House Appropriations Committee Issues Report on Military Construction, VA, Related Agencies Appropriations Bill, 2018 (Part 3 of 5)
Prescription drug abuse
Comprehensive Addiction and Recovery Act (CARA).--The bill includes
State prescription drug monitoring programs.--The Committee notes that, with the problem of opioid use disorders escalating among veterans, it is very important that
Opioid addiction treatment.--The Committee appreciates
Oversight of
Other health issues
Hispanic-serving institution affiliations with
Historically black colleges and universities (HBCU) health professions schools.--The Committee is pleased that
Minority veteran care.--The Committee recognizes that in the last ten years, the number of minority veterans enrolled in the
Veterans end-of-life care.--Veterans often have a unique set of physical, psychological and emotional needs at the end of life, including post-traumatic stress disorder, service- related disabilities, and other emotional and spiritual needs. The Committee applauds
Volunteer physicians.--The Committee is encouraged by the success of the Physician Ambassadors Helping Veterans Pilot Program to date and encourages
Antimicrobial stewardship directives
The Committee is pleased with
Regarding another aspect of antimicrobial stewardship,
Vet centers.--The Committee appreciates the efforts
National Veterans Sport Programs.--The bill includes
Colorectal cancer screening.--In 2016, the
Veterans identification card fee.--The Veterans Identification Card Act requires the Department to issue identification cards to any requesting veteran who was discharged from the armed forces. The Committee is concerned that the law requires
Patients' rights.--The Committee notes that veterans' rights while in treatment at
Provision of kidney dialysis services.--The Committee is aware that
Patient safety.--The Committee applauds the Department for continuing to make strides in safe, high quality healthcare through its efforts to become a high reliability organization, as recommended by the Joint Commission throughout all healthcare, and is encouraged by the interest of a number of
Eye screening pilot.--The Committee is aware that
Lung cancer screening.-- The Committee notes with concern that veterans at risk for lung cancer are not always afforded the same access to lung cancer screening programs that are offered to Medicare beneficiaries. The Committee requests the Secretary to report to the Committee not later than 90 days after enactment of this Act on the steps
Analytic surgery evaluations.--The Committee is committed to ensuring that veterans receive the most appropriate, least invasive, quality surgical care possible in order to decrease the clinical risk to patients while simultaneously reducing costs through greater efficiencies. The Committee encourages the Secretary to explore systems and approaches that would objectively compare
Delays in reimbursements.--The Committee is concerned by reports that veterans can wait months for reimbursement for the costs of their travel to
Services to Indian veterans.--In 2010,
Detection of early pressure ulcers in veterans.--
Outdoor recreational therapy.--The Committee supports
Disruption in medical facility moves.--The Committee recognizes that
Organ donation policy.--The Committee is concerned that veterans may not have a complete understanding of
Medical Community Care
Fiscal year 2017 enacted level........................
Fiscal year 2018 enacted level........................ 9,409,118,000
Fiscal year 2018 additional request................... 254,000,000
Committee 2018 additional recommendation.............. 254,000,000
Fiscal year 2019 advance appropriation request........ 8,384,704,000
Committee 2019 advance appropriation recommendation... 8,384,704,000
Comparison with:
Fiscal year 2018 enacted level.................... (1,024,414,000)
Fiscal year 2019 advance budget request........... - - -
The Medical Community Care account was created in the Surface Transportation and Veterans Health Care Choice Improvement Act of 2015. It is intended to consolidate all community care programs under a single appropriation. For fiscal year 2018, the bill provides an additional
As the Choice program reaches the end of its mandatory funding in 2018, the authorizing committees are considering legislation to consolidate
Exceptions to distance rules.--The Committee is pleased that
Problems with network administrators.--The Committee is concerned about the continued communication gaps between patients and third party administrators (TPAs) who operate the Choice provider networks. The Committee is aware of numerous complaints from veterans and community care providers about program eligibility, delays in scheduling of appointments, and inadequate resources to resolve billing issues. The Committee urges
Referral delays.--The Committee is concerned by a recent GAO report suggesting that
Travel burdens.--All too often, infirm or elderly veterans are required to travel long distances or endure significant drive times to access
Delayed provider payments.--The Committee continues to be concerned about the timeliness of reimbursements from
Network administrator poor performance.--The Committee is aware of problems experienced by veterans utilizing the Choice program, including challenges scheduling appointments; appointments being canceled without notification; and slow payments to physicians for services provided. The Committee remains concerned that
Choice Act staffing increases.--The Committee repeats its request for a report due not later than 90 days after enactment of this Act describing for each VISN the amount of Choice Act funding received in fiscal year 2016 to hire additional staff; the number of staff hired; the number of employees who left
Medical Support and Compliance
Fiscal year 2017 enacted level........................
Fiscal year 2018 enacted level........................ 6,654,480,000
Fiscal year 2018 additional request................... 284,397,000
Committee 2018 additional recommendation.............. 284,397,000
Fiscal year 2019 advance budget request............... 7,239,156,000
Committee 2018 recommendation in the bill............. 7,239,156,000
Comparison with:
Fiscal year 2018 enacted level.................... 584,676,000
Fiscal year 2019 advance budget request........... - - -
The Medical Support and Compliance appropriation funds the expenses of management and administration of the Department's health care system, including financial management, public health and environmental hazard, quality and performance management, medical inspection, human research oversight, training programs and continuing education, security, volunteer operations, and human resources.
The bill provides
Fiscal year 2017 enacted level........................
Fiscal year 2018 enacted level........................ 5,434,880,000
Fiscal year 2018 additional request................... 1,079,795,000
Committee 2018 additional recommendation.............. 1,079,795,000
Fiscal year 2019 advance budget request............... 5,914,288,000
Committee 2019 recommendation in the bill............. 5,914,288,000
Comparison with:
Fiscal year 2018 enacted level.................... 479,408,000
Fiscal year 2019 advance budget request........... - - -
The
The bill provides
Spending plan.--The Committee expects
Medical imaging equipment.--The Committee remains committed to helping
Fiscal year 2017 enacted level........................
Fiscal year 2018 budget request....................... 640,000,000
Committee recommendation in the bill.................. 698,228,000
Comparison with:
Fiscal year 2017 enacted level.................... 22,862,000
Fiscal year 2018 budget request................... 58,228,000
This appropriation provides for medical, rehabilitative, and health services research. The bill makes this account funding available through
Medical research is an important aspect of the Department's programs, providing complete medical and hospital services for veterans. The prosthetic research program is also essential in the development and testing of prosthetic, orthopedic, and sensory aids for the purpose of improving the care and rehabilitation of eligible disabled veterans, including amputees, paraplegics, and the blind. The health services research program provides unique opportunities to improve the effectiveness and efficiency of the health care delivery system. Budgetary resources from a number of areas, including appropriations from the medical care accounts, reimbursements from
PTSD research.--
PTSD is a clinically diagnosed psychiatric disorder that can occur following life-threatening events or exposure to traumatic events. Military service can be a strong contributor to PTSD. For example, nearly 20 percent of enlisted soldiers-- approximately 300,000--who returned from
The Committee recognizes the importance of the
The Committee remains concerned by the rates of PTSD among the veteran population. The Committee is aware of innovative medical and pharmacological treatments for PTSD that are currently in development, and encourages
As a mechanism to explore treatments for PTSD, the Committee is aware that the use of modeling and simulation technology has enabled the development of innovative and immersive therapies, which can extend trauma management therapy protocol. The Committee encourages
Collaboration with private sector research.--The Committee is aware of research efforts conducted in the private sector on medical and pharmacological treatments for a number of conditions that affect veterans, such as PTSD.
Prosthetics research for female veterans.--While the number of female veterans who have been wounded in action and lost a limb is low (less than 1.5 percent), women have unique needs when they lose an arm or leg. According to VHA, female veteran amputees use more health care, rehabilitation services and are seen more frequently when compared to men. Furthermore, female veterans are also more likely to be unsuccessful in fitting of their prosthesis, to experience skin problems after lower extremity amputation, and to have greater intensity of pain. Women with upper extremity amputation are more likely to reject their prosthesis. Female veterans with lower extremity amputations have higher rates of hip and knee osteoarthritis. The Committee is concerned that
Innovative treatments.--The Committee appreciates the efforts
Specialized and modular prosthetics research.--While
Exoskeleton rehabilitation studies.--The Committee commends
Canine therapy.--The Committee is aware that canine therapy for treatment of PTSD and TBI symptoms is an emerging alternative therapy to pharmaceutical treatments. While still experimental, canine therapy has demonstrated effectiveness in treating PTSD and other psychological disorders for psychiatric patients, patients with substance abuse problems, and victims of trauma. The Committee notes that canine therapy is a promising area for further research as a complementary or alternative treatment for the signature wounds of the wars in
Intergenerational effects of toxic exposures.--The Committee understands that exposure to toxic chemicals can have lifelong and intergenerational effects, the impacts of which are still being determined. The Committee recognizes that the generational effects of toxic exposure have not been sufficiently studied to determine what conditions children and grandchildren of exposed veterans may face. The Committee requests that
Research transparency.--The Committee commends
Use of animals in research.--The Committee is concerned by recent reports of medical experimentation on dogs at
Mental health treatments.--The Committee supports the progress made by the
Burn pit exposures.--The Committee understands that many post-9/11 veterans have experienced health effects potentially associated with exposure to burn pits, the potential impacts of which are still being determined. The Committee recognizes the need for further studies into the issue of service-connected conditions caused from exposure to burn pits and urges
Respiratory disease.--The Committee notes the high burden of respiratory illnesses, such as lung cancer, in the veteran population. The Committee urges
Fiscal year 2017 enacted level........................
Fiscal year 2018 budget request....................... 306,193,000
Committee recommendation in the bill.................. 306,193,000
Comparison with:
Fiscal year 2017 enacted level.................... 20,000,000
Fiscal year 2018 budget request................... - - -
The
The bill includes language making ten percent of the total available until
Rural cemetery access.--In H. Rept. 112-94, the Committee first expressed concern that
Cemetery deferred maintenance.--The Committee was concerned about the level of deferred maintenance at
GENERAL ADMINISTRATION
(INCLUDING TRANSFER OF FUNDS)
Fiscal year 2017 enacted level........................
Fiscal year 2018 budget request....................... 346,891,000
Committee recommendation in the bill.................. 346,891,000
Comparison with:
Fiscal year 2017 enacted level.................... 1,500,000
Fiscal year 2018 budget request................... - - -
White House Veterans Complaint Hotline.--The Committee did not learn until the Secretary's "State of
Central office responsiveness.--The Secretary testified before the Committee that he was committed to responding to Congressional requests in a timely way--within 14 days for urgent matters and within 30 days for less time-sensitive issues--and he acknowledged that it was not a standard the Department had met in the past. The Committee is disturbed to learn that
Additional budgetary information.--The Committee continues its request that items described in the fiscal year 2015, 2016 and 2017 House reports continue to be included in the budget justifications submitted each year.
Quarterly financial information reports.--The bill includes an administrative provision which extends the requirement for submission of the quarterly financial information required in the fiscal year 2017 bill and conference report.
Staff relocations within
Minority veteran population increase.--The Committee recognizes that the veteran population is becoming increasingly diverse. According to
Small, minority-and women-owned businesses.--The Committee directs the Department to submit a quarterly report to the Committee on its efforts to work with small-, minority-, and women-owned businesses. The report shall specify the following data about use of funds appropriated under this Act: the total number of contracts awarded by the Department; the number of contracts awarded to small businesses, veteran-, minority-, and women-owned businesses; the median dollar value of contracts awarded in each category; and the median, mean and range of length of contracts awarded in each category. When data are available, this report should include data disaggregated by race and ethnicity.
Data on women and minority veterans.--The Committee recognizes the lack of data specific to women and minority veterans made available to
Improved patient access to
Kingdomware decision.--The Committee understands that the Kingdomware court decision has necessitated significant alterations in
Telework productivity.--The Committee expects
Third party fee collection pilot.--The report that accompanied P.L. 114-113 included language instructing
Management reforms.--The Committee notes that
Fiscal year 2017 enacted level........................
Fiscal year 2018 budget request....................... 155,596,000
Committee recommendation in the bill.................. 156,096,000
Comparison with:
Fiscal year 2017 enacted level.................... - - -
Fiscal year 2018 budget request................... 500,000
The bill makes ten percent of this funding available through
The bill also provides the
Continues with Part 4 of 5
New Orleans Mayor Landrieu Issues Statement on Senate GOP Health Care Bill
House Appropriations Committee Issues Report on Military Construction, VA, Related Agencies Appropriations Bill, 2018 (Part 1 of 5)
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