Senate Veterans’ Affairs Committee Issues Report on Caring for Our Veterans Act (Part 5 of 7)
Section 252 would authorize
Using information from the
Compensation for Medical Directors. Section 205 would remove the cap on basic pay for directors of regional and medical facilities at the department. Under current law, the salary for those positions is capped at level V of the executive schedule. CBO expects that this section would allow
Modify Threshold for Major Medical Facilities. Section 241 would expand the authority of
Section 241 would allow
Using information on planned construction projects in
In addition, this section would expand
In total, CBO estimates implementing section 241 would cost
Mobile Deployment Teams. Section 233 would require
Podiatrists. Section 202 would add podiatrists to the same pay schedule as physicians and dentists and thereby increase their pay. Currently,
Peer Specialist Program. Section 208 would require that
Demonstration Program on Dental Care. Section 215 would require
Based on the scope of a similar demonstration program operated by HHS, CBO expects that developing and operating the program would require two additional full-time employees at each facility to engage in research, training, and assessment of the program. Based on the costs of similar proposals, CBO expects this program would operate within 10 medical facilities and that the annual cost per staff person would be
CBO expects that the use of alternative dental care providers would increase
In total, implementing section 215 would cost
The program would pay up to the full amount of the medical loans for newly licensed physicians and up to
Coordinated-Care Program. Section 251 would require
Based on
Pay for Perfusionists. Section 203 would increase the maximum salary for perfusionists employed by
Studies, Reports, and Training. S. 2193 would require
By
Section 104 would require that
Starting in 2019 and every 2 years thereafter, section 106 would require that
Other provisions, including sections 108, 121, 122, 123, 201, 207, and 222 would require periodic reports on education and training programs, personnel, telemedicine, and performance awards and bonuses for employees at
Direct spending
S. 2193 would appropriate funds for the Veterans Choice Program and for health care at
Veterans Choice Program. Section 402 would appropriate
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Major
2For more information on the budgetary treatment of third-party financing, see
The facilities are designed and constructed to the unique specifications of the government;
The facilities are constructed at the request of the federal government;
The leases on the newly constructed facilities are long term--usually 20 years;
Payments from the federal government are the only or the primary source of income for the facilities;
The term of the contractual agreements coincides with the term of the private partner's financing instrument for developing and constructing the facility (that is, a facility financed with a 20-year bond will have a 20-year lease term);
The federal government commits to make fixed annual payments that are sufficient to service the debt incurred to develop and construct the facility, regardless of whether the agency continues to occupy the facility during the guaranteed term of the lease; and
The fixed payments over the life of the lease are sufficient to retire the debt for the facility.3
3See testimony of
Thus, although those transactions are structured as leases, they are essentially government purchases. Under the normal procedures governing the budgetary treatment of the purchase of capital assets, budget authority should be available and obligations should be recorded at the time the acquisitions are initiated, and amounts recorded should equal the full development and construction costs of the medical facilities. Instead,
To the extent that the full costs of developing and constructing the facilities exceeds the relatively small amount that
In addition, at the time the contracts are signed,
Section 241 would allow
After reviewing
When the government leases a facility the lessor charges the government for the cost to construct the facility plus interest on those costs over the period it takes to recover them through the lease payments. CBO's estimate of direct spending reflects an amount equal to the cost of constructing the facilities, plus the net present value of the portion of lease costs attributable to interest rates that would exceed
On that present value basis for each lease over the term of the lease agreement, CBO estimates that enacting this provision would increase direct spending by
4A present value is a single number that expresses a flow of past and future income or payments in terms of an equivalent lump sum received or paid today. The value depends on the rate of interest, known as the discount rate, used to translate past and future cash flows into current dollars. CBO calculated costs for the 20-year leases by discounting the expected annual rent payments using the rate on
Shared
Pay-As-You-Go Considerations: The Statutory Pay-As-You-Go Act of 2010 establishes budget-reporting and enforcement procedures for legislation affecting direct spending or revenues. The net changes in outlays that are subject to those pay-as-you-go procedures are shown in Table 4.
Table 4.--CBO Estimate of Pay-As-You-Go Effects of S.2193, The Caring for Our Veterans Act of 2017, as Ordered
Reported by the
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Increase in long-term direct spending and deficits
CBO estimates that enacting the draft bill would not increase net direct spending or on-budget deficits by more than
Mandates
S. 2193 would impose an intergovernmental mandate as defined in UMRA by preempting state laws that prohibit
The bill contains no private-sector mandates as defined in UMRA.
Previous CBO estimates: On
On
On
Estimate prepared by: Federal Costs:
Estimate approved by:
Regulatory Impact Statement
In compliance with paragraph 11(b) of rule XXVI of the Standing Rules of the
Tabulation of Votes Cast in Committee
In compliance with paragraph 7(b) of rule XXVI of the Standing Rules of the
Chairman Isakson called up nineteen amendments to be considered en bloc. The amendments were sponsored by Senators Sullivan, Heller, Cassidy, Rounds, Sanders, Blumenthal, Moran, Tillis, and Brown. The amendments were agreed to by voice vote.
An amendment by
An amendment by
The Committee also discussed amendments sponsored by
The Committee Bill, as amended during the Committee meeting, was agreed to by a roll call vote.
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Agency Reports
On
STATEMENT OF DR.
Good morning, Chairman Isakson, Ranking Member Tester, and Members of the Committee. Thank you for inviting us here today to present our views on several bills that would affect the
There are a number of bills on the agenda today, and we are unable at this time to provide views and cost estimates on a few of these provisions. Specifically, we do not have cost estimates on S. 543 and S. 764.
S. 591--MILITARY AND VETERAN CAREGIVERS SERVICE IMPROVEMENT ACT OF 2017
S. 591 would expand eligibility for
The Caregivers and Veterans Omnibus Health Services Act of 2010, Public Law 111-163, signed into law on
Section 2 of S. 591, the Military and Veteran Caregiver Services Improvement Act of 2017, would remove "on or after
This section would also expand the assistance available to primary family caregivers under the Program of Comprehensive Assistance for Family Caregivers to include child care services, financial planning and legal services "relating to the needs of injured and ill Veterans and their caregivers," and respite care that includes peer-oriented group activities. The bill would ensure that in certain circumstances
Section 2 would also authorize
In
In the report, however,
We wish to make it very clear that
Additionally, before expanding eligibility under the Program, we believe it prudent for
Section 3 of this bill proposes to add a new section 3319A to title 38 to authorize individuals who are eligible for and participating in a program of comprehensive assistance for family caregivers under 38 U.S.C. Sec. 1720G(a) the opportunity to transfer their unused Post-9/11 GI Bill education benefits to their dependents. Veterans may complete the transfer of entitlement any time during the 15-year period beginning on the date of their last discharge or release from active duty. There is no length of service requirement, and the monthly rate of educational assistance would be the same rate payable to the individual making the transfer. The Secretary would be authorized to prescribe regulations to carry out this section. We note that the Survivors' and Dependents' Educational Assistance (DEA) program, or chapter 35, currently offers education and training benefits to eligible dependents of members of the Armed Forces and Veterans who have a service- connected disability rated as permanently and totally disabling, including individuals who are eligible for a program of comprehensive assistance for family caregivers. Assistance includes up to 45 months of full-time benefits.
Additionally, under the proposed section 3319A, dependents would receive the same rate of payment as otherwise payable to the individual making the transfer. This is different than the rate payable for a dependent child using transferred entitlement under section 3319. Currently, a dependent child is awarded benefits as if the individual making the transfer were not on active duty. As such, a child is entitled to the monthly housing allowance stipend even though the individual transferring benefits is still on active duty. Under the proposed legislation, a child would not be eligible for the housing allowance while the individual described in 38 U.S.C. Sec. 1720G(a)(2) is on active duty. This change would impact the Long-Term Solution for processing Post-9/11 GI Bill claims, as
Section 4(a) would amend 37 U.S.C. 439, providing for special compensation for members of the uniformed services with catastrophic injuries or illnesses requiring assistance in everyday living, by amending the definition of covered members to include those Servicemembers who have a serious injury or illness that was incurred or aggravated in the line of duty and are in need of personal care services as a result of such injury or illness. Section 4(b) would further amend section 439 by requiring
Regarding section 4 of the bill,
Section 5 would authorize the
Section 6 would amend the Public Health Service Act (42 U.S.C. Sec. 300ii), which governs lifespan respite care, to amend the definition of "adult with a special need" to include a Veteran participating in the family caregiver program under 38 U.S.C. Sec. 1720G(a). It would also amend the definition of "family caregiver" to include family caregivers under 38 U.S.C. Sec. 1720G. Furthermore, in awarding grants or cooperative agreements to eligible state agencies to furnish lifespan respite care, HHS would be required to work in cooperation with the interagency working group on policies relating to caregivers of Veterans established under section 7 of this bill. Section 6 would also authorize appropriations of
Section 7 would establish an interagency working group on policies relating to caregivers of Veterans and Servicemembers. The working group would be composed of a chairperson selected by the President, and representatives from
We also note several technical concerns with the legislation in terms of the creation of the working group, its role, the potential applicability of the Federal Advisory Committee Act to such a group, and which agency (if any) would be responsible for initiating, managing, and funding the working group. We would be happy to discuss these issues with you upon your request.
Section 8(a) would require
DRAFT--VETERAN PARTNERS' EFFORTS TO ENHANCE REINTEGRATION (PEER) ACT
The draft bill would require the Secretary to phase in and conduct a program whereby peer specialists would be included in patient aligned care teams at VAMCs to promote the use and integration of mental health services in a primary care setting. Not later than 180 days after the date of enactment, this program would have to be established at not fewer than 10 VAMCs. By not later than 2 years from the date of enactment, it would have to be in place at not fewer than 25 VAMCs. Under the bill, the Secretary would be directed to consider specified factors when selecting sites for this program, but, not fewer than five would have to be established at
The bill specifies program participation of female peer specialists. I am pleased to report that women peer specialists are already well represented, with 16.2 percent of the national peer specialist workforce being women. While at first glance 16.2 percent may seem a low rate, please bear in mind that this figure is higher than the percentage of Veterans seeking services through
Also, it is unclear if the peers will address substance use disorders under the umbrella of their mental health duties. Given the comorbidity of these issues, the need for integration of substance use disorder identification and care, the need for overdose prevention and links as needed to Medication Assisted Treatment for opioid use disorders, and the need to increase the numbers of Veterans achieving long-term recovery, we recommend that this be clarified and, if possible, included.
We estimate this bill would cost
Continues with Part 6 of 7
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