[House Report 110-78]
[From the U.S. Government Publishing Office]
110th Congress Report
HOUSE OF REPRESENTATIVES
1st Session 110-78
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PROVIDING FOR CONSIDERATION OF THE BILL (H.R. 1538) TO AMEND TITLE 10,
UNITED STATES CODE, TO IMPROVE THE MANAGEMENT OF MEDICAL CARE,
PERSONNEL ACTIONS, AND QUALITY OF LIFE ISSUES FOR MEMBERS OF THE ARMED
FORCES WHO ARE RECEIVING MEDICAL CARE IN AN OUTPATIENT STATUS, AND FOR
OTHER PURPOSES
_______
March 27, 2007.--Referred to the House Calendar and ordered to be
printed
_______
Ms. Castor, from the Committee on Rules, submitted the following
R E P O R T
[To accompany H. Res. 274]
The Committee on Rules, having had under consideration
House Resolution 274, by a nonrecord vote, report the same to
the House with the recommendation that the resolution be
adopted.
SUMMARY OF PROVISIONS OF THE RESOLUTION
The resolution provides for consideration of H.R. 1538 to
improve the management of medical care, personnel actions, and
quality of life issues for members of the Armed Forces who are
receiving medical care in an outpatient status. The resolution
provides for one hour and twenty minutes of general debate,
with one hour equally divided and controlled by the Chairman
and Ranking Minority Member of the Committee on Armed Services
and twenty minutes equally divided and controlled by the
Chairman and Ranking Minority Member of the Committee on
Veterans' Affairs.
The resolution waives all points of order against
consideration of the bill except those arising under clause 9
or 10 of rule XXI. The resolution makes in order the amendment
in the nature of a substitute recommended by the Committee on
Armed Services as the original bill for the purpose of further
amendment.
The resolution makes in order those amendments printed in
this report. Finally, the resolution provides one motion to
recommit with or without instructions.
EXPLANATION OF WAIVERS
The resolution includes a waiver of all points of order
against consideration of the bill except for those arising
under clauses 9 and 10 of rule XXI. The waiver includes a
waiver of clause 3(c)(4) of rule XIII (regarding statement of
general performance goals and objectives in committee report).
COMMITTEE VOTES
The results of each record vote on an amendment or motion
to report, together with the names of those voting for and
against, are printed below:
Rules Committee record vote No. 105
Date: March 27, 2007.
Measure: H.R. 1538.
Motion by: Mr. Dreier.
Summary of motion: To report an open rule.
Results: Defeated 3-9.
Vote by Members: McGovern--Nay; Hastings (FL)--Nay;
Matsui--Nay; Cardoza--Nay; Welch--Nay; Castor--Nay; Arcuri--
Nay; Sutton--Nay; Dreier--Yea; Hastings (WA)--Yea; Sessions--
Yea; Slaughter--Nay.
Rules Committee record vote No. 106
Date: March 27, 2007.
Measure: H.R. 1538.
Motion by: Mr. Dreier.
Summary of motion: To make in order and provide appropriate
waivers for an amendment by Rep. Shays (#6) requiring the
establishment, publication, and monitoring of medical holdover
(MHO) process performance standards and requiring holdover and
inspection reports to be submitted to the Secretary of Defense
and the Defense Department Inspector General.
Results: Defeated 3-9.
Vote by Members: McGovern--Nay; Hastings (FL)--Nay;
Matsui--Nay; Cardoza--Nay; Welch--Nay; Castor--Nay; Arcuri--
Nay; Sutton--Nay; Dreier--Yea; Hastings (WA)--Yea; Sessions--
Yea; Slaughter--Nay.
Rules Committee record vote No. 107
Date: March 27, 2007.
Measure: H.R. 1538.
Motion by: Mr. Hastings of Washington.
Summary of motion: To make in order and provide appropriate
waivers for an amendment by Rep. Moran of Kansas (#21)
establishing a pilot program to allow combat veterans residing
in highly rural areas to receive covered Department of
Veterans' Affairs health care services through a non-VA
provider.
Results: Defeated 3-9.
Vote by Members: McGovern--Nay; Hastings (FL)--Nay;
Matsui--Nay; Cardoza--Nay; Welch--Nay; Castor--Nay; Arcuri--
Nay; Sutton--Nay; Dreier--Yea; Hastings (WA)--Yea; Sessions--
Yea; Slaughter--Nay.
Rules Committee record vote No. 108
Date: March 27, 2007.
Measure: H.R. 1538.
Motion by: Mr. Hastings of Washington.
Summary of motion: To make in order and provide appropriate
waivers for an amendment by Rep. Pearce (#14) requiring the VA
Secretary to contract with local doctors and hospitals on a
case-by-case basis to provide medical services, including
primary care, for those veterans who live far away from VA
medical centers.
Results: Defeated 3-9.
Vote by Members: McGovern--Nay; Hastings (FL)--Nay;
Matsui--Nay; Cardoza--Nay; Welch--Nay; Castor--Nay; Arcuri--
Nay; Sutton--Nay; Dreier--Yea; Hastings (WA)--Yea; Sessions--
Yea; Slaughter--Nay.
Rules Committee record vote No. 109
Date: March 27, 2007.
Measure: H.R. 1538.
Motion by: Mr. Sessions.
Summary of motion: To make in order and provide appropriate
waivers for an amendment by Rep. Shays (#7) establishing a
patient advocate or ``navigator'' program for wounded service
members. The Navigators will be representatives for patients
and their families, independent of current military service.
Results: Defeated 3-9.
Vote by Members: McGovern--Nay; Hastings (FL)--Nay;
Matsui--Nay; Cardoza--Nay; Welch--Nay; Castor--Nay; Arcuri--
Nay; Sutton--Nay; Dreier--Yea; Hastings (WA)--Yea; Sessions--
Yea; Slaughter--Nay.
SUMMARY OF AMENDMENTS MADE IN ORDER
1. Barrow (GA): The amendment eliminates the deductible and
changes the method of determining the mileage reimbursement
rate under the beneficiary travel program administered by the
Secretary of Veterans' Affairs. The reimbursement rate will be
increased to the level at which Government employees are
reimbursed for the use of privately owned vehicles on official
business. (10 minutes)
2. Skelton (MO): The amendment would make technical changes
in section 101 to clarify the qualification of military
officers who may supervise medical care case managers and in
section 107 to require that the tracking system for reports to
medical authorities regarding wounded warrior symptoms of post-
traumatic stress disorder or suicidal tendencies be developed
not later than 180 days after the date of enactment and that
the results be included in the Congressional reporting
requirement. (10 minutes)
3. Kline (MN): This amendment directs the Secretary of
Defense to ensure that $10,000,000 is directed to support
programs, activities, and facilities associated with the Marine
Corps Wounded Warrior Regiment program from the Medical Support
Fund created by this bill. (10 minutes)
4. Sestak (PA)/Kennedy, Patrick (RI): The amendment adds a
definition to Sec. 2 to clarify that ``medical care'' includes
mental health care. (10 minutes)
5. Brown, Corrine (FL): This amendment will ensure
confidentiality for members of the military who call the
hotline for help. (10 minutes)
6. Johnson, Eddie Bernice (TX): The amendment strengthens
language that professionals' training be ``improved'' rather
than ``modified,'' and it also places greater emphasis on
adequate training to detect mental health conditions among
recovering service members. (10 minutes)
7. Kennedy, Patrick (RI)/Sestak (PA): This amendment would
require the Secretary of the Department of Defense to develop
and implement a plan to help prevent Post-Traumatic Stress
Disorder and other stress-related psychopathologies (including
substance abuse conditions) trom developing in our military
service members. In addition, this amendment would establish a
new Peer-Reviewed research program within the Defense Health
Program's research and development function to research the
prevention of Post-Traumatic Stress Disorder and how to best
strengthen the psychological resiliency of our military service
members. (10 minutes)
8. Hooley (OR): Amendment would give members of the Reserve
Component the option to use Military Medical Treatment
Facilities closest to home for treatment on an outpatient basis
of injuries sustained in theater. (10 minutes)
9. Hensarling (TX): This amendment would direct the
Secretary of Veterans Affairs to conduct a study to determine
what the average length of time is between the date for which a
veteran requests an appointment and the date he is able to
receive care. This amendment also requires that the Secretary
report back to Congress within 180 days with recommendations as
to how this time could be decreased to 15 days. (10 minutes)
10. Bilirakis (FL): The amendment creates an office of the
ombudsman within the Office of the Secretary of Defense which
would develop policies for the military departments on
providing assistance to recovering service members and their
families. (10 minutes)
11. Buchanan (FL): The amendment would direct the Secretary
of Defense to submit to Congress a report on the feasibility of
a Soldier Patient Tracking System so any patient can be located
in the medical holdover (MHO) process. (10 minutes)
12. Welch (VT): The amendment requires that the Secretary
concerned provide the medical care managers and service member
advocates with all the resources they need to expeditiously
carry out their work. The amendment would also require the
Department of Defense to conduct outreach to inform all service
members and their families about the existence of and services
available to them by the medical care managers and service
member advocates contained in the bill. (10 minutes)
TEXT OF AMENDMENTS MADE IN ORDER UNDER THE RULE
1. An Amendment To Be Offered by Representative Barrow of Georgia, or
His Designee, Debatable for 10 Minutes
Add at the end of the bill the following new section:
SEC. 304. VETERANS BENEFICIARY TRAVEL PROGRAM.
(a) Elimination of Deductible.--Subsection (c) of section 111
of title 38, United States Code, is repealed.
(b) Determination of Mileage Reimbursement Rate.--
(1) Determination.--Paragraph (1) of subsection (g)
of such section is amended to read as follows:
``(1) In determining the amount of allowances or
reimbursement to be paid under this section, the Secretary
shall use the mileage reimbursement rates for the use of
privately owned vehicles by Government employees on official
business, as prescribed by the Administrator of General
Services under section 5707(b) of title 5, United States
Code.''.
(2) Conforming amendment.--Subsection (g) of such
section is further amended by striking paragraphs (3)
and (4).
(c) Source of Funds.--Such section is further amended by
adding at the end the following new subsection:
``(i) Funds for payments made under this section shall be
appropriated separately from other amounts appropriated for the
Department.''.
(d) Effective Date.--The amendments made by this Act shall
apply with respect to travel expenses incurred after the
expiration of the 90-day period that begins on the date of the
enactment of this Act.
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2. An Amendment To Be Offered by Representative Skelton of Missouri, or
His Designee, Debatable for 10 Minutes
At the end of section 1074l(a)(4)(B) of title 10, United
States Code, as proposed to be added by section 101 of the
bill, strike ``or Air Force Medical Service.'' and insert ``Air
Force Medical Service, or other corps comprised of health care
professionals at the discretion of the Secretary of Defense.''.
In section 107(b), add at the end the following:
(3) The progress made in developing the tracking
system under subsection (c) and the results of the
system.
In section 107(c), strike ``The'' and insert ``Not later than
180 days after the date of the enactment of this Act, the''.
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3. An Amendment To Be Offered by Representative Kline of Minnesota, or
His Designee, Debatable for 10 Minutes
Insert the following after subsection (d) of section 111 (and
redesignate subsection (e) as subsection (f)):
(e) Wounded Warrior Regiment Program.--The Secretary of
Defense shall ensure that $10,000,000 for fiscal year 2007 is
transferred from the Medical Support Fund to support programs,
activities, and facilities associated with the Marine Corps
Wounded Warrior Regiment program, to be used as follows:
(1) $6,550,000 for Case Management and Patient
Support.
(2) $1,200,000 for Wounded Warrior Interim Regimental
Headquarters Building conversion.
(3) $1,300,000 for Case Management System
Development.
(4) $95,000 for Support Equipment.
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4. An Amendment To Be Offered by Representative Sestak of Pennsylvania,
or His Designee, Debatable for 10 Minutes
At the end of section 2, add the following:
(5) Medical care.--The term ``medical care'' includes
mental health care.
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. An Amendment To Be Offered by Representative Corrine Brown of
Florida, or Her Designee, Debatable for 10 Minutes
In section 1567 of title 10, United States Code, as proposed
to be added by section 102 of the bill--
(1) redesignate subsections (b), (c), and (d) as
subsections (c), (d), and (e), respectively; and
(2) insert after subsection (a) the following new
subsection (b):
``(b) Confidentiality.--(1) Individuals who seek to provide
information through use of the toll-free telephone number under
subsection (a) shall be notified, immediately before they
provide such information, of their option to elect, at their
discretion, to have their identity remain confidential.
``(2) In the case of information provided through use of the
toll-free telephone number by an individual who elects to
maintain the confidentiality of his or her identity, any
individual who, by necessity, has had access to such
information for purposes of conducting the investigation or
executing the response plan required by subsection (c) may not
disclose the identity of the individual who provided the
information.''.
----------
6. An Amendment To Be Offered by Representative Eddie Bernice Johnson
of Texas, or Her Designee, Debatable for 10 Minutes
In section 107(a), in the first sentence, strike
``modification of the training'' and insert ``improvement of
the training''.
In section 107(a), strike the second sentence and insert the
following: ``The recommendations shall include, at a minimum,
specific recommendations to ensure that such health care
professionals, medical care case managers, and service member
advocates are adequately trained and able to detect early
warning signs of post-traumatic stress disorder (PTSD),
suicidal tendencies, and other mental health conditions among
recovering service members.''.
----------
7. An Amendment To Be Offered by Representative Kennedy of Rhode
Island, or His Designee, Debatable for 10 Minutes
At the end of title I, add the following new section (and
conform the table of contents accordingly):
SEC. 113. PLANS AND RESEARCH FOR REDUCING POST TRAUMATIC STRESS
DISORDER.
(a) Plans for Reducing Post Traumatic Stress Disorder.--
(1) Plan for prevention.--
(A) In general.--The Secretary of Defense
shall develop a plan to incorporate evidence-
based preventive and early-intervention
measures, practices, or procedures that reduce
the likelihood that personnel in combat will
develop post-traumatic stress disorder or other
stress-related psychopathologies (including
substance use conditions) into--
(i) basic and pre-deployment training
for enlisted members of the Armed
Forces, noncommissioned officers, and
officers;
(ii) combat theater operations; and
(iii) post-deployment service.
(B) Updates.--The Secretary of Defense shall
update the plan under subparagraph (A)
periodically to incorporate, as the Secretary
considers appropriate, the results of relevant
research, including research conducted pursuant
to subsection (b).
(2) Research.--Subject to subsection (b), the
Secretary of Defense shall develop a plan, in
consultation with the Department of Veterans Affairs,
the National Institutes of Health, and the National
Academy of Sciences, to conduct such research as is
necessary to develop the plan described in paragraph
(1).
(b) Evidence-Based Research and Training.--
(1) Working group.--The Secretary of Defense shall
conduct a study, in coordination with the Department of
Veterans Affairs, the National Institutes of Health,
and the National Academy of Sciences' Institute of
Medicine, to determine the feasibility of establishing
a working group tasked with researching and developing
evidence-based measures, practices, or procedures that
reduce the likelihood that personnel in combat will
develop post-traumatic stress disorder or other stress-
related psychological pathologies (including substance
use conditions). The working group shall include
personnel with experience in a combat theater, and
behavioral health personnel who have experience
providing treatment to individuals with experience in a
combat theater.
(2) Peer-reviewed research program.--Not later than
180 days after the date of the enactment of this Act,
the Secretary of Defense shall submit to Congress a
plan for a peer-reviewed research program within the
Defense Health Program's research and development
function to research and develop evidence-based
preventive and early intervention measures, practices,
or procedures that reduce the likelihood that personnel
in combat will develop post-traumatic stress disorder
or other stress-related psychopathologies (including
substance use conditions).
(c) Report.--The Secretary of Defense shall submit to
Congress annually a report on the plans and studies required
under this section.
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8. An Amendment To Be Offered by Representative Hooley of Oregon, or
Her Designee, Debatable for 10 Minutes
At the end of title I, add the following new section (and
conform the table of contents accordingly):
SEC. 113. OPTION FOR MEMBERS OF RESERVE COMPONENTS TO USE MILITARY
MEDICAL TREATMENT FACILITIES CLOSEST TO HOME FOR
CERTAIN INJURIES.
The Secretary of Defense shall provide that, in the case of
members of the reserve components returning from a combat
theater, if a member requires treatment on an outpatient basis
for injuries or wounds sustained in theater, the member may be
provided treatment at the military medical treatment facility
closest to the member's home rather than closest to the base
from which the member was deployed.
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9. An Amendment To Be Offered by Representative Hensarling of Texas, or
His Designee, Debatable for 10 Minutes
At the end of title II, add the following new section (and
conform the table of contents accordingly):
SEC. 207. STUDY AND REPORT ON WAITING PERIODS FOR APPOINTMENTS AT
DEPARTMENT OF VETERANS AFFAIRS MEDICAL FACILITIES.
(a) Study Required.--The Secretary of Veterans Affairs shall
conduct a study on the average length of time between the
desired date for which a veteran seeks to schedule an
appointment for health care at a Department of Veterans Affairs
medical facility and the date on which such appointment is
completed.
(b) Focus of Study.--In conducting the study under subsection
(a), the Secretary shall focus on appointments scheduled and
completed at Department medical facilities located in both
rural and urban areas.
(c) Report.--Not later than 180 days after the date of the
enactment of this Act, the Secretary shall submit a report to
Congress containing the findings of the study under subsection
(a) and recommendations for decreasing the waiting time between
the desired date of an appointment and the completion of the
appointment to a maximum of 15 days.
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10. An Amendment To Be Offered by Representative Bilirakis of Florida,
or His Designee, Debatable for 10 Minutes
After section 101, insert the following new section (and
conform the table of contents accordingly):
SEC. 102. ESTABLISHMENT OF A DEPARTMENT OF DEFENSE-WIDE OMBUDSMAN
OFFICE.
(a) Establishment.--The Secretary of Defense shall establish
a Department of Defense-wide Ombudsman Office (in this section
referred to as the ``Ombudsman Office'') within the Office of
the Secretary of Defense.
(b) Functions.--
(1) In general.--The functions of the Ombudsman
Office are to provide policy guidance to, and oversight
of, the ombudsman offices in the military departments.
(2) Policy guidance.--The Ombudsman Office shall
develop policy guidance with respect to the following:
(A) Providing assistance to and answering
questions from recovering service members and
their families regarding--
(i) administrative processes,
financial matters, and non-military
related services available to the
members and their families throughout
the member's evaluation, treatment, and
recovery;
(ii) transfer to the care of the
Veterans Administration; and
(iii) support services available upon
the member's return home.
(B) Accountability standards, including--
(i) creating and maintaining case
files for individual specific questions
received, and initiating inquiries and
tracking responses for all such
questions;
(ii) setting standards for timeliness
of responses; and
(iii) setting standards for
accountability to recovering service
members and their families, including
requirements for daily updates to the
members and their families about steps
being taken to alleviate problems and
concerns until problems are addressed
(c) Status Reports.--The ombudsman office in each military
department shall submit status reports of actions taken to
address individual concerns to the Ombudsman Office, at such
times as the Ombudsman Office considers appropriate.
(d) Responses From Other Offices.--The Secretary of Defense
shall ensure that all other offices within the Department of
Defense and the military departments respond in a timely manner
to resolve questions and requests from the Ombudsman Office on
behalf of recovering service members and their families,
including offices responsible for medical matters (including
medical holdover processes), financial and accounting matters,
legal matters, human resources matters, reserve component
matters, installation and management matters, and physical
disability matters.
(e) Staff of the Office.--The staff of the Ombudsman Office
shall include representatives from each military department,
including persons with experience in medical holdover processes
and other medical matters.
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11. An Amendment To Be Offered by Representative Buchanan of Florida,
or His Designee, Debatable for 10 Minutes
At the end of title II, add the following new section:
SEC. 207. STUDY AND REPORT ON STANDARD SOLDIER PATIENT TRACKING SYSTEM.
(a) Study Required.--The Secretary of Defense shall conduct a
study on the feasibility of developing a joint soldier tracking
system for recovering service members.
(b) Matters Covered.--The study under subsection (a) shall
include the following:
(1) Review of the feasibility of allowing each
recovering service member, each family member of such a
member, each commander of a military installation
retaining medical holdover patients, each patient
navigator, and ombudsman office personnel, at all
times, to be able to locate and understand exactly
where a recovering service member is in the medical
holdover process.
(2) A determination of whether the tracking system
can be designed to ensure that--
(A) the commander of each military medical
facility where recovering service members are
located is able to track appointments of such
members to ensure they are meeting timeliness
and other standards that serve the member; and
(B) each recovering service member is able to
know when his appointments and other medical
evaluation board or physical evaluation board
deadlines will be and that they have been
scheduled in a timely and accurate manner.
(3) Any other information needed to conduct oversight
of care of the member throughout the medical holdover
process.
(c) Report.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of Defense shall submit to
the Committees on Armed Services of the Senate and the House of
Representatives a report on the results of the study, with such
findings and recommendations as the Secretary considers
appropriate.
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12. An Amendment To Be Offered by Representative Welch of Vermont, or
His Designee, Debatable for 10 Minutes
Insert at the end of section 1074l(a) of title 10, United
States Code, as proposed to be added by section 101 of the
bill, the following new paragraph:
``(6) The Secretary concerned shall ensure that medical care
case managers have the resources necessary to ensure that they
expeditiously carry out the responsibilities and duties of
their position.
Insert at the end of section 1074l(b) of title 10, United
States Code, as proposed to be added by section 101 of the
bill, the following new paragraph:
``(7) The Secretary concerned shall ensure that service
member advocates have the resources necessary to ensure that
they expeditiously carry out the responsibilities and duties of
their position.
Insert after subsection (b) of section 1074l of title 10,
United States Code, as proposed to be added by section 101 of
the bill, the following new subsection (and redesignate
subsections (c) and (d) of such section as subsections (d) and
(e), respectively):
``(c) Outreach.--The Secretary of Defense shall make
available to each member in an outpatient status at a military
medical treatment facility, and to the family members of all
such members, information on the availability of services
provided by the medical care case managers and service member
advocates, including information on how to contact such
managers and advocates and how to use their services.