[House Report 110-722]
[From the U.S. Government Publishing Office]
110th Congress Report
HOUSE OF REPRESENTATIVES
2d Session 110-722
======================================================================
VETERANS' EPILEPSY TREATMENT ACT OF 2008
_______
June 19, 2008.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Filner, from the Committee on Veterans' Affairs, submitted the
following
R E P O R T
[To accompany H.R. 2818]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred the
bill (H.R. 2818) to amend title 38, United States Code, to
provide for the establishment of Epilepsy Centers of Excellence
in the Veterans Health Administration of the Department of
Veterans Affairs, having considered the same, report favorably
thereon with amendments and recommend that the bill as amended
do pass.
CONTENTS
Page
Amendment........................................................ 1
Purpose and Summary.............................................. 3
Background and Need for Legislation.............................. 3
Hearings......................................................... 4
Committee Consideration.......................................... 4
Committee Votes.................................................. 5
Committee Oversight Findings..................................... 5
Statement of General Performance Goals and Objectives............ 5
New Budget Authority, Entitlement Authority, and Tax Expenditures 5
Earmarks and Tax and Tariff Benefits............................. 5
Committee Cost Estimate.......................................... 5
Congressional Budget Office Estimate............................. 5
Federal Mandates Statement....................................... 6
Advisory Committee Statement..................................... 6
Constitutional Authority Statement............................... 7
Applicability to Legislative Branch.............................. 7
Section-by-Section Analysis of the Legislation................... 7
Changes in Existing Law Made by the Bill, as Reported............ 7
Amendment
The amendments are as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Veterans' Epilepsy Treatment Act of
2008''.
SEC. 2. EPILEPSY CENTERS OF EXCELLENCE.
(a) Requirement for Establishment of Epilepsy Centers of
Excellence.--Subchapter II of chapter 73 of title 38, United States
Code, is amended by adding at the end the following new section:
``Sec. 7330A. Epilepsy centers of excellence
``(a) Designation of Centers.--Not later than 120 days after the date
of enactment of this section, the Secretary shall designate an epilepsy
center of excellence at each of the 5 centers designated under section
7327.
``(b) Expert Clinical and Research Staff.--Each center designated
under subsection (a) shall employ such expert clinical and research
staff, including board certified neurologists and neurosurgeons, as may
be necessary to ensure that such center is capable of serving as a
center of excellence in research, education, and clinical care
activities in the diagnosis and treatment of epilepsy, including post-
traumatic epilepsy.
``(c) Requirements and Operation of Centers.--Each center designated
under subsection (a) shall function as a center for--
``(1) research on the diagnosis, treatment, and long-term
effects of epilepsy, including epilepsy developed as a result
of combat, in order to support the provision of services for
such diagnosis and treatment in accordance with the most
current information on epilepsy;
``(2) the development of evidence-based methodologies for
treating individuals with epilepsy;
``(3) the continuous and consistent coordination of care from
the point of referral throughout the diagnostic and treatment
process and ongoing follow-up after return to home and
community;
``(4) the development of a national system of coordinated
care for veterans with epilepsy, including the development and
maintenance of a national network of Department health care
personnel with an interest and expertise in the care and
treatment of epilepsy and the establishment of a referral
system and procedure within each Veterans Integrated Service
Network;
``(5) assist in the expansion, where appropriate, of the
utilization of telehealth technology, including exploring the
use of such technology to develop, transmit, monitor, and
review neurological diagnostic tests and other applicable uses
of telehealth technology for the diagnosis, care, and treatment
of veterans with epilepsy; and
``(6) the dissemination of educational materials and research
regarding diagnosis, care, and treatment of epilepsy,
throughout the Department.
``(d) Administration.--In order to assist the Secretary in carrying
out this section, the Secretary shall designate a national coordinator
for epilepsy programs who shall report to the official responsible for
neurology at the Veterans Health Administration and shall--
``(1) supervise the operation of the centers designated under
this section;
``(2) coordinate and support the national network of
Department health care professionals with an interest and
expertise in the care and treatment of epilepsy;
``(3) ensure that the education and research mission of such
centers is being accomplished; and
``(4) conduct regular evaluations of such centers to ensure
compliance with the requirements of this section.
``(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $5,000,000 for each of fiscal
years 2009 through 2013.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item relating to section
7330 the following new item:
``7330A. Epilepsy centers of excellence.''.
Amend the title so as to read:
A bill to amend title 38, United States Code, to provide
for the establishment of epilepsy centers of excellence in the
Veterans Health Administration of the Department of Veterans
Affairs.''.
Purpose and Summary
H.R. 2818 was introduced by Representative Ed Perlmutter of
Colorado on June 21, 2007. This legislation would establish
Epilepsy Centers of Excellence in the Veterans Health
Administration of the Department of Veterans Affairs.
Background and Need for Legislation
Epilepsy is a neurological condition, which affects the
nervous system and causes seizures. Epilepsy is usually
diagnosed after a person has had at least two seizures that
were not caused by some known medical condition. There is not
one single cause of epilepsy and, in up to half of the epilepsy
cases, it is not possible to specify the cause of the seizures.
Research indicates that children may be born with a defect in
the structure of their brain, or they may suffer a head injury
or infection that causes epilepsy. Severe head injury and other
neurological conditions such as strokes, tumors, and
degenerative conditions such as Alzheimer's disease are also
known causes of epilepsy.
According to the Veterans Health Administration (VHA) there
are approximately 89,000 veterans with epilepsy enrolled in the
Department of Veterans Affairs (VA) Health Care System. Of
those veterans enrolled with epilepsy, about 42 percent, or
37,000, are service-connected for epilepsy.
In testimony presented to the Senate Committee on Veterans'
Affairs on May 23, 2007, on behalf of the American Academy of
Neurology, Dr. John Booss stated that in 1972, the VA created
Health Centers which specialized in research and treatment of
epilepsy. These VA Health Centers partnered with medical
schools to assist in treating veterans with seizures, and build
a body of knowledge around the diagnosis and treatment of
epilepsy. However, in the early 1990's, funding dissipated and
the Centers were curtailed.
At this time, the VA operates seven Epilepsy Monitoring
sites. According to the Department of Veterans Affairs, the
seven sites have the following capabilities: (1) an epilepsy
monitoring unit; (2) capacity to perform invasive monitoring;
(3) ability to implant vagus nerve stimulators; and, (4)
ability to perform resection of epileptic foci. Five additional
sites have the capacity to perform epilepsy surgery but not all
of the other components listed above.
The use of improvised explosive devices (IEDs) in Iraq and
Afghanistan and the prevalence of the types of blast injuries
they inflict on the servicemembers are devastating. Loss of
limb, traumatic brain injury (TBI), eye injuries, and other
polytrauma injuries present new challenges to medicine and the
overall treatment modalities within VA. The long-term effect of
blast exposures is not known. Although there is no data on
post-traumatic epilepsy in the current conflicts, during
Vietnam, a number of men and women returned home with head
wounds and head injuries. According to the 1985 report of the
Vietnam Head Injury Study published in Neurology, of 421
veterans who had penetrating brain wounds in Vietnam 15 years
ago, 53 percent had post-traumatic epilepsy, and one-half of
those still had seizures 15 years after injury.
H.R. 2818, as amended, would establish Epilepsy Centers of
Excellence within the Department of Veterans Affairs. The
Epilepsy Centers of Excellence would function as centers for
research on the diagnosis, treatment and long-term effects of
epilepsy. These Centers would develop evidence-based
methodology for treatment of epilepsy, coordinate care for
veterans with epilepsy, develop a national referral system for
veterans with epilepsy, expand telehealth technology for
treatment of veterans with epilepsy and disseminate educational
materials on the diagnosis and treatment of epilepsy.
H.R. 2818 would further require that the Epilepsy Centers
of Excellence be co-located with the five VA Polytrauma
Rehabilitation Centers located in Palo Alto, California;
Minneapolis, Minnesota; Richmond, Virginia; Tampa, Florida;
and, San Antonio, Texas. Co-locating the Epilepsy Centers of
Excellence and the Polytrauma Rehabilitation Centers will allow
VA to optimize its already-existing resources and
infrastructure to more effectively carry out the mission of the
Centers.
The Committee generally supports the establishment of
Centers of Excellence for conditions that effect veterans.
However, given the resources of the VA, the Committee feels
that any new Centers of Excellence should be established to
give VA the ability to leverage already existing Department
infrastructure and resources. Integration of resources will
allow the VA to offer veterans a full continuum of
comprehensive care throughout the VA healthcare system.
Hearings
On April 15, 2008, the Subcommittee on Health held a
legislative hearing on a number of bills introduced in the
110th Congress, including H.R. 2818. The following witnesses
testified: The Honorable Bob Filner of California; The
Honorable Michael H. Michaud of Maine; The Honorable Ginny
Brown-Waite of Florida; The Honorable Ed Perlmutter of
Colorado; The Honorable Christopher P. Carney of Pennsylvania;
The Honorable Brad Ellsworth of Indiana; Joseph L. Wilson,
Deputy Director, Veterans Affairs and Rehabilitation
Commission, The American Legion; Joy J. Ilem, Assistant
National Legislative Director, Disabled American Veterans;
Christopher Needham, Senior Legislative Associate, National
Legislative Service, Veterans of Foreign Wars of the United
States; Richard F. Weidman, Executive Director for Policy and
Government Affairs, Vietnam Veterans of America; Gerald M.
Cross, MD, FAAFP, Principal Deputy Under Secretary for Health,
Veterans Health Administration, U.S. Department of Veterans
Affairs, accompanied by Walter Hall, Assistant General Counsel,
U.S. Department of Veterans Affairs. Those submitting
statements for the record included: American Veterans (AMVETS)
and the Paralyzed Veterans of America.
Committee Consideration
On June 5, 2008, the Subcommittee on Health met in open
markup session and ordered favorably forwarded to the full
Committee H.R. 2818, as amended, by voice vote. During
consideration of the bill the following amendment was
considered:
An amendment in the nature of a substitute by Mr.
Salazar of Colorado to require that the Epilepsy
Centers of Excellence be co-located with the 5
polytrauma centers in the Department of Veterans
Affairs was agreed to by voice vote.
On June 11, 2008, the full Committee met in open markup
session, a quorum being present, and ordered H.R. 2818, as
amended, reported favorably to the House of Representatives, by
voice vote.
Committee Votes
Clause 3(b) of rule XIII of the Rules of the House of
Representatives requires the Committee to list the record votes
on the motion to report the legislation and amendments thereto.
There were no record votes taken on amendments or in connection
with ordering H.R. 2818 reported to the House. A motion by Mr.
Buyer of Indiana to order H.R. 2818, as amended, reported
favorably to the House of Representatives was agreed to by
voice vote.
Committee Oversight Findings
In compliance with clause 3(c)(1) of rule XIII and clause
(2)(b)(1) of rule X of the Rules of the House of
Representatives, the Committee's oversight findings and
recommendations are reflected in the descriptive portions of
this report.
Statement of General Performance Goals and Objectives
In accordance with clause 3(c)(4) of rule XIII of the Rules
of the House of Representatives, the Committee's performance
goals and objectives are reflected in the descriptive portions
of this report.
New Budget Authority, Entitlement Authority, and Tax Expenditures
In compliance with clause 3(c)(2) of rule XIII of the Rules
of the House of Representatives, the Committee adopts as its
own the estimate of new budget authority, entitlement
authority, or tax expenditures or revenues contained in the
cost estimate prepared by the Director of the Congressional
Budget Office pursuant to section 402 of the Congressional
Budget Act of 1974.
Earmarks and Tax and Tariff Benefits
H.R. 2818 does not contain any congressional earmarks,
limited tax benefits, or limited tariff benefits as defined in
clause 9(d), 9(e), or 9(f) of rule XXI of the Rules of the
House of Representatives.
Committee Cost Estimate
The Committee adopts as its own the cost estimate on H.R.
2818 prepared by the Director of the Congressional Budget
Office pursuant to section 402 of the Congressional Budget Act
of 1974.
Congressional Budget Office Cost Estimate
Pursuant to clause 3(c)(3) of rule XIII of the Rules of the
House of Representatives, the following is the cost estimate
for H.R. 2818 provided by the Congressional Budget Office
pursuant to section 402 of the Congressional Budget Act of
1974:
U.S. Congress,
Congressional Budget Office,
Washington, DC, June 18, 2008.
Hon. Bob Filner,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 2818, the Veterans
Epilepsy Treatment Act of 2008.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Sunita
D'Monte.
Sincerely,
Robert A. Sunshine
(For Peter R. Orszag, Director).
Enclosure.
H.R. 2818--Veterans Epilepsy Treatment Act of 2008
H.R. 2818 would require the Secretary of the Department of
Veterans Affairs (VA) to establish five centers of excellence
for epilepsy research, education, and clinical care at VA
health care facilities, and to appoint a national coordinator
for those centers and for other epilepsy programs at the
Veterans Health Administration. The bill would authorize the
appropriation of $5 million each year over the 2009-2013
period.
In total, CBO estimates that implementing H.R. 2818 would
cost $25 million over the 2009-2013 period, assuming that the
specified amounts are appropriated and that outlays follow
historical spending patterns for similar programs. Enacting the
bill would have no effect on direct spending or revenues.
H.R. 2818 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act and
would impose no costs on state, local, or tribal governments.
On November 30, 2007, CBO transmitted a cost estimate for
S. 2004, a similar bill that was ordered reported by the Senate
Committee on Veterans' Affairs on November 14, 2007. S. 2004
would authorize the appropriation of $6 million a year for the
centers of excellence and such sums as may be necessary for the
national coordinator over the 2008-2012 period. CBO estimated
that implementing S. 2004 would cost $31 million over the 2008-
2012 period, assuming appropriation of the specified and
estimated amounts.
The CBO staff contact for this estimate is Sunita D'Monte.
This estimate was approved by Peter H. Fontaine, Assistant
Director for Budget Analysis.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates regarding H.R. 2818 prepared by the Director of the
Congressional Budget Office pursuant to section 423 of the
Unfunded Mandates Reform Act.
Advisory Committee Statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act would be created by H.R.
2818.
Constitutional Authority Statement
Pursuant to clause 3(d)(1) of rule XIII of the Rules of the
House of Representatives, the Committee finds that the
Constitutional authority for H.R. 2818 is provided by Article
I, section 8 of the Constitution of the United States.
Applicability to Legislative Branch
The Committee finds that the legislation does not relate to
the terms and conditions of employment or access to public
services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act.
Section-by-Section Analysis of the Legislation
Section 1. Short title
This section would provide the short title of H.R. 2818 as
the ``Veterans'' Epilepsy Treatment Act of 2008.''
Section 2. Epilepsy Centers of Excellence
This section would amend chapter 73 of title 38, United
States Code, to establish Epilepsy Centers of Excellence at
each of the five polytrauma rehabilitation centers within the
Department of Veterans Affairs. It requires that each center
employ expert clinical and research staff. It also requires
each center to function as a center for research on diagnosis,
treatment and long-term effects of epilepsy; development of
evidence-based methodology for treatment of epilepsy;
coordination of care for veterans with epilepsy; development of
a national referral system for veterans with epilepsy;
expansion of telehealth technology for treatment of veterans
with epilepsy; and dissemination of educational materials on
the diagnosis and treatment of epilepsy. This section
authorizes appropriations in the amount of $5,000,000 for each
fiscal year from 2009 through 2013.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (new matter is
printed in italic and existing law in which no change is
proposed is shown in roman):
TITLE 38, UNITED STATES CODE
* * * * * * *
PART V--BOARDS, ADMINISTRATIONS, AND SERVICES
* * * * * * *
CHAPTER 73--VETERANS HEALTH ADMINISTRATION - ORGANIZATION AND FUNCTIONS
* * * * * * *
SUBCHAPTER I--ORGANIZATION
Sec.
7301. Functions of Veterans Health Administration: in general.
* * * * * * *
SUBCHAPTER II--GENERAL AUTHORITY AND ADMINISTRATION
7311. Quality assurance.
* * * * * * *
7330A. Epilepsy centers of excellence.
* * * * * * *
SUBCHAPTER II--GENERAL AUTHORITY AND ADMINISTRATION
* * * * * * *
Sec. 7330A. Epilepsy centers of excellence
(a) Designation of Centers.--Not later than 120 days after
the date of enactment of this section, the Secretary shall
designate an epilepsy center of excellence at each of the 5
centers designated under section 7327.
(b) Expert Clinical and Research Staff.--Each center
designated under subsection (a) shall employ such expert
clinical and research staff, including board certified
neurologists and neurosurgeons, as may be necessary to ensure
that such center is capable of serving as a center of
excellence in research, education, and clinical care activities
in the diagnosis and treatment of epilepsy, including post-
traumatic epilepsy.
(c) Requirements and Operation of Centers.--Each center
designated under subsection (a) shall function as a center
for--
(1) research on the diagnosis, treatment, and long-
term effects of epilepsy, including epilepsy developed
as a result of combat, in order to support the
provision of services for such diagnosis and treatment
in accordance with the most current information on
epilepsy;
(2) the development of evidence-based methodologies
for treating individuals with epilepsy;
(3) the continuous and consistent coordination of
care from the point of referral throughout the
diagnostic and treatment process and ongoing follow-up
after return to home and community;
(4) the development of a national system of
coordinated care for veterans with epilepsy, including
the development and maintenance of a national network
of Department health care personnel with an interest
and expertise in the care and treatment of epilepsy and
the establishment of a referral system and procedure
within each Veterans Integrated Service Network;
(5) assist in the expansion, where appropriate, of
the utilization of telehealth technology, including
exploring the use of such technology to develop,
transmit, monitor, and review neurological diagnostic
tests and other applicable uses of telehealth
technology for the diagnosis, care, and treatment of
veterans with epilepsy; and
(6) the dissemination of educational materials and
research regarding diagnosis, care, and treatment of
epilepsy, throughout the Department.
(d) Administration.--In order to assist the Secretary in
carrying out this section, the Secretary shall designate a
national coordinator for epilepsy programs who shall report to
the official responsible for neurology at the Veterans Health
Administration and shall--
(1) supervise the operation of the centers designated
under this section;
(2) coordinate and support the national network of
Department health care professionals with an interest
and expertise in the care and treatment of epilepsy;
(3) ensure that the education and research mission of
such centers is being accomplished; and
(4) conduct regular evaluations of such centers to
ensure compliance with the requirements of this
section.
(e) Authorization of Appropriations.--There is authorized to
be appropriated to carry out this section $5,000,000 for each
of fiscal years 2009 through 2013.
* * * * * * *