10 1 this chapter. The amounts to be charged the Veterans' Ad2 ministration for care and treatment of veterans in hospitals 3 shall be calculated on the basis of a rate approved by the 4 Office of Management and Budget. 5 "§ 618. Therapeutic and rehabilitation activities 6 "The Administrator, upon the recommendation of the 7 Chief Medical Director, may utilize the services of patients 8 and members in Veterans' Administration hospitals and dom9 iciliaries for therapeutic and rehabilitative purposes, at nomi10 nal remuneration or without remuneration, and such patients 11 and members shall not under these circumstances be held or 12 considered as employees of the United States for any purpose. 13 The Administrator shall prescribe the conditions for utiliza14 tion of such services. 15 "§ 620. Community nursing home care 16 "(a) Subject to subsection (b) of this section, the Ad17 ministrator may authorize for any veteran requiring nursing 18 home care direct admission for such care at the expense of the 19 United States to any public or private institution, not under 20 the jurisdiction of the Administrator, which furnishes nursing 21 home care. Such admission may be authorized upon deter22 mination of need therefor by a physician employed by the 23 Veterans' Administration, or, in areas where no such physi24 cian is available, by a physician carrying out such function 25 under contract or fee arrangement, based on an examination 26 by such physician. 1 11 "(b) Nursing home care may not be furnished pursuant 2 to this section at the expense of the United States for more 3 than six months in the aggregate in connection with any one 4 admission, except (1) in the case of the veteran whose 5 hospitalization was primarily for a service-connected dis6 ability, or (2) where in the judgment of the Administrator a 7 longer period is warranted in the case of any other veteran. 8 The cost of such nursing home care in such institution will 9 not exceed 40 per centum of the cost of care furnished by the 10 Veterans' Administration in a general hospital under the 11 direct and exclusive jurisdiction of the Administrator, as such 12 cost may be determined from time to time by the Admin13 istrator. 14 "(c) No veteran may be transferred or admitted to 15 any institution for nursing home care under this section, un16 less such institution is determined by the Administrator to 17 meet such standards as he may prescribe. The standards 18 prescribed and any report of inspection of institutions fur19 nishing care to veterans under this section made by or for 20 the Administrator shall, to the extent possible, be made 21 available to all Federal, State, and local agencies charged 22 with the responsibility of licensing or otherwise regulating 222 23 24 or inspecting such institutions. "(d) In applying the provisions of section 2 (b) (1) 25 of the Service Contract Act of 1965 with respect to any 12 1 contract entered into under this section to provide nursing 2 home care of veterans, the payment of wages not less than 3 those specified in section 6(b) of the Fair Labor Standards 4 Act of 1938, as amended, shall be deemed to constitute 5 compliance with such provisions.". 6 SEC. 2. The analysis of chapter 17 of title 38, United 7 States Code, is amended by striking out "Subchapter II-Hospital or Domiciliary Care and Medical Treatment "Sec. "610. Eligibility for hospital and domiciliary care. "611. Hospitalization during examinations and in emergencies. "612. Eligibility for medical treatment. "613. Medical care for survivors and dependents of certain veterans. "614. Fitting and training in use of prosthetic devices; seeing-eye dogs. "615. Tobacco for hospitalized veterans. "616. Hospital care by other agencies of the United States. "617. Invalid lifts and other devices. "618. Therapeutic and rehabilitative activities. "619. Repair or replacement of certain prosthetic and other appliances. "620. Transfers for nursing home care." 8 and inserting in lieu thereof the following: "Sec. "Subchapter II-Health Services 9 "610. Eligibility for health services. "611. Health services during examinations and in emergencies. "613. Medical care for survivors and dependents of certain veterans. "616. Hospital care by other agencies of the United States. "618. Therapeutic and rehabilitation activities. "620. Community nursing home care." SEC. 3. Nothing in this Act, or any amendment or repeal 10 made by it, shall be deemed to deprive any Spanish-Ameri 11 can War veteran or Indian Wars veteran of any medical care 12 and treatment to which he was entitled on the day before 13 the date of the enactment of this Act. [No. 36] COMMITTEE ON VETERANS' AFFAIRS, HOUSE OF REPRESENTATIVES VETERANS' ADMINISTRATION, OFFICE OF THE ADMINISTRATOR OF VETERANS' AFFAIRS, Hon. RAY ROBERTS, Washington, D.C., July 15, 1975. Chairman, Committee on Veterans' Affairs, House of Representatives, Washington, D.C. DEAR MR. CHAIRMAN: This will respond to your request for a report by the Veterans' Administration on H.R. 3347, 94th Congress, a bill "To amend title 38 of the United States Code in order to revise the eligibility requirements and the medical benefits provided to eligible veterans, and for other purposes." The subject bill is similar in purpose to draft legislation recommended by the Special Task Force appointed last year by the Chief Medical Director after studying the problem of veteran eligibility for medical care. It is designed to simplify and make uniform the eligibility requirements of all types of health care and treatment, so that generally if a veteran is eligible for VA treatment he is eligible for any of the health services offered by VA, without regard to whether the condition is service-connected or non-service-connected. To accomplish the foregoing purpose, the bill amends section 601 of title 38, United States Code, to contain a broad, almost all-encompassing, definition of "health services." Among the major changes contemplated are the inclusion of preventive health services-a concept significantly broader than the treatment currently authorized; expanded use of fee-basis care; a broader use of ambulatory care; greater availability of prescriptions; a specific reference to rehabilitative medical services, which would include the work-for-pay and similar programs; liberalization of the furnishing of outpatient dental care on an ́adjunct basis so that the condition affected would no longer need to be service-connected, although the other limitations concerning outpatient dental care would be retained; and authorization for intermediate care. The authorization to contract for private facilities for hospital care and medical services for service-connected veterans would be expanded so that under certain circumstances it would apply for non-serviceconnected veterans. The eligibility provisions of section 610 are restated to pertain to health services rather than to specific types of care, but are expanded so that any veteran with a service-connected condition is eligible for the complete range of health services. The humanitarian emergency treatment of section 611 becomes applicable to any of the health services instead of being limited to just hospital care. In addition, section 611 would authorize the Administrator to furnish health services to any veteran, not eligible under section 610, if a State or local health official were to certify that nonFederal medical facilities are not adequate to meet the medical needs 57-086-75-No. 36 2 of the community. In effect, this would authorize treatment of the veteran with no service-connected condition who cannot meet the inability-to-pay test because of excessive income. All health services provided under the authority of section 611 are on a reimbursable basis. The bill would also amend section 618 to allow the, Administrator to utilize the services of patients and members in VA hospitals and domiciliaries for therapeutic and rehabilitative purposes, at nominal remuneration or without remuneration. Current law requires that nominal remuneration be paid for such services. Finally, the bill would amend section 620 to authorize community nursing home care by direct admission for all eligible veterans, thus deleting the present requirement of a prior VA hospitalization episode with admission by transfer, unless the condition is service-connected. It would retain the current 6-month limitation for a non-serviceconnected veteran and would continue the limitation on the cost payable to the present 40% of VA general hospital cost. While we realize the subject bill is related to a Special Task Force recommendation, we cannot support the all-encompassing medical care eligibility liberalization which it would provide. The primary obligation of the Department of Medicine and Surgery has historically been directed to the health care needs of the service-connected veteran. This obligation is clearly enunciated in statutory language, and a departure from such special recognition cannot be supported. Furthermore, expanded medical care for non-service-connected conditions is already authorized by Public Law 93-82, and the impact was not fully evident at the time of the Special Task Force study. For the above reasons, and the excessive costs which would be incurred, we recommend against enactment of H.R. 3347. Enactment of the subject bill would result in the following estimated costs to the VA: 1st year 2d year- 3d year--4th year 5th year $74, 334, 000 89,098, 000 103, 861, 000 118,624, 000 133, 387, 000 We are advised by the Office of Management and Budget that there is no objection to the presentation of this report from the standpoint of the Administration's program. Sincerely, RICHARD L. ROUDEBUSH, Vet. Letters 36 |