II
Calendar No. 360
111th CONGRESS
2d Session
S. 1237
[Report No. 111–175]
IN THE SENATE OF THE UNITED STATES
June 11, 2009
Mrs. Murray (for herself, Mr. Johnson, Mr. Reed, Mr. Merkley, Mr. Specter, Mr. Baucus, and Mr. Byrd) introduced the following bill; which was read twice and referred to the Committee on Veterans' Affairs
April 29, 2010
Reported by Mr. Akaka, with an amendment and an amendment to the title
Strike out all after the enacting clause and insert the part printed in italic
A BILL
To amend title 38, United States Code, to expand the grant program for homeless veterans with special needs to include male homeless veterans with minor dependents and to establish a grant program for reintegration of homeless women veterans and homeless veterans with children, and for other purposes.
Short title
This Act may be cited as the
Homeless Women Veterans and Homeless
Veterans with Children Act of 2009
.
Expansion of grant program for homeless veterans with special needs
Inclusion under grant program for homeless veterans with special needs of entities eligible for comprehensive service program grants and per diem payments for services to homeless veterans
Subsection (a) of section 2061 of title 38, United States Code, is amended—
by striking
to grant and per diem providers
and inserting to entities
eligible for grants and per diem payments under sections 2011 and 2012 of this
title
; and
by striking
by those facilities and providers
and inserting by those
facilities and entities
.
Inclusion of male homeless veterans with minor dependents
Subsection (b) of such section is amended—
in paragraph (1),
by striking , including women who have care of minor
dependents
;
in paragraph (3),
by striking or
;
in paragraph (4),
by striking the period at the end and inserting ; or
; and
by adding at the end the following new paragraph:
veterans who have care of minor dependents.
.
Authorization of provision of services to dependents
Such section is further amended—
by redesignating subsection (c) as subsection (d); and
by inserting after subsection (b) the following new subsection (c):
Provision of services to dependents
A recipient of a grant under subsection (a) may use such grant to provide services directly to a dependent of a homeless veteran with special needs described in subsection (b) who is under the care of such homeless veteran while such homeless veteran receives services from the grant recipient under this section.
.
Grant program for reintegration of homeless women veterans and homeless veterans with children
In general
Chapter 20 of title 38, United States Code, is amended by inserting after section 2021 the following new section:
Grant program for reintegration of homeless women veterans and homeless veterans with children
Grants
Subject to the availability of appropriations provided for such purpose, the Secretary of Labor shall award grants to eligible programs and facilities to provide the services described in subsection (c) to expedite the reintegration into the labor force of the following:
Homeless women veterans.
Homeless veterans with children.
Eligible programs and facilities
An eligible program or facility for purposes of this section is a program or facility that provides dedicated services for homeless women veterans or homeless veterans with children.
Services
The services described in this subsection are the following:
Job training.
Counseling.
Job placement services, including job readiness, literacy, and skills training.
Child care.
Monitoring of use of funds
The Secretary of Labor shall monitor and evaluate the use of amounts granted under this section. In monitoring and evaluating the use of such amounts, the Secretary shall collect from grantees such information as the Secretary considers appropriate, including data on the results or outcomes of the services provided to each homeless veteran under this section.
Administration through Assistant Secretary for Veterans' Employment and Training
The Secretary of Labor shall carry out this section through the Assistant Secretary for Veterans' Employment and Training.
Biennial report to congress
The Secretary of Labor shall include as part of the report required by section 2021(d) of this title an evaluation of the grant program under this section. The information included in such report under this subsection shall include—
an evaluation of services furnished to veterans under this section; and
an analysis of the information collected under subsection (d).
Authorization of appropriations
There is authorized to be appropriated to carry out this section $10,000,000 for each of fiscal years 2010 through 2014.
The amount authorized to be appropriated by paragraph (1) is in addition to any amounts authorized to be appropriated by section 2021(e) of this title.
Funds appropriated to carry out this section shall remain available until expended. Funds obligated in any fiscal year to carry out this section may be expended in that fiscal year and the succeeding fiscal year.
.
Clerical amendment
The table of sections at the beginning of chapter 20 of such title is amended by inserting after the item relating to section 2021 the following new item:
.
Short title; table of contents
Short title
This Act may be cited as the Homeless Veterans and Other Veterans Health Care
Authorities Act of 2010
.
Table of contents
The table of contents for this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. References to title 38, United States Code.
TITLE I—Homeless veterans matters
Sec. 101. Enhancement of comprehensive service programs.
Sec. 102. Grant program for workforce reintegration of homeless women veterans and homeless veterans with children.
Sec. 103. Expansion of grant program for homeless veterans with special needs.
Sec. 104. Program on prevention of veteran homelessness.
Sec. 105. Homeless Veterans Management Information System.
Sec. 106. Rental assistance for veterans through Department of Housing and Urban Development.
Sec. 107. Special Assistant for Veterans Affairs in Office of Secretary of Housing and Urban Development.
Sec. 108. Plan to end veteran homelessness.
TITLE II—Toxic substances exposure
Sec. 201. Extension of eligibility for health care for veterans with disabilities who served in Persian Gulf War notwithstanding lack of evidence to conclude such disabilities are associated with such service.
TITLE III—Health care matters
Sec. 301. Increase in number of authorized Assistant Secretaries and Deputy Assistant Secretaries.
Sec. 302. Establishment of Director of Physician Assistant Services in Veterans Health Administration.
Sec. 303. Department of Veterans Affairs Medical Center Quality Report Card Initiative.
Sec. 304. Report on pay-for-performance compensation under health care services contracts.
Sec. 305. Expansion of State home care for parents of veterans who died while serving in the Armed Forces.
Sec. 306. Automatic enrollment of eligible demobilizing members of the National Guard and Reserve in health care and dental care programs of the Department of Veterans Affairs.
Sec. 307. Provision of chiropractic services to veterans enrolled in health care system of Department of Veterans Affairs.
Sec. 308. Name of Department of Veterans Affairs outpatient clinic, Alexandria, Minnesota.
TITLE IV—Other matters
Sec. 401. Funding.
References to title 38, United States Code
Except as otherwise expressly provided, whenever in this Act an amendment or repeal is expressed in terms of an amendment to, or repeal of, a section or other provision, the reference shall be considered to be made to a section or other provision of title 38, United States Code.
Homeless veterans matters
Enhancement of comprehensive service programs
Enhancement of grants
Section 2011 is amended—
in subsection (b)(1)(A), by striking
expansion, remodeling, or alteration of existing facilities, or
acquisition of facilities,
and inserting new construction of
facilities, expansion, remodeling, or alteration of existing facilities, or
acquisition of facilities
; and
in subsection (c)—
in the first sentence, by striking A
grant
and inserting (1) A grant
;
in the second sentence of paragraph (1), as
designated by subparagraph (A), by striking The amount
and
inserting the following:
The amount
; and
by adding at the end the following new paragraph:
The Secretary may not deny an application from an entity that seeks a grant under this section to carry out a project described in subsection (b)(1)(A) solely on the basis that the entity proposes to use funding from other private or public sources, if the entity demonstrates that a private nonprofit organization will provide oversight and site control for the project.
In this paragraph, the term private nonprofit organization means the following:
An incorporated private institution, organization, or foundation—
that has received, or has temporary clearance to receive, tax-exempt status under paragraph (2), (3), or (19) of section 501(c) of the Internal Revenue Code of 1986;
for which no part of the net earnings of the institution, organization, or foundation inures to the benefit of any member, founder, or contributor of the institution, organization, or foundation; and
that the Secretary determines is financially responsible.
A for-profit limited partnership or limited liability company, the sole general partner or manager of which is an organization that is described by subclauses (I) through (III) of clause (i).
A corporation wholly owned and controlled by an organization that is described by subclauses (I) through (III) of clause (i).
.
Grant and per diem payments
Study and development of payment method
Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall—
complete a study of all matters relating to the method used by the Secretary to make per diem payments under section 2012(a) of title 38, United States Code; and
develop an improved method for adequately reimbursing recipients of grants under section 2011 of such title for services furnished to homeless veterans.
Consideration
In developing the method required by paragraph (1)(B), the Secretary may consider payments and grants received by recipients of grants described in such paragraph from other departments and agencies of Federal and local governments and from private entities.
Report
Not later than one year after the date of the enactment of this Act, the Secretary shall submit to Congress a report on—
the findings of the Secretary with respect to the study required by subparagraph (A) of paragraph (1);
the method developed under subparagraph (B) of such paragraph; and
any recommendations of the Secretary for revising the method described in subparagraph (A) of such paragraph and any legislative action the Secretary considers necessary to implement such method.
Authorization of appropriations
Section 2013
is amended by striking subchapter $150,000,000
and all that
follows through the period and inserting the following: “subchapter—
$150,000,000 for each of fiscal years 2007 through 2009;
$200,000,000 for fiscal year 2010; and
such sums as may be necessary for each of fiscal years 2011 through 2014.
.
Minimum funding in rural areas
Section 2011 is amended by adding at the end the following new subsection:
Minimum funding in rural areas
The Secretary shall ensure that not less than five percent of the aggregate of the grant amounts awarded under this section in each fiscal year is awarded to eligible entities located in rural areas.
.
Grant program for workforce reintegration of homeless women veterans and homeless veterans with children
In general
Subchapter III of chapter 20 is amended by inserting after section 2021 the following new section:
Grant program for reintegration of homeless women veterans and homeless veterans with children
Grants
Subject to the availability of appropriations for such purpose, the Secretary of Labor shall award grants to eligible programs and facilities to provide the services described in subsection (c) to expedite the reintegration into the labor force of the following:
Homeless women veterans.
Homeless veterans with children.
Eligible programs and facilities
A program or facility is an eligible program or facility for purposes of this section if the program or facility provides dedicated services for homeless women veterans or homeless veterans with children.
Services
The services described in this subsection are the following:
Job training.
Counseling.
Job placement services, including job readiness, literacy, and skills training.
Child care.
Minimum
The Secretary shall ensure that not less than five percent of the aggregate of the grant amounts awarded under this section in each fiscal year is awarded to eligible programs and facilities located in rural areas.
Monitoring of use of funds
The Secretary of Labor shall monitor and evaluate the use of amounts granted under this section. In monitoring and evaluating the use of such amounts, the Secretary shall collect from grantees such information as the Secretary considers appropriate, including data on the results or outcomes of the services provided to each homeless veteran under this section.
Administration
The Secretary of Labor shall carry out this section through the Assistant Secretary of Labor for Veterans' Employment and Training.
Biennial report to congress
The Secretary of Labor shall include as part of the report required by section 2021(d) of this title an evaluation of the grant program under this section. The information included in such report under this subsection shall include—
an evaluation of services furnished to veterans under this section; and
an analysis of the information collected under subsection (d).
Authorization of appropriations
There is authorized to be appropriated to carry out this section $10,000,000 for each of fiscal years 2010 through 2014.
The amount authorized to be appropriated by paragraph (1) is in addition to any amounts authorized to be appropriated by section 2021(e) of this title.
Funds appropriated to carry out this section shall remain available until expended. Funds obligated in any fiscal year to carry out this section may be expended in that fiscal year and the succeeding fiscal year.
.
Clerical amendment
The table of sections at the beginning of chapter 20 is amended by inserting after the item relating to section 2021 the following new item:
.
Expansion of grant program for homeless veterans with special needs
Inclusion of entities eligible for comprehensive service program grants and per diem payments for services to homeless veterans
Subsection (a) of section 2061 is amended—
by striking to
grant and per diem providers
and inserting to entities eligible
for grants and per diem payments under sections 2011 and 2012 of this
title
; and
by striking by
those facilities and providers
and inserting by those facilities
and entities
.
Inclusion of male homeless veterans with minor dependents
Subsection (b) of such section is amended—
in paragraph (1), by
striking , including women who have care of minor
dependents
;
in paragraph (3), by
striking or
;
in paragraph (4), by
striking the period at the end and inserting ; or
; and
by adding at the end the following new paragraph:
individuals who have care of minor dependents.
.
Authorization of provision of services to dependents
Such section is further amended—
by redesignating subsection (c) as subsection (d); and
by inserting after subsection (b) the following new subsection (c):
Provision of services to dependents
A recipient of a grant under subsection (a) may use amounts under the grant to provide services directly to a dependent of a homeless veteran with special needs who is under the care of such homeless veteran while such homeless veteran receives services from the grant recipient under this section.
.
Program on prevention of veteran homelessness
Program on prevention of veteran homelessness
In general
Subchapter VII of chapter 20 is amended by adding at the end the following new section:
Prevention of veteran homelessness
Prevention of veteran homelessness
Not later than 180 days after the date of the enactment of this section, the Secretary shall establish a program to prevent veteran homelessness by—
identifying in a timely fashion any veteran who is homeless or at imminent risk of becoming homeless; and
providing, directly or in conjunction with an existing program, assistance to veterans identified under paragraph (1).
Types of assistance
The assistance provided under subsection (a)(2) may include the following:
The provision of short-term or medium-term rental assistance.
Housing relocation and stabilization services, including housing search, mediation, and outreach to property owners.
Services to resolve personal credit issues that have led to negative credit reports.
Assistance with paying security or utility deposits and utility payments.
Assistance with covering costs associated with moving.
A referral to a program of another department or agency of the Federal Government.
Such other activities as the Secretary considers appropriate to prevent veterans homelessness.
No duplication of services
The Secretary may provide assistance under subsection (a)(2) to a veteran receiving supportive services from an eligible entity receiving financial assistance under section 2044 of this title only to the extent that the assistance provided under subsection (a)(2) does not duplicate the supportive services provided to such veteran by such entity or by any other Federal, State, or local entity.
Protection from abuse
To protect the program established under subsection (a) from abuse, the Secretary may establish a limit on the number of times that a particular veteran may receive assistance under the program in a fiscal year.
Staffing
The Secretary shall assign such employees at such locations as the Secretary considers necessary to carry out this section.
Authorization of Appropriations
There are authorized to be appropriated to carry out this section $50,000,000 for each of fiscal years 2010 through 2014.
.
Clerical amendment
The table of sections at the beginning of chapter 20 of such title is amended by adding at the end the following new item:
.
Responsibilities of homeless veterans program coordinators
Section 2003(a) is amended—
in paragraph (3), by striking The
housing
and inserting Any housing
;
by redesignating paragraph (7) as paragraph (8); and
by inserting after paragraph (6) the following new paragraph (7):
The program under section 2067 of this title.
.
Report
In general
Not later than 180 days after the date of the establishment of the program required by section 2067 of title 38, United States Code, as added by subsection (a), the Secretary of Veterans Affairs shall submit to Congress a report on the operation of such program.
Elements
The report required by paragraph (1) shall include the following:
The types and sources of assistance provided under such section 2067.
An assessment of the effectiveness of the services provided under such section.
Homeless Veterans Management Information System
In general
Subchapter VII of chapter 20, as amended by section 104, is further amended by adding at the end the following new section:
Homeless Veterans Management Information System
Method for data collection and aggregation
Not later than one year after the date of the enactment of this section, the Secretary shall, in consultation with the Special Assistant for Veterans Affairs of the Department of Housing and Urban Development and the United States Interagency Council on Homelessness established under section 201 of the McKinney-Vento Homeless Assistance Act (42 U.S.C. 11311), establish a method for the collection and aggregation of data on homeless veterans participating in programs of the Department of Veterans Affairs and the Department of Housing and Urban Development, including the following with respect to such veterans:
Age, race, sex, disability status, marital status, income, employment history, and whether the veteran is a parent.
If the veteran received assistance for housing, the number of days that the veteran resided in such housing and the type of such housing.
If the veteran is no longer participating in a program of assistance for the homeless, the reason the veteran left the program.
The method required by paragraph (1) shall ensure that each veteran is counted only once.
Annual data collection and aggregation
Not later than one year after the method is established under subsection (a), and annually thereafter, the Secretary shall collect and aggregate data using the method established under subsection (a).
Annual reports
Not later than two years after the date of enactment of this section and annually thereafter, the Secretary shall submit to Congress a report on the data collected and aggregated under subsection (b).
Authorization of appropriations
There are authorized to be appropriated to carry out this section—
$10,000,000 for fiscal year 2010; and
such sums as may be necessary for fiscal years 2011 through 2014.
.
Clerical amendment
The table of sections at the beginning of chapter 20 is amended by adding at the end the following new item:
2068. Homeless Veterans Management Information System.
.
Rental assistance for veterans through Department of Housing and Urban Development
Section 8(o)(19) of the United States Housing Act of 1937 (42 U.S.C. 1437f(o)(19)) is amended to read as follows:
Rental vouchers for Veterans Affairs supported housing program
Rental vouchers
The Secretary shall make available to public housing agencies described in subparagraph (C) the amounts described in subparagraph (B), to provide rental assistance through a supported housing program administered in conjunction with the Department of Veterans Affairs.
Amount
The amounts specified in this subparagraph are the amounts necessary to ensure that—
not more than 30,000 vouchers for rental assistance under this paragraph are outstanding at any one time during fiscal year 2010;
not more than 40,000 vouchers for rental assistance under this paragraph are outstanding at any one time during fiscal year 2011;
not more than 50,000 vouchers for rental assistance under this paragraph are outstanding at any one time during fiscal year 2012; and
not more than 60,000 vouchers for rental assistance under this paragraph are outstanding at any one time during fiscal year 2013 and each fiscal year thereafter.
Public housing agencies
A public housing agency described in this subparagraph is a public housing agency that—
has a partnership with a Department of Veterans Affairs medical center or an entity determined to be appropriate by the Secretary of Veterans Affairs;
is located in an area that the Secretary of Veterans Affairs determines has a high concentration of veterans in need of assistance;
has demonstrated expertise in providing housing for homeless individuals; and
meets any other criteria that the Secretary, in consultation with the Secretary of Veterans Affairs may prescribe.
Case management
The Secretary of Veterans Affairs shall ensure that the case managers described in section 2003(b) of title 38, United States Code, provide appropriate case management for each veteran who receives rental assistance under this paragraph that—
assists the veteran in—
locating available housing;
working with the appropriate public housing agency;
accessing benefits and health services provided by the Department of Veterans Affairs and other departments and agencies of the Federal Government;
negotiating with landlords; and
other areas, as the Secretary determines is necessary to help the veteran maintain housing or avoid homelessness; and
ensures that a veteran with a severe disability, including a veteran that has been homeless for a substantial period of time, is referred to sufficient supportive services to provide the veteran with stable housing, including—
mental health services, including treatment and recovery support services;
substance abuse treatment and recovery support services, including counseling, treatment planning, recovery coaching, and relapse prevention;
integrated, coordinated treatment and recovery support services for co-occurring disorders;
health education, including referrals for medical and dental care;
services designed to help individuals make progress toward self-sufficiency and recovery, including job training, assistance in seeking employment, benefits advocacy, money management, life-skills training, self-help programs, and engagement and motivational interventions;
parental skills and family support; and
other supportive services that promote an end to chronic homelessness.
.
Special Assistant for Veterans Affairs in Office of Secretary of Housing and Urban Development
Section 4 of the Department of Housing and Urban Development Act (42 U.S.C. 3533) is amended by adding at the end the following new subsection:
Special Assistant for Veterans Affairs
Establishment
There shall be in the Department a Special Assistant for Veterans Affairs, who shall be in the Office of the Secretary.
Appointment
The Special Assistant for Veterans Affairs shall be appointed by the Secretary, based solely on merit and shall be covered under the provisions of title 5, United States Code, governing appointments in the competitive service.
Responsibilities
The Special Assistant for Veterans Affairs shall be responsible for—
ensuring that veterans have access to housing and homeless assistance under each program of the Department providing such assistance;
coordinating all programs and activities of the Department relating to veterans; and
carrying out such other duties as may be assigned to the Special Assistant by the Secretary or by law.
.
Plan to end veteran homelessness
In general
Not later than one year after the date of enactment of this Act, the Secretary of Veterans Affairs shall submit to Congress a comprehensive plan to end homelessness among veterans that includes—
an analysis of programs of the Department of Veterans Affairs and other departments and agencies of the Federal Government that are designed to prevent homelessness among veterans and assist veterans who are homeless;
an evaluation of whether and how partnerships between the programs described in paragraph (1) would contribute to ending homelessness among veterans;
recommendations for improving the programs described in paragraph (1), creating partnerships between such programs, or eliminating programs that are no longer effective;
recommendations for new programs to prevent and end homelessness among veterans, including an estimation of the cost of such programs;
a timeline for implementing the plan; and
such other information as the Secretary determines necessary.
Consideration of veterans located in rural areas
The analysis, evaluation, and recommendations included in the report required by subsection (a) shall include consideration of the circumstances and requirements that are unique to veterans located in rural areas.
Toxic substances exposure
Extension of eligibility for health care for veterans with disabilities who served in Persian Gulf War notwithstanding lack of evidence to conclude such disabilities are associated with such service
In general
Subsection (e)(3)(B)
of section 1710 is amended by inserting after December 31, 2002
the following: , except that such care and services may also be provided
to such a veteran during the period beginning on the date of the enactment of
the Homeless Veterans and Other Veterans
Health Care Authorities Act of 2010 and ending on December 31,
2012
.
Technical correction
Subsection (a)(2)(F) of such section is amended by
striking conditions
and inserting occupational or
environmental hazards
.
Health care matters
Increase in number of authorized Assistant Secretaries and Deputy Assistant Secretaries
Increase in number of authorized Assistant Secretaries; revision of functions
Section 308 is amended—
in subsection (a), by
striking seven
and inserting eight
in the first
sentence; and
in subsection (b)—
in paragraph (6), by
striking Capital
and inserting Construction
capital
; and
in paragraph (10) by
striking Procurement
and inserting
Acquisition
.
Increase in number of authorized Deputy Assistant Secretaries
Section 308(d)(1) is amended by striking
19
and inserting 27
in the first sentence.
Conforming amendments to title 38, United States Code
Title 38, United States Code, is amended as follows:
Section 312A is repealed.
The table of sections at the beginning of chapter 3 is amended by striking the item relating to section 312A.
Conforming amendment to title 5, United States Code
Section 5315 of title 5, United States
Code, is amended by striking Assistant Secretaries, Department of
Veterans Affairs (7)
and inserting Assistant Secretaries,
Department of Veterans Affairs (8)
.
Establishment of Director of Physician Assistant Services in Veterans Health Administration
In general
Section 7306(a) is amended by striking paragraph (9) and inserting the following new paragraph (9):
The Director of Physician Assistant Services, who shall—
serve in a full-time capacity at the Central Office of the Department;
be a qualified physician assistant; and
be responsible and report directly to the Chief Patient Care Services Officer of the Veterans Health Administration on all matters relating to the education and training, employment, appropriate utilization, and optimal participation of physician assistants within the programs and initiatives of the Administration.
.
Deadline for implementation
The Secretary of Veterans Affairs shall ensure that an individual is serving as the Director of Physician Assistant Services under paragraph (9) of section 7306(a) of title 38, United States Code, as amended by subsection (a), by not later than 120 days after the date of the enactment of this Act.
Department of Veterans Affairs Medical Center Quality Report Card Initiative
Purpose
The purpose of this section is to provide
for the establishment within the Department of Veterans Affairs of an
initiative (to be known as the Medical Center Quality Report Card
Initiative
) to ensure that information on the quality and performance
of medical centers administered by the Secretary of Veterans Affairs is readily
available and accessible for purposes as follows:
To inform patients and consumers about health care quality in such medical centers.
To assist health care providers of the Department in identifying opportunities for quality improvement and cost containment.
To enhance the understanding of policy makers and public officials of health care issues, raise public awareness of medical center quality issues, and help constituents of such policy makers and officials identify quality health care options for the Department.
Establishment
Subchapter I of chapter 17 is amended by inserting after section 1706 the following new section:
Management of health care: Medical Center Quality Report Card Initiative
In general
Not later than 18 months after the date of the enactment
of the Homeless Veterans and Other Veterans
Health Care Authorities Act of 2010, the Secretary shall
establish and implement an initiative, to be known as the Medical Center
Quality Report Card Initiative
(in this section referred to as the
Initiative), to publish information on health care quality in
Department medical centers.
Publication of information on quality and performance of Department medical centers
Under the Initiative, not less frequently than twice each year, the Secretary shall make available to the public, on the Hospital Compare website of the Centers for Medicaid and Medicare Services, data consisting of the most current information on the quality and performance of each Department medical center. Such information shall include quality measures that allow for an assessment with respect to health care provided by Department medical centers, of the following:
Effectiveness.
Safety.
Timeliness.
Efficiency.
Patient-centeredness.
Patient satisfaction.
Satisfaction of health professionals employed at Department medical centers.
The equity of care provided to various patient populations, including female, geriatric, disabled, rural, homeless, mentally ill, and racial and ethnic minority populations.
For each quality measure made available under subparagraph (A), the Secretary shall include—
quality measures that are common to the health care industry and are based on information reported in paragraph (2); and
such other information as the Secretary considers appropriate.
The Secretary shall conduct focus groups with veterans to identify additional types of quality information and display formats regarding such quality measures that would be meaningful to the needs of veterans.
In making data available pursuant to paragraph (1), the Secretary shall, except as provided in subparagraph (B), include to the maximum extent practicable information about Department medical centers using best available measures that reflect emerging quality and safety trends and the priorities of veteran-centered care.
In making data available to the public under paragraph (1), the Secretary may provide information in addition to the information required by subparagraph (A) or provide information in lieu of the information required by subparagraph (A) if the Secretary—
not later than 15 days before the date on which such data is made available to the public, submits to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a certification in writing that such additional or substituted information is more appropriate for purposes of carrying out the requirement of paragraph (2)(B); and
includes with such data and in such certification an indication of which information has been added or substituted under this subparagraph.
In making data available as provided for under paragraph (1), the Secretary may make risk adjustments to quality measures to account for differences relating to—
the characteristics of a Department medical center, such as licensed bed size, geography, and teaching hospital status; and
patient characteristics, such as health status, severity of illness, and socioeconomic status.
If the Secretary makes data available under paragraph (1) using risk-adjusted quality measures, the Secretary shall establish procedures for making the unadjusted data available to the public in a manner determined appropriate by the Secretary.
Under the Initiative, the Secretary may verify data made available under this subsection to ensure accuracy and validity.
Before disclosing to the public any data under this subsection, the Secretary shall disclose the methodology for the publication of such data and the nature and scope of such data to—
each organization the Secretary considers relevant to such data; and
each Department medical center that is the subject of such data.
The Secretary shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a copy of each set of data made available to the public under paragraph (1).
The Secretary shall ensure that each set of data made available to the public under paragraph (1) is made available—
in an electronic format;
in a manner that can be understood by individuals who are not medical professionals and individuals with low functional health literacy; and
at each Department medical center covered by the set of data.
The Secretary shall ensure that information on health care quality made available under paragraph (1) is made available in a manner that is conducive for comparisons with other local medical centers or regional medical centers, as appropriate.
The Secretary shall establish procedures for making the information included in the data made available to the public under paragraph (1) available to the public upon request in non-electronic format, such as through a toll-free telephone number.
The analytic methodologies and limitations on information sources utilized by the Secretary to develop and disseminate comparative information under this subsection shall be identified and acknowledged in a notice or disclaimer as part of the dissemination of such information, and include the appropriate and inappropriate uses of such information.
Identifying and reporting actions that could lead to false or artificial improvements in quality measurements
Not less frequently than annually, the Secretary shall compare quality measures data submitted by each Department medical center to the Secretary with quality measures data submitted to the Secretary in the prior year or years by each such Department medical center in order to identify and report actions that could lead to false or artificial improvements in the quality measurements of such Department medical centers for purposes of this section.
Privacy and security
The Secretary shall develop and implement effective safeguards to protect against the unauthorized use or disclosure of Department medical center data that is made available under this section.
The Secretary shall develop and implement effective safeguards to protect against the dissemination under this section of inconsistent, incomplete, invalid, inaccurate, or subjective Department medical center data.
The Secretary shall ensure that identifiable patient data is not released to the public under this section.
Reports
The Secretary shall periodically submit to Congress a report on the effectiveness of the Initiative.
Each report required by paragraph (1) shall include the following:
An assessment of the effectiveness of the Initiative in meeting the purpose described in section 302(a) of the Homeless Veterans and Other Veterans Health Care Authorities Act of 2010.
If necessary, a description of the measures the Secretary can undertake to ensure that the Initiative meets such purpose.
The Secretary shall carry out each measure the Secretary includes in a report under paragraph (2)(B).
The Secretary shall make each report submitted under paragraph (1) available to the public.
Department medical center defined
In this section, the term Department medical center means a Department of Veterans Affairs Medical Center administered by the Secretary.
Authorization of appropriations
There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2010 through 2018.
.
Clerical amendment
The table of sections at the beginning of chapter 17 is amended by inserting after the item relating to section 1706 the following new item:
1706A. Management of health care: Medical Center Quality Report Card Initiative.
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Report on pay-for-performance compensation under health care services contracts
In general
Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report on the use by the Department of Veterans Affairs of pay-for-performance compensation mechanisms in the provision of health care services in contracts which compensate contractors of the Department for the provision of health care services through community based outpatient clinics.
Elements
The report required by subsection (a) shall include the following:
An assessment of the feasibility and advisability of utilizing pay-for-performance compensation mechanisms in the provision of health care services by the Department in contracts described in subsection (a).
The number of community based outpatient clinics of the Department that were operating under a pay-for-performance compensation mechanism in the provision of health care services on the day before the date of the enactment of this Act and the impact such mechanisms have had with respect to—
providing incentives for community based outpatient clinics to provide high quality health care; and
providing incentives to better assure patient satisfaction.
Incorporation of views and experiences of private health care systems
In meeting the requirements of this section the Secretary shall incorporate the views and experiences of representatives of at least two private health care systems that have utilized pay-for-performance compensation mechanisms in the operation of medical clinics to ascertain whether such mechanisms have had an effect on the delivery of quality, timely, medical care in the private sector.
Expansion of State home care for parents of veterans who died while serving in the Armed Forces
In administering section 51.210(d) of title 38, Code of Federal Regulations, the Secretary of Veterans Affairs shall permit a State home to provide services to, in addition to non-veterans described in such subsection, a non-veteran any of whose children died while serving in the Armed Forces.
Automatic enrollment of eligible demobilizing members of the National Guard and Reserve in health care and dental care programs of the Department of Veterans Affairs
Automatic enrollment
In general
Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall, in consultation and coordination with the Secretary of Defense, take appropriate actions to provide for the automatic enrollment of covered members in the health care or dental care programs for veterans of the Department of Veterans Affairs for which they will be eligible upon discharge or release from active duty in the Armed Forces.
Covered members
In this section, a covered member is any member of a reserve component of the Armed Forces who is being discharged or released from active duty in the Armed Forces and who upon such discharge or release will be eligible to participate in a health care or dental care program for veterans of the Department of Veterans Affairs.
Enrollment during demobilization and discharge process
The Secretary of Veterans Affairs shall, in consultation and coordination with the Secretary of Defense, ensure that the automatic enrollment described in paragraph (1) occurs during the participation of covered members in the demobilization and discharge process used for members of the reserve components of the Armed Forces.
Assistance
In general
In providing for the enrollment of covered members under subsection (a), the Secretary of Veterans Affairs shall, in consultation and coordination with the Secretary of Defense, provide covered members assistance in the completion of any enrollment activities required under such subsection. Such assistance shall be provided during the demobilization and discharge process of such members utilizing such personnel of the Department of Veterans Affairs, including personnel of the Veterans Health Administration and the Veterans Benefits Administration, as the Secretary shall assign for such purposes.
Education and outreach
In providing assistance under paragraph (1) to covered members, the personnel of the Department providing such assistance shall also provide such members—
information about the programs, benefits, and services of the Department for which they may be eligible, including—
how such members can apply for and access such programs, benefits, and services; and
the advantages of enrolling in such programs, benefits, and services; and
a list of Department of Veterans Affairs medical facilities, including medical centers, outpatient clinics, mental health centers, and benefits offices located within 100 miles of the residence in which the covered member will first reside after being discharged or released from active duty in the Armed Forces.
Personnel
Beginning not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall, in consultation and coordination with the Secretary of Defense and the appropriate officials of each State, ensure that sufficient personnel are present, including such personnel as are assigned under subsection (b)(1), at each demobilization and discharge event of a reserve component of the Armed Forces for the performance by covered members of any enrollment activities pursuant to subsection (a) and for any assistance in the performance of such activities under subsection (b).
Facilities and other resources
Beginning not later than 180 days after the date of the enactment of this Act, the Secretary of Defense shall ensure that the facilities and other resources (including space and computer facilities) for the demobilization and discharge process used for members of reserve components of the Armed Forces include adequate facilities and resources for the performance by covered members of any enrollment activities required under subsection (a) and for any assistance in the performance of such activities under subsection (b).
Protection of privacy
Any enrollment activities performed by covered members pursuant to subsection (a) shall provide appropriate protections for the privacy of such members and their personal information in accordance with applicable requirements of law.
Opt out provisions
Option not to enroll
During the demobilization and discharge process for a covered member and prior to enrolling the member pursuant to subsection (a), the Secretary of Veterans Affairs shall, in coordination with the Secretary of Defense, provide the member with the option to decline such enrollment.
Notice to Secretary; prohibition on enrollment
If a covered member provides notice to the Secretary of Veterans Affairs that the member declines enrollment under paragraph (1), the Secretary may not enroll the member pursuant to subsection (a).
Construction
Nothing in this section shall be construed to require a member of a reserve component of the Armed Forces to participate in any health care or dental care program or use any service of the Department of Veterans Affairs.
Reports
In general
Not later than one year after the date of the enactment of this Act and each year thereafter for five years, the Secretary of Veterans Affairs shall, in consultation and coordination with the Secretary of Defense, submit a report on the implementation of the requirements of this section to—
the Committee on Veterans' Affairs and the Committee on Appropriations of the Senate; and
the Committee on Veterans' Affairs and the Committee on Appropriations of the House of Representatives.
Elements
Each report required by paragraph (1) shall include the following:
A description of the activities undertaken by the Secretary of Veterans Affairs to carry out the requirements of this section.
An assessment of the effect of such activities on—
the enrollment of covered members in health care and dental care programs for veterans of the Department of Veterans Affairs; and
the participation of such members in such programs.
An assessment of the potential budgetary impact and demand for services that actions taken under subsection (a) may have on the Department of Veterans Affairs and any need for additional staff or resources to meet that demand.
Such recommendations for legislative or administrative action as the Secretary of Veterans Affairs considers appropriate in order to improve or enhance the requirements of this section so as to further facilitate the enrollment of covered members in health care and dental care programs for veterans of the Department of Veterans Affairs.
Such other matters with respect to the requirements of this section as the Secretary of Veterans Affairs considers appropriate.
Definitions
In this section:
Enrollment
The term enrollment, with respect to a covered member in a health care or dental care program for veterans of the Department of Veterans Affairs, means the collection and recording of appropriate information on such member in the recordkeeping system of the Department of Veterans Affairs to facilitate participation of such member in such program if such member is eligible for such participation and elects such participation.
State
The term State means each of the several States of the United States, the District of Columbia, and any commonwealth, territory, or possession of the United States.
Provision of chiropractic services to veterans enrolled in health care system of Department of Veterans Affairs
Comprehensive policy on chiropractic services
In general
Not later than October 1, 2010, the Secretary of Veterans Affairs shall develop and implement a comprehensive policy on the provision of chiropractic services provided at the expense of the Department of Veterans Affairs to veterans enrolled in the health care system of the Department.
Scope of Policy
The policy required by paragraph (1) shall cover each of the following:
The Department-wide protocols governing referrals for chiropractic services.
The Department-wide protocols governing direct access to chiropractic services.
The Department-wide protocols governing the scope of practice of chiropractic practitioners.
The definition of chiropractic services to be provided.
The assurance of prompt and appropriate chiropractic services by the Department, system-wide, when medically appropriate.
Department programs of education and training for health care personnel of the Department regarding the benefits of chiropractic services.
Department programs of patient education for veterans suffering from back pain and related disorders.
Updates
The Secretary shall revise the policy required by paragraph (1) on a periodic basis in accordance with experience and evolving best practice guidelines.
Consultation
The Secretary shall develop the policy required by paragraph (1), and revise such policy under paragraph (3), in consultation with veterans service organizations and other organizations with expertise regarding the benefits of chiropractic services.
Locations for provision of chiropractic services
In carrying out the policy required by subsection (a), the Secretary shall provide chiropractic services at—
not less than two locations in each Veterans Integrated Service Network (VISN); and
such locations as the Secretary considers appropriate based on the Secretary's assessment of demand for chiropractic services provided by the Department, including consideration of the following:
The average time a veteran seeking chiropractic services from the Department is required to wait for such services.
Rates of fee-based care.
Such other considerations as the Secretary considers appropriate.
Annual Report
In general
Not later than 180 days after the date of the completion and initial implementation of the policy required by subsection (a)(1) and on October 1 of every fiscal year thereafter through fiscal year 2020, the Secretary shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report on the implementation of the policy required by subsection (a)(1).
Elements
The report required by paragraph (1) shall include the following:
A description of the policy developed and implemented under paragraph (1) of subsection (a) and any revisions to such policy under paragraph (3) of such subsection.
A description of the performance measures used to determine the effectiveness of such policy in improving the availability of chiropractic services for veterans system-wide.
An assessment of the adequacy of Department chiropractic services based on a survey of patients managed in Department clinics.
An assessment of the training provided to Department health care personnel with respect to the benefits of chiropractic services and the appropriate referral of patients for chiropractic services.
An assessment of the patient pain care education programs of the Department.
The number of episodes of chiropractic services (including referrals for chiropractic services to non-Department providers) granted in the preceding fiscal year, disaggregated by facility.
Veterans Service Organization defined
In this section, the term veterans service organization means any organization recognized by the Secretary for the representation of veterans under section 5902 of title 38, United States Code.
Name of Department of Veterans Affairs outpatient clinic, Alexandria, Minnesota
Designation
The Department of Veterans Affairs
outpatient clinic in Alexandria, Minnesota, shall after the date of the
enactment of this Act be known and designated as the Max J. Beilke
Department of Veterans Affairs Outpatient Clinic
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References
Any reference in any law, regulation, map, document, record, or other paper of the United States to the outpatient clinic referred to in subsection (a) shall be considered to be a reference to the Max J. Beilke Department of Veterans Affairs Outpatient Clinic.
Other matters
Funding
In general
Subject to subsection (b), amounts to carry out this Act and the amendments made by this Act shall be derived, in whole or in part, from the following:
In fiscal years after fiscal year 2009, from amounts appropriated or otherwise available for fiscal year 2009 for the Department of Veterans Affairs for medical services that remain available for obligation as of the date of the enactment of this Act.
In fiscal years after fiscal year 2010, from amounts appropriated or otherwise available for fiscal year 2010 for the Department of Veterans Affairs for medical services that remain available for obligation as of October 1, 2010.
Limitation
Amounts described in subsection (a) shall not be available in accordance with that subsection to the extent, as determined by the Secretary, the availability of such amounts in accordance with that subsection would otherwise limit or impede the delivery of health care services to veterans.
Amend the title so as to read:
A bill to amend title 38, United States Code, to improve the provision
of assistance to homeless veterans and the provision of health care to
veterans, and for other purposes.
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April 29, 2010
Reported with an amendment and an amendment to the title