 75 percent
of their facility beds to veterans, except for those facilities
constructed solely with state funds which may allot only 50
percent of facility beds for veterans. This section also
requires that all non-veteran residents of State homes must be
spouses of veterans or parents, all of whose children died
while serving in the Armed Forces.
This requirement for parents to have lost all of their
children in order to be eligible for residency leaves out some
parents from being able to receive care in State homes. VA
already provides certain benefits to surviving dependent
parents of veterans who died during military service or as the
result of a service-connected disability. Currently, certain
surviving parents may qualify for Dependency and Indemnity
Compensation if they are in financial need. Additional amounts
are payable if the parent is a patient in a nursing home,
blind, or so significantly disabled or blind to require the
regular aid and attendance of another person. Parents may also
be beneficiaries of life insurance policies.
Committee Bill. Section 305 of the Committee bill would
direct VA, in administering section 51.210 (d) of title 38,
CFR, to permit a State home to admit parents, any--but not
necessarily all--of whose children died while serving in the
Armed Forces.
The Committee anticipates the costs of providing this care
would be negligible. According to a recent survey conducted by
the National Association of State Veterans Homes, as of
February 11, 2010, only nine surviving parents were residing in
State homes across the country. Also, VA pays no per diem for
surviving spouses or parents of veterans residing in state
homes. The State homes typically charge such individuals a
private pay rate. If a surviving spouse or parent receives
Dependency and Indemnity Compensation, the amount may be
increased due to the need for nursing home care.
Sec. 306. Automatic enrollment of eligible demobilizing members of the
National Guard and Reserve in health care and dental care
programs of the Department of Veterans Affairs.
Section 306 of the Committee bill, which is derived from
S. 1798, would direct VA and DOD jointly to provide automatic
enrollment of eligible demobilizing members of the National
Guard and Reserve in VA's health care and dental care programs.
Background. Currently, veterans must be enrolled in the VA
health care system to receive health care benefits in the form
of the comprehensive Medical Benefits Package. Eligibility for
enrollment is dependent upon if an individual has ``veteran
status'' which is defined as having been activated for federal
duty and subsequently discharged or released from active
service, under conditions other than dishonorable.
At present, many members of the National Guard and Reserve
fail to enroll in the VA health care and dental care programs
during the demobilization and discharge processes or during the
subsequent five year window of opportunity for enrollment in
such programs. DOD's Defense Manpower Data Center reported in
October 2009 that 1,094,502 OEF/OIF servicemembers have been
discharged and become eligible for VA health care. More than 46
percent have sought VA care since 2002 following a cumbersome
and time consuming enrollment process. The percentage of
veterans seeking VA care is expected to increase over the next
five years.
As discussed in the April 2010 Institute of Medicine
report, ``Returning Home from Iraq and Afghanistan: Preliminary
Assessment of Readjustment Needs of Veterans, Service Members,
and Their Families,'' many OEF/OIF veterans return home with
psychological wounds that may not manifest until months or
years after their redeployment. Further, the RAND Corporation's
2008 study, ``Invisible Wounds of War,'' stressed the
importance of providing treatment for veterans with mental
illnesses as early as possible, due to the increased severity
of such illnesses over time if not treated.
Committee Bill. Section 306 of the Committee bill, in a
freestanding provision consisting of nine subsections, would
direct VA, in consultation and coordination with DOD, to
provide for the automatic enrollment of eligible demobilizing
members of the National Guard and Reserve (hereinafter,
``covered members'') in health care and dental care programs of
the Department of Veterans Affairs.
Subsection (a) of section 306 of the Committee bill would
require the automatic enrollment of covered members in VA
health care or dental care programs, no later than 180 days
after the enactment of the legislation. Covered members would
include any member of a reserve component of the Armed Forces
who is discharged or released and would be eligible to
participate in a VA health care and dental care program. This
automatic enrollment would be required to occur during the
demobilization process used for National Guard and Reserve
members.
Subsection (b) of section 306 of the Committee bill would
require the provision of assistance in the completion of
enrollment activities of covered members. Relevant personnel of
the VHA and Veterans Benefits Administration would be required
to be assigned to participate in the provision of assistance.
This assistance would include information about VA programs,
benefits, and services for which the covered member might be
eligible and a list of VA medical facilities located within 100
miles of the residence of the covered member.
Subsection (c) of section 306 of the Committee bill would
require VA and DOD, in consultation and coordination with
appropriate officials of each state such as the Adjutant
General and State Director of Veterans Affairs, to ensure the
presence of sufficient personnel at each demobilization and
discharge event of a covered member for the performance of any
VA health care and dental care program enrollment activities
and for any assistance in the performance of such activities,
not later than 180 days after the enactment of the Committee
bill.
Subsection (d) of section 306 of the Committee bill would
require DOD to ensure that the facilities and other resources
used for the demobilization and discharge process for covered
members are adequate for enrollment activities and assistance
for such enrollment activities, no later than 180 days after
the enactment of the Committee bill.
Subsection (e) of section 306 of the Committee bill would
require that covered members who participate in such enrollment
activities be provided protections in regard to their privacy
and personal information.
Subsection (f) of section 306 of the Committee bill would
provide any covered member the option to not enroll during the
automatic enrollment program, as long as such covered member
provides notice of that decision during the demobilization and
discharge process.
Subsection (g) of section 306 of the Committee bill would
clarify that no covered members are required to participate in
any VA program, including the health care and dental care
programs.
Subsection (h) of section 306 of the Committee bill would
require VA/DOD reports on the implementation of this section to
be submitted to the Committees on Veterans' Affairs of the
Senate and the House of Representatives and the Committees on
Appropriations of the Senate and the House of Representatives.
The first report would be required to be submitted not later
than one year after the enactment of this section of the
Committee bill and annually thereafter for five years.
The elements of the report would include a description of
activities undertaken by VA and an assessment of how such
activities affected enrollment and participation of covered
members in VA health care and dental programs. It would also
include an assessment of the potential impact on the budget and
demand for services in VA and additional resources needed to
meet the demand. The report would also require recommendations
for legislative or administrative action to enhance or further
facilitate the requirements of this new section.
It is the Committee's expectation that this section will
address the concerns of many servicemembers who, upon
redeployment to the United States, desire to return to their
families as soon as possible, and who view the VA health care
registration process as an impediment to their return to
civilian life. The automatic enrollment of covered members is
not intended to affect covered members' out-processing time,
would not force any member to enroll in the VA health care
system, and would not change existing eligibility criteria. It
is intended to only ensure that all eligible Guard and Reserve
members are registered and enrolled in the VA health care
system to provide a more seamless transition from active duty
to civilian life. Automatic enrollment is especially important
as many OEF/OIF veterans return home with psychological wounds
that may not manifest until months or years after their
redeployment.
Sec. 307. Provision of chiropractic services to veterans enrolled in
health care system of Department of Veterans Affairs.
Section 307 of the Committee bill, which is derived from
S. 1204, would require VA to develop, implement, and fund a
comprehensive policy on the provision of chiropractic services.
Background. Under the Department of Veterans Affairs Health
Care Programs Enhancement Act of 2001 (Public Law 107-135), VA
carries out a program to provide chiropractic services to
veterans through VA medical centers and clinics. The Secretary
is required to designate at least one site in each Veterans
Integrated Service Network (hereinafter ``VISN'') to offer
chiropractic services. Currently, 36 VA facilities provide such
services.
Dr. Rick McMichael, President of the American Chiropractic
Association, testified before the Committee on October 21,
2009, in support of expanding VA chiropractic services. He
stated that a significant majority of the nation's eligible
veterans continue to be denied access to chiropractic care
because these services are still not provided at approximately
120 major VA facilities. Further, according to a VA report
released in October 2009, nearly 52 percent of OEF/OIF veterans
who have sought VA health care were treated for musculoskeletal
ailments. Doctors of chiropractic offer vital expertise in the
treatment of some of such ailments.
Committee Bill. Section 307 of the Committee bill would
require VA to develop and implement a comprehensive policy on
the provision of chiropractic services by October 1, 2010.
Subsection (a) of section 307 of the Committee bill would
require the scope of this policy to include: VA-wide protocols
for governing referrals and direct access to chiropractic
services, and governing the scope of practice of chiropractic
practitioners; the definition of chiropractic services to be
provided; the assurance of prompt and appropriate chiropractic
services by VA, when medically appropriate; VA programs of
education and training of health care personnel on the benefits
of chiropractic services; and VA programs of patient education
for veterans suffering from back pain and related disorders.
The Secretary would also be required, in consultation with
veterans' service organizations and other relevant
organizations, to revise such policy on a periodic basis, in
accordance with evolving best practice guidelines.
Subsection (b) would require the Secretary to carry out the
policy on chiropractic services at no less than two locations
in each VISN and in locations deemed appropriate with respect
to demand for chiropractic services.
Subsection (c) would require a report on the implementation
of the chiropractic services policy no later than 180 days
after the completion and initial implementation of such policy,
and on October 1 of every fiscal year thereafter until fiscal
year 2020, to the Committees on Veterans' Affairs of the Senate
and the House of Representatives. The report would be required
to include a description of the policy, the performance
measures used to determine the effectiveness of such policy, an
assessment of the adequacy of VA chiropractic services based on
patient surveys, an assessment of the training provided to VA
health care personnel in terms of chiropractic services and
appropriate referrals of patients for such services, an
assessment of the patient pair care education programs, and the
number of episodes of chiropractic services (including
referrals to non-VA providers) granted in the preceding fiscal
year, by facility.
Sec. 308. Name of Department of Veterans Affairs outpatient clinic,
Alexandria, Minnesota.
Section 308 of the Committee bill, which is derived from
S. 1483, would rename the Department of Veterans Affairs
outpatient clinic in Alexandria, Minnesota, as the ``Max J.
Beilke Department of Veterans Affairs Outpatient Clinic.''
Background. Max J. Beilke was a native of Alexandria,
Minnesota. He was drafted into the U.S. Army in 1952 following
high school. In the Army, Beilke served in Korea and Vietnam.
He retired from active duty as a master sergeant in 1974. After
his retirement, Beilke worked on veterans' issues as a DOD
civilian employee. On September 11, 2001, he was killed in the
attack on the Pentagon. Beilke was awarded the Defense of
Freedom Medal and the Meritorious Civilian Service Award.
Committee Bill. The Committee bill would rename the
Department of Veterans Affairs outpatient clinic in Alexandria,
Minnesota as the ``Max J. Beilke Department of Veterans Affairs
Outpatient Clinic.''
TITLE IV--FUNDING
Sec. 401. Funding
Section 401 of the Committee bill, adopted as an amendment
at the Committee's January 28, 2010, meeting would require
funding for the provisions of the Committee bill to be derived
from certain unobligated funds.
Background. In any fiscal year, VA's operating budget for
medical care comes from four principal sources: Congressional
appropriations; medical collections from VA beneficiaries and
insurance companies; reimbursements made to VA from certain
entities; and carryover of any combination of these sources of
funding from one year to the next. Historically, it is common
for there to be some amount of money assumed for obligation in
a year other than which the money was received, however, the
President's fiscal year 2010 budget submission assumed there
would be no carryover of unobligated funds for medical services
appropriated in fiscal year 2009. Despite that assumption, $619
million was in fact carried over; the President's fiscal year
2011 budget once again assumes no carryover of unobligated
funding from fiscal year 2010.
Although the Committee recognizes that variables such as
unanticipated demand for health services or deferred spending
on approved programs may compel VA to use carryover funds at a
later date, to the extent that such carryover is unanticipated
or represents a surplus of appropriation, it is important that
it be properly accounted for and directed to a purpose Congress
intends.
Committee Bill. The Committee bill would direct VA to pay
for the provisions of the bill with any unobligated carryover
funds appropriated for VA medical services in fiscal year 2009
or 2010 so long as it does not adversely affect health care
delivery to veterans.
Committee Bill Cost Estimate
In compliance with paragraph 11(a) of rule XXVI of the
Standing Rules of the Senate, the Committee based on
information supplied by the CBO, estimates that implementing
the bill would cost $3.4 billion over the 2010-2015 period,
assuming appropriation of the specified and estimated amounts.
CBO further estimates that enacting the bill would increase
direct spending by $7 million over the 2010-2020 period but
would not affect revenues. Enactment of the Committee bill
would not affect receipts and would not affect the budget of
state, local or tribal governments.
The cost estimate provided by CBO, setting forth a detailed
breakdown of costs, follows:
Congressional Budget Office,
Washington, DC, April 28, 2010.
Hon. Daniel K. Akaka,
Chairman,
Committee on Veterans' Affairs,
U.S. Senate, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for S. 1237, the Homeless
Veterans and Other Veterans Health Care Authorities Act of
2010.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Sunita
D'Monte.
Sincerely,
Douglas W. Elmendorf,
Director.
Enclosure.
S. 1237--Homeless Veterans and Other Veterans Health Care Authorities
Act of 2010
Summary: S. 1237 would expand programs for homeless
veterans, and make other changes to health care programs
offered by the Department of Veterans Affairs (VA). In total,
CBO estimates that implementing the bill would cost $3.4
billion over the 2010-2015 period, assuming appropriation of
the specified and estimated amounts. CBO further estimates that
enacting the bill would increase direct spending by $7 million
over the 2010-2020 period but would not affect revenues.\1\
---------------------------------------------------------------------------
\1\Different time periods are relevant for enforcing the current
pay-as-you-go rules in the Senate and the House of Representatives. CBO
estimates that enacting S. 1237 would increase direct spending by $7
million over both the 2010-2014 and 2010-2019 periods.
---------------------------------------------------------------------------
Pay-as-you-go procedures apply because enacting the
legislation would affect direct spending.
S. 1237 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA).
Estimated cost to the Federal Government: The estimated
budgetary impact of S. 1237 is shown in the following table.
The costs of this legislation fall within budget functions 600
(income security) and 700 (veterans benefits and services).
Table 1.
----------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
----------------------------------------------------------------
2010 2011 2012 2013 2014 2015 2010-2015
----------------------------------------------------------------------------------------------------------------
CHANGES IN SPENDING SUBJECT TO APPROPRIATION
Department of Housing and Urban Development-VA
Supportive Housing Program
Estimated Authorization Level.............. 0 392 524 643 656 673 2,888
Estimated Outlays.......................... 0 338 505 626 654 670 2,793
Homeless Providers Grant and Per Diem Program
Estimated Authorization Level.............. 50 53 57 61 66 0 287
Estimated Outlays.......................... 11 73 70 61 65 6 286
Homelessness Prevention
Authorization Level........................ 50 50 50 50 50 0 250
Estimated Outlays.......................... 10 72 63 50 50 5 250
Information Management System
Estimated Authorization Level.............. 10 10 10 11 11 0 52
Estimated Outlays.......................... 2 15 12 11 11 1 52
Workforce Reintegration Program
Authorization Level........................ 10 10 10 10 10 0 50
Estimated Outlays.......................... * 1 13 13 9 3 39
VA Personnel
Estimated Authorization Level.............. * 2 2 2 2 2 10
Estimated Outlays.......................... * 2 2 2 2 2 10
Chiropractic Care
Estimated Authorization Level.............. * 1 1 2 2 2 8
Estimated Outlays.......................... * 1 1 2 2 2 8
Special Assistant at the Department of Housing
and Urban Development
Estimated Authorization Level.............. * * * * * * 1
Estimated Outlays.......................... * * * * * * 1
----------------------------------------------------------------
Total Changes
Estimated Authorization Level.......... 120 518 654 779 797 677 3,547
Estimated Outlays...................... 23 502 666 765 793 689 3,439
CHANGES IN DIRECT SPENDINGa
Estimated Budget Authority................. 0 4 3 0 0 0 7
Estimated Outlays.......................... 0 4 3 0 0 0 7
----------------------------------------------------------------------------------------------------------------
Note: * = less than $500.000.
aCBO estimates that enacting the bill would increase direct spending by $7 million over the 2010-2015 and 2010-
2020 periods.
Basis of estimate: For this estimate, CBO assumes the
legislation will be enacted in fiscal year 2010, that the
authorized amounts will be provided in 2010 and near the start
of each subsequent fiscal year, and that outlays will follow
historical patterns for similar and existing programs.
Spending subject to appropriation
S. 1237 would expand programs for homeless veterans and
amend other VA health care programs. In total, CBO estimates
that implementing the bill would cost $3.4 billion over the
2010-2015 period, assuming appropriation of the specified and
estimated amounts.
Department of Housing and Urban Development-VA Supportive
Housing (HUD-VASH) Program. The HUD-VASH program is a
collaboration between HUD and VA to provide permanent housing
to homeless veterans and their families. Section 106 would
authorize 40,000 rental vouchers in 2011, 50,000 in 2012, and
60,000 in 2013 and each year thereafter. That authorization
would exceed the current authorization for such vouchers in
2011, the final year for which the program is now authorized.
Based on information from HUD, CBO estimates that the average
annual cost of those vouchers would be about $8,000 in 2011.
Assuming appropriation of the necessary amounts, and adjusting
for projected changes in rents and tenant incomes, CBO
estimates that implementing this provision would cost $2.1
billion over the 2011-2015 period.
Veterans enrolled in the HUD-VASH program receive case
management and supportive services through VA. Based on amounts
appropriated for those activities in recent years and assuming
appropriation of the necessary amounts, CBO estimates that VA
would spend $700 million over the 2011-2015 period.
All together, CBO estimates that implementing section 106
would cost $2.8 billion over the 2011-2015 period.
Homeless Providers Grants and Per Diem (GPD) Program.
Section 101 would increase the annual amounts authorized for
the GPD program from $150 million a year to $200 million for
2010 and such sums as may be necessary for the 2011-2014
period. That program provides capital grants for constructing,
renovating, or acquiring buildings and per diem payments to
fund operating costs. After adjusting for inflation, CBO
estimates that implementing that provision would cost $286
million over the 2010-2015 period, assuming appropriation of
the necessary amounts.
Homelessness Prevention. Section 104 would authorize the
appropriation of $50 million a year over the 2010-2014 period
for a new homelessness prevention program at VA. CBO estimates
that implementing that provision would cost $250 million over
the 2010-2015 period, assuming appropriation of the specified
amounts.
Information Management System. Section 105 would authorize
the appropriation of $10 million for 2010 and such sums as may
be necessary for the 2011-2014 period to establish a system for
collecting and aggregating data on homeless veterans. After
adjusting for inflation, CBO estimates that implementing that
provision would cost $52 million over the 2010-2015 period,
assuming appropriation of the necessary amounts.
Workforce Reintegration Program. Section 102 would
authorize the appropriation of $10 million a year over the
2010-2014 period to the Department of Labor for the Workforce
Reintegration Program. The funds would provide grants to
agencies and organizations that provide job placement,
training, vocational counseling, and childcare to homeless
veterans who are female or have children. CBO estimates that
implementing that provision would cost $39 million over the
2010-2015 period, assuming appropriation of the specified
amounts.
VA Personnel. Two sections of the bill would establish new
positions at VA. Section 301 would establish a new Assistant
Secretary and eight Deputy Assistant Secretaries. Section 302
would establish a Director of Physician Assistant Services in
the Veterans Health Administration. CBO estimates that
implementing those provisions would cost $10 million over the
2010-2015 period, assuming appropriation of the necessary
amounts.
Chiropractic Care. Section 307 would require VA to provide
comprehensive chiropractic services at two or more locations in
each of the 21 Veterans Integrated Services Networks (VISNs),
which are VA's regional networks of medical facilities, and in
other locations as the Secretary determines appropriate. Nine
VISNs currently meet those requirements and the remaining 12
VISNs each provide care at one location. Based on information
from VA and after adjusting for inflation, CBO estimates that
providing chiropractic care at one additional location in each
of those 12 VISNs would cost $8 million over the 2010-2015
period, assuming appropriation of the necessary amounts.
Special Assistant at HUD. Section 107 would establish a new
position of Special Assistant for Veterans Affairs at HUD and
require that employee to oversee HUD's programs of housing and
homeless assistance for veterans. CBO estimates that
implementing that provision would cost $1 million over the
2010-2015 period, assuming the availability of appropriated
funds.
Direct spending
Section 401 would require VA to use certain unobligated
balances from the Medical Services budget account to fund some
of the activities authorized under the bill. That provision
would extend the availability of expiring balances, resulting
in a reappropriation of those funds.
Based on historical data on such balances, CBO estimates
that VA would have $8 million available to spend in 2011 (from
funds appropriated in 2009 that would expire in 2010) and $5
million available in 2012 (from funds appropriated in 2010 that
would expire in 2011). CBO assumes that VA would retain about
half of those balances to record, adjust, or liquidate existing
obligations to the account and use the remainder on programs
authorized by S. 2971. Enacting this bill would increase direct
spending by about $7 million over the 2010-2020 period, CBO
estimates.
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. The net changes in outlays and
revenues that are subject to those pay-as-you-go procedures are
shown in the following table.
Table 2.--CBO Estimate of Pay-As-You-Go Effects for S.1237 as ordered reported by the Senate Committee on Veterans' Affairs on January 28, 2010
--------------------------------------------------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
--------------------------------------------------------------------------------------------------
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2010-2015 2010-2020
--------------------------------------------------------------------------------------------------------------------------------------------------------
NET INCREASE OR DECREASE (-) IN THE DEFICIT
Statutory Pay-As-You-Go Impact 0 4 3 0 0 0 0 0 0 0 0 7 7
--------------------------------------------------------------------------------------------------------------------------------------------------------
Intergovernmental and private-sector impact
S. 1237 contains no intergovernmental or private-sector
mandates as defined in UMRA. State, local, and tribal
governments that provide assistance to veterans would benefit
from grant and program activities authorized in the bill.
Previous CBO Estimate: On March 15, 2010, CBO transmitted a
cost estimate for H.R. 4810, the End Veterans Homelessness Act
of 2010, as ordered reported by the House Committee on
Veterans' Affairs on March 10, 2010. Section 2 of that bill is
similar to section 101 of S. 1237; however, CBO estimates that
S. 1237 would authorize the appropriation of slightly higher
amounts for the GPD program than were specified in H.R. 4810.
On March 26, 2009, CBO transmitted a cost estimate for H.R.
1171, the Homeless Veterans Reintegration Program
Reauthorization Act of 2009, as ordered reported by the House
Committee on Veterans' Affairs on March 25, 2009. Section 3 of
that bill is similar to section 102 of S. 1237; differences in
the estimated costs reflect a later assumed enactment date for
S. 1237.
Estimate prepared by: Federal Costs: Sunita D'Monte; Impact
on State, Local, and Tribal Governments: Lisa Ramirez-Branum;
Impact on the Private Sector: Elizabeth Bass.
Estimate approved by: Theresa Gullo, Deputy Assistant
Director for Budget Analysis.
Regulatory Impact Statement
In compliance with paragraph 11(b) of rule XXVI of the
Standing Rules of the Senate, the Committee on Veterans Affairs
has made an evaluation of the regulatory impact that would be
incurred in carrying out the Committee bill. The Committee
finds that the Committee bill would not entail any regulation
of individuals or businesses or result in any impact on the
personal privacy of any individuals and that the paperwork
resulting from enactment would be minimal.
Tabulation of Votes Cast in Committee
In compliance with paragraph 7 of rule XXVI of the Standing
Rules of the Senate, the following is a tabulation of votes
cast in person or by proxy by members of the Committee on
Veterans' Affairs at its January 28, 2010, meeting. On that
date, the Committee ordered S. 1237, as amended, reported
favorably to the Senate, with amendments, by voice vote with no
dissent. The following senators were present: Mrs. Murray, Mr.
Brown, Mr. Tester, Mr. Begich, Mr. Burris, Mr. Burr, Mr.
Isakson, and Chairman Akaka.
On that date, the Committee considered an amendment offered
by Senator Burr to prohibit certain increases to costs in
TRICARE. The Chairman made a motion to table because he
believed the bill is out of the Committee's jurisdiction. The
motion to table prevailed by a 9 to 5 vote.
----------------------------------------------------------------------------------------------------------------
Yeas Senator Nays
----------------------------------------------------------------------------------------------------------------
X (by proxy) Mr. Rockefeller
X Mrs. Murray
X (by proxy) Mr. Sanders
X Mr. Brown
Mr. Webb
X Mr. Tester
X Mr. Begich
X Mr. Burris
X (by proxy) Mr. Specter
Mr. Burr X
Mr. Isakson X
Mr. Wicker X (by proxy)
Mr. Johanns X (by proxy)
Mr. Graham X (by proxy)
X Mr. Chairman
----------------------------------------------------------------------------------------------------------------
9 TALLY 5
----------------------------------------------------------------------------------------------------------------
The Committee then considered an amendment offered by
Senator Tester regarding funding for rural veterans who are
homeless. The amendment was accepted by the Chairman.
The Committee then considered another amendment offered by
Senator Burr on Camp Lejeune Exposures. The amendment failed on
a roll call vote of 5 to 9.
----------------------------------------------------------------------------------------------------------------
Yeas Senator Nays
----------------------------------------------------------------------------------------------------------------
Mr. Rockefeller X (by proxy)
Mrs. Murray X (by proxy)
Mr. Sanders X (by proxy)
Mr. Brown X (by proxy)
Mr. Webb
Mr. Tester X
Mr. Begich X (by proxy)
Mr. Burris X
Mr. Specter X (by proxy)
X Mr. Burr
X Mr. Isakson
X (by proxy) Mr. Wicker
X (by proxy) Mr. Johanns
X (by proxy) Mr. Graham
Mr. Chairman X
----------------------------------------------------------------------------------------------------------------
5 TALLY 9
----------------------------------------------------------------------------------------------------------------
The Committee next considered an amendment offered by
Senator Sanders on automatic enrollment of National Guard and
Reserve in VA health care. This amendment was accepted by the
Chairman.
The Committee then considered an amendment offered by
Senator Burr on carryover funds for unobligated spending. The
amendment was accepted by the Chairman with a caveat that it
may need technical changes to give the Secretary of VA more
discretion.
Agency Report
On October 21, 2009, Gerald M. Cross, the Acting Under
Secretary for Health, Department of Veterans Affairs, appeared
before the Committee and submitted testimony on a number of
bills. In addition, on March 23, 2010, VA provided views on
S. 1547. Excerpts of both the testimony and Department views
are reprinted below:
STATEMENT OF GERALD M. CROSS, MD, FAAFP, ACTING UNDER SECRETARY FOR
HEALTH, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS
AFFAIRS
Good Morning Mr. Chairman and Members of the Committee:
Thank you for inviting me here today to present views on
several bills that would affect Department of Veterans Affairs
(VA) benefits and services. Joining me today are Mr. Brad
Mayes, Director of the Compensation and Pension Service, Mr.
Richard Hipolit, Assistant General Counsel, and Mr. Walter
Hall, Assistant General Counsel. We appreciate the opportunity
to address these bills that would affect the Department's
health care and benefits programs.
* * * * * * *
S. 1155--``ESTABLISHING POSITION OF DIRECTOR OF PHYSICIAN ASSISTANT
SERVICES''
S. 1155 would eliminate the Physician Assistant (PA)
Advisor position established by Public Law 106-419, the
Veterans Benefits and Health Care Improvement Act of 2000, and
establish a Director of Physician Assistant (PA) Services
within the Office of the Under Secretary for Health. VA does
not support this bill.
The functions of the proposed Director of PA Services are
already being performed by the PA Advisor. Moreover, the PA
Advisor position was converted to full-time on April 14, 2008,
and it will be based in VA Central Office at the expiration of
the current incumbent's term in April 2010.
In addition, VA does not support the proposed
organizational realignment of the Director of PA Services to
the Office of the Under Secretary for Health. The position's
current alignment within the Office of Patient Care Services is
consistent with most other clinical program leadership
positions and provides the PA Advisor access to the Under
Secretary for Health for any issues that cannot be resolved
within the current structure. The cost of implementing this
bill is insignificant.
* * * * * * *
S. 1204--``CHIROPRACTIC CARE AVAILABLE TO ALL VETERANS
ACT OF 2009''
S. 1204 would require VA to increase to not fewer than 75
the number of VA facilities directly providing chiropractic
care through VA medical centers and clinics by December 31,
2009. In addition, S. 1204 would require that chiropractic care
be provided at all VA medical centers by December 31, 2011.
VA opposes S. 1204. While musculoskeletal conditions are
common in VA patients, and are increasingly prevalent among
Operation Enduring Freedom and Operation Iraqi Freedom (OEF/
OIF) Veterans, there is currently a facility with an in-house
chiropractic care program in each of our geographic service
areas. Specifically, VA has 28.5 chiropractors providing on-
station care and services at 36 facilities. VA does not oppose
eventually increasing the number of VA sites providing
chiropractic care; however, the projected demand for
chiropractic care is insufficient to justify mandating it at
all VA medical centers by the end of 2011. Moreover, the
requirement to increase the number of facilities in which VA
provides chiropractic care from 36 facilities to 75 facilities
by the end of the calendar year is unrealistic and unnecessary.
Currently, 98 percent of VA patients are able to receive
chiropractic care within thirty days of their desired date.
VA estimates that S. 1204 would cost $5.3 million in fiscal
year (FY) 2010, $5.5 million in FY 2011, $29.8 million over 5
years, and $63.6 million over 10 years.
* * * * * * *
S. 1237--``HOMELESS WOMEN VETERANS AND HOMELESS VETERANS WITH CHILDREN
ACT OF 2009''
S. 1237 would expand those eligible to receive grants under
38 U.S.C. 2061 beyond grant and per diem providers to include
those entities eligible to receive grant and per diem payments.
It would also provide that both male and female homeless
Veterans who are responsible for the care of minor dependents
may qualify as Veterans with special needs. In addition,
S. 1237 would authorize the use of funds for the provision of
direct services to the dependents of homeless Veterans. Section
3 of S. 1237 would require the Secretary of Labor to award
grants to eligible programs and facilities to provide services
to reintegrate homeless women Veterans and homeless Veterans
with children into the workforce. Grant recipients would
provide job training, counseling, job placement services and
child care. The law would be implemented by the Assistant
Secretary for Veterans' Employment and Training, who would
report through the Secretary of Labor on this program
biennially. An additional $10 million, in excess of other
appropriated funds, would be made available for fiscal years
2010 and 2014.
* * * * * * *
S. 1302--``VETERANS HEALTH CARE IMPROVEMENT ACT OF 2009''
S. 1302 would require VA to submit to Congress within one
year a plan to introduce pay-for-performance measures into
community-based outpatient clinic (CBOC) contracts. This plan
would require VA to include measures to ensure contracts
utilize pay-for-performance mechanisms including incentives for
providing high-quality health care, patient satisfaction, and
data collection on the outcomes of services provided by CBOCs.
The plan would also require VA to impose penalties for
substandard care, and to eliminate abuses by CBOCs that use
capitated-basis compensation. Moreover, VA's plan would need to
include mechanisms to ensure Veterans are not denied care and
do not face undue delays. VA would be required to implement
this plan within 60 days of submitting it to Congress, though
in implementing the plan the Secretary may initially carry out
of one or more pilot programs to assess its feasibility and
advisability. VA would be required to report to Congress every
6 months providing recommendations on the feasibility and
advisability of utilizing pay-for-performance compensation in
providing health care services through means other than CBOCs.
VA does not support S. 1302. VA is devoting significant
effort into quality control and effective incentives in its
CBOC contracting now, and that is a complex multi-faceted
endeavor. There is a great deal of emerging research in the
medical field on pay-for-performance, and it is clear that
programs must be carefully thought out to avoid unintended
consequences. Prescribing a fixed set of tools would impair VA
flexibility. Additionally the legislation would not provide any
additional statutory authority to establish a CBOC performance-
based patient quality care incentive contract than what is
currently provided in the Federal Acquisition Regulations.
VA estimates there would be no additional costs associated
with this legislation as it only requires VA to develop a
different type of contract during the normal acquisition
process.
* * * * * * *
S. 1427--``DEPARTMENT OF VETERANS AFFAIRS HOSPITAL QUALITY REPORT CARD
ACT OF 2009''
S. 1427 would add section 1706A to title 38 and require VA,
within 18 months of enactment, to establish and implement a
Hospital Quality Report Card Initiative. This initiative would
require the Secretary to publish a report at least twice a year
on Department medical centers containing information on
effectiveness, safety, timeliness, efficiency, patient-
centeredness, patient satisfaction, health professional
satisfaction, and equity of care for various populations
(female, geriatric, disabled, rural, homeless, mentally ill,
racial and ethnic minorities). VA would be required to grade
facilities in these areas on a scale from A+ to F. VA would
also be required to provide information, to the maximum extent
practicable, on: staffing levels of nurses and other health
professionals; rates of nosocomial infections; volumes of
different procedures performed; hospital sanctions and
violations; quality of care to various populations;
availability of emergency rooms, intensive care units (ICUs),
maternity and specialty services; quality of care in inpatient,
outpatient, emergency, maternity and ICU; ongoing patient
safety initiatives; use of health information technology; and
other matters. S. 1427 would allow the Secretary to provide
information in addition to or in lieu of the specific
requirements identified in the bill by informing the Senate and
House Committees on Veterans' Affairs at least 15 days before
the report is to be published. S. 1427 would also allow
Secretary to adjust quality measures based upon risk, but it
would require VA to establish procedures for making unadjusted
data available to the public in a manner deemed appropriate by
VA and to disclose its analysis methodology. These reports
would need to be written for non-medical professionals and
available electronically and in hard copy upon request at each
medical center. The legislation is intended to ensure
information VA provides is of a type and in a form that is
conducive to comparisons with other local or regional
hospitals. At least once a year, VA would be required to
annually compare quality measures across years to identify and
report any false or artificial improvements in quality
measurements. In addition, VA would be required to develop and
implement effective safeguards to protect against unauthorized
use or disclosure of medical center data and to ensure that no
identifiable patient data is released to the public.
VA does not oppose increasing transparency of quality
measures for its facilities and agrees with the general premise
of this legislation; however, the agency does not support
S. 1427 as written because some of the requirements may not be
possible or would require VA to develop its own data categories
that could not be compared or benchmarked to other leading
health care organizations.
VA has identified health care transparency as one of its
major Strategic Transformation Initiatives this fiscal year and
is working with the Centers for Medicare & Medicaid Services
(CMS) to post VA comparable data on their ``Hospital Compare''
Web site (www.hospitalcompare.hhs.gov). CMS requires three data
streams, each of which has different reporting periods based on
assuring data validity. They post process data quarterly but
outcome and patient satisfaction data annually. VA consequently
believes that it is impractical to report data twice a year as
the data may be invalid. VA is similarly exploring other public
reporting programs, such as the Medicare Prescription Drug Plan
Finder, Medicare Options Compare, CMS' Nursing Home Compare,
Commonwealth Fund's WhyNotTheBest, and others.
Additionally, VA is developing composite metrics meaningful
to both consumers and stakeholders. While seemingly simple, an
incremental letter grade scale may not be the best way to
communicate the quality of a particular hospital to consumers.
For example, CMS uses a five star rating system for Nursing
Home Compare. VA will be conducting focus groups with Veterans
to determine how they would like to be provided quality
information about medical facilities. VA has proposed an
initiative to develop an internal VA Hospital Report Card
prototype for internal measurements and comparison at all
organizational levels. The data elements are similar but not
exactly the same as the elements identified in this
legislation. VA proposes to include: structure and volume;
workforce productivity; population and disease burden; care
delivery utilization; quality, efficiency and outcomes; and
trends and benchmarks. This approach offers VA the flexibility
to provide meaningful measures that may be benchmarked with
other hospitals and develop new measures through consensus-
based processes involving all stakeholders. Measures should
focus on areas with the greatest potential for making care
safe, effective, timely, efficient or equitable, and patient-
centered. Primarily, these data will be used to identify areas
where VA can improve the most.
VA estimates S. 1427 would cost $2 million in FY 2010, $2.1
million in FY 2011, $10.8 million over 5 years, and $24.0
million over 10 years.
* * * * * * *
S. 1483--``DESIGNATING THE ALEXANDRIA, MINNESOTA,
OUTPATIENT CLINIC''
S. 1483 would designate the Department of Veterans Affairs
Outpatient Clinic in Alexandria, Minnesota, as the ``Max J.
Beilke Department of Veterans Affairs Outpatient Clinic.'' Mr.
Beilke died in service to his country at the Pentagon on
September 11, 2001. The Department has no objection to this
proposal and defers to Congress in the naming of Federal
property.
* * * * * * *
S. 1531--``DEPARTMENT OF VETERANS AFFAIRS REORGANIZATION
ACT OF 2009''
S. 1531 would amend 38 U.S.C. 308 to increase the number of
Assistant Secretaries in the Department from seven to eight. It
would also increase the number of Deputy Assistant Secretaries
from 19 to 27. The bill would also require that one Assistant
Secretary be appointed Assistant Secretary for Acquisition,
Logistics, and Construction and would cap the number of Deputy
Assistant Secretaries the Secretary may appoint to manage
programs relating to construction, facilities, asset
management, and IT. In addition, S. 1531 would modernize some
of nomenclature relating to construction and acquisition
functions in 38 U.S.C. 308.
VA generally supports this legislation. Elevating the
construction and acquisition function to the Assistant
Secretary (AS) level will help ensure consistent and sound
business decisions are made in VA's acquisitions, logistics,
and construction programs. This position will also further
transform and modernize VA's business practices and processes.
Similarly, expanding the number of Deputy Assistant Secretaries
(DAS) is necessary given the size, scope, and complexity of
VA's missions and geographic distribution. However, VA opposes
language in S. 1531 which specifies the title and
responsibilities of the AS and which caps the number of DAS
assigned to certain functions as this limits the agency's
flexibility to address changing needs and demands.
* * * * * * *
S. 1547--``ZERO TOLERANCE FOR VETERANS HOMELESSNESS
ACT OF 2009''
S. 1547 proposes to alter and expand a number of
authorities available to VA with regard to preventing and
reducing Veteran homelessness. VA has initiated an ambitious
plan to end homelessness among Veterans and supports the
Committee's interest in providing additional services and
assistance to homeless Veterans. However, VA needs additional
time to evaluate S. 1547. We will provide views and costs on
these provisions as soon as they are available.
------
The Secretary of Veterans Affairs,
Washington, DC, March 23, 2010.
Hon. Daniel K. Akaka,
Chairman,
Committee on Veterans' Affairs,
U.S. Senate, Washington, DC.
Dear Mr. Chairman: This letter is in response to your
invitation to submit for the record the Department's views on
several bills, S. 1467, S. 1547, and S. 1753. These bills were
on the schedule of the October 21, 2009 legislative hearing,
but we were unable to provide views at that time. We thank you
for the opportunity to provide our comments and cost estimates
for the record.
* * * * * * *
S. 1547--``Zero Tolerance for Veterans Homelessness
Act of 2009''
S. 1547 proposes to alter and expand a number of VA
authorities designed to prevent and reduce Veteran
homelessness. One of VA's top priorities is eliminating Veteran
homelessness. As such, the FY 2010 President's Budget
significantly increased funding targeted to enhancing homeless
programs, and VA has also increased its collaboration with
federal and local partners to expand services.
Although VA supports the intent of this bill, we have three
significant concerns-- 1) assigning this program to VBA instead
of the Department in general, 2) creating an entitlement for
homeless services, and 3) the duplication of current programs.
As a result, VA can support certain provisions in S. 1547 as
discussed below.
Section 3 would require the Secretary of Veterans Affairs
to establish a program in the Veterans Benefit Administration
(VBA) to prevent homelessness by identifying Veterans who are
homeless or at imminent risk of becoming homeless and by
providing various types of assistance to those identified. Such
assistance may include the provision of short-term or medium-
term rental assistance, housing relocation and stabilization
services, services to resolve personal credit issues,
assistance with security or utility deposits, moving costs,
referral to other Government programs, and other assistance the
Secretary determines is appropriate. VA supports the intent of
this bill; however we note that many of these services are
currently provided by VA or our federal partners. In some
cases, we believe some services are more appropriately provided
through our partners that have specific expertise and operate
programs specific to these services. Also, the administration
of such a comprehensive program should be assigned to the
Department in general rather than solely to VBA. We look
forward to working with Committee staff to identify gaps in
services provided to homeless Veterans. VA estimates the cost
of enacting section 3 at $50 million in the first year, and
$250 million over 5 years.
Section 4 would allow the use of grants for new
construction of facilities under 38 U.S.C. 2011 and would
permit grant applicants to be considered if the entity proposes
to use funding from other private or non-profit sources,
contingent upon the applicant's demonstration of oversight by a
private non-profit organization. It would also require VA to
conduct a study within 1 year of enactment concerning grant and
per diem (GPD) payments under 38 U.S.C. 2012 and to develop
improved methods for disbursing funds and reimbursing grant
recipients. VA would, within 1 year of enactment, report on the
findings of the study and provide any recommendations based on
the study's findings. This section would also increase VA's
authorization for programs carried out under 38 U.S.C. 2013 to
$200 million for FY 2010 and ``such sums as may be necessary''
for each of fiscal years 2011 through 2014. In addition,
section 4 would remove the phrase ``[s]ubject to the
availability of appropriations'' from 38 U.S.C. 2011(a)(1). The
amendment would establish section 2011 as an entitlement
authority. Entitlement spending is mandatory under the Budget
Enforcement Act.
VA supports the increase in GPD authorization to include
$200 million in FY 2010 and such sums as may be necessary for
each of fiscal years 2011 through 2014. The Administration and
the Department have a goal of ultimately ending homelessness
among our nation's Veterans. To achieve this goal, VA will
strive to assist every eligible homeless Veteran willing to
accept its services. We will help them acquire safe housing and
obtain needed treatment, services, and benefits assistance,
while working with our partners at the Department of Labor to
also provide opportunities to return to employment. This
includes education, job training, substance abuse and mental
health care, as well as an assortment of other benefits. It
will require close partnership with Federal and State agencies,
local, non-profit and private groups; outreach and education to
Veterans, people and organizations providing services to
Veterans, and the general public; universal and targeted
prevention; treatment focused on recovery and tailored to
individual Veterans' needs; housing and supportive services;
and income, employment and benefits assistance. We will leave
no opportunity unexplored, and we will continue this pursuit
until every Veteran has safe housing available and access to
needed treatment services.
Though we are in favor of increasing the GPD authorization,
the Department opposes establishing 38 U.S.C. 2011 as an
entitlement authority. Accordingly, we recommend that the
Committee retain the phrase ``[s]ubject to the availability of
appropriations'' in 38 U.S.C. 2011(a)(1).
VA currently estimates the cost of the Homeless Grants and
Per Diem program, which is an integral part of VA's plan to end
homelessness, to be $171.6 million in FY 2010, $217.6 million
in FY 2011, $1.2 billion over 5 years, and $2.8 billion over 10
years.
Section 5 would expand the Housing and Urban Development-
Veterans Affairs Supported Housing (HUD-VASH) voucher program
by 10,000 vouchers each year through FY 2013 (beginning with
30,000 vouchers in 2010 and ending with 60,000 vouchers in
2013). It would also require the Secretary of Veterans Affairs
to ensure homeless-Veteran case managers provide appropriate
supportive services, including medical care to Veterans to help
achieve an end to chronic homelessness.
VA supports the intent of this section; however, our role
is to execute the vouchers funded through the Department of
Housing and Urban Development. Over the last year, VA, in
conjunction with HUD, have placed great focus on aggressively
expanding outreach, and the agencies capacity to assign and
execute increased numbers of housing vouchers to homeless
Veterans. Within requested resources, we will reach our goal of
reducing the number of homeless Veterans from 131,000 to 59,000
by 2012. VA estimates this section would cost $43.4 million in
FY 2010, $132.1 million in FY 2011, $1.54 billion over 5 years
and $7.74 billion over 10 years.
Section 6 would create a Special Assistant for Veterans
Affairs within the Office of the Secretary for Housing and
Urban Development. VA defers to HUD regarding section 6.
Section 7 would require development of a homeless Veteran
management information system available to HUD and VA with data
on Veterans within 1 year from the date of enactment. Ten
million dollars is authorized for this project.
The Department notes that HUD has already created and
implemented a Homeless Management Information System (HMIS) in
Continuums of Care throughout the country. VA has committed to
support the use of local Homeless Management Information
Systems to track its own performance; however, as part of VA's
plan to eliminate Veteran homelessness, we need a system with
national identified data, which HMIS does not contain, in order
to have a real time data management system to monitor its
progress in meeting the goals for a zero tolerance for
homelessness among Veterans. VA also has a need for a long term
data warehouse to further evaluate the effectiveness and
outcomes of its programs and services. The data warehouse/
registry will also assist VA in monitoring the progress and
service utilization of Veterans who have been homeless or are
at risk for homelessness. This data will also be used to
generate reports to Congress regarding the effectiveness of
VA's homeless Veteran programs.
VA estimates the cost of supplementing HMIS with
identifiable information to be $10 million for FY 2010. The
proposed budget would be used to develop the many different
intellectual documents such as requirements, project plan and
the software requirements specification. These are needed to
define and procure the different IT systems and services needed
to initiate and build the needed components for the VA/VHA
Homeless program. Funding for the out years for this effort are
estimated to be $5 million per year for ongoing design,
upgrades and operations costs from an overall perspective.
Section 8 would require VA to develop a plan within 1 year
of enactment on how to end Veteran homelessness, with special
consideration for homeless Veterans in rural areas.
As described above, VA has already initiated an ambitious
goal to expand outreach, collaboration, and programs in order
to ultimately end homelessness among our Nation's Veterans. In
addition, legislation enacted by Congress in May of this year,
the Homeless Emergency Assistance and Rapid Transition to
Housing Act of 2009 (``HEARTH ACT'') (Division B of PI 111-22),
requires that not later than 12 months after enactment, the
United States Interagency Council on Homelessness shall
``develop, make available for public comment, and submit to the
President and to Congress a National Strategic Plan to End
Homelessness, and shall update such plan annually'' (42 U.S.C.
11313). Work on developing this plan has begun and VA, as one
of the 19 member agencies of the Council, is at the table. As
such, we do not believe this section is necessary.
* * * * * * *
Thank you again, Mr. Chairman, for the opportunity to
provide VA's views on these bills.
The Office of Management and Budget advises that there is
no objection from the standpoint of the Department's program to
the submission of this letter on S. 1467, S. 1547, and S. 1753
to the Congress.
Sincerely,
Eric K. Shinseki.
* * * * * * *
Changes in Existing Law
In compliance with rule XXVI paragraph 12 of the Standing
Rules of the Senate, changes in existing law made by the
Committee 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. Veterans' Benefits
Part I. General Provisions
* * * * * * *
Chapter 3. Department of Veterans Affairs
SEC.
301. DEPARTMENT.
* * * * * * *
[312A. DIRECTOR OF CONSTRUCTION AND FACILITIES MANAGEMENT.]
313. AVAILABILITY OF APPROPRIATIONS.
* * * * * * *
SEC. 301. DEPARTMENT
* * * * * * *
SEC. 308. ASSISTANT SECRETARIES; DEPUTY ASSISTANT SECRETARIES
(a) There shall be in the Department not more than [seven]
eight Assistant Secretaries. Each Assistant Secretary shall be
appointed by the President, by and with the advice and consent
of the Senate.
(b) * * *
(1) * * *
* * * * * * *
(6) [Capital] Construction capital facilities and
real property program functions.
* * * * * * *
(10) [Procurement] Acquisition functions.
* * * * * * *
(d)(1) There shall be in the Department such number of
Deputy Assistant Secretaries, not exceeding [19] 27, as the
Secretary may determine. Each Deputy Assistant Secretary shall
be appointed by the Secretary and shall perform such functions
as the Secretary prescribes.
* * * * * * *
[SEC. 312A. DIRECTOR OF CONSTRUCTION AND FACILITIES MANAGEMENT
[(a) In General.--(1) There is in the Department a Director
of Construction and Facilities Management, who shall be
appointed by the Secretary.
[(2) The position of Director of Construction and
Facilities Management is a career reserved position, as
such term is defined in section 3132(a)(8) of title 5.
[(3) The Director shall provide direct support to the
Secretary in matters covered by the responsibilities of
the Director under subsection (c).
[(4) The Director shall report to the Deputy
Secretary in the discharge of the responsibilities of
the Director under subsection (c).
[(b) Qualifications.--Each individual appointed as Director
of Construction and Facilities Management shall be an
individual who--
[(1) holds an undergraduate or master's degree in
architectural design or engineering; and
[(2) has substantive professional experience in the
area of construction project management.
[(c) Responsibilities.--(1) The Director of Construction
and Facilities Management shall--
[(A) be responsible for overseeing and managing the
planning, design, construction, and operation of
facilities and infrastructure of the Department,
including major and minor construction projects; and
[(B) perform such other functions as the Secretary
shall prescribe.
[(2) In carrying out the oversight and management of
construction and operation of facilities and infrastructure
under this section, the Director shall be responsible for the
following:
[(A) Development and updating of short-range and
long-range strategic capital investment strategies and
plans of the Department.
[(B) Planning, design, and construction of facilities
for the Department, including determining architectural
and engineering requirements and ensuring compliance of
the Department with applicable laws relating to the
construction program of the Department.
[(C) Management of the short-term and long-term
leasing of real property by the Department.
[(D) Repair and maintenance of facilities of the
Department, including custodial services, building
management and administration, and maintenance of
roads, grounds, and infrastructure.
[(E) Management of procurement and acquisition
processes relating to the construction and operation of
facilities of the Department, including the award of
contracts related to design, construction, furnishing,
and supplies and equipment.]
* * * * * * *
Part II. General Benefits
* * * * * * *
Chapter 17. Hospital, Nursing Home, Domiciliary, and Medical Care
SUBCHAPTER I. GENERAL
SEC.
1701. DEFINITIONS.
* * * * * * *
1706. MANAGEMENT OF HEALTH CARE: OTHER REQUIREMENTS.
1706A. MANAGEMENT OF HEALTH CARE: MEDICAL CENTER QUALITY REPORT CARD
INITIATIVE.
1707. LIMITATIONS.
1708. TEMPORARY LODGING.
* * * * * * *
Subchapter I. General
* * * * * * *
SEC. 1706A. MANAGEMENT OF HEALTH CARE: MEDICAL CENTER QUALITY REPORT
CARD INITIATIVE
(a) In General.--Not later than 18 months after the date of
the enactment of the Homeless Veterans and Other Veterans
Health Care Authorities Act of 2010, the Secretary shall
establish and implement an initiative, to be known as the
``Medical Center Quality Report Card Initiative'' (in this
section referred to as the ``Initiative''), to publish
information on health care quality in Department medical
centers.
(b) Publication of Information on Quality and Performance
of Department Medical Centers.--(1)(A) Under the Initiative,
not less frequently than twice each year, the Secretary shall
make available to the public, on the Hospital Compare website
of the Centers for Medicaid and Medicare Services, data
consisting of the most current information on the quality and
performance of each Department medical center. Such information
shall include quality measures that allow for an assessment
with respect to health care provided by Department medical
centers, of the following:
(i) Effectiveness.
(ii) Safety.
(iii) Timeliness.
(iv) Efficiency.
(v) Patient-centeredness.
(vi) Patient satisfaction.
(vii) Satisfaction of health professionals employed
at Department medical centers.
(viii) The equity of care provided to various patient
populations, including female, geriatric, disabled,
rural, homeless, mentally ill, and racial and ethnic
minority populations.
(B) For each quality measure made available under
subparagraph (A), the Secretary shall include--
(i) quality measures that are common to the health
care industry and are based on information reported in
paragraph (2); and
(ii) such other information as the Secretary
considers appropriate.
(C) The Secretary shall conduct focus groups with veterans
to identify additional types of quality information and display
formats regarding such quality measures that would be
meaningful to the needs of veterans.
(2)(A) In making data available pursuant to paragraph (1),
the Secretary shall, except as provided in subparagraph (B),
include to the maximum extent practicable information about
Department medical centers using best available measures that
reflect emerging quality and safety trends and the priorities
of veteran-centered care.
(B) In making data available to the public under paragraph
(1), the Secretary may provide information in addition to the
information required by subparagraph (A) or provide information
in lieu of the information required by subparagraph (A) if the
Secretary--
(i) not later than 15 days before the date on which
such data is made available to the public, submits to
the Committee on Veterans' Affairs of the Senate and
the Committee on Veterans' Affairs of the House of
Representatives a certification in writing that such
additional or substituted information is more
appropriate for purposes of carrying out the
requirement of paragraph (2)(B); and
(ii) includes with such data and in such
certification an indication of which information has
been added or substituted under this subparagraph.
(3)(A) In making data available as provided for under
paragraph (1), the Secretary may make risk adjustments to
quality measures to account for differences relating to--
(i) the characteristics of a Department medical
center, such as licensed bed size, geography, and
teaching hospital status; and
(ii) patient characteristics, such as health status,
severity of illness, and socioeconomic status.
(B) If the Secretary makes data available under paragraph
(1) using risk-adjusted quality measures, the Secretary shall
establish procedures for making the unadjusted data available
to the public in a manner determined appropriate by the
Secretary.
(4) Under the Initiative, the Secretary may verify data
made available under this subsection to ensure accuracy and
validity.
(5) Before disclosing to the public any data under this
subsection, the Secretary shall disclose the methodology for
the publication of such data and the nature and scope of such
data to--
(A) each organization the Secretary considers
relevant to such data; and
(B) each Department medical center that is the
subject of such data.
(6)(A) The Secretary shall submit to the Committee on
Veterans' Affairs of the Senate and the Committee on Veterans'
Affairs of the House of Representatives a copy of each set of
data made available to the public under paragraph (1).
(B) The Secretary shall ensure that each set of data made
available to the public under paragraph (1) is made available--
(i) in an electronic format;
(ii) in a manner that can be understood by
individuals who are not medical professionals and
individuals with low functional health literacy; and
(iii) at each Department medical center covered by
the set of data.
(C) The Secretary shall ensure that information on health
care quality made available under paragraph (1) is made
available in a manner that is conducive for comparisons with
other local medical centers or regional medical centers, as
appropriate.
(D) The Secretary shall establish procedures for making the
information included in the data made available to the public
under paragraph (1) available to the public upon request in
non-electronic format, such as through a toll-free telephone
number.
(7) The analytic methodologies and limitations on
information sources utilized by the Secretary to develop and
disseminate comparative information under this subsection shall
be identified and acknowledged in a notice or disclaimer as
part of the dissemination of such information, and include the
appropriate and inappropriate uses of such information.
(c) Identifying and Reporting Actions That Could Lead to
False or Artificial Improvements in Quality Measurements.--Not
less frequently than annually, the Secretary shall compare
quality measures data submitted by each Department medical
center to the Secretary with quality measures data submitted to
the Secretary in the prior year or years by each such
Department medical center in order to identify and report
actions that could lead to false or artificial improvements in
the quality measurements of such Department medical centers for
purposes of this section.
(d) Privacy and Security.--(1) The Secretary shall develop
and implement effective safeguards to protect against the
unauthorized use or disclosure of Department medical center
data that is made available under this section.
(2) The Secretary shall develop and implement effective
safeguards to protect against the dissemination under this
section of inconsistent, incomplete, invalid, inaccurate, or
subjective Department medical center data.
(3) The Secretary shall ensure that identifiable patient
data is not released to the public under this section.
(e) Reports.--(1) The Secretary shall periodically submit
to Congress a report on the effectiveness of the Initiative.
(2) Each report required by paragraph (1) shall include the
following:
(A) An assessment of the effectiveness of the
Initiative in meeting the purpose described in section
302(a) of the Homeless Veterans and Other Veterans
Health Care Authorities Act of 2010.
(B) If necessary, a description of the measures the
Secretary can undertake to ensure that the Initiative
meets such purpose.
(3) The Secretary shall carry out each measure the
Secretary includes in a report under paragraph (2)(B).
(4) The Secretary shall make each report submitted under
paragraph (1) available to the public.
(f) Department Medical Center Defined.--In this section,
the term ``Department medical center'' means a Department of
Veterans Affairs Medical Center administered by the Secretary.
(g) Authorization of Appropriations.--There are authorized
to be appropriated to carry out this section such sums as may
be necessary for each of fiscal years 2010 through 2018.
* * * * * * *
Subchapter II. Hospital, Nursing Home, or Domiciliary Care and Medical
Treatment
SEC. 1710. ELIGIBILITY FOR HOSPITAL, NURSING HOME, AND DOMICILIARY CARE
(a)(1) * * *
* * * * * * *
(2) * * *
(A) * * *
* * * * * * *
(F) who was exposed to a toxic substance, radiation,
or other [conditions] occupational or environmental
hazards, as provided in subsection (e); or
* * * * * * *
(e)(1)(A) * * *
* * * * * * *
(3) * * *
(A) * * *
(B) in the case of care for a veteran described in
paragraph (1)(C), after December 31, 2002, except that
such care and services may also be provided to such a
veteran during the period beginning on the date of the
enactment of the Homeless Veterans and Other Veterans
Health Care Authorities Act of 2010 and ending on
December 31, 2012; and
* * * * * * *
Chapter 20. Benefits for Homeless Veterans
SUBCHAPTER I. PURPOSE; DEFINITIONS; ADMINISTRATIVE MATTERS
* * * * * * *
SUBCHAPTER III. TRAINING AND OUTREACH
SEC.
2021. HOMELESS VETERANS REINTEGRATION PROGRAMS.
2021A. GRANT PROGRAM FOR REINTEGRATION OF HOMELESS WOMEN VETERANS AND
HOMELESS VETERANS WITH CHILDREN.
2022. COORDINATION OF OUTREACH SERVICES FOR VETERANS AT RISK OF
HOMELESSNESS.
* * * * * * *
SUBCHAPTER VII. OTHER PROVISIONS
SEC.
2061. GRANT PROGRAM FOR HOMELESS VETERANS WITH SPECIAL NEEDS.
2062. DENTAL CARE.
2063. EMPLOYMENT ASSISTANCE.
2064. TECHNICAL ASSISTANCE GRANTS FOR NONPROFIT COMMUNITY-BASED GROUPS.
2065. ANNUAL REPORT ON ASSISTANCE TO HOMELESS VETERANS.
2066. ADVISORY COMMITTEE ON HOMELESS VETERANS.
2067. PREVENTION OF VETERAN HOMELESSNESS.
2068. HOMELESS VETERANS MANAGEMENT INFORMATION SYSTEM.
Subchapter I. Purpose; Definitions; Administrative Matters
* * * * * * *
SEC. 2003. STAFFING REQUIREMENTS
(a) * * *
(1) * * *
(2) * * *
(3) [The housing] Any housing program for veterans
supported by the department of housing and urban
development.
* * * * * * *
(7) The program under section 2067 of this title.
(8) [(7)] Such other programs relating to homeless
veterans as may be specified by the Secretary.
Subchapter II. Comprehensive Service Programs
SEC. 2011. GRANTS
* * * * * * *
(b) * * *
(1) * * *
(A) [expansion, remodeling, or alteration of
existing buildings, or acquisition of
facilities,] new construction of facilities,
expansion, remodeling, or alteration of
existing facilities, or acquisition of
facilities for use as service centers,
transitional housing, or other facilities to
serve homeless veterans; and
* * * * * * *
(c) Funding Limitations.--[A grant] (1) A grant under this
section may not be used to support operational costs. [The
amount]
(2) The amount of a grant under this section may not exceed
65 percent of the estimated cost of the project concerned.
(3)(A) The Secretary may not deny an application from an
entity that seeks a grant under this section to carry out a
project described in subsection (b)(1)(A) solely on the basis
that the entity proposes to use funding from other private or
public sources, if the entity demonstrates that a private
nonprofit organization will provide oversight and site control
for the project.
(B) In this paragraph, the term ``private nonprofit
organization'' means the following:
(i) An incorporated private institution,
organization, or foundation--
(I) that has received, or has temporary
clearance to receive, tax-exempt status under
paragraph (2), (3), or (19) of section 501(c)
of the Internal Revenue Code of 1986;
(II) for which no part of the net earnings of
the institution, organization, or foundation
inures to the benefit of any member, founder,
or contributor of the institution,
organization, or foundation; and
(III) that the Secretary determines is
financially responsible.
(ii) A for-profit limited partnership or limited
liability company, the sole general partner or manager
of which is an organization that is described by
subclauses (I) through (III) of clause (i).
(iii) A corporation wholly owned and controlled by an
organization that is described by subclauses (I)
through (III) of clause (i).
* * * * * * *
(i) Minimum Funding in Rural Areas.--The Secretary shall
ensure that not less than five percent of the aggregate of the
grant amounts awarded under this section in each fiscal year is
awarded to eligible entities located in rural areas.
* * * * * * *
SEC. 2013. AUTHORIZATION OF APPROPRIATIONS
There is authorized to be appropriated to carry out this
[subchapter $150,000,000 for fiscal year 2007 and each fiscal
year thereafter.] subchapter--
(1) $150,000,000 for each of fiscal years 2007
through 2009;
(2) $200,000,000 for fiscal year 2010; and
(3) such sums as may be necessary for each of fiscal
years 2011 through 2014.
Subchapter III. Training and Outreach
SEC. 2021. HOMELESS VETERANS REINTEGRATION PROGRAMS
* * * * * * *
SEC. 2021A. GRANT PROGRAM FOR REINTEGRATION OF HOMELESS WOMEN VETERANS
AND HOMELESS VETERANS WITH CHILDREN
(a) Grants.--Subject to the availability of appropriations
for such purpose, the Secretary of Labor shall award grants to
eligible programs and facilities to provide the services
described in subsection (c) to expedite the reintegration into
the labor force of the following:
(1) Homeless women veterans.
(2) Homeless veterans with children.
(b) Eligible Programs and Facilities.--A program or
facility is an eligible program or facility for purposes of
this section if the program or facility provides dedicated
services for homeless women veterans or homeless veterans with
children.
(c) Services.--The services described in this subsection
are the following:
(1) Job training.
(2) Counseling.
(3) Job placement services, including job readiness,
literacy, and skills training.
(4) Child care.
(d) Minimum.--The Secretary shall ensure that not less than
five percent of the aggregate of the grant amounts awarded
under this section in each fiscal year is awarded to eligible
programs and facilities located in rural areas.
(e) Monitoring of Use of Funds.--The Secretary of Labor
shall monitor and evaluate the use of amounts granted under
this section. In monitoring and evaluating the use of such
amounts, the Secretary shall collect from grantees such
information as the Secretary considers appropriate, including
data on the results or outcomes of the services provided to
each homeless veteran under this section.
(f) Administration.--The Secretary of Labor shall carry out
this section through the Assistant Secretary of Labor for
Veterans' Employment and Training.
(g) Biennial Report to Congress.--The Secretary of Labor
shall include as part of the report required by section 2021(d)
of this title an evaluation of the grant program under this
section. The information included in such report under this
subsection shall include--
(1) an evaluation of services furnished to veterans
under this section; and
(2) an analysis of the information collected under
subsection (d).
(h) Authorization of Appropriations.--(1) There is
authorized to be appropriated to carry out this section
$10,000,000 for each of fiscal years 2010 through 2014.
(2) The amount authorized to be appropriated by paragraph
(1) is in addition to any amounts authorized to be appropriated
by section 2021(e) of this title.
(3) Funds appropriated to carry out this section shall
remain available until expended. Funds obligated in any fiscal
year to carry out this section may be expended in that fiscal
year and the succeeding fiscal year.
* * * * * * *
Subchapter VII. Other Provisions
SEC. 2061. GRANT PROGRAM FOR HOMELESS VETERANS WITH SPECIAL NEEDS
(a) Establishment.--The Secretary shall carry out a program
to make grants to health care facilities of the Department and
[to grant and per diem providers] to entities eligible for
grants and per diem payments under sections 2011 and 2012 of
this title in order to encourage development [by those
facilities and providers] by those facilities and entities of
programs for homeless veterans with special needs.
(b) Homeless Veterans With Special Needs.--For purposes of
this section, homeless veterans with special needs include
homeless veterans who are--
(1) women[, including women who have care of minor
dependents];
(2) frail elderly;
(3) terminally ill; [or]
(4) chronically mentally ill[.] ; or
(5) individuals who have care of minor dependents.
(c) Provision of Services to Dependents.--A recipient of a
grant under subsection (a) may use amounts under the grant to
provide services directly to a dependent of a homeless veteran
with special needs who is under the care of such homeless
veteran while such homeless veteran receives services from the
grant recipient under this section.
(d) [(c)] Funding.--(1) * * *
* * * * * * *
SEC. 2067. PREVENTION OF VETERAN HOMELESSNESS
(a) Prevention of Veteran Homelessness.--Not later than 180
days after the date of the enactment of this section, the
Secretary shall establish a program to prevent veteran
homelessness by--
(1) identifying in a timely fashion any veteran who
is homeless or at imminent risk of becoming homeless;
and
(2) providing, directly or in conjunction with an
existing program, assistance to veterans identified
under paragraph (1).
(b) Types of Assistance.--The assistance provided under
subsection (a)(2) may include the following:
(1) The provision of short-term or medium-term rental
assistance.
(2) Housing relocation and stabilization services,
including housing search, mediation, and outreach to
property owners.
(3) Services to resolve personal credit issues that
have led to negative credit reports.
(4) Assistance with paying security or utility
deposits and utility payments.
(5) Assistance with covering costs associated with
moving.
(6) A referral to a program of another department or
agency of the Federal Government.
(7) Such other activities as the Secretary considers
appropriate to prevent veterans homelessness.
(c) No Duplication of Services.--The Secretary may provide
assistance under subsection (a)(2) to a veteran receiving
supportive services from an eligible entity receiving financial
assistance under section 2044 of this title only to the extent
that the assistance provided under subsection (a)(2) does not
duplicate the supportive services provided to such veteran by
such entity or by any other Federal, State, or local entity.
(d) Protection From Abuse.--To protect the program
established under subsection (a) from abuse, the Secretary may
establish a limit on the number of times that a particular
veteran may receive assistance under the program in a fiscal
year.
(e) Staffing.--The Secretary shall assign such employees at
such locations as the Secretary considers necessary to carry
out this section.
(f) Authorization of Appropriations.--There are authorized
to be appropriated to carry out this section $50,000,000 for
each of fiscal years 2010 through 2014.
SEC. 2068. HOMELESS VETERANS MANAGEMENT INFORMATION SYSTEM
(a) Method for Data Collection and Aggregation.--(1) Not
later than one year after the date of the enactment of this
section, the Secretary shall, in consultation with the Special
Assistant for Veterans Affairs of the Department of Housing and
Urban Development and the United States Interagency Council on
Homelessness established under section 201 of the McKinney-
Vento Homeless Assistance Act (42 U.S.C. 11311), establish a
method for the collection and aggregation of data on homeless
veterans participating in programs of the Department of
Veterans Affairs and the Department of Housing and Urban
Development, including the following with respect to such
veterans:
(A) Age, race, sex, disability status, marital
status, income, employment history, and whether the
veteran is a parent.
(B) If the veteran received assistance for housing,
the number of days that the veteran resided in such
housing and the type of such housing.
(C) If the veteran is no longer participating in a
program of assistance for the homeless, the reason the
veteran left the program.
(2) The method required by paragraph (1) shall ensure that
each veteran is counted only once.
(b) Annual Data Collection and Aggregation.--Not later than
one year after the method is established under subsection (a),
and annually thereafter, the Secretary shall collect and
aggregate data using the method established under subsection
(a).
(c) Annual Reports.--Not later than two years after the
date of enactment of this section and annually thereafter, the
Secretary shall submit to Congress a report on the data
collected and aggregated under subsection (b).
(d) Authorization of Appropriations.--There are authorized
to be appropriated to carry out this section--
(1) $10,000,000 for fiscal year 2010; and
(2) such sums as may be necessary for fiscal years
2011 through 2014.
* * * * * * *
Part V. Boards, Administrations, and Services
* * * * * * *
Chapter 73. Veterans Health Administration. Organization and Functions
Subchapter I. Organization
* * * * * * *
SEC. 7306. OFFICE OF THE UNDER SECRETARY FOR HEALTH
(a) * * *
(1) * * *
* * * * * * *
[(9) The Advisor on Physician Assistants, who shall
be a physician assistant with appropriate experience
and who shall advise the Under Secretary for Health on
all matters relating to the utilization and employment
of physician assistants in the Administration.]
(9) The Director of Physician Assistant Services, who
shall--
(A) serve in a full-time capacity at the
Central Office of the Department;
(B) be a qualified physician assistant; and
(C) be responsible and report directly to the
Chief Patient Care Services Officer of the
Veterans Health Administration on all matters
relating to the education and training,
employment, appropriate utilization, and
optimal participation of physician assistants
within the programs and initiatives of the
Administration.
* * * * * * *
Title 5. Government Organization and Employees
* * * * * * *
Part III. Employees
* * * * * * *
Subpart D. Pay and Allowances
* * * * * * *
Chapter 53. Pay Rates and Systems
* * * * * * *
Subchapter II. Executive Schedule Pay Rates
* * * * * * *
SEC. 5315. POSITIONS AT LEVEL IV
Level IV of the Executive Schedule applies to the following
positions, for which the annual rate of basic pay shall be the
rate determined with respect to such level under chapter 11 of
title 2,as adjusted by section 5318 of this title:
* * * * * * *
[Assistant Secretaries, Department of Veterans
Affairs (7).]
Assistant Secretaries, Department of Veterans Affairs
(8)
* * * * * * *
UNITED STATES HOUSING ACT OF 1937
Title 42. The Public Health and Welfare
* * * * * * *
CHAPTER 8. LOW-INCOME HOUSING
* * * * * * *
SUBCHAPTER I. GENERAL PROGRAM OF ASSISTED HOUSING
* * * * * * *
SEC. 1437F. LOW-INCOME HOUSING ASSISTANCE
(a) * * *
* * * * * * *
(o) Voucher program.
(1) * * *
* * * * * * *
(19) Rental vouchers for veterans affairs supported
housing program.--
(A) Rental vouchers.--The Secretary shall
make available to public housing agencies
described in subparagraph (C) the amounts
described in subparagraph (B), to provide
rental assistance through a supported housing
program administered in conjunction with the
Department of Veterans Affairs.
(B) Amount.--The amounts specified in this
subparagraph are the amounts necessary to
ensure that--
(i) not more than 30,000 vouchers for
rental assistance under this paragraph
are outstanding at any one time during
fiscal year 2010;
(ii) not more than 40,000 vouchers
for rental assistance under this
paragraph are outstanding at any one
time during fiscal year 2011;
(iii) not more than 50,000 vouchers
for rental assistance under this
paragraph are outstanding at any one
time during fiscal year 2012; and
(iv) not more than 60,000 vouchers
for rental assistance under this
paragraph are outstanding at any one
time during fiscal year 2013 and each
fiscal year thereafter.
(C) Public housing agencies.--A public
housing agency described in this subparagraph
is a public housing agency that--
(i) has a partnership with a
Department of Veterans Affairs medical
center or an entity determined to be
appropriate by the Secretary of
Veterans Affairs;
(ii) is located in an area that the
Secretary of Veterans Affairs
determines has a high concentration of
veterans in need of assistance;
(iii) has demonstrated expertise in
providing housing for homeless
individuals; and
(iv) meets any other criteria that
the Secretary, in consultation with the
Secretary of Veterans Affairs may
prescribe.
(D) Case management.--The Secretary of
Veterans Affairs shall ensure that the case
managers described in section 2003(b) of title
38, United States Code, provide appropriate
case management for each veteran who receives
rental assistance under this paragraph that--
(i) assists the veteran in--
(I) locating available
housing;
(II) working with the
appropriate public housing
agency;
(III) accessing benefits and
health services provided by the
Department of Veterans Affairs
and other departments and
agencies of the Federal
Government;
(IV) negotiating with
landlords; and
(V) other areas, as the
Secretary determines is
necessary to help the veteran
maintain housing or avoid
homelessness; and
(ii) ensures that a veteran with a
severe disability, including a veteran
that has been homeless for a
substantial period of time, is referred
to sufficient supportive services to
provide the veteran with stable
housing, including--
(I) mental health services,
including treatment and
recovery support services;
(II) substance abuse
treatment and recovery support
services, including counseling,
treatment planning, recovery
coaching, and relapse
prevention;
(III) integrated, coordinated
treatment and recovery support
services for co-occurring
disorders;
(IV) health education,
including referrals for medical
and dental care;
(V) services designed to help
individuals make progress
toward self-sufficiency and
recovery, including job
training, assistance in seeking
employment, benefits advocacy,
money management, life-skills
training, self-help programs,
and engagement and motivational
interventions;
(VI) parental skills and
family support; and
(VII) other supportive
services that promote an end to
chronic homelessness.
[(19) Rental vouchers for Veterans Affairs supported
housing program.--
[(A) Set aside.--Subject to subparagraph (C),
the Secretary shall set aside, from amounts
made available for rental assistance under this
subsection, the amounts specified in
subparagraph (B) for use only for providing
such assistance through a supported housing
program administered in conjunction with the
Department of Veterans Affairs. Such program
shall provide rental assistance on behalf of
homeless veterans who have chronic mental
illnesses or chronic substance use disorders,
shall require agreement of the veteran to
continued treatment for such mental illness or
substance use disorder as a condition of
receipt of such rental assistance, and shall
ensure such treatment and appropriate case
management for each veteran receiving such
rental assistance.
[(B) Amount.--The amount specified in this
subparagraph is--
[(i) for fiscal year 2007, the amount
necessary to provide 500 vouchers for
rental assistance under this
subsection;
[(ii) for fiscal year 2008, the
amount necessary to provide 1,000
vouchers for rental assistance under
this subsection;
[(iii) for fiscal year 2009, the
amount necessary to provide 1,500
vouchers for rental assistance under
this subsection;
[(iv) for fiscal year 2010, the
amount necessary to provide 2,000
vouchers for rental assistance under
this subsection; and
[(v) for fiscal year 2011, the amount
necessary to provide 2,500 vouchers for
rental assistance under this
subsection.
[(C) Funding through incremental
assistance.--In any fiscal year, to the extent
that this paragraph requires the Secretary to
set aside rental assistance amounts for use
under this paragraph in an amount that exceeds
the amount set aside in the preceding fiscal
year, such requirement shall be effective only
to such extent or in such amounts as are or
have been provided in appropriation Acts for
such fiscal year for incremental rental
assistance under this subsection.]
* * * * * * *
Chapter 44. Department of Housing and Urban Development
* * * * * * *
SEC. 3533. OFFICERS OF DEPARTMENT
(a) * * *
* * * * * * *
(g) Special Assistant for Veterans Affairs.--
(1) Establishment.--There shall be in the Department
a Special Assistant for Veterans Affairs, who shall be
in the Office of the Secretary.
(2) Appointment.--The Special Assistant for Veterans
Affairs shall be appointed by the Secretary, based
solely on merit and shall be covered under the
provisions of title 5, United States Code, governing
appointments in the competitive service.
(3) Responsibilities.--The Special Assistant for
Veterans Affairs shall be responsible for--
(A) ensuring that veterans have access to
housing and homeless assistance under each
program of the Department providing such
assistance;
(B) coordinating all programs and activities
of the Department relating to veterans; and
(C) carrying out such other duties as may be
assigned to the Special Assistant by the
Secretary or by law.