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116th Congress    }                                           {   Report
                         HOUSE OF REPRESENTATIVES
 1st Session      }                                           {   116-75

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



 
                  VET CENTER ELIGIBILITY EXPANSION ACT

                                _______
                                

  May 20, 2019.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

  Mr. Takano, from the Committee on Veterans' Affairs, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 1812]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 1812) to amend title 38, United States Code, to 
furnish Vet Center readjustment counseling and related mental 
health services to certain individuals, having considered the 
same, report favorably thereon with an amendment and recommend 
that the bill as amended do pass.

                                CONTENTS

                                                                   Page
Amendment........................................................     2
Purpose and Summary..............................................     2
Background and Need for Legislation..............................     2
Hearings.........................................................     3
Subcommittee Consideration.......................................     3
Committee Consideration..........................................     3
Committee Votes..................................................     4
Committee Oversight Findings.....................................     4
Statement of General Performance Goals and Objectives............     4
New Budget Authority, Entitlement Authority, and Tax Expenditures     4
Earmarks and Tax and Tariff Benefits.............................     4
Committee Cost Estimate..........................................     4
Congressional Budget Office Estimate.............................     4
Federal Mandates Statement.......................................     6
Advisory Committee Statement.....................................     6
Constitutional Authority Statement...............................     6
Applicability to Legislative Branch..............................     6
Statement on Duplication of Federal Programs.....................     6
Section-by-Section Analysis of the Legislation...................     6
Changes in Existing Law Made by the Bill as Reported.............     7
    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Vet Center Eligibility Expansion 
Act''.

SEC. 2. EXPANSION OF VET CENTER SERVICES.

  Section 1712A of title 38, United States Code, is amended--
          (1) by striking ``clauses (i) through (iv)'' both places it 
        appears and inserting ``clauses (i) through (vi)'';
          (2) by striking ``in clause (v)'' both places it appears and 
        inserting ``in clause (vii)'';
          (3) in subsection (a)(1)(C)--
                  (A) by redesignating clauses (iv) and (v) as clauses 
                (vi) and (vii), respectively; and
                  (B) by inserting after clause (iii) the following new 
                clauses:
          ``(iv) Any individual who is a veteran or member of the Armed 
        Forces, including a member of a reserve component of the Armed 
        Forces, who served--
                  ``(I) on active service in response to a national 
                emergency or major disaster declared by the President; 
                or
                  ``(II) in the National Guard of a State under orders 
                of the chief executive of that State in response to a 
                disaster or civil disorder in such State.
          ``(v) Any individual who participated in a drug interdiction 
        operation as a member of the Coast Guard, regardless of the 
        location of that operation.''; and
          (4) in subsection (h), by adding at the end the following new 
        paragraphs:
          ``(4) The term `active service' has the meaning given that 
        term in section 101 of title 10.
          ``(5) The term `civil disorder' has the meaning given that 
        term in section 232 of title 18.''.

SEC. 3. PLAN TO PROVIDE VET CENTER SERVICES TO VETERANS LIVING IN AREAS 
                    WHERE NO VET CENTER IS LOCATED.

  The Secretary of Veterans Affairs shall submit to the Committees on 
Veterans' Affairs of the Senate and House of Representatives a plan to 
provide Vet Center services to veterans living in geographic areas 
where no Vet Center is located, including in the United States insular 
areas.

                          Purpose and Summary

    H.R. 1812, as amended, would expand eligibility for the 
provision of readjustment counseling and other mental 
healthcare from Vet Centers to certain members of the Coast 
Guard and members of the National Guard and Reservists that 
served in the United States but never deployed. H.R. 1812, as 
amended, would also require the U.S. Department of Veterans 
Affairs (VA) to submit to the Committees on Veterans' Affairs 
of both the House and Senate a plan to provide Vet Center 
services to those geographical areas in which no Vet Centers 
are located, including the insular areas of the United States.
    Representative David P. Roe of Tennessee introduced H.R. 
1812 on March 18, 2019.

                  Background and Need for Legislation

    According to VA, approximately 20 servicemembers and 
veterans take their lives every day. However, statistics show 
that on average, only 6 out of those 20 sought care from VA in 
the two years preceding their death. Of the remaining 14 who 
did not seek VA care, as many as 4 of those suicides occur 
among never-deployed National Guard or Reserve members.\1\
---------------------------------------------------------------------------
    \1\VA National Suicide Data Report 2005-2016, Office of Mental 
Health and Suicide Prevention, U.S. Department of Veterans Affairs.
---------------------------------------------------------------------------
    VA is authorized to provide counseling through Vet Centers 
to veterans, servicemembers, and National Guard and Reserve 
members who served on active military duty in any combat 
theater or area of hostility, experienced military sexual 
trauma, provided direct emergent medical care or mortuary 
services to casualties of war, served as a member of an 
unmanned aerial vehicle crew that provided direct support to 
operations in a combat zone or area of hostility, or served in 
other capacities.\2\ However, members of the National Guard, 
Reserve, or Coast Guard who participated in a drug 
interdiction, or who served in response to a President or state 
chief executive declared national emergency, major disaster, or 
civil disorder are not currently eligible to receive Vet Center 
care despite the serious consequences such service can have on 
mental health. The Vet Center Eligibility Expansion Act would 
correct this oversight by extending eligibility for Vet Center 
care to these individuals.
---------------------------------------------------------------------------
    \2\38 USC Sec. 1712A(a)(1)(C).
---------------------------------------------------------------------------
    In addition, the Vet Center Eligibility Expansion Act would 
require VA to submit to the Committees of jurisdiction a plan 
to expand access to services provided by Vet Centers to areas 
not currently served by a Vet Center. This plan should properly 
consider not only rural areas, but also territories and insular 
areas. By assessing the steps necessary to providing access to 
Vet Centers for veterans living in these underserved areas, the 
Vet Center Eligibility Expansion Act is ensuring veterans, 
servicemembers, Reservists and members of the Coast Guard and 
National Guard are allowed access to the lifesaving services 
Vet Centers provide.

                                Hearings

    For the purposes of section 103(i) of H.Res. 6 of the 116th 
Congress--(1) the following hearing was used to develop or 
consider H.R. 1812:
        H.R. 1812 was considered by the Committee on Veterans' 
        Affairs on May 8, 2019.

                       Subcommittee Consideration

    H.R. 1812 was not considered before the Subcommittee on 
Health.

                        Committee Consideration

    On May 8, 2019, the Committee on Veterans' Affairs met in 
an open markup session, a quorum being present, and favorably 
reported H.R. 1812, as amended, to the House of Representatives 
by voice vote. During consideration of the bill, the following 
amendment was considered and agreed to by voice vote:
          An amendment offered by Representative Gregorio 
        Sablan of Northern Mariana Islands that would require 
        VA to submit a plan for expansion of Vet Center 
        services to areas not currently serviced by a Vet 
        Center, including insular areas of the U.S., to the 
        Committees on Veterans' Affairs of the House and 
        Senate.

                            Committee Votes

    In compliance with clause 3(b) of rule XIII of the Rules of 
the House of Representatives, there were no recorded votes 
taken on amendments or in connection with reporting H.R. 1812, 
as amended, to the House. A motion by Ranking Member David P. 
Roe of Tennessee to report H.R. 1812, as amended, favorably to 
the House of Representatives was adopted 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 to expand access to high quality 
mental healthcare and related resources to curb the prevalence 
of suicide among veterans, servicemembers, Reservists, and 
members of the Coast Guard and National Guard.

   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. 1812 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. 
1812 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. 1812 provided by the Director of the Congressional 
Budget Office pursuant to section 402 of the Congressional 
Budget Act of 1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                      Washington, DC, May 17, 2019.
Hon. Mark Takano,
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. 1812, the Vet 
Center Eligibility Expansion 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,
                                                Keith Hall,
                                                          Director.
    Enclosure.

    
    

    H.R. 1812 would require the Department of Veterans Affairs 
(VA) to provide mental health counseling at Vet Centers for the 
following individuals:
           Veterans or members of the armed forces 
        (including reservists) who respond to national 
        emergencies or disasters declared by the President;
           Members of the National Guard who respond to 
        disasters or civil disorders in a state; or
           Members of the Coast Guard who participate 
        in drug interdiction operations.
    Vet Centers are facilities where VA provides social and 
psychological counseling to help veterans and service members 
cope with the stress of military service and the difficulties 
of adjusting to civilian life after that service. VA provides 
that counseling to individuals who served on active duty in 
combat and in several other circumstances. In 2018, VA spent an 
average of $1,900 per patient to provide such counseling to 
134,000 veterans and active-duty service members at 300 Vet 
Centers nationwide. On the basis of information from VA and the 
Department of Defense, CBO estimates that roughly 5,000 
individuals would receive counseling each year under the bill. 
Thus, CBO estimates that implementing H.R. 1812 would cost $55 
million over the 2020-2024 period; subject to the availability 
of appropriated funds (see Table 1).

               TABLE 1.--ESTIMATED INCREASES IN SPENDING SUBJECT TO APPROPRIATION UNDER H.R. 1812
----------------------------------------------------------------------------------------------------------------
                                                              By fiscal year, millions of dollars--
                                                ----------------------------------------------------------------
                                                   2019     2020     2021     2022     2023     2024   2019-2024
----------------------------------------------------------------------------------------------------------------
Estimated Authorization........................        0       11       11       11       11       12        56
Estimated Outlays..............................        0       10       11       11       11       12        55
----------------------------------------------------------------------------------------------------------------

    The CBO staff contact for this estimate is Ann E. Futrell. 
The estimate was reviewed by Theresa Gullo, Assistant Director 
for Budget Analysis.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates regarding H.R. 1812 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. 
1812, as amended.

                   Constitutional Authority Statement

    Pursuant to Article I, section 8 of the United States 
Constitution, H.R. 1812, as amended, 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 H.R. 1812, as amended, does not 
relate to the terms and conditions of employment or access to 
public services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

              Statement on Duplication of Federal Programs

    Pursuant to clause 3(c)(5) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that no provision 
of H.R. 1812, as amended, establishes or reauthorizes a program 
of the Federal Government known to be duplicative of another 
Federal program, a program that was included in any report from 
the Government Accountability Office to Congress pursuant to 
section 21 of Public Law 111-139, or a program related to a 
program identified in the most recent Catalog of Federal 
Domestic Assistance.

             Section-by-Section Analysis of the Legislation


Sec. 1. Short title

    Section 1 states H.R. 1812, as amended, may be cited as the 
``Vet Center Eligibility Expansion Act.''

Sec. 2. Expansion of Vet Center services

    Section 2 expands eligibility for Vet Center services to 
certain members of the National Guard, members of the Coast 
Guard and Reservists. Those newly eligible for Vet Center 
services are: (1) members of a reserve component of the Armed 
Forces who served on active service, as defined in section 101 
of title 10, in response to a national emergency or major 
disaster declared by the President; (2) members of the National 
Guard of a State activated in response to a disaster or civil 
disorder, as defined in section 232 of title 18; and (3) 
members of the Coast Guard who participated in a drug 
interdiction operation.

Sec. 3. Plan to provide Vet Center services to veterans living in areas 
        where no Vet Center is located

    Section 3 requires VA to submit to the Committees on 
Veterans' Affairs of the House and Senate a plan to provide Vet 
Center services to veterans living in areas with no access to a 
Vet Center including insular areas of the United States.

         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):

         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, and existing law in which no 
change is proposed is shown in roman):

                      TITLE 38, UNITED STATES CODE



           *       *       *       *       *       *       *
PART II--GENERAL BENEFITS

           *       *       *       *       *       *       *


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

           *       *       *       *       *       *       *


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

           *       *       *       *       *       *       *


Sec. 1712A. Eligibility for readjustment counseling and related mental 
                    health services

  (a)(1)(A) Upon the request of any individual referred to in 
subparagraph (C), the Secretary shall furnish counseling, 
including by furnishing counseling through a Vet Center, to the 
individual--
          (i) in the case of an individual referred to in 
        [clauses (i) through (iv)] clauses (i) through (vi) of 
        subparagraph (C), to assist the individual in 
        readjusting to civilian life; and
          (ii) in the case of an individual referred to [in 
        clause (v)] in clause (vii) of such subparagraph who is 
        a family member of a veteran or member described in 
        such clause--
                  (I) in the case of a member who is deployed 
                in a theater of combat operations or an area at 
                a time during which hostilities are occurring 
                in that area, during such deployment to assist 
                such individual in coping with such deployment; 
                and
                  (II) in the case of a veteran or member who 
                is readjusting to civilian life, to the degree 
                that counseling furnished to such individual is 
                found to aid in the readjustment of such 
                veteran or member to civilian life.
  (B) Counseling furnished to an individual under subparagraph 
(A) may include a comprehensive individual assessment of the 
individual's psychological, social, and other characteristics 
to ascertain whether--
          (i) in the case of an individual referred to in 
        [clauses (i) through (iv)] clauses (i) through (vi) of 
        subparagraph (C), such individual has difficulties 
        associated with readjusting to civilian life; and
          (ii) in the case of an individual referred to [in 
        clause (v)] in clause (vii) of such subparagraph, such 
        individual has difficulties associated with--
                  (I) coping with the deployment of a member 
                described in subclause (I) of such clause; or
                  (II) readjustment to civilian life of a 
                veteran or member described in subclause (II) 
                of such clause.
                  (C) Subparagraph (A) applies to the following 
                individuals:
          (i) Any individual who is a veteran or member of the 
        Armed Forces, including a member of a reserve component 
        of the Armed Forces, who served on active duty in a 
        theater of combat operations or an area at a time 
        during which hostilities occurred in that area.
          (ii) Any individual who is a veteran or member of the 
        Armed Forces, including a member of a reserve component 
        of the Armed Forces, who provided direct emergency 
        medical or mental health care, or mortuary services to 
        the causalities of combat operations or hostilities, 
        but who at the time was located outside the theater of 
        combat operations or area of hostilities.
          (iii) Any individual who is a veteran or member of 
        the Armed Forces, including a member of a reserve 
        component of the Armed Forces, who engaged in combat 
        with an enemy of the United States or against an 
        opposing military force in a theater of combat 
        operations or an area at a time during which 
        hostilities occurred in that area by remotely 
        controlling an unmanned aerial vehicle, notwithstanding 
        whether the physical location of such veteran or member 
        during such combat was within such theater of combat 
        operations or area.
          (iv) Any individual who is a veteran or member of the 
        Armed Forces, including a member of a reserve component 
        of the Armed Forces, who served--
                  (I) on active service in response to a 
                national emergency or major disaster declared 
                by the President; or
                  (II) in the National Guard of a State under 
                orders of the chief executive of that State in 
                response to a disaster or civil disorder in 
                such State.
          (v) Any individual who participated in a drug 
        interdiction operation as a member of the Coast Guard, 
        regardless of the location of that operation.
          [(iv)] (vi) Any individual who received counseling 
        under this section before the date of the enactment of 
        the National Defense Authorization Act for Fiscal Year 
        2013.
          [(v)] (vii) Any individual who is a family member of 
        any--
                  (I) member of the Armed Forces, including a 
                member of a reserve component of the Armed 
                Forces, who is serving on active duty in a 
                theater of combat operations or in an area at a 
                time during which hostilities are occurring in 
                that area; or
                  (II) veteran or member of the Armed Forces 
                described in this subparagraph.
  (2) Upon request of an individual described in paragraph 
(1)(C), the Secretary shall provide the individual a 
comprehensive individual assessment as described in paragraph 
(1)(B) as soon as practicable after receiving the request, but 
not later than 30 days after receiving the request.
  (b)(1) If, on the basis of the assessment furnished under 
subsection (a) of this section, a licensed or certified mental 
health care provider employed by the Department (or, in areas 
where no such licensed or certified mental health care provider 
is available, a licensed or certified mental health care 
provider carrying out such function under a contract or fee 
arrangement with the Secretary) determines that the provision 
of mental health services to such veteran is necessary to 
facilitate the successful readjustment of the veteran to 
civilian life, such veteran shall, within the limits of 
Department facilities, be furnished such services on an 
outpatient basis. For the purposes of furnishing such mental 
health services, the counseling furnished under subsection (a) 
of this section shall be considered to have been furnished by 
the Department as a part of hospital care. Any hospital care 
and other medical services considered necessary on the basis of 
the assessment furnished under subsection (a) of this section 
shall be furnished only in accordance with the eligibility 
criteria otherwise set forth in this chapter (including the 
eligibility criteria set forth in section 1784 of this title).
  (2) Mental health services furnished under paragraph (1) of 
this subsection may, if determined to be essential to the 
effective treatment and readjustment of the veteran, include 
such consultation, counseling, training, services, and expenses 
as are described in sections 1782 and 1783 of this title.
  (c) Upon receipt of a request for counseling under this 
section from any individual who has been discharged or released 
from active military, naval, or air service but who is not 
otherwise eligible for such counseling, the Secretary shall--
          (1) provide referral services to assist such 
        individual, to the maximum extent practicable, in 
        obtaining mental health care and services from sources 
        outside the Department; and
          (2) if pertinent, advise such individual of such 
        individual's rights to apply to the appropriate 
        military, naval, or air service, and to the Department, 
        for review of such individual's discharge or release 
        from such service.
  (d) The Under Secretary for Health may provide for such 
training of professional, paraprofessional, and lay personnel 
as is necessary to carry out this section effectively, and, in 
carrying out this section, may utilize the services of 
paraprofessionals, individuals who are volunteers working 
without compensation, and individuals who are veteran-students 
(as described in section 3485 of this title) in initial intake 
and screening activities.
  (e)(1) In furnishing counseling and related mental health 
services under subsections (a) and (b) of this section, the 
Secretary shall have available the same authority to enter into 
contracts with private facilities that is available to the 
Secretary (under sections 1703(a)(2) and 1710(a)(1)(B) of this 
title) in furnishing medical services to veterans suffering 
from total service-connected disabilities.
  (2) Before furnishing counseling or related mental health 
services described in subsections (a) and (b) of this section 
through a contract facility, as authorized by this subsection, 
the Secretary shall approve (in accordance with criteria which 
the Secretary shall prescribe by regulation) the quality and 
effectiveness of the program operated by such facility for the 
purpose for which the counseling or services are to be 
furnished.
  (3) The authority of the Secretary to enter into contracts 
under this subsection shall be effective for any fiscal year 
only to such extent or in such amounts as are provided in 
appropriation Acts.
  (f) The Secretary, in cooperation with the Secretary of 
Defense, shall take such action as the Secretary considers 
appropriate to notify veterans who may be eligible for 
assistance under this section of such potential eligibility.
  (g) In carrying out this section and in furtherance of the 
Secretary's responsibility to carry out outreach activities 
under chapter 63 of this title, the Secretary may provide for 
and facilitate the participation of personnel employed by the 
Secretary to provide services under this section in 
recreational programs that are--
          (1) designed to encourage the readjustment of 
        veterans described in subsection (a)(1)(C); and
          (2) operated by any organization named in or approved 
        under section 5902 of this title.
  (h) For the purposes of this section:
          (1) The term ``Vet Center'' means a facility which is 
        operated by the Department for the provision of 
        services under this section and which is situated apart 
        from Department general health care facilities.
          (2) The term ``Department general health-care 
        facility'' means a health-care facility which is 
        operated by the Department for the furnishing of 
        health-care services under this chapter, not limited to 
        services provided through the program established under 
        this section.
          (3) The term ``family member'', with respect to a 
        veteran or member of the Armed Forces, means an 
        individual who--
                  (A) is a member of the family of the veteran 
                or member, including--
                          (i) a parent;
                          (ii) a spouse;
                          (iii) a child;
                          (iv) a step-family member; and
                          (v) an extended family member; or
                  (B) lives with the veteran or member but is 
                not a member of the family of the veteran or 
                member.
          (4) The term ``active service'' has the meaning given 
        that term in section 101 of title 10.
          (5) The term ``civil disorder'' has the meaning given 
        that term in section 232 of title 18.

           *       *       *       *       *       *       *