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HR 2116 -- 09/20/

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H.R. 2116 - Veterans' Millennium Health Care Act
(Rep. Stearns (R) FL and 20 cosponsors)

The Administration, however, has serious concerns about some of the bill's provisions and will work with the Senate to address them. In particular, the Administration is concerned by provisions:

• Pertaining to long-term care benefits for the highest-priority veterans. As the veteran population ages, the need for long-term care is increasing. The Administration is committed to providing a range of home- and community-based care for those high-priority veterans who do not have access to such services. Hence, the Administration has indicated its support for additional medical care funding, a portion of which would go toward long-term non-institutional community-based care, targeted to the Department of Veterans Affairs' (VA's) top priority category of veterans with disability ratings of 50 percent or greater. The Administration has concerns, however, about this bill's approach to the problem (i.e., "shall provide") and believes that more time is needed to understand fully the complex legal, policy, and cost issues associated with this proposal to ensure that it supports VA's efforts to provide the full continuum of care to all top-priority veterans.

• Requiring the Department of Defense (DoD) and VA to enter into an agreement that would allow military retirees to utilize VA health care services at DoD's expense. This provision would result in increased costs for DoD estimated at approximately $175 million per year. Both the DoD TRICARE and VA health care systems individually manage continuity of care for their users, but the uncontrolled interagency utilization of services that this provision encourages could threaten this coordination. Moreover, DoD and VA already cooperate in providing access to high-quality care to this population through resource sharing initiatives, and TRICARE contractors may enter into provider agreements with VA facilities whenever beneficial. This provision would duplicate these efforts.

• Making VA's enhanced-use lease authority permanent. VA's original pilot was undertaken to test alternatives to the Property Act. The pilot authority did not contain provisions to protect the opportunities available under Title V of the Stewart B. McKinney Homeless Assistance Act for homeless assistance providers to lease or obtain by deed certain Federal real property. However, VA recently used this pilot authority to address the crucial needs of the homeless by supporting the construction of a transitional housing facility. In addition, VA's homeless assistance programs constitute the largest integrated network of services in the United States. VA provides medical services, rehabilitation, and housing assistance internally and through construction partnerships with public and private agencies and organizations. Because the Administration has a long-standing commitment to Title V, the implications of making VA's lease authority permanent must be carefully evaluated to determine their impact on this important homeless assistance resource. Appropriate safeguards must be developed and incorporated into any permanent authority. An extension of the current pilot authority through December 31, 2005, would allow the Department to continue to develop leases currently under preliminary consideration.

• Imposing burdensome and costly restrictions and reporting requirements on the management of VA's hospitals. These changes would inhibit VA's ability to manage its health care facilities appropriately and cost-effectively because they would require congressional approval for changes in inpatient beds, an outdated measure of the availability of health care. This provision threatens to delay VA's continuing efforts to improve its health care system and to increase the costs of that care.

H.R. 2116 would affect direct spending and receipts; therefore, it is subject to the pay-as-you-go (PAYGO) requirement of the Omnibus Budget Reconciliation Act of 1990. OMB's preliminary scoring estimate indicates that the bill would increase direct spending by a total of $2 million during FYs 2000-2004.