[House Report 113-598]
[From the U.S. Government Publishing Office]
113th Congress } { Report
2d Session } HOUSE OF REPRESENTATIVES { 113-598
=======================================================================
VETERANS TRAUMATIC BRAIN INJURY CARE IMPROVEMENT ACT OF 2014
_______
September 15, 2014.--Committed to the Committee of the Whole House on
the State of the Union and ordered to be printed
_______
Mr. Miller of Florida, from the Committee on Veterans' Affairs,
submitted the following
R E P O R T
[To accompany H.R. 4276]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred
the bill (H.R. 4276) to extend and modify a pilot program on
assisted living services for veterans with traumatic brain
injury, having considered the same, report favorably thereon
with an amendment and recommend that the bill as amended do
pass.
CONTENTS
Page
Purpose and Summary.............................................. 3
Background and Need for Legislation.............................. 3
Hearings......................................................... 4
Committee Consideration.......................................... 4
Committee Votes.................................................. 4
Committee Oversight Findings..................................... 4
Statement of General Performance Goals and Objectives............ 4
New Budget Authority, Entitlement Authority, and Tax Expenditures 4
Earmarks and Tax and Tariff Benefits............................. 5
Committee Cost Estimate.......................................... 5
Congressional Budget Office Estimate............................. 5
Federal Mandates Statement....................................... 6
Advisory Committee Statement..................................... 6
Statement of Constitutional Authority............................ 6
Applicability to Legislative Branch.............................. 6
Statement on Duplication of Federal Programs..................... 6
Disclosure of Directed Rulemaking................................ 6
Section-by-Section Analysis of the Legislation................... 6
Changes in Existing Law Made by the Bill, as Reported............ 7
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Veterans Traumatic Brain Injury Care
Improvement Act of 2014''.
SEC. 2. EXTENSION AND MODIFICATION OF PILOT PROGRAM ON ASSISTED LIVING
SERVICES FOR VETERANS WITH TRAUMATIC BRAIN INJURY.
(a) Modification of Report Requirements.--Subsection (e) of section
1705 of the National Defense Authorization Act for Fiscal Year 2008
(Public Law 110-181; 38 U.S.C. 1710C note) is amended to read as
follows:
``(e) Reports.--
``(1) Quarterly reports.--
``(A) In general.--For each calendar quarter
occurring during the period beginning January 1, 2015,
and ending September 30, 2017, the Secretary shall
submit to the Committees on Veterans' Affairs of the
Senate and the House of Representatives a report on the
pilot program.
``(B) Elements.--Each report submitted under
subparagraph (A) shall include each of the following
for the quarter preceding the quarter during which the
report is submitted the following:
``(i) The number of individuals that
participated in the pilot program.
``(ii) The number of individuals that
successfully completed the pilot program.
``(iii) The degree to which pilot program
participants and family members of pilot
program participants were satisfied with the
pilot program.
``(iv) The interim findings and conclusions
of the Secretary with respect to the success of
the pilot program and recommendations for
improvement.
``(2) Final report.--
``(A) In general.--Not later than 60 days after the
completion of the pilot program, the Secretary shall
submit to the Committees on Veterans' Affairs of the
Senate and the House of Representatives a final report
on the pilot program.
``(B) Elements.--The final report required by
subparagraph (A) shall include the following:
``(i) A description of the pilot program.
``(ii) The Secretary's assessment of the
utility of the activities carried out under the
pilot program in enhancing the rehabilitation,
quality of life, and community reintegration of
veterans with traumatic brain injury.
``(iii) An evaluation of the pilot program in
light of independent living programs carried
out by the Secretary under title 38, United
States Code, including--
``(I) whether the pilot program
duplicates services provided under such
independent living programs;
``(II) the ways in which the pilot
program provides different services
that the services provided under such
independent living program;
``(III) how the pilot program could
be better defined or shaped; and
``(IV) whether the pilot program
should be incorporated into such
independent living programs.
``(iv) Such recommendations as the Secretary
considers appropriate regarding improving the
pilot program.''.
(b) Definition of Community-based Brain Injury Residential
Rehabilitative Care Services.--Such section is further amended--
(1) in the section heading, by striking ``assisted living''
and inserting ``community-based brain injury residential
rehabilitative care'';
(2) in subsection (c), in the subsection heading, by striking
``Assisted Living'' and inserting ``Community-Based Brain
Injury Residential Rehabilitative Care'';
(3) by striking ``assisted living'' each place it appears,
and inserting ``community-based brain injury rehabilitative
care''; and
(4) in subsection (f)(1), by striking ``and personal care''
and inserting ``rehabilitation, and personal care''.
(c) Effective Date.--The amendments made by this section shall take
effect on the date of the enactment of this Act.
Purpose and Summary
H.R. 4276, the Veterans Traumatic Brain Injury Care
Improvement Act, was introduced by Representative Bill Cassidy
of Louisiana on March 18, 2014. H.R. 4276, as amended, would:
(1) require the Department of Veterans Affairs (VA), beginning
in January 2015, to issue quarterly reports to Congress on the
pilot program for assisted living services for veterans with
traumatic brain injury with a final report to Congress due not
later than 60 days after the completion of the pilot; and, (2)
amend the definition of ``assisted living'' for purposes of the
pilot program to encompass community-based brain injury
residential rehabilitative care.
Background and Need for Legislation
Section 1705 of Public Law (P.L.) 110-181, the National
Defense Authorization Act for Fiscal Year 2008, required VA to:
(1) carry out a five-year pilot program in collaboration with
the Defense and Veterans Brain Injury Center to assess the
effectiveness of providing assisted living services to veterans
with Traumatic Brian Injury (TBI) to enhance rehabilitation,
quality of life, and community integration; (2) provide special
consideration to eligible veterans in rural areas in carrying
out the pilot program; (3) carry out at least one part of the
pilot program in a region of the Veterans Health Administration
that contains a VA polytrauma center; and, (4) report to the
Committees on Veterans' Affairs of the United States House of
Representatives and the United States Senate on the pilot
program.
Section 501 of P.L. 113-146, the Veterans Access, Choice,
and Accountability Act of 2014, extended the date of
termination for the pilot program an additional three years,
from October 6, 2014, to October 6, 2017.
TBI is defined by the Defense and Veterans Brain Injury
Center as a blow or jolt to the head that disrupts the normal
function of the brain. TBI is increasingly prevalent in the
veteran population and is one of the foremost combat injuries
affecting veterans of Iraq and Afghanistan.
Identifying and implementing innovative treatment
techniques to aid these veterans in their recovery has been a
long-standing Committee priority and was the impetus behind the
authorization of the pilot program. Specialized residential
rehabilitation care for veterans with TBI is not currently
available to veterans through VA apart from the pilot program.
According to information provided by VA, as of June 1,
2014, 187 veterans across 46 different facilities in 22 states
have been enrolled in the pilot program. Anecdotal evidence
seems to indicate that these veterans and their families are
satisfied with the pilot program and, importantly, veterans
enrolled in the pilot program appear to experience functional
gains as a result of the services they receive. In a briefing
provided to Committee staff in July 2014, VA reported that
interim analysis of clinical data indicates veterans enrolled
in the pilot program have experienced significant positive
changes in several domains, including general health, activity
tolerance, and social activities. According to VA, these gains
appear to develop within the first six months of participation
in the pilot program and appear to be sustained over time.
However, VA has yet to issue a report fully assessing the pilot
program.
To ensure that the Department is continually tracking
important components of the pilot program, recognizing areas
where additional improvements are needed, and evaluating
whether or not the pilot program is successful and should be
continued, H.R. 4276, as amended, would require VA to provide
the Congressional veterans' committees with quarterly reports
on the status of the pilot program and a final report sixty
days after the completion of the pilot.
H.R. 4276 would also replace the term ``assisted living''
with ``community-based brain injury residential rehabilitative
care.'' Conversations with stakeholders regarding the pilot
program over the last several months have made it clear that
this term is more appropriate and applicable to the services
the pilot program is providing than the term ``assisted
living.''
Hearings
H.R. 4276 was not the subject of any Subcommittee or full
Committee hearings.
Committee Consideration
On September 10, 2014, the full Committee met in an open
markup session, a quorum being present and ordered H.R. 4276,
as amended, reported favorably to the House of Representatives
by voice vote.
Committee Votes
Clause 3(b) of rule XIII of the Rules of the House of
Representatives requires the Committee to list the record votes
on the motion to report the legislation and amendments thereto.
There were no record votes taken on amendments or in connection
with ordering H.R. 4276, as amended, reported to the House. A
motion by Ranking Member Michael H. Michaud of Maine to report
H.R. 4276, as amended, favorably to the House of
Representatives was agreed to by voice vote.
Committee Oversight Findings
In compliance with clause 3(c)(1) of rule XIII and clause
2(b)(1) of rule X of the Rules of the House of Representatives,
the Committee's oversight findings and recommendations are
reflected in the descriptive portions of this report.
Statement of General Performance Goals and Objectives
In accordance with clause 3(c)(4) of rule XIII of the Rules
of the House of Representatives, the Committee's performance
goals and objectives are reflected in the descriptive portions
of this report.
New Budget Authority, Entitlement Authority, and Tax Expenditures
In compliance with clause 3(c)(2) of rule XIII of the Rules
of the House of Representatives, the Committee adopts as its
own the estimate of new budget authority, entitlement
authority, or tax expenditures or revenues contained in the
cost estimate prepared by the Director of the Congressional
Budget Office pursuant to section 402 of the Congressional
Budget Act of 1974.
Earmarks and Tax and Tariff Benefits
H.R. 4276, as amended, does not contain any congressional
earmarks, limited tax benefits, or limited tariff benefits as
defined in clause 9 of rule XXI of the Rules of the House of
Representatives.
Committee Cost Estimate
The Committee adopts as its own the cost estimate on H.R.
4276, as amended, prepared by the Director of the Congressional
Budget Office pursuant to section 402 of the Congressional
Budget Act of 1974.
Congressional Budget Office Cost Estimate
Pursuant to clause 3(c)(3) of rule XIII of the Rules of the
House of Representatives, the following is the cost estimate
for H.R. 476, as amended, provided by the Congressional Budget
Office pursuant to section 402 of the Congressional Budget Act
of 1974:
U.S. Congress,
Congressional Budget Office,
Washington, DC, September 12, 2014.
Hon. Jeff Miller,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 4276, the Veterans
Traumatic Brain Injury Care Improvement Act of 2014.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Ann E.
Futrell.
Sincerely,
Douglas W. Elmendorf.
Enclosure.
H.R. 4276--Veterans Traumatic Brain Injury Care Improvement Act of 2014
H.R. 4276 would require the Department of Veterans Affairs
(VA) to submit detailed quarterly reports to the Congress
regarding the pilot program for rehabilitative services for
veterans with traumatic brain injury. Based on information from
VA, CBO estimates that implementing this bill would cost $1
million over the 2015-2019 period, assuming the availability of
appropriated funds.
Enacting H.R. 4276 would not affect direct spending or
revenues; therefore, pay-as-you-go procedures do not apply.
H.R. 4276 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act and
would not affect the budgets of state, local, or tribal
governments.
The CBO staff contact for this estimate is Ann E. Futrell.
The estimate was approved by Theresa Gullo, Deputy Assistant
Director for Budget Analysis.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates regarding H.R. 4276, as amended, prepared by the
Director of the Congressional Budget Office pursuant to section
423 of the Unfunded Mandates Reform Act.
Advisory Committee Statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act would be created by H.R.
4276, as amended.
Statement of Constitutional Authority
Pursuant to Article I, section 8 of the United States
Constitution, the reported bill is authorized by Congress'
power to ``provide for the common Defense and general Welfare
of the United States.''
Applicability to Legislative Branch
The Committee finds that the legislation does not relate to
the terms and conditions of employment or access to public
services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act.
Statement on Duplication of Federal Programs
Pursuant to section 3(j) of H. Res. 5, 113th Cong. (2013),
the Committee finds that no provision of H.R. 4276, as amended,
establishes or reauthorizes a program of the Federal Government
known to be duplicative of another Federal program, a program
that was included in any report from the Government
Accountability Office to Congress pursuant to section 21 of
Public Law 111-139, or a program related to a program
identified in the most recent Catalog of Federal Domestic
Assistance.
Disclosure of Directed Rulemaking
Pursuant to section 3(k) of H. Res. 5, 113th Cong. (2013),
the Committee estimates that H.R. 4276, as amended, does not
require any directed rule makings.
Section-by-Section Analysis of the Legislation
Section 1. Short title
Section 1 of the bill would provide the short title of H.R.
4276, as amended, as the ``Veterans Traumatic Brain Injury Care
Improvement Act of 2014.''
Section 2. Extension and Modification of Pilot Program on Assisted
Living Services for Veterans with Traumatic Brain Injury
Section 2(a) of the bill would create a new subsection (e)
of 1710(C) of title 38 U.S.C. Subsection (e)(1)(A) would
require VA to submit quarterly reports on the pilot program
beginning on January 1, 2015, and ending September 30, 2017, to
the Committees on Veterans' Affairs of the Senate and the House
of Representatives. Subsection (e)(1)(B) would require each
such report to include the number of individuals that
participated in the pilot program; the number of individuals
that successfully completed the pilot program; the degree to
which pilot program participants and family members were
satisfied with the pilot program; and, interim findings and
conclusions of the Secretary with respect to the success of the
pilot program and recommendations for improvement. Subsection
(e)(2)(A) would require VA to submit a final report on the
pilot program to the Committees on Veterans' Affairs of the
Senate and the House of Representatives not later than 60 days
after completion of the pilot. Subsection (e)(2)(B) would
require the final report to include a description of the pilot
program; the Secretary's assessment of the utility of the
activities carried out under the pilot program in enhancing the
rehabilitation, quality of life, and community reintegration of
veterans with TBI; an evaluation of the pilot program in light
of independent living programs carried out by VA under title 38
U.S., to include whether the pilot is duplicative of such
programs, the ways in which the pilot program provides
different services than those provided under such programs, how
the pilot program could be better defined or shaped, and
whether the pilot program should be incorporated into such
programs; and, such recommendations as the Secretary considers
appropriate regarding improving the pilot program.
Section 2(b)(1) of the bill would amend the heading of
section by striking ``assisted living'' and inserting
``community-based brain injury residential rehabilitative
care'' and by
Section 2(b)(2) of the bill would amend the subsection
heading by striking ``assisted living'' and inserting
``community-based residential rehabilitative care.''
Section 2(b)(3) of the bill would amend subsection (c) of
1710(C) of title 38 U.S.C. by striking ``assisted living'' and
inserting ``community-based residential rehabilitative care.''
Section 2(b)(4) of the bill would amend subsection (f)(1)
by striking ``and personal care'' and inserting
``rehabilitation, and personal care.''
Section 2(c) of the bill would set an effective date for
the amendments made in Section 2 of the date of enactment.
Section 2(d) of the bill would stipulate that no additional
funds are authorized to be appropriated to carry out the bill
and amendments shall be carried out using amounts otherwise
available for sure purpose.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italic, existing law in which no change is
proposed is shown in roman):
NATIONAL DEFENSE AUTHORIZATION ACT FOR FISCAL YEAR 2008
* * * * * * *
DIVISION A--DEPARTMENT OF DEFENSE AUTHORIZATIONS
* * * * * * *
TITLE XVII--VETERANS MATTERS
* * * * * * *
SEC. 1705. PILOT PROGRAM ON [ASSISTED LIVING] COMMUNITY-BASED BRAIN
INJURY RESIDENTIAL REHABILITATIVE CARE SERVICES FOR
VETERANS WITH TRAUMATIC BRAIN INJURY
(a) Pilot Program.--Beginning not later than 90 days after
the date of the enactment of this Act, the Secretary of
Veterans Affairs, in collaboration with the Defense and
Veterans Brain Injury Center of the Department of Defense,
shall carry out a pilot program to assess the effectiveness of
providing [assisted living] community-based brain injury
rehabilitative care services to eligible veterans to enhance
the rehabilitation, quality of life, and community integration
of such veterans.
* * * * * * *
(c) Provision of [Assisted Living] Community-Based Brain
Injury Residential Rehabilitative Care Services.--
(1) Agreements.--In carrying out the pilot program,
the Secretary may enter into agreements for the
provision of [assisted living] community-based brain
injury rehabilitative care services on behalf of
eligible veterans with a provider participating under a
State plan or waiver under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.).
(2) Standards.--The Secretary may not place,
transfer, or admit a veteran to any facility for
[assisted living] community-based brain injury
rehabilitative care services under the pilot program
unless the Secretary determines that the facility meets
such standards as the Secretary may prescribe for
purposes of the pilot program. Such standards shall, to
the extent practicable, be consistent with the
standards of Federal, State, and local agencies charged
with the responsibility of licensing or otherwise
regulating or inspecting such facilities.
(d) Continuation of Case Management and Rehabilitation
Services.--In carrying out the pilot program, the Secretary
shall--
(1) continue to provide each veteran who is receiving
[assisted living] community-based brain injury
rehabilitative care services under the pilot program
with rehabilitative services; and
* * * * * * *
[(e) Report.--
[(1) In general.--Not later than 60 days after the
completion of the pilot program, the Secretary shall
submit to the Committees on Veterans' Affairs of the
Senate and House of Representatives a report on the
pilot program.
[(2) Contents.--The report required by paragraph (1)
shall include the following:
[(A) A description of the pilot program.
[(B) An assessment of the utility of the
activities under the pilot program in enhancing
the rehabilitation, quality of life, and
community reintegration of veterans with
traumatic brain injury.
[(C) Such recommendations as the Secretary
considers appropriate regarding the extension
or expansion of the pilot program.]
(e) Reports.--
(1) Quarterly reports.--
(A) In general.--For each calendar quarter
occurring during the period beginning January
1, 2015, and ending September 30, 2017, the
Secretary shall submit to the Committees on
Veterans' Affairs of the Senate and the House
of Representatives a report on the pilot
program.
(B) Elements.--Each report submitted under
subparagraph (A) shall include each of the
following for the quarter preceding the quarter
during which the report is submitted the
following:
(i) The number of individuals that
participated in the pilot program.
(ii) The number of individuals that
successfully completed the pilot
program.
(iii) The degree to which pilot
program participants and family members
of pilot program participants were
satisfied with the pilot program.
(iv) The interim findings and
conclusions of the Secretary with
respect to the success of the pilot
program and recommendations for
improvement.
(2) Final report.--
(A) In general.--Not later than 60 days after
the completion of the pilot program, the
Secretary shall submit to the Committees on
Veterans' Affairs of the Senate and the House
of Representatives a final report on the pilot
program.
(B) Elements.--The final report required by
subparagraph (A) shall include the following:
(i) A description of the pilot
program.
(ii) The Secretary's assessment of
the utility of the activities carried
out under the pilot program in
enhancing the rehabilitation, quality
of life, and community reintegration of
veterans with traumatic brain injury.
(iii) An evaluation of the pilot
program in light of independent living
programs carried out by the Secretary
under title 38, United States Code,
including--
(I) whether the pilot program
duplicates services provided
under such independent living
programs;
(II) the ways in which the
pilot program provides
different services that the
services provided under such
independent living program;
(III) how the pilot program
could be better defined or
shaped; and
(IV) whether the pilot
program should be incorporated
into such independent living
programs.
(iv) Such recommendations as the
Secretary considers appropriate
regarding improving the pilot program.
(f) Definitions.--In this section:
(1) The term ``[assisted living] community-based
brain injury rehabilitative care services'' means
services of a facility in providing room, board, [and
personal care] rehabilitation, and personal care for
and supervision of residents for their health, safety,
and welfare.
* * * * * * *