[Senate Report 107-82]
[From the U.S. Government Publishing Office]
Calendar No. 191
107th Congress Report
SENATE
1st Session 107-82
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HEATHER FRENCH HENRY HOMELESS VETERANS ASSISTANCE ACT OF 2001
_______
October 11, 2001.--Ordered to be printed
_______
Mr. Rockefeller, from the Committee on Veterans' Affairs, submitted the
following
R E P O R T
[To accompany S. 739]
The Committee on Veterans' Affairs, to which was referred
the bill (S. 739) to amend title 38, United States Code, to
improve programs for homeless veterans and for other purposes,
having considered the same, reports favorably and recommends
that the bill, as amended, do pass.
Introduction
On April 6, 2001, Committee member Paul D. Wellstone
introduced S. 739, the proposed ``Heather French Henry Homeless
Veterans Assistance Act of 2001,'' with the cosponsorship of
Committee member Patty Murray, and Senators Jeff Bingaman,
Harry Reid, John F. Kerry, Thomas A. Daschle, Jon Corzine,
Byron L. Dorgan, Deborah Ann Stabenow, Tim Johnson, Mark
Dayton, Richard J. Durbin, Edward M. Kennedy, and Mary L.
Landrieu. S. 739, as introduced, would have reauthorized,
modified, and enhanced certain programs that the Department of
Veterans Affairs (VA) and a program that the Department of
Labor administers to homeless veterans.
Committee Hearing
On July 19, 2001, the Committee held a hearing on a number
of bills pending before the Committee, including S. 739. The
Committee received testimony from representatives of VA and
organizations which assist homeless veterans, including
representatives of the National Coalition for Homeless
Veterans, the Minnesota Assistance Council for Veterans, the
Non-Commissioned Officers Association of the United States of
America, and the American Federation of Government Employees.
Committee Meeting
On July 31, 2001, the Committee met in open session to
consider S. 739, as amended, and other legislation pending
before the Committee. The Committee voted by unanimous voice
vote to report the Committee bill favorably to the Senate.
Summary of S. 739 As Reported
S. 739, as reported (herein referred to as the ``Committee
bill''), contains amendments to title 38, United States Code,
and freestanding provisions that:
(a) state the national goal of ending homelessness
within the next decade and encourage interagency and
multilevel cooperation in order to achieve this goal;
(b) establish an Advisory Committee on Homeless
Veterans within VA that will examine and report to the
Secretary of Veterans Affairs on various services
provided to homeless veterans, and require annual
meetings of the Interagency Council on the Homeless;
(c) mandate the continued support of at least one
evaluation center to monitor the effectiveness of VA's
various homeless programs;
(d) require VA to report on the activities of both
the Veterans Benefits and Health Administrations in
assisting homeless veterans;
(e) link the per diem rate for domiciliary care
allotted to State Veterans Homes to the amount given to
community-based organizations for homeless veterans
through the Grant and Per Diem Program, thereby raising
the amount from $19 to $24 per day for FY 2002;
(f) clarify the eligibility for dental care services
to homeless veterans who are currently receiving care
or services through the VA;
(g) authorize VA to spend up to $55 million per year
on the transitional housing Grant and Per Diem Program;
(h) require VA to establish at least five new
comprehensive service centers for homeless veterans in
those metropolitan areas found to have the greatest
need;
(i) extend the Homeless Chronically Mentally Ill and
Comprehensive Homeless Programs until December 31,
2006;
(j) authorize the Secretary to allow homeless
veterans receiving care through the vocational
rehabilitation programs to participate in the
Compensated Work Therapy (CWT) program, authorize the
Secretary to allow homeless veterans in the CWT program
to receive housing through the therapeutic residence
program, require VA to report on Homeless Coordinators
assigned to VBA Regional Offices, and require each
disabled veterans outreach program specialist to
coordinate employment services and training assistance
provided to veterans by entities receiving grants under
the McKinney Act;
(k) require that real property of grantees under VA's
homeless Grant and Per Diem Program meet fire and
safety requirements applicable under the Life Safety
Code of the National Fire Protection Association;
(l) require the Secretary to conduct a technical
assistance grants program to assist nonprofit groups in
applying for grants for programs that address problems
of homeless veterans and authorize $750,000 for each of
FY's 2002 through 2006 for this purpose; and
(m) extend the Homeless Veterans Reintegration
Program and authorize $50 million a year for each of
FY's 2002 through 2006.
Discussion
Background
The VA currently administers a number of programs which
furnish services aimed at addressing the needs of homeless
veterans, including mental health and substance abuse
treatment; social services such as case management, employment
assistance, and transitional housing; and primary health care.
In assisting homeless veterans to receive benefits, VA employs
Homeless Coordinators at over 50 VBA Regional Offices who
provide outreach to homeless veterans. Additionally, claims for
VA benefits are expedited for homeless veterans in order to
assist in the establishment of a steady income and return to
stable housing. The two main health care programs that VA
administers for homeless veterans are Health Care for Homeless
Veterans (HCHV) and Domiciliary Care for Homeless Veterans
(DCHV). In the area of social services, VA partners with
community-based providers through the Transitional Housing
Grant and Per Diem Program to be able to ensure that homeless
veterans receive care across the continuum. Since 1987, VA has
spent upward of $640 million on combating veterans'
homelessness.
The VA is certainly not alone in its quest to reduce
homelessness. Today, eight different Federal departments and
agencies administer about 50 low income and homeless assistance
programs. These programs enable the provision of services such
as primary and mental health care, substance abuse treatment,
transitional and long-term housing, education, job training,
and transportation. The total annual funding for all of these
efforts now exceeds $1.2 billion.
Still, homelessness remains a large and difficult problem
for veterans and for the general population. It is estimated
that roughly one-third of our Nation's total homeless
population are veterans. As the homeless population is
difficult to track, estimates of the total number of homeless
veterans range from 250,000 to 500,000 on any given night. This
Committee, VA, and the veterans service organizations all
acknowledge that this is a national disgrace that must continue
to be addressed. It is imperative that VA develop new programs
to attempt to address unmet needs, while maintaining the
current specialized programs they have specifically tailored to
serve homeless veterans.
Several of the provisions in the Committee bill seek to
enhance VA's existing health care programs by extending current
programs and by authorizing an increase in the appropriation
level. The Grant and Per Diem Program, for example, is one VA
program that has met with great success, and the Committee
believes that an increase in funding is warranted. The
Committee bill also places added emphasis on the benefits-
related programs for homeless veterans, by requiring annual
reports on Veterans Benefits Administration programs and on the
assignments of Homeless Coordinators at VBA Regional Offices.
Another facet of the Committee bill would create new
programs that will contribute to the overall quality of care VA
delivers to homeless veterans. An example of this is the
Advisory Committee on Homeless Veterans that would be
established within VA.
The title of this bill is also quite significant. By naming
the bill for Heather French Henry, Miss America 2000, the
Committee acknowledges her tenacity and dedication on behalf of
homeless veterans. Mrs. Henry brought the issue of homeless
veterans to national attention by committing herself to it
during her reign and subsequent to the end of her tenure as
Miss America. On March 9, 2000, she testified before the House
Committee on Veterans' Affairs Subcommittee on Benefits and
Health, expressing the harsh reality of the problem:
On any given night there are the equivalent of 17
infantry divisions on the streets of this great nation
with no place to call home. These are men and women who
served our nation during its greatest times of need and
now live without shelter or food or medical care. They
are the once young men and women now aging who we sent
abroad to defend our country but cast aside upon their
return. They are our country's forgotten heroes, those
who at one time may have been awarded a Medal of Honor
or Purple Heart.
Committee Bill
Sections 1-3.
Sections 1 through 3 include the following: findings as to
the problem of homelessness in this country and the number of
homeless veterans; a definition of ``homeless veteran''; and
the declaration of a national goal to end homelessness among
veterans in the coming decade.
Section 4. Advisory Committee on Homeless Veterans
While the current Secretary of Veterans Affairs has
declared his commitment to homeless veterans, there is
currently no formal advisory committee mandated by legislation.
The Secretary has already taken steps to form such a committee
internally. On July 31, 2001, VA issued a press release
announcing a plan to establish such an advisory group to ``make
recommendations to the VA secretary and other senior VA
leaders.'' Despite this recent action, this Committee seeks to
formalize, via public law, such an advisory committee--ensuring
that those who are closest to the problem will always have a
voice. To that end, the advisory committee envisioned in the
legislation would be made up of 12-15 members, and would
consist of representatives from the veterans service
organizations, community-based providers, homeless advocates,
VA's homeless program employees, mental health and substance
abuse treatment experts, state veterans affairs officials,
experts in the development of permanent housing alternatives
for lower income populations, vocational rehabilitation
experts, and formerly homeless veterans. The following ex-
officio members will be included on the advisory committee: the
Secretaries (or their representatives) of the Departments of
Labor, Defense, Health and Human Services, and Housing and
Urban Development.
The primary role of this advisory committee will be to
review current programs and make recommendations to the VA
Secretary. The advisory committee will also conduct a
comprehensive review of current outreach efforts to homeless
veterans carried out by VA, and provide placement options for
homeless veterans ineligible for vocational rehabilitation or
independent living. At this time, there is no comparable body
within VA to make recommendations to the Secretary on any of
these issues as they relate to homeless veterans.
While this Committee acknowledges and applauds the current
Secretary's efforts to establish an advisory group, this
Committee also recognizes that administrations change and wants
to ensure that this initiative will be carried out through any
changes in personnel.
Section 5. Annual Meetings of the Interagency Council on the Homeless
In 1987, the Interagency Council on the Homeless was
created by Public Law 100-77, with the intent of coordinating
the homeless programs of the various Federal agencies that
administer them. The council is chaired on a rotating basis by
the Secretaries of Housing and Urban Development, Health and
Human Services, Labor, and VA. However, the council has not met
in over 5 years, as it lacks funding, organization, and
leadership. Section 5 of the Committee bill seeks to rejuvenate
the council by requiring that it meet at the call of its
chairperson or a majority of its members, but not less often
than annually. This Committee recognizes that the VA-HUD
Appropriations Subcommittee and the Executive Branch have taken
steps to do this by staffing and funding the council, and the
Committee fully supports these efforts. The Committee bill, as
in section 4, seeks to ensure that the council's support
transcends changes in administrations by requiring annual
meetings.
Section 6. Evaluation of Homeless Programs
Performance measures are the primary method Congress
employs to evaluate the effectiveness of any given program.
With regard to homeless programs, these measures have been
seriously lacking, and consequently it is difficult to
determine which programs are successful and which are not. At
the Committee's hearing on S. 739, the Veterans Organization
Homeless Council (VOHC) endorsed this principle in the
testimony of the Non-Commissioned Officers Association, a
member of VOHC. Specifically, Richard Snyder of NCOA stated
that:
There is a need for evaluation of homeless programs
to ensure the effective use of resources. . . . A
greater emphasis on program outcomes is necessary to
assure that veterans' grant programs operated by the
Departments of Veterans Affairs, Labor, and Housing and
Urban Development are efficient and effective.
VA already does a great deal of evaluation, primarily of
its health care services for homeless veterans, through the
Northeast Program Evaluation Center (NEPEC). Section 6 of the
Committee bill would encourage the continued support of NEPEC.
It also calls for two annual reports to Congress: one on VA's
health care programs for homeless veterans, and one on VA's
benefits-related programs for homeless veterans. As the bulk of
evaluation up until now has been focused on health care, this
bill seeks to include the benefits-related services provided by
VA to homeless veterans in its regular evaluation processes.
Section 7. Per Diem Payments for Furnishing Services to Homeless
Veterans
The VA Grant and Per Diem Program, authorized in 1992 by
Public Law 102-590, has proven to be highly successful. As a
result of the program, about 5,000 new beds will be available
to homeless veterans.
Under the program, community-based providers may apply for
grants from VA to provide direct services to homeless veterans.
In addition to providing grants, VA also subsidizes eligible
facilities with a daily per diem rate, currently $19 per day,
for expenses of care. Section 7 of the Committee bill would
link this daily rate to the amount given for domiciliary care
allotted to State Veterans Homes, thereby raising the rate from
$19 to $24 per day. Homeless service providers in the community
have expressed the need for this increase, as the National
Coalition for Homeless Veterans (NCHV) estimates that the cost
of providing beds alone is expected to increase next year.
According to NCHV, if the increase in the daily rate is not
implemented, we can expect the elimination of up to 1,000 beds
for homeless veterans.
Section 8. Dental Care for Homeless Veterans
Dental care is considered by many homeless advocates, such
as the National Coalition for Homeless Veterans, to be
essential in assisting homeless veterans obtain employment. It
is understandably difficult to apply for a job with serious
dental problems. S. 739, as introduced, contained a requirement
that substantial new dental benefits for homeless veterans be
provided. VA strongly opposed this proposal for a number of
reasons, most notably the relative inadequacy of the current
dental care eligibility for all veterans. VA expressed this in
their testimony at the Committee hearing on S. 739:
Although we recognize that these veterans need dental
care and services, we do not support this provision
because it would result in a disparity in access to
needed outpatient dental care and services among
equally deserving veterans. As an alternative, we will
heighten and expand our current efforts to obtain
dental care and services for homeless veterans through
pro bono providers, dental schools and related teaching
programs, and service providers receiving grants under
VA's Homeless Providers Grant and Per Diem Program.
In response to these concerns, section 8 of the Committee
bill would amend section 1712(a) of title 38 U.S.C. to clarify
eligibility for dental care services under the law. The
Committee encourages VA to do what is necessary to facilitate
dental care for homeless veterans through available sources.
Section 9. Programmatic Expansions
To complement the increase in the daily per diem rate under
the Grant and Per Diem program, section 9 of the Committee bill
would provide an overall funding cap for the grants portion of
the program. It would authorize VA to spend up to $55 million a
year on grants to community-based service providers. Since the
inception of the program, 243 grants have been approved and the
numbers are expected to increase.
Section 9 also requires the establishment of at least five
new comprehensive service centers for homeless veterans. These
centers are to be located in those metropolitan areas found to
have the greatest need. The Committee intends to give VA
discretion in determining where the need for homeless services
is highest, as well as flexibility in the number of new centers
to be created in accordance with the demand found in the
various metropolitan areas that do not currently have such
services.
The Committee bill also extends the Homeless Chronically
Mentally Ill (HCMI) and Comprehensive Homeless Programs until
December 31, 2006. As these programs offer services targeted
specifically to meet the needs of homeless veterans, extending
them is necessary for maintaining the continuum of care
essential to ending homelessness. The Homeless Chronically
Mentally Ill program, in particular, provides extensive
outreach, physical and psychiatric health exams, treatment,
referrals, and ongoing case management to homeless veterans
with mental health and substance abuse problems. The HCMI
program will also place homeless veterans needing longer-term
care into community-based facilities as deemed appropriate.
Over 20,000 homeless veterans have received treatment under the
HCMI program, with over 3,000 veterans receiving residential
treatment.
The Comprehensive Homeless Program encompasses all of the
services that compose the ``continuum of care'' often referred
to with regard to the treatment of the homeless. This section
of the bill is directly related to section 9, which requires VA
to establish at least five new comprehensive service centers in
the metropolitan areas determined to need those services the
most. The services offered at these centers through the
Comprehensive Homeless Program include the full range from
mental health/substance abuse treatment to transitional
housing. The program enables these centers to offer such a wide
array of services through partnerships with community-based
providers.
Section 10. Various Authorities
In an effort to make some of VA's existing homeless
veterans employment training programs better complement each
other, the Committee bill would allow homeless veterans already
receiving care through vocational rehabilitation programs to
participate in the Compensated Work Therapy (CWT) program.
Additionally, the bill would permit homeless veterans in the
CWT program to receive housing through the therapeutic
residence program or through grantees of VA's homeless
providers Grant and Per Diem Program. At the Committee's
hearing, VA testified in support of both of these provisions.
Section 10 would also require a report from VA on the
current assignments of Homeless Coordinators at each of the
Veterans Benefits Administration's Regional Offices. This is
based on Section 14(c) of S. 739, as introduced, which would
have required the Secretary to ensure that a Homeless
Coordinator is assigned to every regional office. The need to
make sure that there is substantial oversight and coordination
of homeless programs is recognized by this Committee.
Therefore, the Committee amended the original provision to
instead require a report on the current assignments of Homeless
Coordinators. Specifically, the report would be required to
include a list of those regional offices that already have
Homeless Coordinators; a description of the caseload and how
the duties of the coordinator are assigned, such as whether
they are collateral or full-time; and evaluations of the need
for such services at the various regional offices and how that
need is currently being met, if not by an assigned Homeless
Coordinator.
Rather than mandating the assignment of a Homeless
Coordinator to every regional office--included in S. 739 as
originally introduced--the Committee has chosen to give VA
discretion in assigning this position so as to avoid
duplication or lack of necessity in assigning such a
Coordinator to a given regional office.
Section 11. Life Safety Code for Grant and Per Diem Providers
Under current law, Grant and Per Diem providers are not
required to meet Federal fire safety standards, even if they
are receiving Federal monies. Section 11 would change this by
requiring that real property of grantees under VA's Homeless
Grant and Per Diem Program meet fire and safety requirements
applicable under the Life Safety Code of the National Fire
Protection Association. All the witnesses at the Committee's
hearing supported this change.
Section 12. Assistance for Grant Applications
While VA has provided more than 200 grants through the
Grant and Per Diem Program since its inception in 1994, over
400 applicants have been denied funding, according to the
National Coalition for Homeless Veterans. This is due to a
number of factors, including potential grantees' inability to
master the complex application processes of the multiple
federal agencies that offer grants. As many of these providers
are nonprofit organizations, grant money is often their primary
source of funding.
Section 12 would require the Secretary of Veterans Affairs
to conduct a technical grants assistance program to help these
nonprofit groups in applying for grants for programs that
address the problems of homeless veterans. The bill authorizes
$750,000 for this purpose for each of fiscal years 2002 through
2006. It is the Committee's goal that this will lead to an
increase in the number of successful applicants, as it will
allow more service providers to correctly apply for grants
through the Grant and Per Diem Program.
Section 13. Extension of Homeless Veterans Reintegration Program
The Homeless Veterans Reintegration Program is administered
through the Department of Labor's Veterans' Employment and
Training Service. It is one of the few programs that focuses
specifically on assisting homeless veterans in obtaining
employment. This program is critical in combating homelessness,
as it provides the job training and placement necessary to
reintegrate veterans into the workforce. It is also a
relatively low cost program. The National Coalition for
Homeless Veterans emphasized these points at the Committee's
July 19, 2001, hearing, stating that:
HVRP is an extraordinarily cost efficient program,
with a cost per placement of about $1,500 per veteran
entering employment. Based on years of experience of
our member organizations, NCHV strongly believes that
helping homeless veterans to get and keep a job is the
key to reducing homelessness among veterans.
Section 13 of the reported bill would extend this program
and authorize $50 million per year for each of fiscal years
2002 through 2006.
Cost Estimate
In compliance with paragraph 11(a) of rule XXVI of the
Standing Rules of the Senate, the Committee, based on
information supplied by the Congressional Budget Office (CBO),
estimates that, compared to the CBO baseline, there would be
costs resulting from enactment of the Committee bill.
The cost estimate provided by CBO follows:
U.S. Congress,
Congressional Budget Office,
Washington, DC, August 17, 2001.
Hon. John D. Rockefeller IV,
Chairman, Committee on Veterans' Affairs,
U.S. Senate, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for S. 739, the Heather
French Henry Homeless Veterans Assistance Act.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Sam
Papenfuss.
Sincerely,
Dan L. Crippen, Director.
Enclosure.
S. 739, Heather French Henry Homeless Assistance Act of 2001 (As
ordered reported by the Senate Committee on Veterans' Affairs
on August 2, 2001)
SUMMARY
S. 739 contains several provisions that would change how
the Department of Veterans Affairs (VA) provides assistance to
homeless veterans. The bill would extend the authority for VA
to provide health care to homeless veterans outside of VA
facilities. S. 739 also would require VA to establish at least
five new comprehensive homeless services centers and increase
funding for programs that provide shelter to homeless veterans.
In addition, the bill would authorize more money for the
homeless veterans reintegration program operated by the
Department of Labor.
S. 739 would authorize funding or modify provisions
governing discretionary spending for veterans' programs, which
CBO estimates would result in additional outlays of $37 million
in 2002 and $342 million over the 2002-2006 period, assuming
appropriation of the necessary amounts. Because the bill would
not affect direct spending or receipts, pay-as-you-go
procedures would not apply.
S. 739 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA)
and would impose no costs on state, local, or tribal
governments.
ESTIMATED COST TO THE FEDERAL GOVERNMENT
The estimated budgetary impact of S. 739 is shown in the
following table. This estimate assumes that S. 739 will be
enacted by October 1, 2001, and that the necessary amounts will
be appropriated for each year. The costs of this legislation
fall within budget functions 500 (education, employment, and
social services) and 700 (veterans benefits and services).
[By Fiscal Year, in Millions of Dollars]
----------------------------------------------------------------------------------------------------------------
2001 2002 2003 2004 2005 2006
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VETERANS' MEDICAL CARE
Baseline Spending Under Current Law:
Estimated Authorization Level a......................... 20,863 21,866 22,110 22,839 23,547 24,285
Estimated Outlays....................................... 20,418 21,501 22,020 22,613 23,298 24,028
Proposed Changes:
Estimated Authorization Level........................... 0 36 37 39 40 40
Estimated Outlays....................................... 0 33 37 38 39 40
Spending Under S. 739:
Estimated Authorization Level........................... 20,863 21,902 22,147 22,878 23,587 24,325
Estimated Outlays....................................... 20,418 21,534 22,057 22,651 23,337 24,068
ASSISTANCE FOR GRANT APPLICATIONS
Spending Under Current Law:
Estimated Authorization Level........................... 0 0 0 0 0 0
Estimated Outlays....................................... 0 0 0 0 0 0
Proposed Changes:
Estimated Authorization Level........................... 0 1 1 1 1 1
Estimated Outlays....................................... 0 1 1 1 1 1
Spending Under S. 739:
Estimated Authorization Level........................... 0 1 1 1 1 1
Estimated Outlays....................................... 0 1 1 1 1 1
HOMELESS VETERANS REINTEGRATION PROGRAM
Spending Under Current Law b:
Authorization Level..................................... 15 20 20 0 0 0
Estimated Outlays....................................... 0 2 14 18 6 0
Proposed Changes:
Authorization Level..................................... 0 30 30 50 50 50
Estimated Outlays....................................... 0 3 21 32 44 50
Spending Under S. 739:
Authorization Level..................................... 15 50 50 50 50 50
Estimated Outlays....................................... 0 5 35 50 50 50
SUMMARY OF CHANGES IN SPENDING SUBJECT TO APPROPRIATION
Estimated Authorization Level............................. 0 67 68 90 91 91
Estimated Outlays......................................... 0 37 59 71 84 91
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a The 2001 level is the estimated amount appropriated for that year. The current-law amounts for the 2002-2006
period assume that appropriations remain at the 2001 level, with adjustments for inflation.
b This program was authorized by Public Law 106-117, but the Congress has not appropriated any money for it yet.
``Spending Under Current Law'' reflects the prior authorization and CBO's estimate of outlays if funds were
appropriated for 2002 and 2003.
BASIS OF THE ESTIMATE
Veterans Medical Care. CBO estimates that implementing S.
739 would increase discretionary spending for veterans' medical
care by $33 million in 2002 and by $187 million over the 2002-
2006 period.
Comprehensive homeless services program. Under current law,
VA provides at least 15 different programs to assist homeless
veterans. These services are provided in over 140 cities across
the country but no one location offers all of the programs.
Within this framework, VA operates eight centers that offer
comprehensive homeless services. Under section 9, VA would be
required to establish at least five new similar centers.
Since none of the existing centers provide exactly the same
services, CBO assumes that these new centers would offer those
services that are provided by a majority of the existing
centers. Seven programs are provided by at least four of the
eight centers including domiciliary care for homeless veterans,
compensated work therapy, and the grant and per diem programs.
Of the seven programs, six are not available in most major
metropolitan areas where these new centers would likely be
established. For those programs that do not already exist in
these metropolitan areas, CBO used data from VA to calculate
the average cost to establish and administer each program. CBO
estimates that creating these comprehensive homeless services
centers and operating these programs would cost $11 million in
2002 and $59 million over the 2002-2006 period, assuming
appropriation of the estimated amounts.
Grant and per diem programs. Under current law, VA may
provide grants to nonprofit organizations that serve the
homeless. These grants partially subsidize the construction,
acquisition, and outreach costs of providing shelter and beds
to homeless veterans but not the daily costs of the operation.
VA may also provide a per diem payment that covers not more
than 50 percent of the daily costs of providing shelter to
homeless veterans. These rates are calculated annually to
ensure that VA does not pay more than half of the daily costs
of providing shelter. In 2001, VA estimated that it would spend
about $33 million on the two programs. Funding for these
programs comes from VA's annual appropriation for medical care.
Section 9 of S. 739 would allow VA to spend not less than
$55 million of its annual medical care appropriation on the
grant and per diem program with that amount increasing at the
same rate that the annual medical care appropriation increases.
CBO assumes that in the absence of this bill, VA would continue
to spend what it has in the past on the grant and per diem
program, with adjustments for inflation. Accordingly, CBO
estimates that this provision would increase spending by $19
million in 2002 and by $107 million over 2002-2006 period,
assuming appropriation of the authorized amounts.
Section 7 would affect the grant and per diem programs by
changing the way per diem rates are calculated. Under the bill,
VA would use the same rate that is authorized for veterans
receiving domiciliary care at VA State Homes. That rate is
about $3 per day higher than the average rate paid for homeless
shelter. According to VA, the number of beds in use will double
from 2,500 in 2001 to about 5,000 in 2003. Thus, CBO estimates
that this provision would cost $3 million in 2002 and $21
million over the 2002-2006 period, assuming appropriation of
the estimated amounts.
Medical care for homeless veterans. Section 9 would extend
for five years a provision of current law that allows VA to
provide outreach services to homeless veterans and medical care
in non-VA facilities including community-based treatment
facilities and halfway houses. This provision is due to expire
on December 31, 2001. VA currently plans to spend about $60
million in 2001 to provide medical care to homeless veterans
both in and out of VA facilities. Based on data from VA, CBO
estimates that about 20 percent of that care is provided under
the expiring provision. Consequently, CBO estimates that
allowing VA to continue these services would cost $8 million in
2002 and $60 million over the 2002-2006 period, assuming
appropriation of the estimated amounts. Because VA is currently
funding this program, the costs associated with this provision
are assumed in the baseline levels shown for medical care.
Assistance for Grant Applications. Section 12 would
authorize $750,000 in each of fiscal years 2002 through 2006
for technical assistance grants to not-for-profit groups with
experience in providing assistance to homeless veterans. These
funds would help the groups in applying for grants relating to
addressing problems of homeless veterans. CBO estimates that
implementing this section would cost about $4 million over the
2002-2006 period, assuming appropriation of the authorized
amounts.
Homeless Veterans Reintegration Program. Section 13 would
increase the authorization of appropriations to be used by the
Department of Labor to integrate homeless veterans into the
labor force from $20 million to $50 million for 2002 and 2003.
It would also authorize $50 million a year for 2004, 2005, and
2006. Although the program was authorized by Public Law 106-
117, the Congress has not yet appropriated any money for it.
CBO estimates that the increased authorization would cost $3
million in 2002 and $150 million over the 2002-2006 period,
assuming appropriation of the authorized amounts.
PAY-AS-YOU-GO CONSIDERATIONS
None.
INTERGOVERNMENTAL AND PRIVATE-SECTOR IMPACT
S. 739 contains no intergovernmental or private-sector
mandates as defined in UMRA and would impose no costs on state,
local, or tribal governments.
PREVIOUS CBO ESTIMATE
On April 12, 2001, CBO prepared a cost estimate of H.R.
936, also called the Heather French Henry Homeless Veterans
Assistance Act. Sections 7, 12, and 13 in S. 739 are identical
to sections 8, 17, and 19 in H.R. 936. Unlike section 12 of
H.R. 936, section 8 of S. 739 would not change the benefit for
dental care for homeless veterans. In addition, section 9 of S.
739 is similar to section 13 of H.R. 936, but S. 739 does not
contain any provisions regarding mental health, or opioid
substitution therapy and authorizes at least five additional
comprehensive homeless services programs as opposed to 14
additional programs under H.R. 936.
Estimate prepared by: Federal Costs: Sam Papenfuss and
Christi Hawley Sadoti. Impact on State, Local, and Tribal
Governments: Elyse Goldman. Impact on the Private Sector: Sally
Sagraves Maxwell.
Estimate approved by: Peter H. Fontaine, Deputy Assistant
Director for Budget Analysis, Congressional Budget Office.
Regulatory Impact Statement
In compliance with paragraph 11(b) of rule XXVI of the
Standing Rules of the Senate, the Committee on Veterans'
Affairs has made an evaluation of the regulatory impact that
would be incurred in carrying out the Committee bill. The
Committee finds that the Committee bill would not entail any
regulation of individuals or businesses or result in any impact
on the personal privacy of any individuals and that the
paperwork resulting from enactment would be minimal.
Tabulation of Votes Cast in Committee
In compliance with paragraph 7 of rule XXVI of the Standing
Rules of the Senate, the following is a tabulation of votes
cast in person or by proxy by members of the Committee on
Veterans' Affairs at its August 2, 2001, meeting. On that date,
the Committee, by unanimous voice vote, ordered S. 739, as
amended, reported favorably to the Senate.
Agency Report
On July 19, 2001, the Honorable Thomas L. Garthwaite, Under
Secretary for Health at the Department of Veterans Affairs,
appeared before the Committee and submitted testimony on, among
other things, S. 739 as originally introduced, the Heather
French Henry Homeless Veterans Assistance Act of 2001. Excerpts
from this statement are reprinted below:
STATEMENT OF THOMAS L. GARTHWAITE, M.D, UNDER SECRETARY FOR
HEALTH, DEPARTMENT OF VETERANS AFFAIRS
* * * * * * *
Mr. Chairman, I will begin by offering comments on S. 739,
a bill entitled the Heather French Henry Homeless Veterans
Assistance Act. The bill is an ambitious and comprehensive
piece of legislation that seeks to improve the services and
benefits furnished to homeless veterans. We strongly support
the objectives of the bill and generally support many of its
provisions. However, we are unable to support some of the
provisions largely because they duplicate long-standing
activities and programs conducted by the Department for
homeless veterans or more recent initiatives begun in Fiscal
Year 2000. Today I will briefly comment on each of the sections
of the bill.
Section 2 articulates Congress' findings regarding the
magnitude and scope of homelessness among veterans, the
inadequacy of current programs to provide them needed services,
the levels of funding needed to provide beds to homeless
veterans, and the commitment of the Congress to end
homelessness among the Nation's veterans. Other findings
articulate statistical information obtained from VA's report on
activities conducted under the Community Homelessness
Assessment, Local Education and Networking Groups (CHALENG)
program for veterans. Section 2 also defines various terms used
in the bill.
It is important to note that in light of more recent
information from our CHALENG program the number of homeless
veterans, as well as the number of additional beds needed for
homeless veterans, are likely to be somewhat lower than the
numbers cited in section 2.
Section 3 would declare a national goal of ending
homelessness among veterans within a decade and encourage all
governmental components, quasi-governmental departments,
agencies, and private and public sector entities to work
cooperatively in reaching this goal. We strongly support
section 3.
Section 4 would establish a 15-member Advisory Committee on
Homeless Veterans within the Department of Veterans Affairs,
articulate the functions and responsibility of the committee,
and establish the pay, allowances and terms for members. It
would also establish various reporting requirements. We share
the view that an advisory committee would be beneficial, but a
statutorily-created Committee is not needed. The Secretary has
already announced his intention to establish an Advisory
Committee on Homeless Veterans with many of the same functions
and objectives.
Section 5 would amend the McKinney-Vento Homeless
Assistance Act to require that the Interagency Council on
Homeless (ICH) meet at the call of its Chairperson or a
majority of its members and that the ICH meet at least
annually. We support this provision.
Section 6 is concerned with evaluation of our programs for
homeless veterans and calls for reporting to Congress on those
programs. It would require the Secretary to support the
continuation of at least one Department center for evaluation
to monitor the structure, process, and outcome of VA's programs
for homeless veterans. It would further require the Secretary
to annually provide Congress with a detailed report on the
health care needs of homeless veterans including information on
our Health Care for Homeless Veterans Program (HCHV) and
Homeless Providers Grant and Per Diem Program. Section 6 would
also require that we carry out our CHALENG assessment program
on an annual basis and report to Congress on the findings and
conclusions of the CHALENG report.
We support the objective of the requirement for maintenance
of an evaluation center, as called for in section 6, but we
believe the objective can be achieved without legislation by
expanding the mission of our Northeast Program Evaluation
Center (NEPEC). We currently rely on NEPEC to monitor and
evaluate the services provided to homeless veterans. Its
current efforts are comprehensive with respect to the health
care related services that are available and furnished to
homeless veterans. However, we capture limited information on
outreach activities and monetary benefits administered by the
Veterans Benefits Administration (VBA) in connection with
homeless veterans. Recognizing that our current efforts in this
area are fragmented and incomplete, we plan to take steps to
improve and strengthen the reporting of all programs and
benefits to fully and effectively monitor and evaluate all of
the Department's programs for homeless veterans.
We do not support the requirements of section 6 that would
statutorily require additional reporting and assessment
activities. We are essentially already performing these
assessment activities and reporting on them. Through the NEPEC,
we provide ongoing monitoring and evaluation of our health care
programs for homeless veterans. NEPEC provides detailed reports
on structure, process, and outcomes for all specially funded
homeless veterans programs as well as evaluation support for a
wide range of other mental health programs that are not
exclusively targeted to homeless veterans but are utilized by
homeless veterans such as the Compensated Work Therapy (CWT)
Program, and the Compensated Work Therapy/Transitional
Residence (CWT/TR) Program. In addition, the CHALENG program
achieves the objectives of the proposed requirements.
Section 7 would require the Secretary to designate care and
services provided to certain specified veterans as ``complex
care'' for purposes of the Veterans Equitable Resource
Allocation system (VERA). Veterans receiving the following
types of care would be covered: (1) veterans enrolled in the
Mental Health Intensive Community Case Management program; (2)
continuous care in homeless chronically mentally ill veterans
programs; (3) continuous care within specialized programs
provided to veterans who have been diagnosed with both serious
chronic mental illness and substance abuse disorders; (4)
continuous therapy combined with sheltered housing provided to
veterans in specialized treatment for substance use disorders;
and (5) specialized therapies provided to veterans with post-
traumatic stress disorders (PTSD), including specialized
outpatient PTSD programs; PTSD clinical teams; women veterans
stress disorder treatment teams; and substance abuse disorder
PTSD teams. Finally, section 7 would require that we ensure
that funds for any new program for homeless veterans carried
out through a Department health care facility are designated as
special purpose program funds (not VERA funds) for the first
three years of the program's operation.
We do not support section 7 of the bill. The complex
reimbursement rate under the VERA system is currently reserved
for reimbursing VISNs for providing the most complex and
expensive care, and should not be based on diagnosis or type of
disorder being treated. Section 7 directs complex reimbursement
based on broad and general diagnosis and does not consider
whether the care is costly. For example, VA now treats some
2,800 veterans in its Mental Health Intensive Community Case
management (MHICM) Program. If a veteran in that program
receives at least 41 visits per year, the VERA model will
reimburse at the complex rate because that veteran is receiving
costly care. Many others in the program have far fewer visits
and are far less costly to treat. Section 7 of this bill would
require complex reimbursement for all of 2,800 veterans in the
program regardless of how many visits they have.
The proposal could add more than 200,000 additional
veterans into the category of patients for whom Veterans
Integrated Service Networks (VISNs) receive complex
reimbursement. This would require VHA to either set aside a
greater percentage of the medical care appropriation for the
care of veterans identified in this section, or significantly
reduce the complex reimbursement rate per veteran treated.
Neither option is acceptable. The first reduces funding for the
standard care of veterans, and the second dilutes the
reimbursement for complex care so that there is little
incentive to provide services to these veterans. In addition,
this approach provides a perverse incentive for clinicians to
provide more treatment than is needed in order to qualify for
the complex reimbursement rate. The effect of this provision
would be to reduce the availability to veterans, including many
who are homeless, of care not identified in the complex
reimbursement category.
Section 8 would require that per diem payments paid to
grantees of our Homeless Providers Grant and Per Diem Program
be calculated at the same rate that currently applies to VA per
diem payments to State homes providing domiciliary care to
veterans. Under current law, the homeless provider per diem
rates are based on each grant recipient's costs. In short, we
pay per diem that amounts to not more than 50% of the
recipient's total costs up to a cap. To calculate the per diem
rate for each grantee, we must document each recipient's costs.
This is an extremely labor intensive and complex process.
We support simplification of program management in the
manner proposed. However, since domiciliary care and care under
the Homeless Providers Grant and Per Diem Program vary in types
of services and intensity, we support a per diem rate of 85
percent of the domiciliary care per diem rate. That would
equate more closely with the actual cost of services provided
under the Homeless Providers Grant and Per Diem Program.
Section 9 would require that we carry out a new grant
program for VA health care facilities and grantees of VA's
Homeless Grant and Per Diem Payment Program. The new program
would encourage the development of programs targeted at meeting
special needs of homeless veterans, including those who are
women, who are age 50 or older, who are substance abusers, who
suffer from PTSD, a terminal illness, or a chronic mental
illness; or who have care of minor dependents or other family
members. The measure would also require a report that includes
a detailed comparison of the results of the new grant program
with those obtained for similar veterans in VA programs or in
programs operated by grantees of VA's Homeless Providers Grant
and Per Diem Program.
We appreciate the intent of this provision, but we do not
support the section because it appears to be unnecessary. We
currently operate and/or support successful programs that are
specifically targeted at meeting the special needs of these
particularly vulnerable groups of homeless veterans. We
undertook several special program initiatives in 2000 that were
specifically targeted at the special needs of homeless
veterans, including women veterans. A study of the
effectiveness of the initiative related to homeless programs
for women veterans is underway. Finally, we have been
successful in establishing and cultivating relations with non-
profits in the community to ensure a continuum of services for
homeless veterans. We are concerned that this proposal may have
a disruptive effect on those relationships by requiring our
community partners to compete with VA facilities for these
limited grant funds.
Section 10 would require that appropriate officials of our
Mental Health Service and Readjustment Counseling Service
initiate a coordinated plan for joint outreach on behalf of
veterans at risk of homelessness, expressly including those who
are being discharged from institutions such as inpatient
psychiatric care units, substance abuse treatment programs, and
penal institutions. The section sets out a detailed list of
items and factors to be included or provided for in the plan.
We support this provision in concept but suggest that it
may be duplicative of our current outreach authority and
statutory requirement to coordinate with other governmental and
non-governmental agencies and organizations. However, we
recognize the need for continuing to expand and improve our
coordination efforts on behalf of homeless veterans and those
at risk for homelessness and the concomitant need to report
adequately on these efforts. We will work towards these ends.
As to the issue of coordination between VHA and Vet
Centers, our Health Care for Homeless Veterans (HCHV) Programs
staff, who primarily serve under mental health service lines at
VA medical centers, currently collaborate with Vet Centers
staff regarding the needs of homeless veterans. (Vet Centers
estimate that approximately 10% of veterans served in Vet
Centers are homeless.) Referrals are regularly made between
VA's specialized homeless programs and Vet Centers for
appropriate services for veterans who are homeless or at risk
for homelessness. In addition, Vet Centers staff are invited to
attend and participate in CHALENG meetings. Further, HCHV staff
and Vet Centers staff already collaborate with non-VA
community-based service providers and with other government
sponsored programs.
Section 11 would require that we conduct two treatment
trials in integrated mental health services delivery. The bill
defines ``integrated mental health services delivery'' as ``a
coordinated and standardized approach to evaluation for
enrollment, treatment, and follow-up with patients who have
both mental health disorders (to include substance use
disorders) and medical conditions between mental health and
primary health care professionals.'' One of the treatment
trials would have to use a model incorporating mental health
primary care teams and the other would have to use a model
using patient assignment to a mental health primary care team
that is linked with the patient's medical primary care team. We
would also have to compare treatment outcomes obtained from the
two treatment trials with those for similar chronically
mentally ill veterans who receive treatment through
traditionally consultative relationships. The VA Inspector
General would have to review the medical records of
participants and controls for both trials to ensure that the
results are accurate.
We share an interest in this area of clinical research and
have decided to carry out the project contemplated by section
11 using mechanisms and special programs already in place, i.e.
VA's Health Services Research and Development Service and the
Department's MIRECCs program. In pursuing this endeavor, we
welcome the opportunity to work with Committee staff to ensure
the language of the request for research proposals satisfies
the objectives of section 11. However, this particular research
study (including the final analysis and report to Congress)
would likely require more than the amount of time permitted
under section 11. Additionally, VA program officials and
evaluators will be expected to manage and report on the results
of a project of this size without immediate and direct
oversight from the Office of the Inspector General (OIG). If
there is a need for human subject protection review, the Office
of Research and Compliance Assurance (ORCA) should conduct it
and OIG involvement should consist only of their current
oversight of the activities of ORCA.
Section 12 would effectively extend eligibility for
outpatient dental services, treatment, and appliances to
certain veterans when such services, treatment, and appliances
are needed to successfully gain or regain employment, to
alleviate pain, or to treat moderate, severe, or severe and
complicated gingival and periodontal pathology. The new
authority would extend benefits to enrolled veterans who are
receiving care in an array of VA settings, and community
programs supported by VA.
Although we recognize that these veterans need dental care
and services, we do not support this provision because it would
result in a disparity in access to needed outpatient dental
care and services among equally deserving veterans. As an
alternative, we will heighten and expand our current efforts to
obtain dental care and services for homeless veterans through
pro bono providers, dental schools and related teaching
programs, and service providers receiving grants under VA's
Homeless Providers Grant and Per Diem Program.
Section 13 contains several varied provisions. The first
would require the Secretary to develop standards to ensure that
mental health services are available to veterans in a manner
similar to that in which primary care is made available to
veterans by requiring every VA primary care health care
facility to have mental health treatment capacity. We certainly
believe in equitable availability of mental health services and
we have included such services in our basic benefits package.
We are also already working to assure that all sites of care
can either directly provide, contract for, or refer patients to
other VA facilities for mental health care.
Another provision in section 13 would require that we
expend not less than $55 million from Medical Care funds for
our Homeless Providers Grant and Per Diem Program. The amounts
to be expended would also have to be increased for any fiscal
year by the overall percentage increase in the Medical Care
account for that fiscal year from the preceding fiscal year. We
don't concur with this provision. We have offered grant funds
each year for the past seven years. Grant fund availability has
ranged from a low of $3.3 million in FY 1996 to a high of $15.3
million in FY 1998. Of the $32.4 million identified for the
Grant and Per Diem Program in FY 2001, approximately $22
million is expected to be spent on per diem payments, leaving
$10 million available for the eighth round of grants. We
believe that making $10 million available for grants is a
reasonable funding level for any given year. Grant awards of
$10 million assist with the development of approximately 1,000
community-based beds. It often takes grant recipients two years
or longer to complete construction or renovation and to bring
the program to full operation. During the development phase, VA
staff at the national, VISN and VAMC level are available to
assist grant recipients with any problems they might encounter.
We believe this personal attention and assistance are partially
responsible for the relatively high success rate of grant
program implementation. Steady and reasonable growth in the
Homeless Providers Grant and Per Diem Program appears to be one
of the keys to the success of this program. It is likely that
the Grant and Per Diem Program will reach a spending level of
$55 million in the next five years.
Moreover, a requirement to spend not less than $55 million
next year and in future years may actually be counter-
productive to achieving the goals of this program because it
would require VA to fund programs that would otherwise not
merit grant assistance based on competitive scoring criteria.
Past experience has shown VA that not all grant applicants are
able to propose viable projects. Indeed, less than 50
applications received in any given year satisfy scoring
criteria. This is not indicative of a program weakness; rather,
it reflects the requirement that we award grants under the
program only to those providers that demonstrate their
viability and ability to succeed in meeting their grant
applications' stated purpose(s).
A third part of section 13 would require that we establish
centers to provide comprehensive services to homeless veterans
in at least each of the 20 largest metropolitan statistical
areas. Currently, we must have eight such centers.
We support this provision, but defining what services would
constitute a comprehensive homeless services program for each
of the 20 largest metropolitan statistical areas is a
particularly complex task, which depends on the specific
demographics of, and the services available in, each particular
area. We would like to work with the Congress in defining what
specific programs and services are envisioned by this
provision.
A fourth aspect of Section 13 would require us to ensure
that opioid substitution therapy is available at each VA
medical center. We don't support this provision on the basis
that a determination to provide opioid substitution therapy is
medical in nature (not legislative) and, as such, is dependent
on the individual clinical facts of each case. The size and
location of medical programs should be determined by veterans'
medical needs. However, we recognize the clinical value of this
particular treatment. Indeed, we have established 36 opioid
substitution programs in VA medical centers across the country
and we are evaluating our substance abuse treatment needs to
determine whether additional programs may be needed. If deemed
to be medically necessary and appropriate, we will not hesitate
to establish more programs where needed.
Finally, the last part of section 13 would extend, through
December 31, 2006, both our authority to treat veterans who are
suffering from serious mental illness, including veterans who
are homeless and VA's authority to provide benefits and
services to homeless veterans through VA's Comprehensive
Homeless Centers. The authority for each of those programs will
expire on December 31, 2001 and we support both extensions.
Section 14 would permit homeless veterans receiving care
through vocational rehabilitation programs to participate in
the Compensated Work Therapy program. It would also allow
homeless veterans in VHA's Compensated Work Therapy program to
receive housing through the therapeutic residence program or
through grantees of VA's Homeless Providers Grant and Per Diem
Program. We support both of those provisions.
Section 14 would also require that we ensure that each
Regional Office assign at least one employee to oversee and
coordinate homeless veterans programs in that region, and that
any regional office with at least 140 employees have at least
one full-time employee assigned to the above-stated functions.
We support the need for continued effective outreach to
homeless veterans, but we have concerns about the proposed
staffing requirements. Homeless Veterans Outreach Coordinators
are already assigned at each VBA regional office. In most
instances, this assignment is a collateral duty and not a full-
time assignment. There are, however, some regional offices at
which a full-time coordinator is assigned as necessitated by
the size of the homeless veteran population and homeless
support programs within its jurisdictional area. In addition,
we have eight full-time homeless outreach coordinators assigned
as members of our Health Care for Homeless Veterans Program and
DCHV programs. We also have two offices that have a part-time
employee on the homeless program. These positions are
reimbursed by VHA. The staffing requirement in this measure
would therefore be an unfunded mandate for which employees
would have to be re-assigned from other key duties such as
claims processing, rating functions, etc. In addition, we
believe the veteran population and its particular needs, not
the organizational structure of an office, should determine the
number and type of outreach coordinators assigned.
Finally, the last part of section 14 would require disabled
veterans' outreach program specialists and local veterans'
employment representatives where available to also coordinate
training assistance benefits provided to veterans by entities
receiving financial assistance under section 738 of the
McKinney-Vento Homeless Assistance Act. We support this
provision.
Section 15 would require that, with a limited exception,
real property of grantees under our Homeless Providers Grant
and Per Diem Program meet fire and safety requirements
applicable under the Life Safety Code of the NFPA.
We strongly support this requirement. The fire and safety
requirements under the Life Safety Code of the National Fire
Protection Association (NFPA) have been developed through
consensus of experts across the country. They assure a
consistent level of safety for homeless veterans living in
transitional housing or receiving services in supportive
service centers developed under the Grant and Per Diem Program.
Entities that have received grants in recent years have been
aware of VA's preference for structures to meet the fire and
safety requirements under the Life Safety Code of NFPA and have
developed their grant applications to cover the costs
associated with meeting those requirements. There are, however,
some organizations that received grant awards and their
buildings do not meet the fire and safety requirements under
the Life Safety Code of NFPA. It is therefore particularly
valuable that this measure would permit VA to award grant
assistance to these entities to enable them to upgrade their
facilities to meet the Life Safety Code of NFPA.
Section 16 would establish a three-year pilot program to
provide transitional assistance grants to up to 600 eligible
homeless veterans at not less than three but not more than six
regional offices. The sites for the pilot must include at least
one regional office located in a large urban area and at least
one serving primarily rural veterans. To be eligible, a veteran
would have to live in the area of the regional office, be a war
veteran or meet minimum service requirements, be recently
released, or in the process of being released from an
institution, be homeless and have less then marginal income.
Grants under the program would be limited to three months
with an exception for any veteran who, while receiving such
transitional assistance, has a claim pending for service-
connected disability compensation or non-service-connected
pension. Such veterans could continue to receive transitional
assistance under this section until the earlier of (A) the date
on which a decision on the claim is made by the regional
office, or (B) the end of the six-month period beginning on the
date of expiration of eligibility under subsection (c). The
measure would also require the Department to expedite its
consideration of pending claims of veterans. VA would have to
pay the grants monthly and in the same amount as that which VA
would be obligated to pay under chapter 15 of title 38, United
States Code, if the veteran had a permanent and total non-
service-connected disability. VA would have to determine the
amount of the grant without regard to the income of the
veteran, once it is determined the veteran meets the
eligibility criteria. Finally it would require the Department
to offset the amount of retroactive disability or pension
benefits paid to a veteran by the amount of transitional
assistance provided to the veteran for the same monthly period.
We cannot support section 16, as it appears to be at odds
with the inherent interest of our attempts at rehabilitation.
The provision lacks safeguards or limitations on the receipt
and use of the grant funds, notwithstanding the strong
likelihood that many of the grant recipients would be veterans
suffering from mental illnesses and/or substance abuse
disorders. Awarding funds to these veterans without also
requiring them to participate in simultaneous clinical
intervention or oversight would result in many of them not
seeking the care and treatment necessary to overcome their
disorders. This, in turn, could keep those veterans in a
condition of homelessness. Simply awarding grant funds, as
proposed, is not, in our view, an appropriate means for making
these vulnerable veterans self-sufficient.
Section 17 would require that we conduct a technical
assistance grants program to assist non-profit groups, which
are experienced in providing services to homeless veterans, to
apply for grants related to addressing problems of homeless
veterans. The measure would authorize $750,000 to be
appropriated for each of fiscal years 2001 through 2005 to
carry out the program. We do not support this section as we
already provide extensive information about the Homeless
Providers Grant and Per Diem Program through the Internet,
participation in national, state and some local conferences and
one-on-one discussions between interested applicants and VA
program managers.
Section 18 would authorize the Secretary to waive any
requirement that a veteran purchasing a manufactured home with
the assistance of a VA guaranteed loan own or purchase a lot to
which the manufactured home is permanently affixed.
We do not favor this provision. Rather than address the
specifics of this section of the bill, we have concluded the
manufactured home loan program no longer provides a viable
benefit to veterans, homeless or otherwise. Accordingly, VA
recommends that the manufactured home loan program, which for
all intents and purposes is dormant, be terminated.
The number of veterans obtaining manufactured housing loans
has significantly declined over the years since Fiscal Year
1983 when VA guaranteed 15,725 such loans. No manufactured
housing loans have been guaranteed since Fiscal Year 1996.
The cumulative foreclosure rate on VA manufactured home
loans is 39.2 percent, which is significantly higher than the
5.6 percent rate for loans for conventionally-built homes. This
foreclosure rate has greatly increased the cost to the
taxpayers of the VA housing loan program and resulted in
substantial debts being established against veterans.
Therefore, VA does not believe the manufactured home loan
program has any role in the effort to assist homeless veterans.
Section 19 would increase from $20 million to $50 million
the amount authorized to be appropriated for the Homeless
Veterans' Reintegration Programs for Fiscal Year 2002 and
Fiscal Year 2003. It would also authorize that same amount to
be appropriated for purposes of this program for Fiscal Years
2004, 2005, and 2006. VA defers to the Secretary of Labor, who
administers the Homeless Veterans' Reintegration Programs.
Section 20 would require the Secretary, before disposing of
real property as excess, to determine that the property is not
suitable for use for the provision of services to homeless
veterans by the Department or by another entity under an
enhanced-use lease. Although we agree with the purpose of
section 20, this provision appears to be redundant with
existing authorities. Under the Department's enhanced-use
leasing authority, we now have the ability to lease available
lands and facilities for compatible uses including those that
provide services to homeless veterans. We have, in fact,
recently used this authority to obtain a 120-unit ``Single Room
Occupancy'' (SRO) housing complex in Vancouver, Washington, and
a 63-unit SRO in Roseburg, Oregon. We are examining similar
initiatives nationwide. In addition, pursuant to the Stewart B.
McKinney Act, the Department surveys its property holdings and
provides quarterly reports to the Department of Housing and
Urban Development on the availability of excess or
underutilized properties for housing for the homeless. In
general terms, the provisions of the McKinney Act related to
surplus federal property require each Department, in deeming
property under its jurisdiction to be unutilized, under-
utilized, or excess, to state that the property cannot be made
available for use to assist the homeless. Before ultimately
disposing of such property, the McKinney Act requires the
Government to again give priority of consideration to uses to
assist the homeless. Given that VA has active programs in place
that strive to achieve the objective reflected in section 20,
establishing a duplicate requirement would only lend confusion
to the process.
* * * * * * *
Changes in Existing Law Made by the Committee bill, As Reported
In compliance with rule XXVI paragraph 12 of the Standing
Rules of the Senate, the following provides a print of the
statute or the part or section thereof to be amended or
replaced (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
CHAPTER 5--AUTHORITY AND DUTIES OF THE SECRETARY
subchapter i--general authorities
Sec.
501. * * *
* * * * * * *
subchapter ii--specified functions
546. ADVISORY COMMITTEE ON HOMELESS VETERANS.
* * * * * * *
Sec. 546. Advisory Committee on Homeless Veterans
(a)(1) There is established in the Department the Advisory
Committee on Homeless Veterans (hereinafter in this section
referred to as the ``Committee'').
(2) The Committee shall consist of not more than 15 members
appointed by the Secretary from among the following:
(A) Veterans service organizationsvocational
rehabilitation.
(J) Such other organizations or groups as the
Secretary considers appropriate.
(3) The Committee shall include, as ex officio members--
(A) the Secretary of Labor (or a representative of
the Secretary selected after consultation with the
Assistant Secretary of Labor for Veterans' Employment
and Training);
(B) the Secretary of Defense (or a representative of
the Secretary);
(C) the Secretary of Health and Human Services (or a
representative of the Secretary); and
(D) the Secretary of Housing and Urban Development
(or a representative of the Secretary).
(4) The Secretary shall determine the terms of service and
pay and allowances of the members of the Committee, except that
a term of service may not exceed three years. The Secretary may
reappoint any member for additional terms of service.
(b)(1) The Secretary shall, on a regular basis, consult with
and seek the advice of the Committee with respect to the
provision by the Department of benefits and services to
homeless veterans.
(2)(A) In providing advice to the Secretary under this
subsection, the Committee shall--
(i) assemble and review information relating to the
needs of homeless veterans;
(ii) provide an on-going assessment of the
effectiveness of the policies, organizational
structures, and services of the Department in assisting
homeless veterans; and
(iii) provide on-going advice on the most appropriate
means of providing assistance to homeless veterans.
(3) The Committee shall--
(A) review the continuum of services provided by the
Department, whether directly or by contract, in order
to define cross-cutting issues and to improve
coordination of all services in the Department that
address the special needs of homeless veterans;
(B) identify (through annual assessments under
section 1774 of this title and other available
resources) gaps in programs of the Department in
serving homeless veterans, including identification of
geographic areas with unmet needs, and provide
recommendations to address those gaps;
(C) identify gaps in existing information systems on
homeless veterans, both within and outside the
Department, and provide recommendations about
redressing problems in data collection;
(D) identify barriers under existing laws and
policies to effective coordination by the Department
with other Federal agencies and with State and local
agencies addressing homeless populations;
(E) identify opportunities for enhanced liaison by
the Department with nongovernmental organizations and
individual groups addressing homeless populations;
(F) with appropriate officials of the Department
designated by the Secretary, participate with the
Interagency Council on the Homeless under title II of
the McKinney-Vento Homeless Assistance Act (42 U.S.C.
11311 et seq.);
(G) recommend appropriate funding levels for
specialized programs for homeless veterans provided or
funded by the Department;
(H) recommend appropriate placement options for
veterans who, because of advanced age, frailty, or
severe mental illness, may not be appropriate
candidates for vocational rehabilitation or independent
living; and
(I) perform such other functions as the Secretary may
direct.
(c)(1) Not later than March 31 of each year, the Committee
shall submit to the Secretary a report on the programs and
activities of the Department that relate to homeless veterans
during the preceding year. Each such report shall include--
(A) an assessment of the needs of homeless veterans;
(B) a review of the programs and activities of the
Department designed to meet such needs, including the
evaluation of outreach activities required under
paragraph (2);
(C) a review of the activities of the Committee; and
(D) such recommendations (including recommendations
for administrative and legislative action) as the
Committee considers appropriate.
(2)(A) The Committee shall include in each report under
paragraph (1) an evaluation of the outreach activities of the
Department with respect to homeless veterans, including
outreach regarding clinical issues and outreach regarding other
benefits.
(B) The Committee shall conduct each evaluation under this
paragraph in consultation with the Under Secretary for
Benefits, the Under Secretary for Health, the Readjustment
Counseling Service, the Director of Homeless Veterans Programs,
and the Mental Health Strategic Health Care Group.
(C) In including an evaluation under this paragraph in a
report under paragraph (1), the Committee shall set forth in
the report the following:
(i) The results of the evaluation.
(ii) Any recommendations that the Committee considers
appropriate to improve the outreach activities of the
Department with respect to homeless veterans, including
recommendations for enhanced interagency cooperation
and enhanced cooperation between the Department and
appropriate community organizations and recommendations
for additional activities to complement, supplement, or
otherwise eliminate deficiencies in the outreach
activities.
(3) Not later than 90 days after the receipt of a report
under paragraph (1), the Secretary shall transmit to the
Committees on Veterans' Affairs of the Senate and House of
Representatives a copy of the report, together with any
comments and recommendations concerning the report that the
Secretary considers appropriate.
(4) The Committee may also submit to the Secretary such other
reports and recommendations as the Committee considers
appropriate.
(5) The Secretary shall include with each annual report
submitted to Congress pursuant to section 529 of this title a
summary of all reports and recommendations of the Committee
submitted to the Secretary since the previous annual report of
the Secretary submitted pursuant to that section.
(d)(1) Except as provided in paragraph (2), the provisions of
the Federal Advisory Committee Act (5 U.S.C. App.) shall apply
to the activities of the Committee under this section.
(2) Section 14 of such Act shall not apply to the Committee.
* * * * * * *
Sec. 1712. Dental care; drugs and medicines for certain
disabled veterans; vaccines
(a)(1) Outpatient dental services and treatment, and related
dental appliances, shall be furnished under this section only
for a dental condition or disability--
* * * * * * *
(H) the treatment of which is medically necessary (i)
in preparation for hospital admission, or (ii) for a
veteran (including a homeless veteran) otherwise
receiving care or services under this chapter.
* * * * * * *
SUBCHAPTER VII--TREATMENT AND REHABILITATION FOR SERIOUSLY MENTALLY ILL
AND HOMELESS VETERANS
Sec. 1771. General treatment
* * * * * * *
(b) The authority of the Secretary under subsection (a)
expires on [December 31, 2001] December 31, 2006.
* * * * * * *
Sec. 1773. Additional services at certain locations
* * * * * * *
(b) The program shall include the establishment of [not fewer
than eight] programs (in addition to any existing programs
providing similar services) at sites under the jurisdiction of
the Secretary to be centers for the provision of comprehensive
services to homeless veterans. The services to be provided at
each site shall include a comprehensive and coordinated array
of those specialized services which may be provided under
existing law.
* * * * * * *
(d) The program under this section shall terminate on
[December 31, 2001] December 31, 2006.
Sec. 1774. Coordination with other agencies and organizations
* * * * * * *
(b)(1) The Secretary shall require the director of each
medical center or the director of each regional benefits office
to make an annual assessment of the needs of homeless veterans
living within the area served by the medical center or regional
office, as the case may be.
* * * * * * *
(6) The Secretary shall review each annual assessment under
this subsection, and shall consolidate the findings and
conclusions of such assessments into an annual report which the
Secretary shall submit to Congress.
* * * * * * *
Sec. 4103A. Disabled veterans' outreach program
* * * * * * *
(c) Each disabled veterans' outreach program specialist shall
carry out the following functions for the purpose of providing
services to eligible veterans in accordance with the priorities
set forth in subsection (b) of this section:
* * * * * * *
(11) Coordination of services provided to veterans
with training assistance provided to veterans by
entities receiving financial assistance under section
738 of the McKinney-Vento Homeless Assistance Act (42
U.S.C. 11448).
Sec. 4104. Local veterans' employment representatives
* * * * * * *
(b) Local veterans' employment representatives shall--
* * * * * * *
(11) when requested by a Federal or State agency, a
private employer, or a service-connected disabled
veteran, assist such agency, employer, or veteran in
identifying and acquiring prosthetic and sensory aids
and devices needed to enhance the employability of
disabled veterans; [and]
(12) facilitate the provision of guidance or
counseling services, or both, to veterans who, pursuant
to section 5(b)(3) of the Veterans' Job Training Act
(29 U.S.C. 1721 note), are certified as eligible for
participation under such Act[.] ; and
(13) coordinate services provided to veterans with
training assistance for veterans provided by entities
receiving financial assistance under section 738 of the
McKinney-Vento Homeless Assistance Act (42 U.S.C.
11448).
* * * * * * *
Sec. 4111. Homeless veterans' reintegration programs
* * * * * * *
(d) Authorization of Appropriations.--(1) There are
authorized to be appropriated to carry out this section amounts
as follows:
* * * * * * *
[(C) $20,000,000 for fiscal year 2002.
[(D) $20,000,000 for fiscal year 2003.]
(C) $50,000,000 for fiscal year 2002.
(D) $50,000,000 for fiscal year 2003.
(E) $50,000,000 for fiscal year 2004.
(F) $50,000,000 for fiscal year 2005.
(G) $50,000,000 for fiscal year 2006.
* * * * * * *
HOMELESS VETERANS COMPREHENSIVE SERVICE PROGRAMS ACT OF 1992
* * * * * * *
SEC. 3. GRANTS.
* * * * * * *
(b) Criteria for Award of Grants.--The Secretary shall
establish criterria and requirements for the award of a grant
under this section, including criteria for entities eligible to
receive such grants. The Secretary shall publish such criteria
and requirements in the Federal Register not later than 90 days
after the date of the enactment of this Act (Nov. 10, 1992). In
developing such criteria and requirements, the Secretary shall
consult with organizations with experience in the area of
providing service to homeless veterans and to the maximum
extent possible shall take into account the findings of the
assessment of the Secretary under section 107 of the Veterans'
Medical Programs Amendments of 1992 (Pub. L. 102-405, 38 U.S.C.
527 note). The criteria established under this section shall
include the following:
* * * * * * *
(5) Provisions to ensure that an entity receiving a
grant shall meet fire and safety requirements
established by Secretary, which shall include such
State and community requirements that may apply[, but
fire and safety requirements applicable to buildings of
the Federal Government shall not apply to real property
to be used by a grantee in carrying out the grant] and
the fire and safety requirements applicable under the
Life Safety Code of the National Fire Protection
Association.
* * * * * * *
SEC. 4. PER DIEM PAYMENTS.
(a) Per Diem Payments for Furnishing Services To Homeless
Veterans.--Subject to the availability of appropriations
provided for under section 12 (set out below), the Secretary of
Veterans Affairs, pursuant to such criteria as the Secretary
shall prescribe, shall provide to a recipient of a grant under
section 3 (or an entity eligible to receive a grant under
section 3 which after the date of enactment of this Act (Nov.
10, 1992) establishes a program which the Secretary determines
carries out the purposes described in section 3) per diem
payments [at such rates as the Secretary shall prescribe by
regulation for services furnished to any homeless veteran--] at
the same rates as the rates authorized for State homes for
domiciliary care provided under section 1741 of title 38,
United States Code, for services furnished to homeless
veterans--
* * * * * * *
(e) Life Safety Code.--(1) Except as provided in paragraph
(2), a per diem payment (or in-kind assistance in lieu of per
diem payments) may not be provided under this section to a
grant recipient unless the facilities of the grant recipient
meet the fire and safety requirements applicable under the Life
Safety Code of the National Fire Protection Association.
(2) During the five-year period beginning on the date of the
enactment of the Heather French Henry Homeless Veterans
Assistance Act, paragraph (1) shall not apply to an entity that
received a grant under section 3 before that date if the entity
meets fire and safety requirements established by the
Secretary.
(3) From amounts available for purposes of this section
pursuant to section 12, not less than $5,000,000 shall be used
only for grants to assist entities covered by paragraph (2) in
meeting the Life Safety Code of the National Fire Protection
Association.
* * * * * * *
[SEC. 12. AUTHORIZATION OF APPROPRIATIONS.
[There are authorized to be appropriated to carry out
this Act (other than section 8) $48,000,000 for each of fiscal
years 1993 through 1997 and $50,000,000 for each of fiscal
years 2000 and 2001. Nothing in this Act shall be construed to
diminish funds for, continuation of, or expansion of existing
programs administered by the Secretary of Veterans Affairs to
serve veterans.]
SEC. 12. FUNDING.
(a) Amounts for Grant and Per Diem Programs.--From amounts
appropriated for `Medical Care' for any fiscal year, the
Secretary may expend not more than $55,000,000 (as adjusted
from time to time under subsection (b)) to carry out the
transitional housing grant and per diem provider programs under
sections 3 and 4 of this Act.
(b) Periodic Increases.--The amount in effect under
subsection (a) shall be increased for any fiscal year by the
overall percentage increase in the Medical Care account for
that fiscal year over the preceding fiscal year.
* * * * * * *
McKINNEY-VENTO HOMELESS ASSISTANCE ACT
* * * * * * *
SEC. 202. MEMBERSHIP.
* * * * * * *
(c) Meetings.--The Council shall meet at the call of its
Chairperson or a majority of its members, but not less often
than annually.