Caregiver Assistance and Resource Enhancement Act

Mr. Speaker, I move to suspend the rules and pass the bill (S. 1963) to amend title 38, United States Code, to provide assistance to caregivers of veterans, to improve the provision of health care to veterans, and for other purposes, as amended.

I ask unanimous consent that all Members may have 5 legislative days in which to revise and extend their remarks and include extraneous materials on S. 1963, as amended.

I yield myself 4 minutes.

Mr. Speaker, when I became chairman of the Committee on Veterans' Affairs 3 years ago, the VA was strained to the breaking point by years of chronic underfunding. We were a country at war; yet, the Department of Veterans Affairs remained unprepared to care for the hundreds of thousands of new veterans returning from Iraq and Afghanistan.

It is simply our duty as a Nation, no matter where we stand on the war, to put our men and women in harm's way under the care of our Nation when they return. Under the Democratic leadership, Congress has provided almost a 60 percent increase for VA medical care funding over the last 3 years, adding over $20 billion to the VA budget baseline.

S. 1963 demonstrates America's commitment to the dedicated servicemembers who have served in uniform and puts front and center the health care needs of veterans and their families. It is our pledge to them that we have not forgotten the sacrifices they have made in defense of this country. So in this bill, we help caregivers of injured veterans, women veterans, rural veterans, homeless veterans, and veterans with mental health issues.

S. 1963 provides immediate support to the mothers, fathers, husbands, and wives caring for warriors from the current conflicts as well as from previous conflicts. Today we have the opportunity to recognize their tremendous sacrifice and share their heavy burden.

The bill also expands and improves VA services for the 1.8 million women veterans currently receiving VA health care and goes a step further by anticipating the expected increase of women warriors over the next 5 years. This bill seeks to build a VA health care system respectful of the unique medical needs of women veterans.

S. 1963 also advances America's commitment to end veterans' homelessness. Hundreds of thousands of veterans are at risk of homelessness because of poverty and the lack of support from family and friends. An increasing number of veterans of operations in Afghanistan and Iraq are falling into this category, and we must be vigilant in providing support to this population.

We expand the number of places where homeless vets may receive supportive services; and for our veterans struggling without a roof over their heads, this small change in the law will make a big difference in their lives.

The bill also includes key provisions to improve health care provided to our rural veterans by authorizing stronger partnerships with community providers and the Department of Health and Human Services. These collaborations will allow VA to offer health care options to servicemembers living far from the nearest medical facility.

In addition, we address the troubling reality of posttraumatic stress disorder and troubling incidents of suicide amongst the veterans' population. The bill requires a much-needed and long-awaited study on veteran suicide and requires the VA to provide counseling referrals for former members of the Armed Forces who are not otherwise eligible for readjustment counseling.

S. 1963 provides higher priority status for Medal of Honor recipients, establishes a director of physician assistant services, and creates a committee on care of veterans with traumatic brain injury. It requires the VA to provide health care for herbicide-exposed Vietnam veterans and veterans of the Persian Gulf War who have insufficient medical evidence to establish a service-connected disability, and it prohibits the VA from collecting copayments from veterans who are catastrophically disabled.

This bill, Mr. Speaker, demands our immediate attention. We owe our veterans a great debt of gratitude, and this bill represents an understanding that the sacrifices of our veterans are shared amongst all Americans.

I urge all of my colleagues to support passage of S. 1963, as amended, and reserve the balance of my time.

Explanatory Statement Submitted by Mr. Filner, Chairman of the House Committee on Veterans' Affairs, Regarding the Amendment of the House of

Representatives to S. 1963

Caregivers and Veterans Omnibus Health Services Act of 2010

S. 1963, as amended, the ``Caregivers and Veterans Omnibus

Health Services Act of 2010,'' reflects the Compromise

Agreement between the Committees on Veterans' Affairs of the

Senate and the House of Representatives (the Committees) on

health care and related provisions for veterans and their

caregivers. The provisions in the Compromise Agreement are

derived from a number of bills that were introduced and

considered by the House and Senate during the 111th Congress.

These bills include S. 1963, a bill to provide assistance to

caregivers of veterans, to improve the provision of health

care to veterans, and for other purposes, which passed the

Senate on November 19, 2009 (Senate bill); and H.R. 3155, a

bill to provide certain caregivers of veterans with training,

support, and medical care, and for other purposes, which

passed the House on July 27, 2009 (House bill).

In addition, the Compromise Agreement includes provisions

derived from the following bills which were passed by the

House: H.R. 402, a bill to designate the Department of

Veterans Affairs Outpatient Clinic in Knoxville, Tennessee,

as the ``William C. Tallent Department of Veterans Affairs

Outpatient Clinic,'' passed by the House on July 14, 2009;

H.R. 1211, a bill to expand and improve health care services

available to women veterans, especially those serving in

Operation Enduring Freedom and Operation Iraqi Freedom, from

the Department of Veterans Affairs, and for other purposes,

passed by the House on June 23, 2009; H.R. 1293, a bill to

provide for an increase in the amount payable by the

Secretary of Veterans Affairs to veterans for improvements

and structural alterations furnished as part of home health

services, passed by the House on July 28, 2009; H.R. 2770, a

bill to modify and update provisions of law relating to

nonprofit research and education corporations, and for other

purposes, passed by the House on July 27, 2009; H.R. 3157, a

bill to name the Department of Veterans Affairs outpatient

clinic in Alexandria, Minnesota, as the ``Max J. Beilke

Department of Veterans Affairs Outpatient Clinic,'' passed by

the House on November 3, 2009; H.R. 3219, a bill to make

certain improvements in the laws administered by the

Secretary of Veterans Affairs relating to insurance and

health care, and for other purposes, passed by the House on

July 27, 2009; and H.R. 3949, a bill to make certain

improvements in the laws relating to benefits administered by

the Secretary of Veterans Affairs, and for other purposes,

passed by the House on November 3, 2009.

The Compromise Agreement also includes provisions derived

from the following House bills, which were introduced and

referred to the Subcommittee on Health of the House Committee

on Veterans' Affairs: H.R. 919, to enhance the capacity of

the Department of Veterans Affairs to recruit and retain

nurses and other critical health care professionals, and for

other purposes, which was introduced on February 9, 2009;

H.R. 3796, to improve per

diem grant payments for organizations assisting homeless

veterans, which was introduced on October 13, 2009; and H.R.

4166, to make certain improvements in the laws administered

by the Secretary of Veterans Affairs relating to educational

assistance for health professionals, and for other purposes,

which was introduced on December 1, 2009, and was

concurrently referred to the Committee on Energy and

Commerce.

The House and Senate Committees on Veterans' Affairs have

prepared the following explanation of the Compromise

Agreement. Differences between the provisions contained in

the Compromise Agreement and the related provisions in the

bills listed above are noted in this document, except for

clerical corrections and conforming changes, and minor

drafting, technical, and clarifying changes.

Title I--Caregiver Support

Assistance and Support Services for Family Caregivers

(section 101)

The Senate bill contains a provision (section 102) that

would create a new program to help caregivers of eligible

veterans who, together with the veteran, submit a joint

application requesting services under the new program.

Eligible veterans are defined as those who have a serious

injury, including traumatic brain injury, psychological

trauma, or other mental disorder, incurred or aggravated

while on active duty on or after September 11, 2001. Within

two years of program implementation, the Department of

Veterans Affairs (VA) would be required to submit a report on

the feasibility and advisability of extending the program to

veterans of earlier periods of service. Severely injured

veterans are defined as those who need personal care services

because they are unable to perform one or more independent

activities of daily living, require supervision as a result

of neurological or other impairments, or need personal care

services because of other matters specified by the VA. For

accepted caregiver applicants, VA would be required to

provide respite care as well as pay for travel, lodging and

per-diem expenses while the caregiver of an eligible veteran

is undergoing necessary training and education to provide

personal care services. Once a caregiver completes training

and is designated as the primary personal care attendant,

this individual would receive ongoing assistance including

direct technical support, counseling and mental health

services, respite care of no less than 30 days annually,

health care through the Civilian Health and Medical Program

of the Department of Veterans Affairs (CHAMPVA), and a

monthly financial stipend. The provision in the Senate bill

would require VA to carry out oversight of the caregiver by

utilizing the services of home health agencies. A home health

agency would be required to visit the home of a veteran not

less often than once every six months and report its findings

to VA. Based on the findings, VA would have the final

authority to revoke a caregiver's designation as a primary

personal care attendant. The provision also would require an

implementation and evaluation report, and provide for an

effective date 270 days after the date of the enactment of

this Act.

The House bill contains comparable provisions (section 2

and section 4) with some key differences. The provisions in

the House bill would provide educational sessions, access to

a list of comprehensive caregiver support services available

at the county level, information and outreach, respite care,

and counseling and mental health services to family and non-

family caregivers of veterans of any era. For family

caregivers of eligible veterans who served in Operation

Enduring Freedom (OEF) or Operation Iraqi Freedom (OIF),

the House bill would require VA to provide a monthly

financial stipend, health care service through CHAMPVA,

and lodging and subsistence to the caregiver when the

caregiver accompanies the veteran on medical care visits.

Eligible OEF or OIF veterans are defined as those who have

a service-connected disability or illness that is severe;

in need of caregiver services without which the veteran

would be hospitalized, or placed in nursing home care or

other residential institutional care; and are unable to

carry out activities (including instrumental activities)

of daily living.

The Compromise Agreement contains the Senate provision

modified to no longer require VA to enter into relationships

with home health agencies to make home visits every six

months. In addition, the Compromise Agreement follows the

House bill in creating a separate program of general family

caregiver support services for family and non-family

caregivers of veterans of any era. Such support services

would include training and education, counseling and mental

health services, respite care, and information on the support

services available to caregivers through other public,

private, and nonprofit agencies. In the event that sufficient

funding is not available to provide training and education

services, the Secretary would be given the authority to

suspend the provision of such services. The Secretary would

be required to certify to the Committees that there is

insufficient funding 180 days before suspending the provision

of these services. This certification and the resulting

suspension of services would expire at the end of the fiscal

year concerned.

The overall caregiver support program for caregivers of

eligible OEF or OIF veterans would authorize VA to provide

training and supportive services to family members and

certain others who wish to care for a disabled veteran in the

home and to allow veterans to receive the most appropriate

level of care. The newly authorized supportive services would

include training and certification, a living stipend, and

health care--including mental health counseling,

transportation benefits, and respite.

The Compromise Agreement also includes an authorization for

appropriations that is below the estimate furnished by the

Congressional Budget Office. The lower authorization level is

based on information contained in a publication (Economic

Impact on Caregivers of the Seriously Wounded, Ill, and

Injured, April 2009) of the Center for Naval Analyses (CNA).

This study estimated that, annually, 720 post-September 11,

2001 veterans require comprehensive caregiver services. The

Compromise Agreement limits the caregiver program only to

``seriously injured or very seriously injured'' veterans who

were injured or aggravated an injury in the line of duty on

or after September 11, 2001. CNA found that the average

requirement for such caregiver services is 18 months, and

that only 43 percent of veterans require caregiver services

over the long-term. CNA also found that, on average, veterans

need only 21 hours of caregiver services per week. Only 233

family caregivers were referred by VA for training and

certification through existing home health agencies in FY

2008. This represented five percent of all home care

referrals. In FY 2009, only 168 family caregivers were

referred to home care agencies for training and

certification.

Medical Care for Family Caregivers (section 102)

The Senate bill contains a provision (section 102) that

would provide health care through the CHAMPVA program for

individuals designated as the primary care attendant for

eligible OEF or OIF veterans and who have no other insurance

coverage.

The House bill contains a comparable provision (section 5),

with a difference in the target population. Under the House

bill, the target population would include all family

caregivers of eligible OEF or OIF veterans, defined as those

who have a service-connected disability or illness that is

severe; are in need of caregiver services without which

hospitalization, nursing home care, or other residential

institutional care would be required; and, are unable to

carry out activities (including instrumental activities) of

daily living.

The Compromise Agreement contains the Senate provision.

Counseling and Mental Health Services for Family Caregivers

(section 103)

The Senate bill contains a provision (section 102) that

would provide counseling and mental health services for

family caregivers of OEF or OIF veterans.

The House bill contains a comparable provision (section 3),

except that counseling and mental health services would be

available to caregivers of veterans of any era.

The Compromise Agreement contains the House provision.

Lodging and Subsistence for Attendants (section 104)

The Senate bill contains a provision (section 103) that

would allow VA to pay for the lodging and subsistence costs

incurred by any attendant who accompanies an eligible OEF or

OIF veteran seeking VA health care.

The House bill contains a comparable provision (section 6),

with a difference in the target population. Under the House

bill, the target population would include all family

caregivers of eligible OEF or OIF veterans, defined as those

who have a service-connected disability or illness that is

severe; are in need of caregiver services without which

hospitalization, nursing home care, or other residential

institutional care would be required; and, are unable to

carry out activities (including instrumental activities) of

daily living.

The Compromise Agreement contains the Senate provision.

Title II--Women Veterans Health Care Matters

Study of Barriers for Women Veterans to Health Care from the

Department of Veterans Affairs (section 201)

The Senate bill contains a provision (section 201) that

would require VA to report, by June 1, 2010, on barriers

facing women veterans who seek health care at VA, especially

women veterans of OEF or OIF.

H.R. 1211 contains a comparable provision (section 101)

that would require a similar study of health care barriers

for women veterans. The House provision also would define the

parameters of the research study sample; direct VA to build

on the work of an existing study entitled ``National Survey

of Women Veterans in Fiscal Year 2007-2008;'' mandate VA to

share the barriers study data with the Center for Women

Veterans and the Advisory Committee on Women Veterans; and

authorize appropriations of $4 million to conduct the study.

VA would be required to submit to Congress a report on the

implementation of this section within six months of the

publication of the ``National Survey of Women Veterans in

Fiscal Year 2007-2008'', and the final report within 30

months of publication.

The Compromise Agreement contains the House provision.

Training and Certification for Mental Health Care Providers

of the Department of Veterans Affairs on Care for

Veterans Suffering from Sexual Trauma and Post-Traumatic

Stress Disorder (section 202)

The Senate bill contains a provision (section 204) that

would require VA to implement a program for education,

training, certification, and continuing medical education

for mental health professionals, which would include

principles of evidence-based treatment and care for sexual

trauma. VA would also be required to submit an annual report

on the counseling, care, and services provided to veterans

suffering from sexual trauma, and to establish education,

training, certification, and staffing standards for personnel

providing treatment for veterans with sexual trauma.

H.R. 1211 contains a similar provision (section 202),

except it included no provision requiring VA to establish

education, training, certification, and staffing standards

for the mental health professionals caring for veterans with

sexual trauma.

The Compromise Agreement contains the House provision.

Pilot Program on Counseling in Retreat Settings for Women

Veterans Newly Separated from Service in the Armed Forces

(section 203)

The Senate bill contains a provision (section 205) that

would require VA to establish, at a minimum of five

locations, a two-year pilot program in which women veterans

newly separated from the Armed Forces would receive

reintegration and readjustment services in a group retreat

setting. The provision also would require a report detailing

the pilot program findings and providing recommendations on

whether VA should continue or expand the pilot program.

There was no comparable House provision.

The Compromise Agreement contains the Senate provision but

specifies that the program be carried out at a minimum of

three, not five, locations.

Service on Certain Advisory Committees of Women Recently

Separated from Service in the Armed Forces (section 204)

The Senate bill contains a provision (section 207) that

would amend the membership of the Advisory Committee on Women

Veterans and the Advisory Committee on Minority Veterans to

require that such committees include women recently separated

from the Armed Forces and women who are minority group

members and are recently separated from the Armed Forces,

respectively.

H.R. 1211 contains a similar provision (section 204) except

that it would allow either men or women who are members of a

minority group to serve on the Advisory Committee on Minority

Veterans.

The Compromise Agreement contains the Senate provision.

Pilot Program on Subsidies for Child Care for Certain

Veterans Receiving Health Care (section 205)

The Senate bill contains a provision (section 208) that

would require VA to establish a pilot program through which

child care subsidies would be provided to women veterans

receiving regular and intensive mental health care and

intensive health care services. The pilot program would be

carried out in no fewer than three Veterans Integrated

Service Networks (VISNs) for a duration of two years and, at

its conclusion, there would be a requirement for a report to

be submitted within six months detailing findings related to

the program and recommendations on its continuation or

extension. The provision also would direct VA, to the extent

practicable, to model the pilot program after an existing VA

Child Care Subsidy Program.

H.R. 1211 contains a comparable provision (section 203),

but it does not stipulate that the child care program shall

be executed through stipends. Rather, stipends are one option

among several listed, including partnership with private

agencies, collaboration with facilities or program of other

Federal departments or agencies, and the arrangement of

after-school care.

The Compromise Agreement contains the Senate provision,

with a modification to clarify that the child care subsidy

payments shall cover the full cost of child care services. In

addition, the provision expands the definition of veterans

who qualify for the child care subsidy to women veterans who

are in need of regular or intensive mental health care

services but who do not seek such care due to lack of child

care services. Finally, the Compromise Agreement follows the

House provision by allowing for other forms of child care

assistance. In addition to stipends, child care services may

be provided through the direct provision of child care at an

on-site VA facility, payments to private child care

agencies, collaboration with facilities or programs of

other Federal departments or agencies, and other forms as

deemed appropriate by the Secretary.

Care for Newborn Children of Women Veterans Receiving

Maternity Care (section 206)

The Senate bill contains a provision (section 209) that

would authorize VA to provide post-delivery health care

services to a newborn child of a woman veteran receiving

maternity care from VA if the child was delivered in a VA

facility or a non-VA facility pursuant to a VA contract for

delivery. Such care would be authorized for up to seven days.

H.R. 1211 contains a comparable provision (section 201),

but would allow VA to provide care for a set seven-day period

for newborn children of women veterans receiving maternity

care.

The Compromise Agreement contains the Senate provision.

Title III--Rural Health Improvements

Improvements to the Education Debt Reduction Program (section

301)

The Senate bill contains a provision (section 301) that

would eliminate the cap in current law on the total amount of

education debt reduction payments that can be made over five

years so as to permit payments equal to the total amount of

principal and interest owed on eligible loans.

H.R. 4166 contains a provision (section 3), that would

expand the purpose of the Education Debt Reduction Program

(EDRP), set forth in subchapter VII of chapter 76 of title

38, United States Code, to include retention in addition to

recruitment, as well as to modify and expand the eligibility

requirements for participation in the program. In addition,

the provision would increase the total education debt

reduction payments made by VA from $44,000 to $60,000 and

raise the cap on payments to be made during the fourth and

fifth years of the program from $10,000 to $12,000. The

provision would also provide VA with the flexibility to waive

the limitations of the EDRP and pay the full principal and

interest owed by participants who fill hard-to-recruit

positions at VA.

The Compromise Agreement contains the House provision.

Visual Impairment and Orientation and Mobility Professionals

Education Assistance Program (section 302)

The Senate bill contains a provision (section 302) that

would require VA to establish a scholarship program for

students accepted or enrolled in a program of study leading

to certification or a degree in the areas of visual

impairment or orientation and mobility. The student would be

required to agree to maintain an acceptable level of academic

standing as well as join VA as a full-time employee for three

years following their completion of the program. VA would be

required to disseminate information on the scholarship

program throughout educational institutions, with a special

emphasis on those with a high number of Hispanic students and

Historically Black Colleges and Universities.

H.R. 3949 contains the same provision (section 302).

The Compromise Agreement contains this provision.

Demonstration Projects on Alternatives for Expanding Care for

Veterans in Rural Areas (section 303)

The Senate bill contains a provision (section 305) that

would authorize VA to carry out demonstration projects to

expand care to veterans in rural areas through the

Department's Office of Rural Health. Projects could include

VA establishing a partnership with the Centers for Medicare

and Medicaid Services to coordinate care for veterans in

rural areas at critical access hospitals, developing a

partnership with the Department of Health and Human Services

to coordinate care for veterans in rural areas at community

health centers, and the expanding coordination with the

Indian Health Service to enhance care for Native American

veterans.

There was no comparable House provision.

The Compromise Agreement contains the Senate provision.

Program on Readjustment and Mental Health Care Services for

Veterans who Served in Operation Enduring Freedom and

Operation Iraqi Freedom (section 304)

The Senate bill contains a provision (section 306) that

would require VA to establish a program providing OEF and OIF

veterans with mental health services, readjustment counseling

and services, and peer outreach and support. The program

would also provide the immediate families of these veterans

with education, support, counseling, and mental health

services. In areas not adequately served by VA facilities, VA

would be authorized to contract with community mental health

centers and other qualified entities for the provision of

such services, as well as provide training to clinicians and

contract with a national non-profit mental health

organization to train veterans participating in the peer

outreach and support program. The provision would require an

initial implementation report within 45 days after enactment

of the legislation. Additionally, the Secretary would be

required to submit a status report within one year of

enactment of the legislation detailing the number of veterans

participating in the program as well as an evaluation of the

services being provided under the program.

There was no comparable House provision.

The Compromise Agreement contains the Senate provision, but

does not include the reporting requirement and authorizes

rather than requires VA to contract with community mental

health centers and other qualified entities in areas not

adequately served by VA facilities.

Travel Reimbursement for Veterans Receiving Treatment at

Facilities of the Department of Veterans Affairs (section

305)

The Senate bill contains a provision (section 308) that

would authorize VA to increase the mileage reimbursement rate

under section 111 of title 38, United States Code, to 41.5

cents per mile, and, a year after the enactment of this

legislation, allow the Secretary to adjust the newly

specified mileage rate to be equal to the rate paid to

Government employees who use privately owned vehicles on

official business. If such an adjustment would result in a

lower mileage rate, the Secretary would be required to submit

to Congress a justification for the lowered rate. The

provision also would allow the Secretary to reimburse

veterans for the reasonable cost of airfare when that is the

only practical way to reach a VA facility.

There was no comparable House provision.

The Compromise Agreement contains the Senate provision.

Pilot Program on Incentives for Physicians Who Assume

Inpatient Responsibilities at Community Hospitals in

Health Professional Shortage Areas (section 306)

The Senate bill contains a provision (section 313) that

would require VA to establish a pilot program under which VA

physicians caring for veterans admitted to community

hospitals would receive financial incentives, of an amount

deemed appropriate by the Secretary, if they maintain

inpatient privileges at community hospitals in health

professional shortage areas. Participation in the pilot

program would be voluntary. VA would be required to carry out

the pilot program for three years, in not less than five

community hospitals in each of not fewer than two VISNs. In

addition, VA would be authorized to collect third party

payments for care provided by VA physicians to nonveterans

while carrying out their responsibilities at the community

hospital where they are privileged.

There was no comparable House provision.

The Compromise Agreement contains the Senate provision.

Grants for Veterans Service Organizations for Transportation

of Highly Rural Veterans (section 307)

The Senate bill contains a provision (section 315) that

would require VA to establish a grant program to provide

innovative transportation options to veterans in highly rural

areas. Eligible grant recipients would include state veterans

service agencies and veterans service organizations, and

grant awards would not exceed $50,000.

There was no comparable House provision.

The Compromise Agreement contains the Senate provision.

Modifications of Eligibility for Participation in Pilot

Program of Enhanced Contract Care Authority for Health

Care Needs of Certain Veterans (section 308)

The Senate bill contains a provision (section 316) that

would clarify the definition of eligible veterans who are

covered under a pilot program of enhanced contract care

authority for rural veterans, created by section 403(b) of

the Veterans' Mental Health and Other Care Improvements Act

of 2008 (P.L. 110-387, 122 Stat. 4110). Eligible veterans

would be defined to include those living more than 60 minutes

driving distance from the nearest VA facility providing

primary care services, living more than 120 minutes driving

distance from the nearest VA facility providing acute

hospital care, and living more than 240 minutes driving

distance from the nearest VA facility providing tertiary

care.

H.R. 3219 contains the same provision (section 206).

The Compromise Agreement contains this provision.

Title IV--Mental Health Care Matters

Eligibility of Members of the Armed Forces Who Served in

Operation Enduring Freedom or Operation Iraqi Freedom for

Counseling and Services Through Readjustment Counseling

Services (section 401)

The Senate bill contains a provision (section 401) that

would allow any member of the Armed Forces, including members

of the National Guard or Reserve, who served in OEF or OIF to

be eligible for readjustment counseling services at VA

Readjustment Counseling Centers, also known as Vet Centers.

The provision of such services would be limited by the

availability of appropriations so that this new provision

would not adversely affect services provided to the veterans

that Vet Centers are currently serving.

There was no comparable House provision.

The Compromise Agreement contains the Senate provision.

Restoration of Authority of Readjustment Counseling Service

to Provide Referral and Other Assistance upon Request to

Former Members of the Armed Forces Not Authorized

Counseling (section 402)

The Senate bill contains a provision (section 402) that

would require VA to help former members of the Armed Forces

who have been discharged or released from active duty, but

who are not otherwise eligible for readjustment

counseling. VA would be authorized to help these

individuals by providing them with referrals to obtain

counseling and services from sources outside of VA, or by

advising such individuals of their right to apply for a

review of their release or discharge through the

appropriate military branch of service.

There was no comparable House provision.

The Compromise Agreement contains the Senate provision.

Study on Suicides among Veterans (section 403)

The Senate bill contains a provision (section 403) that

would require VA to conduct a study to determine the number

of veterans who committed suicide between January 1, 1999 and

the enactment of the legislation. To conduct this study, VA

would be required to coordinate with the Secretary of

Defense, veterans' service organizations, the Centers for

Disease Control and Prevention, and state public health

offices and veterans agencies.

There was no comparable House provision.

The Compromise Agreement contains the Senate provision.

Title V--Other Health Care Matters

Repeal of Certain Annual Reporting Requirements (section 501)

The Senate bill contains a provision (section 501) that

would eliminate the reporting requirements, set forth in

sections 7451 and 8107 of title 38, United States Code, on

pay adjustments for registered nurses. These reporting

requirements date to a time when VA facility directors had

the discretion to offer annual General Schedule (GS)

comparability increases to nurses. Current law requires VA to

provide GS comparability increases to nurses so that that pay

adjustment report is no longer necessary. The provision would

also eliminate the reporting requirement on VA's long-range

health care planning which included the operations and

construction plans for medical facilities. The information

contained in this report is already submitted in other

reports and plans, in particular the Department's annual

budget request.

There was no comparable House provision.

The Compromise Agreement contains the Senate provision.

Submittal Date of Annual Report on Gulf War Research (section

502)

The Senate bill contains a provision (section 502) that

would amend the due date of the Annual Gulf War Research

Report from March 1 to July 1 of each of the five years with

the first report due in 2010.

There was no comparable House provision.

The Compromise Agreement contains the Senate provision.

Payment for Care Furnished to CHAMPVA Beneficiaries (section

503)

The Senate bill contains a provision (section 503) that

would clarify that payments made by VA to providers who

provide medical care to a beneficiary covered under CHAMPVA

shall constitute payment in full, thereby removing any

liability on the part of the beneficiary.

There was no comparable House provision.

The Compromise Agreement contains the Senate provision.

Disclosure of Patient Treatment Information from Medical

Records of Patients Lacking Decision-making Capacity

(section 504)

The Senate bill contains a provision (section 504) that

would authorize VA health care practitioners to disclose

relevant portions of VA medical records to surrogate

decision-makers who are authorized to make decisions on

behalf of patients lacking decision-making capacity. The

provision would only allow such disclosures where the

information is clinically relevant to the decision that the

surrogate is being asked to make.

There was no comparable House provision.

The Compromise Agreement contains the Senate provision.

Enhancement of Quality Management (section 505)

The Senate bill contains a provision (section 506) that

would create a National Quality Management Officer to act as

the principal officer responsible for the Veteran Health

Administration's quality assurance program. The

provision would require each VISN and medical facility to

appoint a quality management officer, as well as require VA

to carry out a review of policies and procedures for

maintaining health care quality and patient safety.

There was no comparable House provision.

The Compromise Agreement contains the Senate provision.

Pilot Program on Use of Community-Based Organizations and

Local and State Government Entities To Ensure That

Veterans Receive Care and Benefits for Which They are

Eligible (section 506)

The Senate bill contains a provision (section 508) that

would require VA to create a pilot program to study the use

of community organizations and local and State government

entities in providing care and benefits to veterans. The

grantees would be selected for their ability to increase

outreach, enhance the coordination of community, local,

state, and Federal providers of health care, and expand the

availability of care and services to transitioning

servicemembers and their families. The two-year pilot program

would be required to be implemented in five locations and, in

making the site selections, the Secretary would be required

to give special consideration to rural areas, areas with high

proportions of minority groups, areas with high proportions

of individuals who have limited access to health care, and

areas that are not in close proximity to an active duty

military station.

There was no comparable House provision.

The Compromise Agreement contains the Senate provision, but

would give VA 180 days to implement the pilot program.

Specialized Residential Care and Rehabilitation for Certain

Veterans (section 507)

The Senate bill contains a provision (section 509) that

would authorize VA to contract for specialized residential

care and rehabilitation services for certain veterans.

Eligible veterans would be those who served in OEF or OIF,

suffer from a traumatic brain injury (TBI), and possess an

accumulation of deficits in activities of daily living and

instrumental activities of daily living that would otherwise

require admission to a nursing home.

There was no comparable House provision.

The Compromise Agreement contains the Senate provision.

Expanded Study on the Health Impact of Project Shipboard

Hazard and Defense (section 508)

The Senate bill contains a provision (section 510) that

would require VA to contract with the Institute of Medicine

(IOM) to study the health impact of veterans' participation

in Project Shipboard Hazard and Defense (SHAD). The study

would be intended

to cover, to the extent practicable, all veterans who

participated in Project SHAD and may utilize results from the

study included in IOM's report on ``Long-Term Health Effects

of Participation in Project SHAD.''

There was no comparable House provision.

The Compromise Agreement contains the Senate provision.

Use of Non-Department Facilities for Rehabilitation of

Individuals with Traumatic Brain Injury (section 509)

The Senate bill contains a provision (section 511) that

would clarify when non-VA facilities may be utilized to

provide treatment and rehabilitative services for veterans

and members of the Armed Forces with TBI. Specifically, the

provision would allow non-VA facilities to be used when VA

cannot provide treatment or services at the frequency or

duration required by the individual plan of the veteran or

servicemember with TBI. The provision also would allow the

use of non-VA facilities if VA determines that it is optimal

for the recovery and rehabilitation of the veteran or

servicemember. Such non-VA facility would be required to

maintain standards that have been established by an

independent, peer-reviewed organization that accredits

specialized rehabilitation programs for adults with TBI.

There was no comparable House provision.

The Compromise Agreement contains the Senate provision.

Pilot Program on Provision of Dental Insurance Plans to

Veterans and Survivors and Dependents of Veterans

(section 510)

The Senate bill contains a provision (section 513) that

would require VA to carry out a three-year pilot program to

provide specified dental services through a contract with a

dental insurer. Additionally, the provision would provide

that the pilot program should take place in at least two but

no more than four VISNs and that enrollment would be

voluntary. The program would provide diagnostic services,

preventive services, endodontic and other restorative

services, surgical services, emergency services, and such

other services as VA considers appropriate.

There was no comparable House provision.

The Compromise Agreement contains the Senate provision,

modified to provide that the pilot program may take place in

any number of VISNs the Secretary deems appropriate. The

purpose of providing the Secretary with this authority is to

ensure the capability, should it be required, to maximize the

number of voluntary enrollees insured under the dental

program so as to reduce premium expenditures.

Prohibition on Collection of Copayments from Veterans who are

Catastrophically Disabled (section 511)

The Senate bill contains a provision (section 515) that

would add a new section 1730A in title 38, United States

Code, to prohibit VA from collecting copayments from

catastrophically disabled veterans for medical services

rendered, including prescription drug and nursing home care

copayments.

H.R. 3219 contains the same provision (section 203).

The Compromise Agreement contains this provision.

Higher Priority Status for Certain Veterans who are Medal of

Honor Recipients (section 512)

H.R. 3519 contains a provision (section 201) that would

amend section 1705 of title 38, United States Code, to place

Medal of Honor recipients in priority group 3 for the

purposes of receiving health care through VA. This would

situate Medal of Honor recipients in a priority group with

former prisoners of war and Purple Heart recipients.

The Senate bill contains no comparable provision.

The Compromise Agreement contains the House provision.

Hospital Care, Medical Services, and Nursing Home Care for

Certain Vietnam-Era Veterans Exposed to Herbicide and

Veterans of the Persian Gulf War (section 513)

H.R. 3219 contains a provision (section 202) that would

amend section 1710 of title 38, United States Code, to

provide permanent authorization for the special treatment

authority of Vietnam-era veterans exposed to an herbicide and

Gulf-War era veterans who have insufficient medical evidence

to establish a service-connected disability.

The Senate bill contains no comparable provision.

The Compromise Agreement contains the House provision.

Establishment of Director of Physician Assistant Services in

Veterans Health Administration (section 514)

H.R. 3219 contains a provision (section 204) that would

create the position of Director of Physician Assistant

Services in VA central office who would report directly to

the Under Secretary for Health on all matters related to

education, training, employment, and proper utilization of

physician assistants.

The Senate bill contains no comparable provision.

The Compromise Agreement contains the House provision,

modified to require the Director of Physician Assistant

Services to report directly to the Chief of the Office of

Patient Services instead of to the Under Secretary for

Health.

Committee on Care of Veterans with Traumatic Brain Injury

(section 515)

H.R. 3219 contains a provision (section 205) that would

require VA to establish a Committee on Care of Veterans with

Traumatic Brain Injury. This Committee would be required to

evaluate VA's capacity to meet the treatment and

rehabilitative needs of veterans with TBI, as well as make

recommendations and advise the Under Secretary for Health on

matters relating to this condition. Additionally, VA would be

required to submit to the Committees on Veterans' Affairs of

the Senate and the House of Representatives an annual report

on the Committee's findings and recommendations and the

Department's response.

The Senate bill contains no comparable provision.

The Compromise Agreement contains the House provision.

Increase in Amount Available to Disabled Veterans for

Improvements and Structural Alterations Furnished as Part

of Home Health Services (section 516)

H.R. 1293 contains a provision that would increase, from

$4,100 to $6,800, the amount authorized to be paid to

veterans who have service-connected disabilities rated 50

percent or more disabling for home improvements and

structural alterations. The provision would also increase

from $1,200 to $2,000, the amount authorized to be paid to

veterans with service-connected disabilities rated less than

50 percent disabling.

The Senate bill contains no comparable provision.

The Compromise Agreement contains the House provision.

Extension of Statutorily Defined Copayments for Certain

Veterans for Hospital Care and Nursing Home Care (section

517)

Under current law, VA has the authority to provide hospital

and nursing home care on a space available basis to veterans

who do not otherwise qualify for such care. VA is authorized

to collect from such a veteran an amount equal to $10 for

every day that a veteran receives hospital care, and $5 for

every day a veteran receives nursing home care. This

authority expires on September 30, 2010.

Neither the House nor Senate bills contain a provision to

extend this authority.

The Compromise Agreement contains a provision which would

extend the statutorily defined copayments for certain

veterans for hospital care and nursing home care to September

30, 2012.

Extension of Authority to Recover Cost of Certain Care and

Services from Disabled Veterans with Health-Plan

Contracts (section 518)

Under current law, VA is authorized to recover the costs

associated with medical care provided to a veteran for a non-

service-connected disability if, among other eligibility

criteria, the veteran receives such care before October 1,

2010, the veteran has a service-connected disability, and the

veteran is entitled to benefits for health care under a

health-plan contract.

Neither the House nor Senate bills contain a provision to

extend this authority.

The Compromise Agreement contains a provision which would

extend the authority to recover the cost of such care and

services from disabled veterans with health-plan contracts to

October 1, 2012.

Title VI--Department Personnel Matters

Enhancement of Authorities for Retention of Medical

Professionals (section 601)

The Senate bill contains provisions (section 601) intended

to improve VA's ability to recruit and retain health

professionals. First, VA would be given the authority to

apply the title 38 hybrid employment system to additional

health care occupations to meet the recruitment and retention

needs of VA. Next, the probationary period for full-time and

part-time registered nurses would be set at two years; part-

time registered nurses who served previously on a full-time

basis would not be subject to a probationary period. In

addition, VA would be authorized to waive the salary offset

where the salary of an employee rehired after retirement from

the Veterans Health Administration is reduced according to

the amount of their annuity under a federal government

retirement system.

Section 601 also would provide for a number of new or

expanded pay authorities, including setting the pay for all

senior executives in the Office of the Under Secretary for

Health at Level II or Level III of the Executive Schedule;

authorizing recruitment and retention special incentive pay

for pharmacist executives of up to $40,000; amending the pay

provisions of physicians and dentists by clarifying the

determination of the non-foreign cost of living adjustment,

exempting physicians and dentists in executive leadership

positions from compensation panels, and allowing for a

reduction in market pay for changes in board certification or

a reduction of privileges; modifying the pay cap for

registered nurses and other covered positions to Level IV of

the Executive Schedule; allowing the pay for certified

registered nurse anesthetists to exceed the pay caps for

registered nurses; increasing the limitation on special pay

for nurse executives from $25,000 to $100,000; adding

licensed practical nurses, licensed vocational nurses, and

nursing positions covered by title 5 to the list of

occupations that are exempt from the limitations on increases

in rates of basic pay; and expanding the eligibility for

additional premium pay to part-time nurses. Finally, section

601 would improve VA's locality pay system by requiring VA to

provide education, training, and support to the directors of

VA health care facilities on the use of locality pay system

surveys.

H.R. 919 contains a comparable provision (section 2) which

would not, in contrast to

the Senate bill, restrict VA from applying hybrid title 38

status to positions that are administrative, clerical or

physical plant maintenance and protective services, would

otherwise be included under the authority of section 5332 of

title 5, United States Code; do not provide direct patient

care services, or would otherwise be available to provide

medical care and treatment for veterans. The House provision

also would not place restrictions on the categories of part-

time nurses for whom the probationary period would be waived.

The House section contains an additional provision which

would provide comparability pay up to $100,000 per year to

all individuals appointed by the Under Secretary for Health

under the authority of section 7306 of title 38, United

States Code, who are not physicians or dentists and who would

be compensated at a higher rate in the private sector.

The Compromise Agreement contains the Senate provision,

modified to eliminate the provision of the Senate bill that

would provide VA with the authority to waive salary offsets

for retirees who are reemployed in the Veterans Health

Administration.

Limitations on Overtime Duty, Weekend Duty, and Alternative

Work Schedules for Nurses (section 602)

The Senate bill contains a provision (section 602) that

would prohibit VA from requiring nurses to work more than 40

hours in an administrative work week or more than 8 hours

consecutively, except under unanticipated emergency

conditions in which the nurses' skills are necessary and good

faith efforts to find voluntary replacements have failed. The

provision also would strike subsection 7456(c) of title 38,

United States Code, which provides that nurses on approved

sick or annual leave during a 12-hour work shift shall be

charged at a rate of five hours of leave per three hours of

absence. Finally, for recruitment and retention purposes, VA

would be authorized to consider a nurse who has worked 6

regularly scheduled 12-hour work shifts within a 14-day

period to have worked a full eighty-hour pay period.

H.R. 919 contains the same provision (section 3).

The Compromise Agreement contains this provision.

Reauthorization of Health Professionals Educational

Assistance Scholarship Program (section 603)

H.R. 919 contains a provision (section 4) that would

reinstate the Health Professionals Educational Assistance

Scholarship Program. Section 2 of H.R. 4166 contains a

similar provision which would also direct VA to fully employ

program graduates as soon as possible following their

graduation, require graduates to perform clinical rotations

in assignments or locations determined by VA, and assign a

mentor to graduates in the same facility in which they are

serving.

The Senate bill contains a similar provision but did not

include the requirement to fully employ graduates as soon as

possible.

The Compromise Agreement contains the provision from

section 2 of H.R. 4166.

Loan Repayment Program for Clinical Researchers from

Disadvantaged Backgrounds (section 604)

H.R. 919 (section 4) and H.R. 4166 (section 4) contain

identical provisions that would allow VA to utilize the

authorities available in the Public Health Service Act for

the repayment of the principal and interest of educational

loans of health professionals from disadvantaged

backgrounds in order to employ such professionals in the

Veterans Health Administration to conduct clinical

research.

The Senate bill contains the same provision (section 603).

The Compromise Agreement contains this provision.

Title VII--Homeless Veterans Matters

Per Diem Grant Payments (section 701)

H.R. 3796 contains a provision that would authorize VA to

make per diem payments to organizations assisting homeless

veterans in an amount equal to the greater of the daily cost

of care or $60 per bed, per day. The provision would also

require VA to ensure that 25 percent of the funds available

for per diem payments are distributed to organizations that

meet some but not all of the criteria for the receipt of per

diem payments. These would include (in order of priority)

organizations that meet each of the transitional and

supportive services criteria and serve a population that is

less than 75 percent veterans; organizations that meet at

least one but not all of the transitional and supportive

services criteria, but have a population that is at least 75

percent veterans; or organizations that meet at least one but

not all of the transitional and supportive services criteria

and serve a population that is less than 75 percent veterans.

The Senate bill contains no comparable provision.

The Compromise Agreement contains the House provision, but

does not require the minimum amount of $60 per bed, per day

for the Grant and Per Diem program. In addition, VA would be

authorized but not required to award the per diem grants to

non-profit organizations meeting some but not all of the

criteria for the receipt of such payments.

Title VIII--Nonprofit Research and Education Corporations

General Authorities on Establishment of Corporations (section

801)

H.R. 2770 contains a provision (section 2) that would

authorize Nonprofit Research and Education Corporations

(NPCs) to merge, thereby creating multi-medical center

research corporations.

The Senate bill contains the same provision (section 801).

The Compromise Agreement contains this provision.

Clarification of Purposes of Corporations (section 802)

H.R. 2770 contains a provision (section 3) that would

clarify the purpose of NPCs to include specific reference to

their role as funding mechanisms for approved research and

education, in addition to their role in facilitating research

and education.

The Senate bill contains the same provision (section 802).

The Compromise Agreement contains this provision.

Modification of Requirements for Boards of Directors of

Corporations (section 803)

The Senate bill contains a provision (section 803) that

would require that a minimum of two members of the Board of

Directors of an NPC be other-than-federal employees.

Additionally, the provision would allow for the appointment

of individuals with expertise in legal, financial, or

business matters. The provision also would conform the law

relating to NPCs to other federal conflict of interest

regulations by removing the requirement that members of the

NPC boards have no financial relationship with any entity

that is a source of funding for research or education by VA.

H.R. 2770 contains a comparable provision (section 4), but

provides that the executive director of the corporation may

be a VA employee.

The Compromise Agreement contains the House provision, with

a modification which removes the provision allowing VA

employees to serve as executive directors.

Clarification of Powers of Corporations (section 804)

H.R. 2770 contains a provision (section 5) that would

clarify the NPCs' authority to accept, administer, and

transfer funds for various purposes. NPCs would be allowed to

enter into contracts and set fees for the education and

training facilitated through the corporation.

The Senate bill contains the same provision (section 804).

The Compromise Agreement contains this provision.

Redesignation of Section 7364A of Title 38, United States

Code (section 805)

H.R. 2770 contains a provision (section 6) that would

provide clerical amendments associated with implementing this

legislation concerning Nonprofit Research and Education

Corporations.

The Senate bill contains the same provision (section 805).

The Compromise Agreement contains this provision.

Improved Accountability and Oversight of Corporations

(section 806)

The Senate bill contains a provision (section 806) that

would strengthen VA's oversight of NPCs by requiring those

NPCs with revenues of over $10,000 to obtain an independent

audit once every three years, or with revenues of over

$300,000 to obtain such an audit each year, and to submit

certain Internal Revenue Service forms.

H.R. 2770 contains a comparable provision (section 7), but

would instead raise to $100,000 the threshold for requiring

three-year audits and to $500,000 the revenue threshold that

would require yearly audits. The provision also would revise

conflict of interest policies to apply to the policies

adopted by the corporation.

The Compromise Agreement contains the House provision.

Title IX--Construction and Naming Matters

Authorization of Medical Facility Projects (section 901)

The Senate bill contains a provision (section 901) that

would authorize funds for the following major medical

facility projects in FY 2010: Livermore, California; Walla

Walla, Washington; Louisville, Kentucky; Dallas, Texas; St.

Louis, Missouri; Denver, Colorado and Bay Pines, Florida.

There was no comparable House provision.

The Compromise Agreement contains the Senate provision, but

strikes the authorization for the construction project in

Walla Walla, Washington, since authorization for this

construction project was provided in Public Law 111-98,

enacted on November 11, 2009.

Designation of Merril Lundman Department of Veterans Affairs

Outpatient Clinic, Havre, Montana (section 902)

The Senate bill contains a provision (section 903) that

would name VA outpatient clinic in Havre, Montana, as the

``Merril Lundman Department of Veterans Affairs Outpatient

Clinic.''

There was no comparable House provision.

The Compromise Agreement contains the Senate provision.

Designation of William C. Tallent Department of Veterans

Affairs Outpatient Clinic, Knoxville, Tennessee (section

903)

In the House, H.R. 402 contains a provision that would name

the VA outpatient clinic in Knoxville, Tennessee as the

``William C. Tallent Department of Veterans Affairs

Outpatient Clinic.''

The Senate bill contains no comparable provision.

The Compromise Agreement contains the House provision.

Designation of Max J. Beilke Department of Veterans Affairs

Outpatient Clinic, Alexandria, Minnesota (section 904)

In the House, H.R. 3157 contains a provision that would

name the VA outpatient clinic in Alexandria, Minnesota as the

``Max J. Beilke Department of Veterans Affairs Outpatient

Clinic.''

The Senate bill contains no comparable provision.

The Compromise Agreement contains the House provision.

Title X--Other Matters

Expansion of Authority for Department of Veterans Affairs

Police Officers (section 1001)

The Senate bill contains a provision (section 1001) that

would provide additional authorities to VA uniformed police

officers, including the authority to carry a VA-issued weapon

in an official capacity when off VA property and in official

travel status, the authority to conduct investigations on and

off VA property of offenses that may have been committed on

VA property, expanded authority to enforce local and State

traffic regulations when such authority has been granted by

local or State law, and to make arrests based upon an arrest

warrant issued by any competent judicial authority.

There was no comparable House provision.

The Compromise Agreement contains the Senate provision.

Uniform Allowance for Department of Veterans Affairs Police

Officers (section 1002)

The Senate bill contains a provision (section 1002) that

would modify VA's authority to pay an allowance to VA police

officers for purchasing uniforms. The provision would provide

a uniform allowance in an amount which is the lesser of the

amount prescribed by the Office of Personnel Management or

the actual or estimated cost as determined by periodic

surveys conducted by VA.

There was no comparable House provision.

The Compromise Agreement contains the Senate provision.

Submission of Reports to Congress by Secretary of Veterans

Affairs in Electronic Form (section 1003)

Under current law, there is no requirement for VA to submit

Congressionally mandated reports in an electronic form.

Neither the House nor Senate bills contained a provision to

change this procedure.

The Compromise Agreement contains a provision which would

create a new section 118 in title 38, United States Code,

which would require VA to submit reports to Congress, or any

Committee thereof, in electronic format. Reports would be

defined to include any certification, notification, or other

communication in writing.

Determination of Budgetary Effects for Purposes of Compliance

with Statutory Pay-As-You-Go-Act of 2010 (section 1004)

Neither the Senate nor House bills contain a provision

relating to compliance with the Statutory Pay-As-You-Go-Act

of 2010, Title I of P.L. 111-139, 124 Stat. 8.

The Compromise Agreement contains a procedural provision to

require the determination of the budgetary effects of

provisions contained in the Compromise Agreement to be based

upon the statement entered into the Congressional Record by

the Chairman of the Committee on the Budget of the House of

Representatives.

Mr. Speaker, the chairman of our Health Subcommittee, Mr. Michaud, and ranking member, Mr. Brown of South Carolina, were the chief hard workers on this bill. We thank them all.

I yield 3\1/2\ minutes to Chairman Michaud.

Mr. Speaker, before I yield to our Speaker, I just want to say with gratitude, on the part of our Nation's veterans, in her 3\1/2\ years as Speaker and her years before that as minority leader, Ms. Pelosi focused like a laser on the needs of our veterans. We would not be here with this landmark bill were it not for our Speaker.

I yield 1 minute to the Speaker of the House, the gentlewoman from California (Ms. Pelosi).

Mr. Speaker, I yield 2 minutes to Ms. Herseth Sandlin of South Dakota, the chair of our Economic Opportunity Subcommittee and the prime mover behind the section of this bill dealing with our women veterans.

Mr. Speaker, the freshman members of our committee have added a new level of commitment and enthusiasm and have played a major part in this bill. I would like to yield 1\1/2\ minutes to one of those great freshmen, Mrs. Halvorson of Illinois.

Mr. Speaker, I yield 1\1/2\ minutes to another one of our great freshmen, Mr. Perriello from Virginia.

Mr. Speaker, Mr. Teague from New Mexico authored an important provision in the bill, and I would yield to him 1\1/2\ minutes to explain that provision.

Mr. Speaker, another valued member of our committee, Mr. Ciro Rodriguez of Texas, authored an important provision in this bill, and I would recognize him for 1\1/2\ minutes.

Mr. Speaker, how much time does each side have remaining?

Mr. Speaker, one of the great provisions of this bill is an incentive program to get doctors in certain specialties into the VA. The author of that scholarship program is Ms. Jackson Lee of Texas, and I would recognize her for 1 minute.

Mr. Speaker, this bill adds an important position to the Department of Veterans Affairs. The author of that legislation is Mr. Hare of Illinois. He was on our committee; I wish we had him back. I yield him 1 minute.

Mr. Speaker, the gentlelady from Texas (Ms. Eddie Bernice Johnson), added an important provision with regard to retention and recruitment of the kind of professionals we need in the VA. I would yield to her 1 minute and thank her for her efforts.

I yield myself the balance of my time, and I want to return the debate to the bill under consideration.

Mr. Speaker, this is a landmark bill. Finally, it gives some help to the caregivers of wounded warriors--family members who have to, perhaps, give up their jobs and spend almost full time with their loved ones. There is the issue of women veterans, which is a rising percentage in what was always a male institution, and we have to change the culture there in the VA. We help our homeless veterans. We help those who are in rural areas, and we provide more money for mental health care for all of our Nation's veterans. This is an important bill, and I urge unanimous approval.

I yield back the balance of my time.

Mr. Speaker, on that I demand the yeas and nays.

I yield myself such time as I may consume.

I rise in support of S. 1963, as amended, the Caregivers and Veterans Omnibus Health Services Act of 2010.

This bill represents a bipartisan effort on behalf of the House and Senate, and I express my thanks to Chairman Filner, Chairman Akaka, and Ranking Member Burr for their leadership. I'd also like to thank Chairman Michaud and Ranking Member Brown of the Subcommittee on Health for their efforts in bringing this legislation forward.

Reflecting the spirit of compromise and cooperation, S. 1963 is composed of a number of bills from both sides of the aisle. It would provide increased access to care, better outreach and support for wounded veterans, rural veterans, and homeless veterans, and also includes enhancements and provisions of mental health care and readjustment counseling for recent veterans of Iraq and Afghanistan.

I would like to thank my good friend and colleague from Kansas, Jerry Moran, for his bill, H.R. 3103, that was included to help VA move forward with a pilot program to enhance contract care authority for highly rural veterans. This pilot, which was enacted in the last Congress, was Mr. Moran's initiative.

I'd also like to thank my friend John Duncan from Tennessee for introducing his bill, H.R. 402, which is included in this legislation. H.R. 402 would name the Veterans Affairs Outpatient Clinic in Knoxville, Tennessee, the William C. Tallent Veterans Outpatient Clinic. This gentleman honorably served in World War II and maintained a lifelong service to veterans.

S. 1963 would also establish a new, all-encompassing system of support for family caregivers. As we all know, some veterans of Iraq and Afghanistan have been severely wounded and will require a great deal of care for the rest of their lives. In previous wars, these veterans would probably not have survived their wounds, but significant improvements in battlefield medicine, the medicine logistics chain and the follow-up treatment have improved the survival rates for the most severely wounded combatants.

Family caregivers are more often than not at the core of what sustains the treatment and recovery of a severely wounded or injured soldier. Their commitment is strong and heartfelt; yet, it can be enormously challenging in a long recovery. There are many struggles that families face when assuming this role, including job absences, lost income, travel and relocation costs, child care concerns, exhaustion, and emotional and psychological stress. Many, understandably, become overwhelmed and eventually experience burnout. So there is a real problem, and the question is how to best address it.

I am concerned, however, about a provision in this bill that would establish an unprecedented stipend for certain family caregivers. I would have preferred to build upon and expand an existing successful Department of Veterans Affairs VA program known as Aid and Attendance. The Aid and Attendance program is paid directly to veterans so they can obtain the needed service in their own homes. The extent and types of services could be expanded, and last summer I proposed to do so in H.R. 3407, the Severely Injured Veterans' Benefits Act of 2009. It would provide a 50 percent increase in compensation for catastrophically injured veterans who are in need of assistance for daily personal needs, such as bathing and eating. It gives the veteran the choice of how to obtain services tailored to their unique needs and circumstances.

It is unclear how the caregiver stipend program in this bill will operate and how it will work in conjunction with the present Aid and Attendance or whether it replaces some of the current services.

Additionally, Mr. Speaker, we lack a Congressional Budget Office estimate of this compromised agreement. It appears that the Democrat majority has not been obtaining CBO cost estimates for discretionary bills, and we still don't have the official views of the administration on the compromised legislation. I am aware of their concerns. I requested the administration to address them in writing on March 18, 2010, and they were due on April 7. Although we have not yet read them, it is my understanding they are still in the concurrence process.

Based on legislative hearing testimony from last year, I believe the VA has concerns about the caregiver stipend as well as some of the other personnel provisions included in the bill. Dr. Cross, who is the principal deputy undersecretary for health, testified before the Senate Veterans Affairs Committee. This is in reference to the caregiver provisions. He stated, The VA does not support section 209. Currently we are able to contract for caregiver services with home health and similar public and private agencies. The contractor trains and pays them and affords them liability protection and oversees the quality of care. This remains the preferable arrangement as it does not divert VA from its primary mission of treating veterans and training clinicians. Moreover, it does not put VA in the position of having to tell family members how, at risk of losing their caregiver compensation, they have to care for their loved ones.

Mr. Speaker, it is unfortunate that the administration's concern regarding the caregiver stipend provision in this bill was not worked out because the bill, as a whole, does many good things for veterans. I hope this issue gets resolved with the administration, and I am pleased that legislation that I had sponsored, H.R. 1293, the Disabled Veterans Home Improvement and Structural Alteration Grant Increase Act of 2009, is in this bill. This would increase the amount VA is authorized to pay under its home health services to make modifications to a veteran's home to enable the veteran to be cared for in their home rather than in a hospital or institutional setting.

We should always be reminded that while veterans may spend only a short time in uniform, the wounds they carry home with them can last a lifetime and profoundly impact their daily lives.

I reserve my time.

I reserve the balance of my time.

Mr. Speaker, I yield myself such time as I may consume.

I would like to thank the Speaker for her kind remarks and her support of the bill. Also, I ask for your support, we have a problem we have to get worked out, and that deals with the widows, orphans, and the Spina Bifida Program was left out of the health care bill that we recently passed to ensure that it's defined as minimum essential benefit.

Madam Speaker, I hope for your support for this. The issue has been addressed in the Senate. The Senate passed it, the bill is at the desk, but it has to originate in the House, so I ask for your support on this.

Thank you, I appreciate that.

I now yield 3 minutes to the gentleman from South Carolina (Mr. Brown).

Mr. Speaker, at this time, I yield 2 minutes to Ms. Ginny Brown-Waite of Florida.

Mr. Speaker, I continue to reserve and defer to the chairman.

I yield myself such time as I may consume.

Mr. Speaker, in an exchange I just had in a colloquy with Speaker Pelosi with regard to her commitment to correct an error in the President's health package, I would like to place that commitment in some context.

Since late July of last year, when the debate on the President's health care package started, I tried on multiple occasions to ensure that the care our Nation's veterans and their families received from the Department would be considered minimum essential coverage. I did that during the markup in the Subcommittee on Health, in the Energy and Commerce Committee, and in the full committee. My efforts included trying to obtain jurisdiction for the Veterans' Affairs Committee on H.R. 3200 back in August of last year.

In November, during the floor debate on H.R. 3962, I again sought to obtain protections for our Nation's veterans and their families. At that time, not only I but Chairman Filner received assurances in writing from the chairman of the House Ways and Means Committee, from the chairman of the House Energy and Commerce Committee, and from the Energy and Labor Committee that veterans and their families would, in fact, be protected.

I think this will be helpful to us, Mr. Filner, as your bill proceeds.

Most recently, in March, I and Ranking Member Buck McKeon of the House Armed Services Committee offered an amendment to H.R. 3590, which would ensure that benefits offered under TRICARE and the Department of Veterans Affairs programs would be considered minimum essential coverage. However, our amendment was not allowed then under the rule, and I made that appeal to the Rules Committee.

This amendment was then introduced in a form of legislation, H.R. 4894, which then was referred to the Energy and Commerce Committee.

I raised the issue again, because in that recently passed Senate health bill, it did not include some of the veterans' programs in the definition of ``minimum essential coverage.'' Unfortunately, the bill did not mention the ``other veterans' programs'' under chapter 17. It mentioned veterans' programs but not the other veterans' programs under chapter 17 of title 38, which includes widows, orphans, and dependents covered by the Civilian Health and Medical Program of the VA, known as CHAMPVA. It also did not mention chapter 18, which includes the spina bifida program for the children of Korea and Vietnam veterans who have spina bifida as a result of their parents' exposure to Agent Orange.

I brought up that issue. When Chairman Skelton recognized that the Senate health bill mentioned TRICARE for Life but did not mention TRICARE, he immediately brought a bill to the floor, and it was considered. I tried to amend that bill. I tried to get it withdrawn. At that time, I received a commitment from the chairman of the House Ways and Means Committee that he would work with us to get that corrected. I even raised the issue during the markup of the President's health bill, itself, on the floor. I know the VFW was very concerned, along with the American Legion.

Yet, as I raised these concerns that this bill had a large error, I was marginalized. I was marginalized by some in the House who said, Oh, those issues are not real. Even the White House issued a press release, along with the Secretary of Veterans Affairs, which read that it was unfounded. Well, it is founded. It is a problem that we have to fix. Senator Akaka passed a bill to protect the veterans. It passed on unanimous consent. It is currently at the Speaker's desk. However, the parliamentarian has ruled that it is a revenue bill. Otherwise, I would immediately call it forward.

So what has happened? A little magic dust again.

I appreciate, with regard to this issue, that the chairman has recognized that there is an error which needs to be corrected. I am deeply appreciative. So is the Speaker. She has just exercised her commitment to correct the error in the bill.

Chairman Filner has taken the language of the Akaka bill and has introduced his own bill. It has been referred now to the Ways and Means Committee. I have written a letter as a follow-up. From the colloquy I had with Chairman Levin of the House Ways and Means Committee, I have asked him to expedite Mr. Filner's bill and to have it brought to the floor so that we can correct this error in the President's health bill and so that we may cover the widows, the orphans, the spina bifida program, and CHAMPVA, all of which were excluded from the definition of ``minimum essential coverage.'' That will correct the error, and I think that needs to be done. I had hoped that Mr. Filner's bill would have been included in the bill we are presently considering. That would have cleaned this up now, but that didn't occur.

So I've taken every opportunity to try to correct this error, but for whatever reason, it just hasn't gotten done. It needs to be done. I think it was an error in the drafting. No one intended for widows, for orphans, and for the beneficiaries of the spina bifida program to be left out. I believe it was unintentional, but it is a real issue, and we need to correct it. Hopefully, we are going to do that.

I want to thank the chairman for his leadership to correct that error, and I want to thank the staff on both sides of the aisle for all of their efforts in the bill.

I would ask my colleagues to pass the bill that is before us, and I yield back the balance of my time.

Mr. President, as chairman of the Committee on Veterans' Affairs, I am proud to urge our colleagues to support S. 1963, the proposed ``Caregivers and Veterans Omnibus Health Services Act of 2010,'' as amended. This bill reflects a compromise agreement between the Committees on Veterans' Affairs of the Senate and the House of Representatives on health care and related provisions for veterans and their caregivers. The House passed this bill, by a vote of 419-0, on April 21, 2009.

When this bill was passed by the Senate on November 19, 2009, it would have greatly expanded assistance for veterans and family members. The bill in its current form, after being reconciled with legislation in the other body, provides even more robust services, but is also significantly less expensive than when this legislation was originally approved unanimously by the Senate.

The centerpiece of this bill is a new program of caregiver assistance for our most seriously wounded veterans. The Committee has heard over and over about family members who quit their jobs, go through their savings, and lose their health insurance as they stay home to care for their wounded family members from the current conflicts. For those family members who manage to keep their jobs, their employers, including many small businesses already struggling in these difficult economic times, lose money from absenteeism and declining productivity. The toll on the caregivers who try to do it all can be measured in higher rates of depression, and worse health status as they struggle to care for their seriously injured family members, an obligation that ultimately belongs to the Federal Government.

The caregiver program that will be established by this compromise bill will help VA to fulfill its obligation to care for the Nation's wounded veterans by providing their caregivers with vital support services and a living stipend. These vital caregiver support services include training, education, counseling, mental health services, and respite care. This measure also provides health care to the family caregivers of injured veterans through CHAMPVA. These caregivers deserve our support and assistance and this new program will begin to meet that obligation.

Another key part of the bill relates to women veterans. Women make up a significantly increasing portion of the overall veteran population. Thanks to the leadership of Senator Murray, this bill will increase funding for mental health services for women who have suffered military sexual trauma, and for medical services for newborn children. In addition, this bill requires VA to report on the barriers facing women veterans who seek health care at VA.

With the help of Senator Tester, this bill also will improve veteran access to care in rural areas by authorizing VA to carry out demonstration projects for expanding care for veterans in rural areas through partnerships with other federal entities, such as the Centers for Medicare and Medicaid Services and the Indian Health Service. States which have an especially high number of veterans living in rural areas will benefit greatly from these programs.

This bill also expands the scope of VA's Education Debt Reduction Program to include retention in addition to recruitment so that VA can address staff shortages in rural areas. Where VA has a shortage of qualified employees due to location or hard-to-recruit positions, this legislation would increase the total education debt reduction payments made by VA from $44,000 to $60,000.

The bill also attacks another very difficult and painful problem-- that of homeless veterans. On any given night, the best estimate is that more than 107,000 veterans are homeless. We know that homelessness is often a consequence of multiple factors, including unstable family support, job loss, and health problems. This bill will create programs to help ease the burden of veteran homelessness and, in so doing, support Secretary Shinseki's efforts to end homelessness among veterans.

Senator Durbin has helped keep attention on issues of overall quality management in VA, and resolving and preventing such problems as those identified at the Marion, IL, VA medical center, and other facilities. Provisions of this bill will make needed improvements in these areas.

I am grateful to all who have worked diligently on this bipartisan bill--including the committee's ranking member, Senator Burr--and the veterans service organizations, who made this one of their priorities. We are particularly indebted to the Disabled American Veterans and the Wounded Warrior Project for being in the vanguard on advocating for family caregivers and for their unrelenting support for this legislation.

Various other advocates have supported this bill as well, including the American Legion, the Veterans of Foreign Wars, the Paralyzed Veterans of America, the Nurses Organization of Veterans Affairs, the Brain Injury Association of America, the American Academy of Ophthalmology, the American Association of Colleges of Nursing, and many others.

It has taken us several years to see this legislation through to what I hope will be final passage today. As we reach this final point in the legislative process, I take a moment to thank the members of the committee staff who worked so hard on this legislation, including former committee staffers who helped craft many of the provisions in this bill, Alexandra Sardegna, Aaron Sheldon, and Andrea Buck. I also thank current committee staff, Ryan Pettit, Preethi Raghavan, Nancy Hogan, and Lexi Simpson, and all the others who, in addition to their work on specific elements of the final agreement, have worked to bring this legislation to final passage.

We have promised to care for veterans when they return from service to the Nation. The provisions in this bill will help us keep our promise by going beyond words and ceremony, and providing the care that veterans have earned through their sacrifices.

I ask my colleagues to give this legislation their unanimous support.

I ask unanimous consent that an explanatory statement developed jointly with our counterparts in the House to accompany this compromise bill be printed in the Record at the conclusion of my remarks.

I thank the gentleman for yielding, I thank him for his leadership, and I am very pleased today that we have bipartisan support for this important legislation to benefit our veterans.

I, too, join my colleagues in rising to honor the sacrifice and service of the bravest among us, the men and women of our Armed Forces. In the name of our safety, they lay their lives on the line. In the name of our security, they fight our enemies far from home. In the name of our values, they serve as our Nation's greatest ambassadors, as champions of America's families.

Each and every day our soldiers, sailors, airmen and marines earn the respect of a grateful Nation. And as long as those in uniform continue the battle abroad, we must do everything in our power to support them here at home.

I would like to thank all Members of Congress on both sides of the aisle who worked so hard to strengthen this bill and bring it to the floor today. Again, I want to commend Bob Filner, the chairman of the Committee on Veterans' Affairs, Chairman Mike Michaud of the Health Subcommittee of the Committee on Veterans' Affairs, and Chairwoman Stephanie Herseth Sandlin of the Economic Opportunity Subcommittee of the Committee on Veterans' Affairs.

I also want to recognize the hard work and commitment to those who have worn our Nation's uniform by three key freshmen Members of Congress, Congressman Tom Perriello, Congresswoman Debbie Halvorson, and Congressman Harry Teague.

In both Houses, this has been a bipartisan effort, and I commend Ranking Member Buyer for his leadership. I know that everything is not in this bill. There is an endless list of everything we want to do for our veterans, but we are very proud of Senator Burr and the role that he has played in the Senate and all of the Members here. Thank you, Mr. Buyer.

The Caregivers and Veterans Omnibus Health Services Act is a landmark moment in the ongoing effort to give back to our veterans and their families. It's a tribute to their service. In the words of the Paralyzed Veterans of America, it will ``provide valuable benefit for veterans and their families, benefits they need, have earned and so richly deserve.''

This legislation will support family members and others who care for the disabled, ill or injured veterans. This is very important to families, military families. Our wounded soldiers and their families have made a serious sacrifice for our country, and this bill will bring them some relief. It will expand mental health services and health care access for veterans in rural areas and prohibit copays for our most severely wounded warriors.

Thank you, Chairwoman Herseth Sandlin, as this bill marks a step forward for the 1.8 million women in uniform, removing existing barriers to female veterans seeking medical care. In a sweeping change long overdue and with strong bipartisan support, we will provide care for newborns in the first time in history. Thank you, Congressman Henry Brown, for your leadership as well, my friend.

Today's vote is one in a series of actions taken by this Congress to give back to America's veterans. Our signature achievement remains our new GI Bill, providing those who serve with a full, 4-year college education. This is also transferable to a family member, and also a new improvement that we made was if a serviceman or woman dies in combat, that this opportunity is provided for their children or another family member.

Late last year, again in a bipartisan way, we celebrated the passage of the Veterans Health Care Budget Reform and Transparency Act, ensuring that the VA has timely and predictable funding and our veterans receive the high quality care they have earned. Working to make sure that our economic recovery truly benefits all Americans, the American Recovery and Reinvestment Act offered a tax credit for hiring veterans and a $250 payment to disabled veterans.

Just this past month we passed the TRICARE Affirmation Act, stating explicitly that our health care reform legislation will not impact the excellent health coverage our veterans and servicemembers already receive. In the last 3 years, we have given our troops a pay raise, helped restore military readiness and bolstered support for our military families. Today we strengthen the benefits our men and women in uniform receive.

Mr. Speaker, in the course of our meetings with the veterans service organizations and with the families of our men and women in uniform and our veterans, we hear directly from them what their needs are and try to establish their priorities and to make it a priority in allocating the resources of our country. In the course of those conversations, we have heard from the families that in the survey they took of their own membership of Blue Star Families, that 94 percent of them thought that most Americans did not have a clear understanding of their needs.

We promised them that in all we do here we will remove doubt in anyone's mind among our military families that we understand their needs, especially if they present them in a prioritized way and will make them our priority in the Congress. In every action we strive to live up to that commitment.

Just as the military on the battlefield has said, on the battlefield we will leave no soldier behind. So too when they come home, we will leave no veteran behind.

As the leaders of the American Legion have stated, this legislation offers bold solutions to major challenges facing servicemembers, veterans and their families on behalf of every American who wears the uniform.

I urge my colleagues to vote ``yes'' on this bill.

Thank you, Mr. Buyer. The chairman has this legislation, as you may be aware, and it is going to Ways and Means and we will be taking it up soon, but we will look forward to working with you and will bring it together in a bipartisan way in the spirit that we owe our veterans. They are all Americans and so are we.

Thank you, Mr. Buyer, and thank you, Mr. Brown, for your leadership as well.

Madam Speaker, I rise in strong support for the veterans' bills considered on the floor this week. I am very pleased that we have reached a point where we can begin to address the many institutional problems our returning soldiers endure under the Department of Veteran Affairs. While some of these issues can be attributed to administrative deficiencies, many of the department's problems can be helped by increased federal support. These brave men and women deserve our support as they risk their lives in combat. This support should be reflected in appropriate legislative action to ease the burdens they confront upon returning home. While many of us in Congress may disagree on our military strategy and presence in Iraq and Afghanistan, we can all agree that our returning veterans deserve far more than what they have received upon returning home from combat.

Although the Bush Administration initiated the wars in Iraq and Afghanistan, it failed to provide for critical veterans' health care benefits and programs that would have helped to reorient our returning troops into society. However, under a new administration and as evidenced by the bills considered this week, Congress is working diligently to introduce and pass critical legislation that will provide our veterans with long overdue support and efficient access to medical resources. Therefore, I am pleased to support all of the veterans' bills on the floor this week, and I commend my colleagues in Congress for their commitment to our nation's troops.

A New York Times report published last fall reported that the nation's newest veterans, particularly the wounded, are paying an exceptionally high price for their service to our country. According to various veterans' advocacy groups, the combination of injury and unemployment coupled with the long VA disability claims process has forced many veterans into foreclosure and other financial hardships. Thus, the legislation on the floor this week will provide for beneficial assistance through federal appropriations, employment and housing resources, and improved veterans' medical insurance programs.

H.R. 3219, the Veterans' Insurance and Health Care Improvements Act of 2009 will expand veterans' insurance and provide much needed healthcare improvements. Additionally, this measure establishes permanent VA authority to provide hospital care, medical services, and nursing home care to Vietnam-era herbicide-exposed veterans and Persian Gulf War veterans who have insufficient medical

evidence to establish a service-connected disability. Undoubtedly, many of our current veterans from past and our present international conflicts stand to benefit a great deal from this bill.

In addition, H.R. 1293, the Disabled Veterans Home Improvement and Structural Alteration Grant Increase Act of 2009, will increase the amount of authorized grants the Department of Veterans Affairs can pay for improvements and structural alterations for homes of veterans with service-connected disabilities of 50 percent or more. Accordingly, this bill will provide much needed assistance for veterans to make any necessary improvements they are otherwise unable to fix on their own. As many may suffer from service-connected physical disabilities impeding their normal life activities, this bill would authorize the VA to increase their financial assistance to veterans. This measure will greatly supplement the bill we passed last Congress, the Homes for Heroes Act, H.R. 3329. Where that bill expanded the supply of permanent housing for veterans, H.R. 1293 will provide the grants to make improvements for veterans' current homes.

Moreover, H.R. 2270, the Veterans Nonprofit Research and Education Corporations (NREC) Enhancement Act of 2009 will amend federal provisions regarding the establishment at the Department of Veterans Affairs medical facilities of nonprofit and research and education corporations (NRECs) to allow an NREC to facilitate the conduct of research or education, or both, at more than one VA medical center. This will greatly benefit the VA so that they can have readily available resources to help them confront challenges facing our veterans.

And H.R. 3155, the Caregiver Assistance and Resource Enhancement Act will provide federal assistance to individuals providing non- institutional extended care to disabled veterans. These valuable services include educational and teaching caring techniques; strategies and skills; nursing care, and mental and health services.

And finally, H.R. 1803, the Veterans Business Center Act of 2009 will amend the Small Business Act to direct the Administrator of the Small Business Administration (SBA) to establish within the SBA a Veterans Business Center program to provide entrepreneurial training and counseling to veterans. This will create yet another resource to benefit our returning veterans who may have trouble finding employment.

Madam Speaker, these are incredibly important bills, providing our veterans with the federal resources so they may have efficient access to much needed medical assistance, job, and housing support. As a strong advocate for veterans' rights, I am pleased to add my voice of support for all of these measures. Moreover, I will be working with my colleagues to make sure we continue to provide the necessary resources towards protecting our veterans' rights and ensuring fair and just access to their rightful benefits.