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Union Calendar No. 603 106Th Congress, 2D Session –––––––––– House Report 106–1041

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Union Calendar No. 603 106Th Congress, 2D Session –––––––––– House Report 106–1041 1 Union Calendar No. 603 106th Congress, 2d Session –––––––––– House Report 106–1041 ACTIVITIES REPORT of the COMMITTEE ON VETERANS’ AFFAIRS HOUSE OF REPRESENTATIVES ONE HUNDRED SIXTH CONGRESS FIRST SESSION Convened January 6, 1999 Adjourned November 22, 1999 SECOND SESSION Convened January 24, 2000 Adjourned December 15, 2000 JANUARY 2, 2001—Committed to the Committee of the Whole House on the State of the Union and ordered to be printed U.S. GOVERNMENT PRINTING OFFICE 89–006 WASHINGTON : 2001 COMMITTEE ON VETERANS’ AFFAIRS BOB STUMP, Arizona, Chairman CHRISTOPHER H. SMITH, New Jersey LANE EVANS, Illinois MICHAEL BILIRAKIS, Florida BOB FILNER, California FLOYD SPENCE, South Carolina LUIS V. GUTIERREZ, Illinois TERRY EVERETT, Alabama CORRINE BROWN, Florida STEVE BUYER, Indiana MICHAEL F. DOYLE, Pennsylvania JACK QUINN, New York COLLIN C. PETERSON, Minnesota CLIFF STEARNS, Florida JULIA CARSON, Indiana JERRY MORAN, Kansas SILVESTRE REYES, Texas J.D. HAYWORTH, Arizona VIC SNYDER, Arkansas HELEN CHENOWETH-HAGE, Idaho CIRO D. RODRIGUEZ, Texas RAY LA HOOD, Illinois RONNIE SHOWS, Mississippi JAMES V. HANSEN, Utah SHELLEY BERKLEY, Nevada HOWARD P. (BUCK) MCKEON, California BARON P. HILL, Indiana JIM GIBBONS, Nevada TOM UDALL, New Mexico MICHAEL K. SIMPSON, Idaho RICHARD H. BAKER, Louisiana CARL D. COMMENATOR, Chief Counsel and Staff Director SUBCOMMITTEE ON HEALTH CLIFF STEARNS, Florida, Chairman CHRISTOPHER H. SMITH, New Jersey LUIS V. GUTIERREZ, Illinois MICHAEL BILIRAKIS, Florida MICHAEL F. DOYLE, Pennsylvania JERRY MORAN, Kansas COLLIN C. PETERSON, Minnesota HELEN CHENOWETH-HAGE, Idaho JULIA CARSON, Indiana HOWARD P. (BUCK) MCKEON, California VIC SNYDER, Arkansas MICHAEL K. SIMPSON, Idaho CIRO D. RODRIGUEZ, Texas RICHARD H. BAKER, Louisiana RONNIE SHOWS, Mississippi SUBCOMMITTEE ON BENEFITS JACK QUINN, New York, Chairman J.D. HAYWORTH, Arizona BOB FILNER, California RAY LA HOOD, Illinois SILVESTRE REYES, Texas JAMES V. HANSEN, Utah SHELLEY BERKLEY, Nevada JIM GIBBONS, Nevada LANE EVANS, Illinois SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS TERRY EVERETT, Alabama, Chairman BOB STUMP, Arizona CORRINE BROWN, Florida FLOYD SPENCE, South Carolina BARON P. HILL, Indiana STEVE BUYER, Indiana TOM UDALL, New Mexico (II) COMMITTEE STAFF CARL D. COMMENATOR, Chief Counsel and Staff Director PATRICK E. RYAN, Deputy Chief Counsel KINGSTON E. SMITH, General Counsel and Staff Director, Subcommittee on Oversight and Investigations DANIEL G. AMON, Press Secretary JOHN M. BRADLEY, Staff Director, Subcommittee on Health BERNADINE DOTSON, Staff Assistant CHARLES M. DURISHIN, Democratic Staff Director SUSAN C. EDGERTON, Democratic Staff Director, Subcommittee on Health ANN HENDRICKS, Staff Assistant, Subcommittee on Oversight and Investigations WILLIAM T. HOUCHINS, Democratic Professional Staff Member DARRYL W. KEHRER, Staff Director, Subcommittee on Benefits ELIZABETH A. KILKER, Democratic Executive Assistant, Subcommittee on Benefits STEVE KIRKLAND, Systems Administrator ALICEMARY O. LEACH, Investigative Counsel, Subcommittee on Oversight and Investigations MARY ELLEN MC CARTHY, Democratic Professional Staff Member SANDRA K. MCCLELLAN, Democratic Executive Assistant, Subcommittee on Health MARY STEVENS MCDERMOTT, Administrative and Financial Assistant PAIGE E. MCMANUS, Professional Staff Member, Subcommittee on Benefits JEANNE M. MCNALLY, Legislative Coordinator THOMAS A. O’DONNELL, Democratic Professional Staff Member JULIANA B. PERRY, Staff Assistant SARAH A. SHIGLEY, Professional Staff Member, Subcommittee on Health DEBORAH A. SMITH, Democratic Administrative Assistant/Executive Assistant, Subcommittee Oversight and Investigations JEREMIAH B. TAN, Printing Clerk ARTHUR K. WU, Professional Staff Member, Subcommittee on Oversight and Investigations (III) LETTER OF SUBMITTAL HOUSE OF REPRESENTATIVES, COMMITTEE ON VETERANS’ AFFAIRS, Washington, DC, January 2, 2001 Hon. JEFF TRANDAHL, Clerk, House of Representatives, Washington, D.C. DEAR MR. TRANDAHL: In accordance with Clause 1(d) of Rule XI of the Rules of the House of Representatives, I submit herewith the report of the Com- mittee on Veterans’ Affairs setting forth its activities in reviewing and studying the application, administration, and execution of those laws, the subject matter of which is within the jurisdiction of our committee. BOB STUMP, Chairman (V) FOREWORD The 106th Congress made far-reaching improvements to the ben- efit programs serving our Nation’s 24 million veterans. An in- creased focus on meeting veterans’ requests for authorized benefits and services resulted in record numbers of veterans drawing dis- ability compensation or using the VA health care system. Looking toward the future, Congress initiated laws authorizing an expan- sion of VA’s long-term health care system and making the Mont- gomery GI Bill (MGIB) educational assistance program more mean- ingful to entitled veterans seeking broader knowledge or advanced skills. Although much remains to be done, the American people can take pride that important issues have been identified and ad- dressed by the 106th Congress, and that the groundwork has been laid for even greater progress in future Congresses. Almost as important as the design and authorization of programs is the need to examine them and provide the necessary resources to ensure that veterans are served as the Congress intended. While continuing the vigorous oversight that it began by establishing the Subcommittee on Oversight and Investigations in the 105th Con- gress, the VA Committee in the 106th Congress took unprece- dented action to advocate increased funding for veterans programs. At the beginning of the 106th Congress, the Administration sub- mitted a VA budget that proposed to fund veterans medical care at the previous year’s level. After examining the funding needs and shortfalls in the Administration’s budget, the VA Committee rec- ommended a $1.7 billion (9.6 percent) increase in veterans medical care funding for fiscal year 2000 that the Congress ultimately pro- vided. In the second session, Congress approved a further increase of $1.4 billion, so that budget authority for veterans medical care increased by a total of $3.1 billion from $17.8 to $20.9 billion. Out- lays for spending for disability compensation, educational assist- ance and other benefit programs rose by more than $2.3 billion (10 percent) during this Congress. Outlays for veterans medical care spending are projected to rise by another $1.5 billion in fiscal year 2001, for a three-year increase of $3.9 billion (22 percent). The in- creased spending will help to meet the increased demand for VA health care by veterans with service-connected disabilities and those who cannot afford to obtain health care through other means. These amounts would also provide funds requested to implement the health care expansions authorized in the Veterans Millenium Health Care and Benefits Act, Public Law 106–117. The 106th Congress was also confronted with a VA health care system that was attempting to shed its historic role as a provider of long-term care at a time when World War II veterans’ demand for such care is expected to peak. Despite significant improvements (VII) VIII in delivering care on an ambulatory basis, and despite its own pio- neering work in caring for chronically ill, elderly and disabled vet- erans, a long-awaited federal advisory committee report on the fu- ture of VA long-term care failed to address several of the major issues on access and equity which the advisory committee had been charged to study. As a result of the advisory committee’s failure to recommend how to establish priorities and reasonable cost-sharing mechanisms, it fell to Congress to set out fundamental principles for VA long-term care policy. It did so with the enactment of the Veterans Millennium Health Care and Benefits Act. This Act: • Requires the Secretary of Veterans Affairs to operate and maintain extended care programs, to include geriatric evalua- tions, VA and community-based nursing home care, domiciliary care, adult day health care, respite care, and such alternatives to institutional care as the Secretary considers reasonable and appropriate. • Requires the Secretary of Veterans Affairs to maintain na- tionally the level of ‘‘in-house’’ extended care services provided as of September 30, 1998. • Requires the Secretary of Veterans Affairs, through 2003, to provide: (a) needed nursing home care for veterans who are 70 percent service-connected or in need of such care for a serv- ice-connected condition; and (b) veterans who are enrolled for VA care with alternatives to institutionalized care. • Requires the Secretary of Veterans Affairs to establish a co- payment policy applicable to extended care of more than 21 days in a year in the case of care furnished to a veteran who has no compensable service-connected disability, and whose in- come is above the pension level. Additionally, this Act contained a number of other health care policy enhancements, benefit improvements, authorizations and re- quirements. These provisions: • Authorize the Secretary of Veterans Affairs to make pay- ments for emergency care on behalf of uninsured enrolled vet- erans and to require that a veteran has received VA care with- in a two-year period of a medical emergency to be eligible. • Establish a specific eligibility for VA health care for a vet- eran who was awarded the Purple Heart. • Establish a specific eligibility, subject to the terms of a memorandum of understanding between the Department of Defense and
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