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112th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 1st Session                                                    112-235

======================================================================



 
   VETERANS SEXUAL ASSAULT PREVENTION AND HEALTH CARE ENHANCEMENT ACT

                                _______
                                

October 5, 2011.--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. 2074]

      [Including cost estimate of the Congressional Budget Office]

  The Committee on Veterans' Affairs, to whom was referred the 
bill (H.R. 2074) to amend title 38, United States Code, to 
require a comprehensive policy on reporting and tracking sexual 
assault incidents and other safety incidents that occur at 
medical facilities of the Department of Veterans Affairs, 
having considered the same, report favorably thereon with 
amendments and recommend that the bill as amended do pass.

                                CONTENTS

                                                                   Page
Amendment........................................................     2
Purpose and Summary..............................................     5
Background and Need for Legislation..............................     6
Hearings.........................................................    11
Subcommittee Consideration.......................................    11
Committee Consideration..........................................    11
Committee Votes..................................................    12
Committee Oversight Findings.....................................    12
Statement of General Performance Goals and Objectives............    12
New Budget Authority, Entitlement Authority, and Tax Expenditures    12
Earmarks and Tax and Tariff Benefits.............................    13
Committee Cost Estimate..........................................    13
Congressional Budget Office Estimate.............................    13
Federal Mandates Statement.......................................    14
Advisory Committee Statement.....................................    14
Statement of Constitutional Authority............................    14
Applicability to Legislative Branch..............................    14
Section-by-Section Analysis of the Legislation...................    14
Changes in Existing Law Made by the Bill as Reported.............    16

                               Amendment

  The amendments are as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Veterans Sexual Assault Prevention and 
Health Care Enhancement Act''.

SEC. 2. COMPREHENSIVE POLICY ON REPORTING AND TRACKING SEXUAL ASSAULT 
                    INCIDENTS AND OTHER SAFETY INCIDENTS.

  (a) Policy.--Subchapter I of chapter 17 of title 38, United States 
Code, is amended by adding at the end the following:

``Sec. 1709. Comprehensive policy on reporting and tracking sexual 
                    assault incidents and other safety incidents

  ``(a) Policy Required.--Not later than March 1, 2012, the Secretary 
of Veterans Affairs shall develop and implement a centralized and 
comprehensive policy on the reporting and tracking of sexual assault 
incidents and other safety incidents that occur at each medical 
facility of the Department, including--
          ``(1) suspected, alleged, attempted, or confirmed cases of 
        sexual assault, regardless of whether such assaults lead to 
        prosecution or conviction;
          ``(2) criminal and purposefully unsafe acts;
          ``(3) alcohol or substance abuse related acts (including by 
        employees of the Department); and
          ``(4) any kind of event involving alleged or suspected abuse 
        of a patient.
  ``(b) Scope.--The policy required by subsection (a) shall cover each 
of the following:
          ``(1) For purposes of reporting and tracking sexual assault 
        incidents and other safety incidents, definitions of the 
        terms--
                  ``(A) `safety incident';
                  ``(B) `sexual assault'; and
                  ``(C) `sexual assault incident'.
          ``(2) The development and use of specific risk-assessment 
        tools to examine any risks related to sexual assault that a 
        veteran may pose while being treated at a medical facility of 
        the Department, including clear and consistent guidance on the 
        collection of information related to--
                  ``(A) the legal history of the veteran; and
                  ``(B) the medical record of the veteran.
          ``(3) The mandatory training of employees of the Department 
        on security issues, including awareness, preparedness, 
        precautions, and police assistance.
          ``(4) The mandatory implementation, use, and regular testing 
        of appropriate physical security precautions and equipment, 
        including surveillance camera systems, computer-based panic 
        alarm systems, stationary panic alarms, and electronic portable 
        personal panic alarms.
          ``(5) Clear, consistent, and comprehensive criteria and 
        guidance with respect to an employee of the Department 
        communicating and reporting sexual assault incidents and other 
        safety incidents to--
                  ``(A) supervisory personnel of the employee at--
                          ``(i) a medical facility of the Department;
                          ``(ii) an office of a Veterans Integrated 
                        Service Network; and
                          ``(iii) the central office of the Veterans 
                        Health Administration; and
                  ``(B) a law enforcement official of the Department.
          ``(6) Clear and consistent criteria and guidelines with 
        respect to an employee of the Department referring and 
        reporting to the Office of Inspector General of the Department 
        sexual assault incidents and other safety incidents that meet 
        the regulatory criminal threshold in accordance with section 
        1.201 and 1.204 of title 38, Code of Federal Regulations.
          ``(7) An accountable oversight system within the Veterans 
        Health Administration that includes--
                  ``(A) systematic information sharing of reported 
                sexual assault incidents and other safety incidents 
                among officials of the Administration who have 
                programmatic responsibility; and
                  ``(B) a centralized reporting, tracking, and 
                monitoring system for such incidents.
          ``(8) Consistent procedures and systems for law enforcement 
        officials of the Department with respect to investigating, 
        tracking, and closing reported sexual assault incidents and 
        other safety incidents.
          ``(9) Clear and consistent guidance for the clinical 
        management of the treatment of sexual assaults that are 
        reported more than 72 hours after the assault.
  ``(c) Updates to Policy.--The Secretary shall review and revise the 
policy required by subsection (a) on a periodic basis as the Secretary 
considers appropriate and in accordance with best practices.
  ``(d) Annual Report.--(1) Not later than 60 days after the date on 
which the Secretary develops the policy required by subsection (a), and 
by not later than October 1 of each year thereafter, the Secretary 
shall submit to the Committee on Veterans' Affairs of the House of 
Representatives and the Committee on Veterans' Affairs of the Senate a 
report on the implementation of the policy.
  ``(2) The report under paragraph (1) shall include--
          ``(A) the number and type of sexual assault incidents and 
        other safety incidents reported by each medical facility of the 
        Department;
          ``(B) a detailed description of the implementation of the 
        policy required by subsection (a), including any revisions made 
        to such policy from the previous year; and
          ``(C) the effectiveness of such policy on improving the 
        safety and security of the medical facilities of the 
        Department, including the performance measures used to evaluate 
        such effectiveness.
  ``(e) Regulations.--The Secretary shall prescribe regulations to 
carry out this section.''.
  (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by adding after the item relating to section 
1708 the following:

``1709. Comprehensive policy on reporting and tracking sexual assault 
incidents and other safety incidents.''.

  (c) Interim Report.--Not later than 30 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall submit 
to the Committee on Veterans' Affairs of the House of Representatives 
and the Committee on Veterans' Affairs of the Senate a report on the 
development of the performance measures described in section 
1709(d)(2)(C) of title 38, United States Code, as added by subsection 
(a).

SEC. 3. INCREASED FLEXIBILITY IN ESTABLISHING PAYMENT RATES FOR NURSING 
                    HOME CARE PROVIDED BY STATE HOMES.

  (a) In General.--Section 1745(a) of title 38, United States Code, is 
amended--
          (1) in paragraph (1), by striking ``The Secretary shall pay 
        each State home for nursing home care at the rate determined 
        under paragraph (2)'' and inserting ``The Secretary shall enter 
        into a contract (or agreement under section 1720(c)(1) of this 
        title) with each State home for payment by the Secretary for 
        nursing home care provided in the home''; and
          (2) by striking paragraph (2) and inserting the following new 
        paragraph (2):
  ``(2) Payment under each contract (or agreement) between the 
Secretary and a State home under paragraph (1) shall be based on a 
methodology, developed by the Secretary in consultation with the State 
home, to adequately reimburse the State home for the care provided by 
the State home under the contract (or agreement).''.
  (b) Effective Date.--The amendment made by subsection (a) shall apply 
to care provided on or after January 1, 2012.

SEC. 4. REHABILITATIVE SERVICES FOR VETERANS WITH TRAUMATIC BRAIN 
                    INJURY.

  (a) Rehabilitation Plans and Services.--Section 1710C of title 38, 
United States Code, is amended--
          (1) in subsection (a)(1), by inserting before the semicolon 
        the following: ``with the goal of maximizing the individual's 
        independence'';
          (2) in subsection (b)--
                  (A) in paragraph (1)--
                          (i) by inserting ``(and sustaining 
                        improvement in)'' after ``improving'';
                          (ii) by inserting ``behavioral,'' after 
                        ``cognitive,'';
                  (B) in paragraph (2), by inserting ``rehabilitative 
                services and'' before ``rehabilitative components''; 
                and
                  (C) in paragraph (3)--
                          (i) by striking ``treatments'' the first 
                        place it appears and inserting ``services''; 
                        and
                          (ii) by striking ``treatments and'' the 
                        second place it appears; and
          (3) by adding at the end the following new subsection:
  ``(h) Rehabilitative Services Defined.--For purposes of this section, 
and sections 1710D and 1710E of this title, the term `rehabilitative 
services' includes--
          ``(1) rehabilitative services, as defined in section 1701 of 
        this title;
          ``(2) treatment and services (which may be of ongoing 
        duration) to sustain, and prevent loss of, functional gains 
        that have been achieved; and
          ``(3) any other rehabilitative services or supports that may 
        contribute to maximizing an individual's independence.''
  (b) Rehabilitation Services in Comprehensive Program for Long-term 
Rehabilitation.--Section 1710D(a) of title 38, United States Code, is 
amended--
          (1) by inserting ``and rehabilitative services (as defined in 
        section 1710C of this title)'' after ``long-term care''; and
          (2) by striking ``treatment''.
  (c) Rehabilitation Services in Authority for Cooperative Agreements 
for Use of Non-Department Facilities for Rehabilitation.--Section 
1710E(a) of title 38, United States Code, is amended by inserting ``, 
including rehabilitative services (as defined in section 1710C of this 
title),'' after ``medical services''.
  (d) Technical Amendment.--Section 1710C(c)(2)(S) of title 38, United 
States Code, is amended by striking ``opthamologist'' and inserting 
``ophthalmologist''.

SEC. 5. USE OF SERVICE DOGS ON PROPERTY OF THE DEPARTMENT OF VETERANS 
                    AFFAIRS.

  Section 901 of title 38, United States Code, is amended by adding at 
the end the following new subsection:
  ``(f) The Secretary may not prohibit the use of service dogs in any 
facility or on any property of the Department or in any facility or on 
any property that receives funding from the Secretary.''.

SEC. 6. DEPARTMENT OF VETERANS AFFAIRS PILOT PROGRAM ON DOG TRAINING 
                    THERAPY.

  (a) In General.--Commencing not later than 120 days after the date of 
the enactment of this Act, the Secretary of Veterans Affairs shall 
implement a three-year pilot program for the purpose of assessing the 
effectiveness of using dog training activities as a component of 
integrated post-deployment mental health and post-traumatic stress 
disorder rehabilitation programs at Department of Veterans Affairs 
medical centers to positively affect veterans with post-deployment 
mental health conditions and post-traumatic stress disorder symptoms 
and to produce specially trained dogs that meet criteria for becoming 
service dogs for veterans with disabilities.
  (b) Location of Pilot Program.--The pilot program shall be carried 
out at between one and three Department of Veterans Affairs medical 
centers selected by the Secretary for such purpose. In selecting 
medical centers for the pilot program, the Secretary shall--
          (1) ensure that each medical center selected--
                  (A) has an established mental health rehabilitation 
                program that includes a clinical focus on 
                rehabilitation treatment of post-deployment mental 
                health conditions and post-traumatic stress disorder; 
                and
                  (B) has a demonstrated capability and capacity to 
                incorporate service dog training activities into the 
                rehabilitation program; and
          (2) shall review and consider using recommendations published 
        by Assistance Dogs International, International Guide Dog 
        Federation, or comparably recognized experts in the art and 
        science of basic dog training with regard to space, equipments, 
        and methodologies.
  (c) Design of Pilot Program.--In carrying out the pilot program, the 
Secretary shall--
          (1) administer the program through the Department of Veterans 
        Affairs Patient Care Services Office as a collaborative effort 
        between the Rehabilitation Office and the Office of Mental 
        Health Services;
          (2) ensure that the national pilot program lead of the 
        Patient Care Services Office has sufficient administrative 
        experience to oversee all pilot program sites;
          (3) establish partnerships through memorandums of 
        understanding with Assistance Dog International organizations, 
        International Guide Dog Federation organizations, academic 
        affiliates, or organizations with equivalent credentials with 
        experience in teaching others to train service dogs for the 
        purpose of advising the Department of Veterans Affairs 
        regarding the design, development, and implementation of pilot 
        program;
          (4) ensure that each pilot program site has obtained a 
        service dog training instructor certified by Assistance Dog 
        International, International Guide Dog Federation, or an 
        organization with equivalent credentials to oversee service dog 
        training activities;
          (5) ensure that dogs selected for use in the program meet all 
        health clearance, age, and temperament criteria as outlined by 
        Assistance Dog International, International Guide Dog 
        Federation, or an organization with equivalent credentials and 
        the Centers for Disease Control and Prevention;
          (6) consider dogs residing in animal shelters or foster homes 
        for participation in the program if such dogs meet the 
        selection criteria under this subsection; and
          (7) ensure that each dog selected for the program is taught 
        all basic commands and behaviors essential to being accepted by 
        an accredited service dog training organization to be partnered 
        with a disabled veteran for final individualized service dog 
        training tailored to meet the needs of the veteran.
  (d) Veteran Participation.--A veteran diagnosed with post-traumatic 
stress disorder or another post-deployment mental health condition may 
volunteer to participate in the pilot program required by subsection 
(a) and may participate in the program if the Secretary determines that 
adequate program resources are available for such veteran to 
participate at the pilot program site.
  (e) Hiring Preference.--In selecting service dog training instructors 
for the pilot program, the Secretary shall give a preference to a 
veteran who successfully completed a post-traumatic stress disorder or 
other residential treatment program and who has received certification 
in service dog training from an Assistance Dog International or 
International Guide Dog Federation accredited program.
  (f) Collection of Data.--The Secretary shall collect data on the 
pilot program to determine the effectiveness of the program in 
positively affecting veterans with post-traumatic stress disorder or 
other post-deployment mental health conditions and the potential for 
expanding the program to additional Department of Veterans Affairs 
medical centers. Such data shall be collected and analyzed using valid 
and reliable methodologies and instruments.
  (g) Reports to Congress.--
          (1) Annual reports.--Not later than one year after the date 
        of the commencement of the pilot program, and annually 
        thereafter for the duration of the pilot program, the Secretary 
        shall submit to Congress a report on the pilot program. Each 
        such report shall include--
                  (A) the number of veterans participating in the pilot 
                program;
                  (B) a description of the services carried out by the 
                Secretary under the pilot program;
                  (C) the effects that participating in the pilot 
                program has on veterans with post-traumatic stress 
                disorder and post-deployment mental health conditions;
          (2) Final report.--At the conclusion of pilot program, the 
        Secretary shall submit to Congress a final report that includes 
        recommendations with respect to the extension or expansion of 
        the pilot program.
  (h) Definition.--For the purposes of this section, the term ``service 
dog training instructor'' means an instructor recognized by an 
accredited dog organization training program who provides hands-on 
training in the art and science of service dog training and handling.

  Amend the title so as to read:

    A bill to amend title 38, United States Code, to require a 
comprehensive policy on reporting and tracking sexual assault 
incidents and other safety incidents that occur at medical 
facilities of the Department of Veterans Affairs, to improve 
rehabilitative services for veterans with traumatic brain 
injury, and for other purposes.

                          Purpose and Summary

    H.R. 2074, the Veterans Sexual Assault Prevention Act, was 
introduced by Representative Ann Marie Buerkle of New York, the 
Chairwoman of the Subcommittee on Health of the Committee on 
Veterans' Affairs, on June 1, 2011. In addition to H.R. 2074, 
the amended version of H.R. 2074 reflects the Committee's 
consideration of several bills introduced during the 112th 
Congress, including: H.R. 1855, the Veterans Traumatic Brain 
Injury Rehabilitative Services Act of 2011, introduced by the 
Honorable Timothy J. Walz of Minnesota; H.R. 2530, to amend 
title 38 United States Code (U.S.C.) to provide increased 
flexibility in establishing rates for reimbursement of State 
Homes by the Secretary of the Department of Veterans Affairs 
(VA) for nursing home care provided to veterans, introduced by 
the Honorable Michael Michaud of Maine; H.R. 1154, the Veterans 
Equal Treatment for Service Dogs (VETS Dogs) Act, introduced by 
the Honorable John Carter of Texas; and, H.R. 198, the Veterans 
Dog Training Therapy Act, introduced by the Honorable Michael 
Grimm of New York.
    H.R. 2074, as amended, the Veterans Sexual Assault 
Prevention and Health Care Enhancement Act, would: (1) require 
VA to establish a comprehensive policy on the reporting and 
tracking of sexual assault and other safety incidents at VA 
medical facilities and require a report on said policy 60 days 
after initial implementation and annually thereafter; (2) 
require VA to enter into a contract or agreement with each 
State Veterans Home (SVH) for payment of nursing home care 
provided to veterans with a service-connected disability rated 
at 70 percent or greater or in need of such care because of a 
service-connected condition; (3) include the goal of maximizing 
independence and improving behavioral and mental health 
functioning within a program of individualized rehabilitation 
and reintegration for veterans with traumatic brain injury 
(TBI) and require rehabilitative services be included within VA 
comprehensive programs of long-term care for veterans with TBI; 
(4) clarify the access rights of service dogs on VA property 
and in VA facilities; and, (5) direct VA to carry out a three 
year pilot program in one to three VA medical centers (VAMCs) 
for the purpose of assessing the effectiveness of addressing 
post deployment mental health and post traumatic stress 
disorder (PTSD) symptoms through service dog training therapy.

                  Background and Need for Legislation


Section 2--Comprehensive policy regarding sexual assault and other 
        safety incidents

    VA operates inpatient mental health units in 111 VAMCs to 
provide intensive treatment to veterans with acute mental 
health needs. These are generally locked units with 24-hour 
supervision intended to stabilize mentally-ill veterans for 
transfer to less intensive levels of care. In some cases, the 
less intensive level of care may be a VA residential program. 
VA operates 237 residential programs in 104 VA medical 
facilities. Designated as residential rehabilitation treatment 
programs, domiciliary programs, or compensated work therapy/
transitional residence programs, VA's residential programs 
provide rehabilitative and clinical care to veterans with a 
variety of mental health conditions.
    Serious concerns about the safety of patients in VA 
residential programs were brought to the attention of the 
Government Accountability Office (GAO) during an investigation 
into services available to female veterans accessing VA health 
care. As a result of these concerns and at the request of 
Chairman Jeff Miller and Ranking Member Bob Filner, GAO 
initiated an investigation into sexual assault and other safety 
incidents at VA medical facilities. On June 7, 2011, GAO 
published the findings of that investigation in a report 
entitled, VA HEALTH CARE: Actions Needed to Prevent Sexual 
Assault and Other Safety Incidents, GAO-11-530.
    In analyzing VA's national police files from January 2007 
through July 2010, GAO identified 284 incidents of alleged 
sexual assault. Included in that total are 67 incidents of 
alleged rape, 185 incidents of alleged inappropriate touching, 
8 incidents of alleged forceful medical examinations, 13 
incidents of alleged forced or inappropriate oral sex, and 11 
other alleged sexual assaults. There were 89 allegations of 
patient-on-patient sexual assaults, 85 allegations of patient-
on-employee sexual assaults, 46 allegations of employee-on-
patient sexual assaults, 28 allegations of persons-with-
unknown-affiliation-on patient sexual assaults, 15 allegations 
of employee-on-employee sexual assaults, and 21 other 
allegations of sexual assault involving patients, employees, 
visitors, and outsiders.
    GAO found that many of the sexual assault incidents 
reported to the VA police were not reported to VA leadership 
officials and/or the VA Office of the Inspector General (OIG), 
as required by VA regulation.
    GAO identified several factors that contribute to the 
underreporting of sexual assault incidents including the lack 
of a: (1) consistent definition of sexual assault; (2) clear 
and comprehensive criteria for communicating and reporting 
sexual assault incidents at each level of VA leadership; (3) 
centralized reporting, tracking and monitoring system; (4) 
satisfactory and operable physical security precaution system; 
and, (5) proper and centralized VA leadership oversight 
mechanism.
    To correct these deficiencies, GAO recommended VA improve 
the reporting and monitoring of sexual assault and other safety 
incidents and the tools used to identify risk and address 
vulnerabilities at VA facilities by: ensuring a consistent 
definition for reporting purposes; clarifying expectations 
about the reporting of sexual assault incidents; implementing a 
centralized tracking system to monitor sexual assault 
incidents; developing an automated mechanism within the VA 
police reporting system, establishing guidance on legal history 
discussions; ensuring effective panic alarm systems; and 
requiring stakeholder input on plans for new and renovated 
units and changes to physical security features in existing 
units.
    Section 2 of the bill would address the safety 
vulnerabilities, security weaknesses, and oversight failures 
identified by GAO and result in a fundamentally safer VA health 
care system for VA patients and employees alike by requiring VA 
to establish a comprehensive policy on reporting and tracking 
sexual assault and other safety incidents at VA medical 
facilities by no later than March 1, 2012. It would mandate 
that the policy include the: (1) development of clear and 
comprehensive criteria with respect to the reporting of sexual 
assault incidents and other safety incidents for both clinical 
personnel and law enforcement personnel; (2) establishment of 
an accountable oversight system within VA to report and track 
sexual assault incidents for all alleged or suspected forms of 
abuse and unsafe acts; (3) systematic information sharing of 
reported sexual assault incidents, and a centralized reporting, 
tracking, and monitoring system to ensure each case is fully 
investigated and victims receive appropriate treatment; (4) use 
of specific ``risk assessment tools'' to examine any danger 
related to sexual assault that a veteran may pose while being 
treated, including clear guidance on the collection of 
information relating to the legal history of the veteran; (5) 
mandatory training of employees on safety awareness and 
security; and, (6) establishment of physical security 
precautions including appropriate surveillance and panic alarm 
systems that are operable and regularly tested. It would also 
require a report on said policy no later than 60 days after 
implementation and by October 1 of each subsequent year.

Section 3--Increased flexibility in establishing payment rates for 
        nursing home care provided by State Veterans Homes

    The Veterans Millennium Health Care and Benefits Act, 
Public Law (P.L.) 106-117, 113 Stat. 1545, requires VA to 
provide nursing home care to certain qualified veterans, 
including those veterans with a service-connected disability 
rated at 70 percent or greater or requiring nursing home care 
because of a service-connected condition.
    The VA nursing home program provides institutional long 
term care for such qualified veterans in various settings 
including VA owned and operated Community Living Centers, 
contract purchased care in Community Nursing Homes, and State 
Veterans Homes (SVHs).
    SVHs are characterized by a long-standing partnership 
between VA and the States to provide long-term care to veterans 
through a joint cost-sharing agreement. Veterans may choose to 
seek care in a SVH and, although VA may refer patients to SVHs, 
it does not control eligibility criteria.
    Prior to the enactment of the Veterans Benefits, Health 
Care, and Information Technology Act of 2006, P.L. 109-461, 120 
Stat. 3403, VA could only pay one per diem rate for care in a 
SVH. This per diem amounted to approximately one-third of the 
total cost of care. VA could not pay the full cost of care for 
a veteran in a SVH, even if that veteran qualified for VA-paid 
nursing home care under the Veterans Millenium Health Care and 
Benefits Act, P.L. 106-117. However, VA would pay the full cost 
of care for that veteran in a VA or community nursing home.
    P.L. 109-461 included a provision requiring VA to pay SVHs 
a new rate for these veterans: the lesser of a prevailing rate 
determined by VA or the actual cost of care in the SVH. This 
provision is known as the ``70% program.''
    The 70% program was meant to provide equity of access to VA 
resources for qualified veterans residing in SVHs. However, 
after implementation of the 70% program, some states and 
individual SVHs began reporting that it resulted in lower total 
payments to SVHs because of the inability to bill other payers 
for care and, therefore, was threatening their financial 
viability and ability to admit the veterans who qualified under 
the 70% program.
    Section 3 of the bill would resolve the unintended issues 
created by P.L. 109-461 by allowing for greater flexibility in 
VA payments to SVHs under the 70% program by requiring VA to 
enter into a contract or agreement separately with each SVH 
based on the particular needs of the veteran population in a 
given SVH.

Section 4--Rehabilitative services for veterans with traumatic brain 
        injury (TBI)

    Approximately 1.3 million Operation Enduring Freedom (OEF), 
Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) 
veterans have left active duty and become eligible for VA 
health care. According to VA, as of FY 2010, 45,606 wounded 
warriors have been diagnosed with TBI-related conditions.
    Current law governing rehabilitative care for veterans with 
TBI within VA, which is codified in sections 1710C and 1710D of 
title 38, U.S.C. These sections direct VA to provide 
comprehensive care in accord with individualized rehabilitation 
plans to veterans with TBI. Although these sections of law do 
not provide a definition of the word ``rehabilitation,'' the 
phrase ``rehabilitative services'' is defined in section 
1701(8) of title 38, U.S.C. for VA health-care purposes as 
``such professional, counseling, and guidance services and 
treatment programs as are necessary to restore, to the maximum 
extent possible, the physical, mental, and psychological 
functioning of an ill or disabled person.''
    Concerns have been raised that VA has interpreted the law 
as limited only to those services that restore function. By 
limiting rehabilitative care in such a manner, individuals with 
TBI may risk losing out on therapy that may prove vital in 
maintaining physical, cognitive, and other progress. Further, 
they may risk losing out on services necessary for a successful 
reintegration into community and civilian life but which fall 
outside of a strictly medical model.
    Section 4 of the bill recognizes the unique responsibility 
we owe to those suffering from TBI, especially those who may 
experience a lifetime of cognitive and neurological impairment, 
to ensure that institutional barriers do not stand in the way 
of those rehabilitative services needed to achieve and maintain 
maximum health and well-being. It would clarify current law to 
require that VA's responsibilities in providing rehabilitative 
care to veterans with TBI include the goal of maximizing 
independence and improving behavioral and mental health 
functioning within a program of individualized rehabilitation 
and reintegration for veterans with TBI and also include 
rehabilitative services within VA comprehensive programs of 
long-term care for veterans with TBI. This would ensure that 
rehabilitative services are directed not simply to ``improving 
functioning'' but also to sustaining improvement and preventing 
loss of functional gains and, further, are not limited only to 
services provided by health professionals but also include 
other services or supports that contribute to maximizing the 
veteran's independence.

Section 5--Use of service dogs on property of the Department of 
        Veterans Affairs

    Regulations regarding veterans and members of the public 
who enter Veterans Health Administration (VHA) facilities or 
properties accompanied by a guide dog are found within 38 Code 
of Federal Regulations (CFR), Part 1, 1.218 (a)(11), which 
states that, ``[d]ogs and other animals, except seeing-eye 
dogs, shall not be brought upon property except as authorized 
by the head of the facility or designee.''
    This regulation was last updated in July of 1985 and does 
not address the access rights of trained service dogs. Service 
dogs, which are classified by VA as a prosthetic appliance and 
are provided to veterans through the VA Prosthetics and Sensory 
Aid Service, have a significant role in maintaining 
functionality and promoting maximum independence of veterans 
with disabilities. However, as a result of current regulation, 
disabled veterans may be denied entrance to VA medical 
facilities if accompanied by their VA-approved service dog.
    There has been growing frustration among veterans and 
veterans service organizations about VA's outdated regulation 
and the access rights of service dogs on VA campuses.
    As a result, VA issued VHA Directive 2011-013 on March 10, 
2011, requiring all VHA facilities to have a written policy on 
access for guide and service dogs that directs both veterans 
and members of the public with disabilities who require the 
assistance of a trained guide or service dog be authorized to 
enter VHA facilities and property accompanied by that trained 
guide or service dog consistent with the same terms and 
conditions, and subject to the same regulations, that govern 
the admission of members of the public to the property.
    Section 5 of the bill would eliminate any inconsistencies 
between VA policy and practice and better fit the needs of 
today's veterans who rely on service dogs for needed aid and 
assistance by amending current law to mandate that service dogs 
have access to any VA facility consistent with the same terms 
and conditions, and subject to the same regulations, as 
generally govern the admittance of guide dogs to VA property.

Section 6--Pilot program on dog training therapy

    Considerable attention has been given in recent years to 
the ``invisible wounds of war'' including mental health 
illnesses such as PTSD. Perhaps the most widely recognized 
mental health issue affecting veterans, PTSD is a severe 
anxiety disorder that can develop after exposure to a traumatic 
event in which grave physical harm occurred or was threatened. 
Given the prevalence of PTSD among our veteran population, 
Congress has recognized the need to provide veterans seeking 
treatment for mental health issues with newer and more 
innovative modes of therapy. In that vein, the Conference 
Report (H. Rept. 111-366) that accompanied the Consolidated 
Appropriations Act, 2010 (P.L. 111-117, 123 Stat. 3034) 
included the recommendation that VA ``expand its partnership 
with accredited nonprofit service dog organizations where 
veterans with PTSD help to train service dogs.''
    Currently, there are therapy dog training programs in use 
at the VA Palo Alto Health Care System in Palo Alto, 
California, and the National Intrepid Center of Excellence in 
Bethesda, Maryland, reporting positive and promising outcomes. 
In each of the above programs, training service dogs for fellow 
veterans is believed to help address symptoms associated with 
post-deployment mental health issues and PTSD. Veterans 
participating in the programs have demonstrated improved 
emotional regulation, sleep patterns, and sense of personal 
safety. They also experienced reduced levels of anxiety and 
social isolation. Further, participation in the pilot enabled 
them to actively instill or re-establish a sense of purpose and 
meaning while also providing an opportunity to help fellow 
veterans and reintegrate healthfully back into the community. 
However, despite the anecdotal evidence of the therapeutic 
benefit of service dog training on veterans with mental health 
issues and PTSD, there is a serious dearth of scientific 
research on the value of such programs.
    Section 6 of the bill would enable VA to reach more 
veterans with this innovative treatment model by requiring VA 
to conduct a three-year pilot program for the purpose of 
assessing the effectiveness of addressing post-deployment 
mental health and PTSD symptoms through a therapeutic medium of 
service dog training therapy. The pilot program would have the 
added benefit of providing a career path to veterans who 
successfully graduate from the program and are interested in 
becoming certified dog trainers.

                                Hearings

    On July 25, 2011, the Subcommittee on Health held a 
legislative hearing on various bills introduced during the 
112th Congress, including H.R. 2074, H.R. 1855, H.R. 2530, H.R. 
1154, and H.R. 198. The following witnesses testified:
    The Honorable Michael G. Grimm of New York; the Honorable 
John R. Carter of Texas, the Honorable Timothy J. Walz of 
Minnesota; the Honorable Larry Bucshon of Indiana; Shane 
Barker, Senior Legislative Associate, National Veterans 
Service, Veterans of Foreign Wars of the United States; Joy J. 
Ilem, Deputy National Legislative Director, Disabled American 
Veterans; Thomas J. Berger, Ph.D., Executive Director, Veterans 
Health Council, Vietnam Veterans of America; Carl Blake, 
National Legislative Director, Paralyzed Veterans of America; 
Christina M. Roof, National Acting Legislative Director, 
AMVETS; and Robert L. Jesse, M.D., Ph.D., Principal Deputy 
Under Secretary for Health, Veterans Health Administration, 
U.S. Department of Veterans Affairs. Individuals and 
organizations submitting statements for the record included: 
the Honorable Scott R. Tipton of Colorado; America's VetDogs; 
National Association of State Veterans Homes; Paws for Purple 
Hearts; Pets2Vets; Service Women's Action Network; VetsFirst, a 
Program of United Spinal Association; and, the Wounded Warrior 
Project.

                       Subcommittee Consideration

    On July 28 2011, the Subcommittee on Health met in an open 
markup session, a quorum being present, and favorably reported 
the following to the Full Committee: H.R. 1154, the ``Veterans 
Equal Treatment for Service Dogs Act;'' H.R. 1855, as amended, 
the ``Veterans'' Traumatic Brain Injury Rehabilitative 
Services' Improvements Act of 2011;'' H.R. 2074 the ``Veterans 
Sexual Assault Prevention Act;'' and H.R. 2530, a bill to amend 
title 38, U.S.C. to provide increased flexibility in 
establishing rates for reimbursement of State homes by the 
Secretary of the Department of Veterans Affairs for nursing 
home care provided to veterans.

                        Committee Consideration

    On September 8, 2011, the full Committee met in an open 
markup session, a quorum being present. Ms. Buerkle offered an 
amendment in the nature of a substititute to H.R. 2074 which 
would combine the contents of H.R. 2074, H.R. 2530, H.R. 1855, 
H.R. 1154, and H.R. 198 and insert a provision eliminating the 
statutory requirement that VA reimburse any full-time board-
certified physician or dentist for expenses incurred, up to 
$1,000 per year, for continuing professional education. Mr. 
McNerney of California offered an amendment to the amendment in 
the nature of a substitute to H.R. 2074 to strike the last 
provision regarding continuing professional education. The 
amendment was adopted and H.R. 2074, as amended, was 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. 
The Honorable Mr. Filner of California requested a recorded 
vote on adoption of the amendment to the amendment in the 
nature of a substitute to H.R. 2074; the recorded vote was 11 
Members voting in favor of adoption, 9 Members voting in 
opposition. The following table reflects the vote:

------------------------------------------------------------------------
             Name                  Yea/Aye       Nay/No         Notes
------------------------------------------------------------------------
Mr. Miller, FL, Chairman......  ............            X   ............
Mr. Bilirakis, FL, Vice         ............            X   ............
 Chairman.....................
Mr. Stearns, FL...............  ............  ............       Absent
Mr. Lamborn, CO...............  ............            X   ............
Mr. Roe, TN...................            X   ............  ............
Mr. Stutzman, IN..............  ............            X   ............
Mr. Flores, TX................  ............            X   ............
Mr. Johnson, OH...............  ............            X   ............
Mr. Denham, CA................  ............  ............       Absent
Mr. Runyan, NJ................  ............            X   ............
Mr. Benishek, MI..............            X   ............  ............
Ms. Buerkle, NY...............  ............            X   ............
Mr. Huelskamp, KS.............  ............            X   ............

Mr. Filner, CA................            X   ............  ............
Ms. Brown, FL.................  ............  ............       Absent
Mr. Reyes, TX.................  ............  ............       Absent
Mr. Michaud, ME...............            X   ............  ............
Ms. Sanchez, CA...............            X   ............  ............
Mr. Braley, IA................            X   ............  ............
Mr. McNerney, CA..............            X   ............  ............
Mr. Donnelly, IN..............            X   ............  ............
Mr. Walz, MN..................            X   ............  ............
Mr. Barrow, GA................            X   ............  ............
Mr. Carnahan, MO..............            X   ............  ............
                               -----------------------------------------
    Total.....................           11             9   ............
------------------------------------------------------------------------

    A motion by the Honorable Gus Bilirakis of Florida to order 
H.R. 2074, as amended, reported 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. 2074, 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. 
2074, 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. 2074, 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 23, 2011.
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. 2074, the Veterans 
Sexual Assault Prevention and Health Care Enhancement Act.
    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. 2074--Veterans Sexual Assault Prevention and Health Care 
        Enhancement Act

    H.R. 2074 would require the Department of Veterans Affairs 
(VA) to develop a comprehensive policy for tracking and 
reporting sexual assault incidents and make other changes to 
health care services. In total, CBO estimates that implementing 
the bill would have discretionary costs of $1 million over the 
2012-2016 period, assuming the availability of appropriated 
funds. Enacting this legislation would not affect direct 
spending or revenues; therefore, pay-as-you-go procedures do 
not apply.
    Section 2 would require VA to prepare and implement a 
comprehensive policy on tracking and reporting sexual assault 
incidents and other safety incidents. VA has already begun to 
address most of the requirements of this section. It has 
established a multidisciplinary workgroup to assess the actions 
necessary to prevent sexual assault incidents and improve 
response to reported incidents. CBO estimates that the costs 
associated with preparing and distributing the required annual 
reports would amount to less than $500,000 over the 2012-2016 
period, assuming the availability of appropriated funds.
    Section 6 would require VA to establish a pilot program 
through which veterans diagnosed with post-traumatic stress 
disorder or other mental health conditions would train service 
dogs for use by disabled veterans. The pilot program would 
operate for three years in one to three VA medical centers and 
require one certified dog trainer at each facility. Based on a 
similar program at the VA facility in Palo Alto, California, 
CBO estimates that each facility would train five service dogs 
every two years. CBO estimates that running the pilot program 
would cost $1 million over the 2012-2016 period, assuming 
appropriation of the necessary amounts.
    H.R. 2074 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act. States 
that provide nursing home care to eligible veterans would be 
required to comply with a new payment structure in order to 
receive federal reimbursement. Any costs to those governments 
would be incurred voluntarily as a condition of federal 
assistance.
    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. 2074, 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. 
2074, 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.

             Section-by-Section Analysis of the Legislation


Section 1. Short title

    This section provides the short title of H.R. 2074, as 
amended, as the ``Veterans Sexual Assault Prevention and Health 
Care Enhancement Act.''

Section 2. Comprehensive policy on reporting and tracking sexual 
        assault incidents and other safety incidents

    Section 2(a) of the bill would amend Subchapter I of 
chapter 17 of title 38, U.S.C., to require a comprehensive 
policy on the reporting and tracking of sexual assault 
incidents and other safety incidents by not later than March 1, 
2012.
    Section 2(b) of the bill would amend the table of sections 
at the beginning of chapter 17 of title 38, U.S.C., to include 
an item relating to the creation of section 1709 in Section 
2(a) of the bill.
    Section 2(c) of the bill would require VA to submit an 
interim report on the development of performance measures added 
by subsection 2(a) of the bill to the Committee on Veterans' 
Affairs of both the House of Representatives and the Senate, 
not later than 30 days after the date of enactment of this Act.

Section 3. Increased flexibility in establishing payment rates for 
        nursing home care provided by state homes

    Section 3(a) of the bill would amend section 1745(a) of 
title 38, U.S.C., by striking the requirement that VA pay each 
State home for nursing home care at a prescribed rate and 
inserting a requirement for VA to enter into a contract (or 
agreement under section 1720 of the same title) with each State 
home for payment by VA for nursing home care provided in the 
home and by inserting a paragraph requiring payment under each 
contract to be based on methodology to adequately reimburse the 
State home for the care provided under the contract.
    Section 3(b) of the bill would require the amendment under 
subsection (a) of the bill to apply to care provided on or 
after January 1, 2012.

Section 4. Rehabilitative services for Veterans with Traumatic Brain 
        Injury

    Section 4(a) of the bill would amend section 1710C of title 
38, U.S.C., to include the goal of maximizing independence 
within an individualized plan for the rehabilitation and 
reintegration of veterans with TBI, include rehabilitation 
objectives for sustaining improvement in cognitive, behavioral, 
and vocational functioning, and defining rehabilitative 
services as those treatment and services (which may be of on-
going duration) which sustain, and prevent loss of, functional 
gains that have been achieved, and any other rehabilitative 
services or supports that may contribute to maximizing 
independence.
    Section 4(b) of the bill would amend section 1710D of title 
38, U.S.C., to include rehabilitation services within 
comprehensive programs for long-term rehabilitation of eligible 
veterans with TBI.
    Section 4(c) of the bill would amend section 1710E(a) of 
title 38, United U.S.C., to include rehabilitation services 
within cooperative agreements for the use of non-Department 
facilities for neurorehabilitation amd recovery programs for 
eligible veterans with TBI.
    Section 4(d) of the bill would amend 1710C(c)(2)(S) of 
title 38, U.S.C., to strike ``opthamologist'' and insert 
``ophthalmologist'' in its place.

Section 5. Use of service dogs on property of the Department of 
        Veterans Affairs

    Section 5 of the bill would amend section 901 of title 38, 
U.S.C., by adding a new subsection declaring that VA may not 
prohibit the use of service dogs in any facility or on any 
property of the Department or in any facility or on any 
property that receives VA funding.

Section 6. Department of Veterans Affairs Pilot Program on dog training 
        therapy

    Section 6(a) of the bill would require VA to implement a 
pilot program on dog training therapy no later than 120 days 
after enactment of the Act for the purpose of assessing the 
effectiveness of using dog-training activities as a component 
of integrated post-deployment mental health and PTSD 
rehabilitation programs.
    Section 6(b) of the bill would require the pilot described 
in Section 2(a) be carried out in at least one but not more 
than three VAMCs who meet certain criteria.
    Section 6(c) of the bill would set out the parameters for 
the design of the pilot program.
    Section 6(d) of the bill would define an eligible veteran 
as a veteran with PTSD or another post-deployment mental health 
issue who willingly volunteers to participate in the pilot 
program.
    Section 6(e) of the bill would create a hiring preference 
for service dog training instructors who are veterans and who 
have successfully completed PTSD or other residential treatment 
programs and received adequate dog training certification.
    Section 6(f) of the bill would require VA to collect data 
to determine the effectiveness of the pilot program.
    Section 6(g) of the bill would require a yearly report to 
Congress on the pilot program.
    Section 6(h) of the bill would define a ``service dog 
training instructor'' as an instructor recognized by an 
accredited dog organization training program who provides 
hands-on training in the art and science of service dog 
training and handling.

         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):

TITLE 38, UNITED STATES CODE

           *       *       *       *       *       *       *



PART I--GENERAL PROVISIONS

           *       *       *       *       *       *       *


     CHAPTER 9--SECURITY AND LAW ENFORCEMENT ON PROPERTY UNDER THE 
JURISDICTION OF THE DEPARTMENT

           *       *       *       *       *       *       *



Sec. 901.   Authority to prescribe rules for conduct and penalties for 
                    violations

  (a) * * *

           *       *       *       *       *       *       *

  (f) The Secretary may not prohibit the use of service dogs in 
any facility or on any property of the Department or in any 
facility or on any property that receives funding from the 
Secretary.

           *       *       *       *       *       *       *


PART II--GENERAL BENEFITS

           *       *       *       *       *       *       *


   CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE

                          SUBCHAPTER I--GENERAL

Sec.
1701. Definitions.
     * * * * * * *
1709. Comprehensive policy on reporting and tracking sexual assault 
          incidents and other safety incidents.
     * * * * * * *

SUBCHAPTER I--GENERAL

           *       *       *       *       *       *       *


Sec. 1709.   Comprehensive policy on reporting and tracking sexual 
                    assault incidents and other safety incidents

  (a) Policy Required.--Not later than March 1, 2012, the 
Secretary of Veterans Affairs shall develop and implement a 
centralized and comprehensive policy on the reporting and 
tracking of sexual assault incidents and other safety incidents 
that occur at each medical facility of the Department, 
including--
          (1) suspected, alleged, attempted, or confirmed cases 
        of sexual assault, regardless of whether such assaults 
        lead to prosecution or conviction;
          (2) criminal and purposefully unsafe acts;
          (3) alcohol or substance abuse related acts 
        (including by employees of the Department); and
          (4) any kind of event involving alleged or suspected 
        abuse of a patient.
  (b) Scope.--The policy required by subsection (a) shall cover 
each of the following:
          (1) For purposes of reporting and tracking sexual 
        assault incidents and other safety incidents, 
        definitions of the terms--
                  (A) ``safety incident'';
                  (B) ``sexual assault''; and
                  (C) ``sexual assault incident''.
          (2) The development and use of specific risk-
        assessment tools to examine any risks related to sexual 
        assault that a veteran may pose while being treated at 
        a medical facility of the Department, including clear 
        and consistent guidance on the collection of 
        information related to--
                  (A) the legal history of the veteran; and
                  (B) the medical record of the veteran.
          (3) The mandatory training of employees of the 
        Department on security issues, including awareness, 
        preparedness, precautions, and police assistance.
          (4) The mandatory implementation, use, and regular 
        testing of appropriate physical security precautions 
        and equipment, including surveillance camera systems, 
        computer-based panic alarm systems, stationary panic 
        alarms, and electronic portable personal panic alarms.
          (5) Clear, consistent, and comprehensive criteria and 
        guidance with respect to an employee of the Department 
        communicating and reporting sexual assault incidents 
        and other safety incidents to--
                  (A) supervisory personnel of the employee 
                at--
                          (i) a medical facility of the 
                        Department;
                          (ii) an office of a Veterans 
                        Integrated Service Network; and
                          (iii) the central office of the 
                        Veterans Health Administration; and
                  (B) a law enforcement official of the 
                Department.
          (6) Clear and consistent criteria and guidelines with 
        respect to an employee of the Department referring and 
        reporting to the Office of Inspector General of the 
        Department sexual assault incidents and other safety 
        incidents that meet the regulatory criminal threshold 
        in accordance with section 1.201 and 1.204 of title 38, 
        Code of Federal Regulations.
          (7) An accountable oversight system within the 
        Veterans Health Administration that includes--
                  (A) systematic information sharing of 
                reported sexual assault incidents and other 
                safety incidents among officials of the 
                Administration who have programmatic 
                responsibility; and
                  (B) a centralized reporting, tracking, and 
                monitoring system for such incidents.
          (8) Consistent procedures and systems for law 
        enforcement officials of the Department with respect to 
        investigating, tracking, and closing reported sexual 
        assault incidents and other safety incidents.
          (9) Clear and consistent guidance for the clinical 
        management of the treatment of sexual assaults that are 
        reported more than 72 hours after the assault.
  (c) Updates to Policy.--The Secretary shall review and revise 
the policy required by subsection (a) on a periodic basis as 
the Secretary considers appropriate and in accordance with best 
practices.
  (d) Annual Report.--(1) Not later than 60 days after the date 
on which the Secretary develops the policy required by 
subsection (a), and by not later than October 1 of each year 
thereafter, the Secretary shall submit to the Committee on 
Veterans' Affairs of the House of Representatives and the 
Committee on Veterans' Affairs of the Senate a report on the 
implementation of the policy.
  (2) The report under paragraph (1) shall include--
          (A) the number and type of sexual assault incidents 
        and other safety incidents reported by each medical 
        facility of the Department;
          (B) a detailed description of the implementation of 
        the policy required by subsection (a), including any 
        revisions made to such policy from the previous year; 
        and
          (C) the effectiveness of such policy on improving the 
        safety and security of the medical facilities of the 
        Department, including the performance measures used to 
        evaluate such effectiveness.
  (e) Regulations.--The Secretary shall prescribe regulations 
to carry out this section.

SUBCHAPTER II--HOSPITAL, NURSING HOME, OR DOMICILIARY CARE AND MEDICAL 
TREATMENT

           *       *       *       *       *       *       *


Sec. 1710C.   Traumatic brain injury: plans for rehabilitation and 
                    reintegration into the community

  (a) Plan Required.--The Secretary shall, for each individual 
who is a veteran or member of the Armed Forces who receives 
inpatient or outpatient rehabilitative hospital care or medical 
services provided by the Department for a traumatic brain 
injury--
          (1) develop an individualized plan for the 
        rehabilitation and reintegration of the individual into 
        the community with the goal of maximizing the 
        individual's independence; and

           *       *       *       *       *       *       *

  (b) Contents of Plan.--Each plan developed under subsection 
(a) shall include, for the individual covered by such plan, the 
following:
          (1) Rehabilitation objectives for improving (and 
        sustaining improvement in) the physical, cognitive, 
        behavioral, and vocational functioning of the 
        individual with the goal of maximizing the independence 
        and reintegration of such individual into the 
        community.
          (2) Access, as warranted, to all appropriate 
        rehabilitative services and rehabilitative components 
        of the traumatic brain injury continuum of care, and 
        where appropriate, to long-term care services.
          (3) A description of specific rehabilitative 
        [treatments] services and other services to achieve the 
        objectives described in paragraph (1), which shall set 
        forth the type, frequency, duration, and location of 
        such [treatments and] services.

           *       *       *       *       *       *       *

  (c) Comprehensive Assessment.--(1) * * *
  (2) The comprehensive assessment required under paragraph (1) 
with respect to an individual is a comprehensive assessment of 
the matters set forth in that paragraph by a team, composed by 
the Secretary for purposes of the assessment, of individuals 
with expertise in traumatic brain injury, including any of the 
following:
          (A) * * *

           *       *       *       *       *       *       *

          (S) An [opthamologist] ophthalmologist.

           *       *       *       *       *       *       *

  (h) Rehabilitative Services Defined.--For purposes of this 
section, and sections 1710D and 1710E of this title, the term 
``rehabilitative services'' includes--
          (1) rehabilitative services, as defined in section 
        1701 of this title;
          (2) treatment and services (which may be of ongoing 
        duration) to sustain, and prevent loss of, functional 
        gains that have been achieved; and
          (3) any other rehabilitative services or supports 
        that may contribute to maximizing an individual's 
        independence.

Sec. 1710D.   Traumatic brain injury: comprehensive program for long- 
                    term rehabilitation

  (a) Comprehensive Program.--In developing plans for the 
rehabilitation and reintegration of individuals with traumatic 
brain injury under section 1710C of this title, the Secretary 
shall develop and carry out a comprehensive program of long-
term care and rehabilitative services (as defined in section 
1710C of this title) for post-acute traumatic brain injury 
rehabilitation that includes residential, community, and home-
based components utilizing interdisciplinary [treatment] teams.

           *       *       *       *       *       *       *


Sec. 1710E.   Traumatic brain injury: use of non-Department facilities 
                    for rehabilitation

  (a) Cooperative Agreements.--The Secretary, in implementing 
and carrying out a plan developed under section 1710C of this 
title, may provide hospital care and medical services, 
including rehabilitative services (as defined in section 1710C 
of this title), through cooperative agreements with appropriate 
public or private entities that have established long-term 
neurobehavioral rehabilitation and recovery programs.

           *       *       *       *       *       *       *


SUBCHAPTER V--PAYMENTS TO STATE HOMES

           *       *       *       *       *       *       *


Sec. 1745.   Nursing home care and medications for veterans with 
                    service-connected disabilities

  (a)(1) [The Secretary shall pay each State home for nursing 
home care at the rate determined under paragraph (2)] The 
Secretary shall enter into a contract (or agreement under 
section 1720(c)(1) of this title) with each State home for 
payment by the Secretary for nursing home care provided in the 
home, in any case in which such care is provided to any veteran 
as follows:
          (A) * * *

           *       *       *       *       *       *       *

  [(2) The rate determined under this paragraph with respect to 
a State home is the lesser of--
          [(A) the applicable or prevailing rate payable in the 
        geographic area in which the State home is located, as 
        determined by the Secretary, for nursing home care 
        furnished in a non- Department nursing home (as that 
        term is defined in section 1720(e)(2) of this title); 
        or
          [(B) a rate not to exceed the daily cost of care, as 
        determined by the Secretary, following a report to the 
        Secretary by the director of the State home.]
  (2) Payment under each contract (or agreement) between the 
Secretary and a State home under paragraph (1) shall be based 
on a methodology, developed by the Secretary in consultation 
with the State home, to adequately reimburse the State home for 
the care provided by the State home under the contract (or 
agreement).

           *       *       *       *       *       *       *