SB1963

VA BENEFITS

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Congressional Research Service Summary

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S: 1963 (Senate Bill 1963)

11/19/2009--Passed Senate without amendment. (This measure has not been amended since it was introduced. The summary has been expanded because action occurred on the measure.) Caregivers and Veterans Omnibus Health Services Act of 2009 -

Title I - Caregiver Support

Section 101 -

Authorizes the Secretary of Veterans Affairs to waive charges for care provided through the Department of Veterans Affairs (VA) in emergency cases to attendants accompanying veterans severely injured while on active duty on or after September 11, 2001, while such veterans are receiving VA care for such injuries.

Section 102 -

Directs the Secretary, as part of authorized VA home health services for veterans, to furnish family caregiver assistance to family members of veterans in need of personal care services due to a serious injury incurred or aggravated during active duty on or after September 11, 2001. Requires the Secretary to: (1) evaluate the services needed by each veteran; (2) provide training and approval to the caregivers; (3) designate a primary personal care attendant for each eligible veteran; (4) provide ongoing family caregiver assistance to such family members; (5) provide respite care for the veteran, in appropriate cases; (6) pay monthly caregiver stipends; (7) conduct oversight of the caregiver assistance program, including visits to each eligible veteran at least every six months; and (8) provide program outreach. Directs the Secretary to: (1) submit to the congressional veterans committees a plan for program implementation; (2) report annually to such committees evaluating the program; and (3) submit a one-time report on the feasibility and advisability of expanding the program to cover veterans who have a serious injury incurred or aggravated before September 11, 2001.

Section 103 -

Directs the Secretary to reimburse attendants for travel expenses, including lodging and subsistence, in connection with authorized VA treatment for veterans.

Section 104 -

Requires the Secretary to: (1) conduct a national survey of family caregivers of seriously disabled veterans and members of the Armed Forces to better understand the size and characteristics of their population and the types of care they provide; and (2) report survey results to Congress.

Title II - Women Veterans Health Care Matters

Section 201 -

Requires the Secretary to report to the veterans committees on barriers to the receipt of comprehensive VA health care encountered by women veterans, especially those of Operations Iraqi Freedom and Enduring Freedom.

Section 202 -

Directs the Secretary to: (1) develop a plan to improve the provision of health care services to women veterans and to plan appropriately for the future health care needs of women serving on active duty in Operations Iraqi Freedom and Enduring Freedom; and (2) submit such plan to the veterans committees.

Section 203 -

Requires: (1) the Secretary to contract with a non-VA entity for an independent study on health consequences of women veterans of active-duty service in Operations Iraqi Freedom and Enduring Freedom; (2) the entity chosen to report study results to the Secretary and Congress; and (3) the Secretary to submit to Congress a response to the study results.

Section 204 -

Directs the Secretary to: (1) implement a program for education, training, certification, and continuing medical education for mental health professionals specializing in the provision of counseling and care to veterans suffering from sexual trauma; and (2) report annually to Congress on the counseling and care provided.

Section 205 -

Requires the Secretary to: (1) conduct a two-year pilot program to evaluate the feasibility and advisability of providing reintegration and readjustment services in group retreat settings to women veterans recently separated from military service after a prolonged deployment; and (2) report to Congress on the pilot program. Authorizes appropriations.

Section 206 -

Directs the Secretary to report to Congress on the employment of full-time women veteran program managers at VA medical centers to ensure that health care needs of women veterans are met.

Section 207 -

Requires the inclusion, respectively, of women veterans recently separated from service and minority women veterans recently separated from service, on: (1) the Advisory Committee on Women Veterans; and (2) the Advisory Committee on Minority Veterans.

Section 208 -

Directs the Secretary to: (1) carry out a two-year pilot program to assess the feasibility and advisability of providing subsidies to veterans receiving regular or intensive mental health services and other intensive health care services in order to obtain child care while receiving such services; and (2) report to Congress on the pilot program. Authorizes appropriations.

Section 209 -

Authorizes the Secretary to furnish care to a newborn child of a woman veteran receiving VA maternity care for up to seven days after the birth of the child.

Title III - Rural Health Improvements

Section 301 -

Revises the VA's health professional education debt reduction program to remove the $44,000-per-individual limit on loan repayments under the program. Directs the Secretary, in each offer of employment to a health professional, to provide notice of such individual's eligibility to participate in the program. Provides for the selection of program participants.

Section 302 -

Directs the Secretary to establish and carry out a scholarship program of financial assistance for individuals who: (1) are accepted for, or currently enrolled in, a program of study leading to a degree or certificate in visual impairment or orientation and mobility, or both; and (2) enter into an agreement to serve, after program completion, as a full-time VA employee for three years within the first six years after program completion. Sets maximum assistance amounts of $15,000 per academic year and $45,000 total. Requires pro rata repayment for failure to satisfy education or service requirements, while allowing the Secretary to waive or suspend repayment when noncompliance is due to circumstances beyond the control of the participant, or when waiver or suspension is in the best interests of the United States.

Section 303 -

Directs the Secretary to transfer specified amounts from Veterans Health Administration (VHA) accounts to the Secretary of Health and Human Services (HHS) in order to include VA facilities in the list of facilities eligible for assignment of participants in the National Health Service Corps

Scholarship Program.

Section 304 -

Requires the Secretary to carry out a program of: (1) teleconsultation for the provision of remote mental health and traumatic brain injury assessments in VA facilities not otherwise able to provide such assessments without contracting with third party providers or reimbursing providers through a fee-basis system; and (2) teleretinal imaging in each Veterans Integrated Services Network. Requires annual reports from the Secretary to Congress on each program. Directs the Secretary to: (1) require each VA facility involved in the training of medical residents to work with each university concerned to develop an elective rotation in telemedicine for such residents; (2) modify the Veterans Equitable Resource Allocation (VERA) system to provide Veterans Integrated Services Networks with incentives to utilize teleconsultation, teleretinal imaging, telemedicine, and telehealth coordination services; and (3) modify the VERA system to require the inclusion of all telemedicine visits in the calculation of facility workload.

Section 305 -

Authorizes the Secretary to carry out demonstration projects to examine the feasibility and advisability of alternatives for expanding care for veterans in rural areas. Requires the Secretary to report project results to the veterans and appropriations committees. Authorizes appropriations.

Section 306 -

Requires the Secretary to establish a program to provide to veterans of Operations Iraqi Freedom and Enduring Freedom, particularly those who so served with the National Guard or reserves: (1) peer outreach services; (2) peer support services; (3) readjustment counseling and related services; and (4) mental health services. Requires the Secretary to establish a program to provide to immediate family members of such veterans, during the three-year period after the veteran's return from such deployment, education, support, counseling, and mental health services to assist in: (1) the veteran's readjustment to civilian life; (2) in the case of a veteran with an injury or illness incurred during such deployment, the recovery of the veteran; and (3) the readjustment of the family following the veteran's return. Directs the Secretary to contract with community mental health centers and other qualified entities in areas not adequately served by other health care facilities or VA vet centers. Requires the appropriate training of veterans and clinicians in the provision of such services. Directs the Secretary to submit to the veterans committees an initial implementation report, as well as a subsequent status report.

Section 307 -

Directs the Secretary to assign, at each of the 10 VA medical centers that serve the greatest number of Indian veterans per capita, a VA official or employee to act as the center's coordinator of health care for Indian veterans. Requires each such coordinator to: (1) improve outreach to tribal communities; (2) coordinate the medical needs of Indian veterans on Indian reservations with the VHA and the Indian Health Service (IHS); (3) expand the access and participation of the VA, IHS, and tribal members in the Department of Veterans Affairs Tribal Veterans Representative program; (4) act as an ombudsman for Indian veterans enrolled in the VHA health care system; and (5) advocate for the incorporation of traditional medicine and healing into VA treatment plans for Indian veterans. Directs the Secretaries of VA and HHS to enter into an agreement to ensure that health records of Indian veterans may be transferred electronically between facilities of the IHS and the VA. Authorizes the VA Secretary to transfer surplus medical and information technology equipment to the IHS. Requires a joint report from such Secretaries to Congress on the feasibility and advisability of the joint VA-IHS establishment and operation of health clinics on Indian reservations to serve the populations of such reservations, including Indian veterans.

Section 308 -

Authorizes the Secretary to pay travel expenses for veterans receiving treatment at VA facilities at the rate of 41.5 cents per mile. (Current law authorizes the rate provided to federal employees in connection with the performance of official duties.) Allows the Secretary, one year after the enactment of this Act, to adjust such rate to make it equal to the mileage reimbursement rate for the use of privately-owned vehicles by government employees on official business (requiring a justification to Congress if such adjustment causes a decrease from the previous rate). Includes within such reimbursement travel by air if it is the only practical way to reach a VA facility. Requires the Secretary, in considering whether travel by air is the only practical way, to consider the veteran's medical condition and any other impediments to the use of ground transportation.

Section 309 -

Requires the VA's Director of the Office of Rural Health to develop a five-year strategic plan for such Office, which shall include specific goals for: (1) the recruitment and retention of health care personnel in rural areas; (2) ensuring the timeliness and quality of health care delivery in rural communities; and (3) the expansion and implementation of telemedicine services in rural areas.

Section 310 -

Directs the Secretary to designate a rural outreach coordinator at each VA community-based outpatient clinic at which at least 50% of the enrolled veterans reside in a highly rural area. Requires the Secretary to adjust the compensation of VA health care providers, and provide certain incentives, to encourage such providers to achieve accreditation in their medical practice and to participate in peer review. Directs the Chief Quality and Performance Officer in each Veterans Integrated Services Network to take specified actions to effect the peer review of patient records by a VA facility.

Section 311 -

Authorizes the VA to use volunteer counselors in the provision of readjustment counseling and related mental health services. Requires such volunteers to: (1) be licensed; (2) never have been named in a tort claim arising from counseling activities; and (3) be free from disciplinary action related to licensing or certification. Directs the Secretary to establish procedures for issuing credentials and privileges to volunteer counselors. Requires each VA vet center to develop an outreach plan for community awareness of the services offered by such center.

Section 312 -

Directs the Secretary to establish and operate at least one and up to five centers of excellence for rural health research, education, and clinical activities, requiring geographic distribution in center selection. Authorizes appropriations.

Section 313 -

Requires the Secretary to carry out a three-year pilot program on financial incentives for VA physicians who assume and maintain inpatient responsibilities at community hospitals in health professional shortage areas. Directs the Secretary to compensate participating physicians for such responsibilities carried out for which the physician would not otherwise be compensated by the VA. Requires a written agreement between the VA and the physician with respect to compensation amounts. Directs the Secretary to report annually to Congress on the pilot program.

Section 314 -

Requires an annual report from the Secretary to Congress on specified provisions of this title related to care for veterans who reside in rural areas, as well as on the establishment and functions of the VA's Office of Rural Health.

Section 315 -

Directs the Secretary to make grants to state veterans service agencies and veterans service organizations to provide innovative transportation options to veterans in highly rural areas. Limits each grant amount to $50,000. Authorizes appropriations.

Section 316 -

Amends the Veterans' Mental Health and Other Care Improvements Act of 2008 to revise eligibility requirements for participation in a pilot program of enhanced VA contract care for the health care needs of VHA-enrolled veterans residing substantial distances from VA facilities providing primary, acute hospital, and tertiary care.

Title IV - Mental Health Care Matters

Section 401 -

Makes any member who serves in Operations Iraqi Freedom or Enduring Freedom eligible for readjustment counseling and related mental health services through the VHA's Readjustment Counseling Service, regardless of whether the member is on active duty at the time of receipt of such counseling and services.

Section 402 -

Directs the Secretary, upon receipt of a request for counseling from an individual who has been discharged or released from active service, to: (1) provide referrals to assist the individual in obtaining mental health care and services outside the VA; and (2) if pertinent, advise such individual of the right to apply for review of the discharge or release.

Section 403 -

Requires the Secretary to: (1) conduct a study to determine the number of veterans who died by suicide between January 1, 1999, and the date of enactment of this Act; and (2) report study results to the veterans committees. Authorizes appropriations.

Section 404 -

Directs the Secretary to transfer specified VHA funds to the HHS Secretary for the Graduate Psychology Education program established under the Public Health Service Act. Requires such funds to be used to award grants to support the training of psychologists in the treatment of veterans with post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), and other combat-related disorders. Provides a preference for VA health care facilities in the awarding of such grants.

Title V - Other Health Care Matters

Section 501 -

Repeals the requirement for annual reports concerning: (1) pay adjustments for registered nurses; and (2) VA long-range health planning.

Section 502 -

Amends the Persian Gulf War Veterans' Health Status Act to: (1) change the due date of an annual report concerning research on the health effects of military service during the Persian Gulf War; and (2) terminate such report requirement after July 1, 2015.

Section 503 -

Requires VA payments made to providers who furnish medical care to a veteran's beneficiary under the Civilian Health and Medical Program of the Veterans Administration (CHAMPVA) to constitute payment in full (thereby extinguishing the beneficiary's liability to that provider).

Section 504 -

Authorizes disclosure of VA medical information to a representative of a patient who lacks decision-making capacity.

Section 505 -

Requires VA patients to disclose health-plan information and their Social Security number. Authorizes the Secretary to deny or terminate medical care and services (with an exception for medical emergencies) to individuals who do not provide their Social Security number.

Section 506 -

Requires: (1) the VHA's Under Secretary of Health to designate a National Quality Management Officer for the VHA quality assurance program; (2) each Network regional director to appoint a quality management officer; and (3)each VHA medical facility director to appoint a quality management officer. Outlines duties for each officer. Authorizes appropriations. Directs: (1) the Under Secretary to establish mechanisms through which VHA employees may submit confidential reports concerning the quality of care in VHA facilities to the designated quality management officers; and (2) the Secretary to review, and report to Congress on, current policies and protocols for maintaining health care quality and patient safety at VA medical facilities.

Section 507 -

Requires a report from the Secretary to the veterans committees on the implementation of provisions of this Act concerning: (1) standards for the appointment and practice of physicians in VA medical facilities; and (2) the enhancement of VHA medical quality assurance through the appointment of quality management officers.

Section 508 -

Directs the Secretary to: (1) conduct a two-year pilot program to assess the feasibility and advisability of using community-based organizations and local and state governmental entities to ensure that veterans receive the care and benefits for which they are eligible, including while transitioning from military service to civilian life; and (2) report to Congress on the pilot program.

Section 509 -

Authorizes the Secretary to contract with appropriate entities to provide specialized residential care and rehabilitation services to a veteran of Operations Enduring Freedom or Iraqi Freedom who suffers from a TBI, has an accumulation of deficits in activities of daily living and instrumental activities of daily living and, because of these deficits, would otherwise require nursing home admission even though such care would generally exceed the veteran's nursing needs.

Section 510 -

Directs the Secretary to contract with the Institute of Medicine of the National Academies to conduct an expanded study on the health impact of Project Shipboard Hazard and Defense. Requires the study to include, as practicable, all veterans who participated in the Project.

Section 511 -

Authorizes the Secretary to utilize non-VA facilities for the care and treatment of veterans suffering from TBI when the Secretary: (1) is unable to provide such treatment or services at the frequency or for the duration necessary; or (2) determines that it is optimal to the veteran's recovery and rehabilitation. Requires the non-VA facility selected to maintain care standards established by an independent, peer-reviewed organization that accredits specialized rehabilitation programs for adults with TBI.

Section 512 -

Treats a health facility of a tribal organization as a state home for purposes of grant payments to such homes for veterans' domiciliary care, nursing home care, and hospital care. Exempts such facility from the prohibition against the Secretary treating a new facility as a state home after September 30, 2009. Authorizes the Secretary to make grants to assist tribal organizations in constructing or acquiring facilities in order to furnish domiciliary or nursing home care to veterans and in expanding, remodeling, or altering existing buildings in order to furnish domiciliary care, nursing home care, adult day health care, or hospital care to veterans in homes.

Section 513 -

Directs the Secretary to conduct a three-year pilot program to assess the feasibility and advisability of providing a dental insurance plan for any veteran enrolled in the VHA annual patient enrollment system, as well as survivors and dependents eligible for VA medical care. Provides for: (1) voluntary plan enrollment and disenrollment; and (2) the payment of plan premiums.

Section 514 -

Revises provisions concerning the authority of the Secretary to reimburse a veteran for the cost of emergency care provided in a non-VA facility to provide that, if the veteran has contractual or legal recourse against a third party that would, in part, extinguish the veteran's liability to the provider of the emergency treatment and payment for the treatment may be made by both the VA and the third party, the amount payable by the VA shall be the amount by which costs exceed the amount payable by the third party. Includes as third parties: (1) the HHS Secretary, with respect to the Medicare program under title XVIII of the Social Security Act; and (2) a state Medicaid agency with respect to payments made under a state plan for medical assistance approved under title XIX (Medicaid) of such Act. Authorizes the Secretary to provide reimbursement for such emergency care provided before the date of enactment of this Act if the Secretary determines it appropriate to do so.

Section 515 -

Prohibits the Secretary from requiring a veteran who is catastrophically disabled from making any copayment for the receipt of VA hospital care or medical services.

Title VI - Department Personnel Matters

Section 601 -

Authorizes the Secretary to appoint personnel for health care positions within the VHA not specifically listed in authorized classes for appointment, as long as the Secretary provides prior notification to the veterans committees and the Office of Management and Budget (OMB). Requires the Secretary, before submitting notification, to solicit comments from any labor organization representing employees in any such class and include such comments in such notification. Authorizes the appointment of nurse assistants within the VHA. Makes the probationary period after appointment as a registered nurse two years. Provides that an appointment on a part-time basis of a VHA health care professional who has previously served on a full-time basis shall be without a probationary period. Limits to two years the probationary period for the appointment of a registered nurse on a temporary, part-time basis, after which time the appointment shall be considered permanent. Provides an exception with respect to appointments made on a term-limited basis of three years or less. Authorizes the Secretary to waive, on a case-by-case basis, the application of salary offsets for VHA retirees reemployed in the VHA. Bases the rate of basic pay for appointees to the Office of the Under Secretary for Health on pay levels in the Senior Executive Service for equivalent positions. Allows for the payment of special incentive pay of up to $40,000 annually for a VHA pharmacist executive. Removes, adjusts, or waives certain pay restrictions, including on the non-foreign cost-of-living adjustment, market pay, and basic and locality pay, for VHA: (1) physicians and dentists; (2) physicians or dentists occupying administrative or executive leadership positions; (3) nurses; and (4) certified registered nurse anesthetists. Requires additional training, education, and support for appropriate VHA employees in the conduct and use of locality pay scale surveys. Requires VHA facility wage-related information, currently provided by way of reports from facility directors to the Secretary, to be made available, upon request, to individuals in VHA positions covered by such report. Increases from $25,000 to $100,000 the special pay for nurse executives. Makes part-time nurses eligible for additional premium nurse pay. Adds nurse service in excess of eight consecutive hours to the services eligible for additional overtime pay. Adds licensed practical nurses, licensed vocational nurses, and certain other nurse positions to those positions exempted from limitations on increases in basic pay rates.

Section 602 -

Prohibits: (1) the Secretary from requiring nursing staff to work more than 40 hours in a week or eight hours in a day (12 hours in the case of three-day workweeks), except under non-recurring emergency circumstances; and (2) discrimination or adverse personnel actions against nurse staff who refuse to work such additional hours. Revises the calculation of leave for nurses working two 12-hour shifts on a weekend. Redefines the VHA alternative work schedule for nurses as six 12-hours shifts within an 80-hour pay period (as opposed to three 12-hour shifts within a work week).

Section 603 -

Reinstates through 2014 the VA's health professionals educational assistance scholarship program. Revises the VA's education debt reduction program to: (1) add retention as a program purpose; and (2) allow all (under current law, only recently appointed) employees to participate. Authorizes the Secretary to utilize certain authorities under the Public Health Service Act to repay educational loans of qualified health professionals from disadvantaged backgrounds in order to secure VHA clinical research by such professionals.

Section 604 -

Directs the Secretary to prescribe standards for appointment and practice as a physician within the VHA. Requires: (1) applicants to provide certain information, including each lawsuit, civil action, or other claim of medical malpractice or negligence, and the results thereof; (2) each appointee to disclose any judgments against the individual for medical malpractice or negligence and any payments made; (3) physicians already employed within the VHA to disclose such information; and (4) the Veterans Integrated Services Network (Network) director in the region in which the physician seeks employment to investigate the information disclosed by such physician. Prohibits a new appointment without the approval of the appropriate Network regional director. Requires each VHA medical facility to enroll practicing physicians in the Proactive Disclosure Service of the National Practitioner Data Bank. Encourages the hiring of physicians who are board-certified or eligible for such certification in their field.

Title VII - Homeless Veterans Matters

Section 701 -

Authorizes the Secretary to carry out a five-year pilot program of grants to public and nonprofit organizations to coordinate the provision of supportive services to very low income, formerly homeless veterans residing in permanent housing on property that was part of a military installation that was closed and that has a redevelopment plan that includes use of the property for homeless veterans. Authorizes appropriations.

Section 702 -

Section 703 -

Authorizes the Secretary to carry out a five-year pilot program of grants to public and nonprofit organizations to provide outreach to low-income and elderly veterans and their spouses who reside in rural areas of the veterans' pension benefits for which they may be eligible. Authorizes appropriations.

Section 704 -

Directs the Secretary to submit to Congress progress reports on each of the pilot programs authorized under this title.

Title VIII - Nonprofit Research and Education Corporations

Section 801 -

Amends federal provisions concerning the establishment at VA medical facilities of nonprofit 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. States that such an NREC shall be known as a multi-medical center research corporation (MCRC). Allows an NREC to act as a MCRC if: (1) the NREC board of directors approve a resolution permitting that NREC to act as a MCRC; and (2) the Secretary of Veterans Affairs approves the resolution. Requires each NREC and MCRC (corporation) to be established in accordance with the nonprofit corporation laws of the state in which the VA medical center(s) which it supports is located. States that neither such corporation shall be considered to be owned or controlled by, or an agent or instrumentality of, the United States.

Section 802 -

Restates corporation purposes, including with respect to their role in: (1) providing a flexible research funding mechanism; and (2) residencies or similar programs.

Section 803 -

Modifies the composition of corporation boards of directors. Revises requirements concerning non-VA members of boards of directors of NRECs and MCRCs to: (1) require a minimum number who are not officers or employees of the federal government; and (2) expand the required areas of experience or expertise. Removes financial relationship restrictions from conflict of interest standards applicable to directors.

Section 804 -

Increases authorized corporation powers to include entering into contracts and setting fees for facilitated education and training.

Section 806 -

Revises annual report procedures to require submission of an Internal Revenue Service return form applicable to tax exempt organizations. Revises conflict of interest policies applicable to directors, officers, and employees of a corporation. Revises requirements for a report to Congress to increase from $35,000 to $50,000 the threshold for identifying payees of the corporation.

Title IX - Construction and Naming Matters

Section 901 -

Authorizes the Secretary to carry out major medical facility construction projects during FY2010 at specified VA facilities in California, Kentucky, Missouri, Texas, and Washington. Extends through FY2010 the authorization for projects in Colorado and Florida. Authorizes appropriations for such projects.

Section 902 -

Designates the Department of Veterans Affairs: (1) Medical Center in Louisville, Kentucky, as the "Robley Rex Department of Veterans Affairs Medical Center;" and (2) outpatient clinic in Havre, Montana, as the "Merril Lundman Department of Veterans Affairs Outpatient Clinic."

Section 904 -

Amends the Emergency Supplemental Appropriations Act for Defense, the Global War on Terror, and Hurricane Recovery, 2006 to revise a restriction on the transfer of VA property in Gulfport, Mississippi.

Title X - Other Matters

Section 1001 -

Expands the authority of VA police officers to include: (1) carrying VA-issued weapons while off VA property in an official capacity or while on official travel; (2) conducting investigations, on and off VA property, of offenses that may have been committed on VA property; (3) carrying out any VA-authorized duties when engaged in duties authorized by other federal statutes; and (4) serving arrest warrants issued by competent judicial authority.

Section 1002 -

Makes the uniform allowance for VA police officers the lesser of: (1) the amount currently permitted by the Office of Personnel Management (OPM); or (2) estimated or actual costs as determined by periodic VA surveys. Requires the allowance to be paid: (1) at the beginning of the officer's employment, for those appointed on or after October 1, 2008; or (2) in the case of any other officer, upon the officer's request.