S. 1963: Caregivers and Veterans Omnibus Health Services Act of 2009

S. 1963

Caregivers and Veterans Omnibus Health Services Act of 2009

April 21, 2010 (111th Congress, 1st Session)

Staff Contact
Sarah Makin

Floor Situation

The House is scheduled to consider S. 1963, on Wednesday, April 21, 2010, under suspension of the rules, requiring a two-thirds majority vote for passage.  S. 1963 was introduced on October 28, 2009, by Sen. Daniel Akaka (D-HI) and after being passed by the Senate (vote 98-0) was referred to the Committee on Veterans Affairs, which took no official action.

Bill Summary

S. 1963 would amend title 38 of the United States Code to provide assistance to caregivers of veterans, to improve the provision of health care to veterans, and for other purposes.


TITLE I - Caregiver Support


The bill establishes a new program of comprehensive assistance for family caregivers of eligible (defined as post 9/11) veterans.  Caregivers are defined as family members and non-family members who reside with the veteran.  The program would make caregivers eligible to receive education and training, ongoing technical support, counseling, lodging, and subsistence.  In addition, one caregiver would be deemed the "primary provider" of care and as such would be eligible for all of the above and mental health services, respite care, medical care, and a personal caregiver stipend based on the amount and degree of services provided.   The bill would require the VA to conduct outreach to inform eligible veterans about this program, with a special emphasis on rural areas. 


The bill would also require that the VA provide any individual designated a "primary provider" to an "Operation Enduring Freedom" or "Operation Iraqi Freedom" (OEF/OIF) veteran with medical care (including mental health care) under the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) if they do not have health coverage already.


The program would also provide attendants who must travel with a veteran for medical examination, treatment, or care with travel expenses including lodging and subsistence upon the same basis as the veteran they accompany.


The bill authorizes $60 million for fiscal year 2010 and $1.542 billion for fiscal years 2011 - 2015 to carry out the program. 


TITLE II - Women Veterans Health Care Matters


The bill would require a new study on the barriers to VA health care for female veterans, and authorizes $4 million to be appropriated for this study.


S. 1963 would require the VA to establish a program to provide graduate medical education, training, certification, and continuing medical education for mental health professionals. 


The bill would require the VA to conduct a pilot program to evaluate providing reintegration and readjustment services through group retreats for female veterans recently separated from service. 

The bill requires the VA to conduct a two-year pilot program on providing child care to veterans who are the primary caretaker of a child(ren) and receiving health care from VHA that requires travel.  Such childcare could include stipends, direct provision of childcare, payments to private childcare, and collaboration with other Federal departments.


S. 1963 would allow the VA to provide health care to a newborn of a women veteran who is receiving maternity care by the VA for up to a week after birth if the veteran delivered in a VA facility or a facility contracted by the VA. 


TITLE III - Rural Health Improvements


The bill increases the amount payable under the Education Debt Reduction Program from $44,000 to a maximum of $60,000 over a total of five years.  S. 1963 also increases the amount payable in the fourth and fifth years from $10,000 to $12,000, and would allow the VA to waive limitations above if participant serves in a position for which there is a shortage.


S. 1963 would require the VA to establish a scholarship program to individuals studying visual impairment or orientation and mobility in an effort to increase the supply of qualified blind rehabilitation specialists.  The bill places specific emphasis on schools with high numbers of African Americans and Hispanics.  The total amount of assistance for a full-time student cannot exceed $15,000 per academic year and $45,000 total.


The bill would allow theVA to carry out demonstration projects on alternative ways to expand care for rural veterans by partnering with Medicare/Medicaid, DHHS community health centers, and the Indian Health Service.  The bill authorizes $5 million for FY 2010 and each fiscal year thereafter.


S. 1963 would require the VA to provide veterans of OIF/OEF with peer outreach and support services, readjustment counseling and mental health services, as well as require the VA to provide immediate family of eligible veterans with education, support, counseling, and mental health services for three years after the date of return from OIF/OEF.  The bill would require the VA to contract with a national not-for-profit mental health organization to carry out a national program of training for peer outreach and support and training for clinicians in community health centers.


The bill authorizes a new program in at least five community hospitals in two Veteran Integrated Service Networks (VISNs) to assess the provision of financial incentives to physicians with inpatient privileges at community hospitals in health professional shortage areas who provide primary and mental health care to veterans. 


S. 1963 would require the VA to establish a new grant program to provide transportation options to veterans in highly rural areas and sets the maximum amount of each grant at $50,000.  The bill authorizes $3 million to be appropriated FY 2010 through FY 2014 for the new program. 

TITLE IV- Mental Health Care Matters

The bill makes small changes to current law, and would require the VA to conduct a study on number of veterans who committed suicide between January 1, 1999, and the date of enactment of this Act by partnering with Secretary of Defense, VSOs, CDC, and state public health offices and veteran agencies, and report to Congress with their findings.   




TITLE V - Other Health Care Matters


The bill would repeal annual reporting requirement for pay adjustments for registered nurses and the VA's long-range health care planning.


S. 1963 creates a National Quality Management Officer to report to the Under Secretary for Health and be responsible for implementation of quality assurance programs.  The bill also creates a similar position within each VISN and medical facility to report to the Director of VISN/facility and the National Quality Management Officer.  The bill authorizes $25 million for a two year fiscal period.


The bill establishes a two-year pilot program on using community organizations and local and state governments to increase health care providers, medical and mental health services, family assistance, and outreach to transitioning veterans and their families.


S. 1963 authorizes the VA to contract out to provide specialized residential care and rehabilitation services to OIF/OEF veterans with traumatic brain injury (TBI) and accumulation of deficits in daily activities that would otherwise require admission to a nursing home.  Similarly, the bill would allow the VA to provide care, treatment, and services through non-VA facilities to veterans with TBI when such treatment is unavailable at the VA facility.


The bill requires the VA to enter into a contract with Institute of Medicine to conduct an expanded study on the health impact of veterans' who participated in Project Shipboard Hazard and Defense (Project SHAD).


S. 1963 establishes a three-year pilot program on providing dental insurance to veterans and their survivors and dependents.  The bill also prohibits the VA from collecting copayments or other fees for hospital or nursing home care in the case of catastrophically disabled veterans.


With respect to the provision of VA health care, the bill would assign a priority 3 status for Medal of Honor recipients equal to that of former POW's or Purple Heart recipients.  S. 1963 would also provide permanent authorization for the special treatment of Vietnam and Gulf War era veterans who currently have insufficient medical evidence to establish service-connected disability but were exposed to herbicide.


The bill would increase from $4,100 to $6,800 the amount authorized to be paid to veterans with 50 percent or more service-connected disabilities for home improvements and structural alterations; and increase from $1,200 to $2,000 the amount to be paid to veterans with less than 50 percent service-connected disabilities.


TITLE VI - Department Personnel Matters

S. 1963 would grant the VA the flexibility to extend title 38 status to additional health care occupations; establish a two-year probationary period for temporary part-time registered nurses; establish rate of pay for Under Secretary of Health appointees according to the SES scale; allow for incentive pay up to  $40,000/year for pharmacy executives; raise the pay cap for base pay for nurses; allow pay for Certified Registered Nurse Anesthetist (CRNAs) to exceed pay caps established for Registered Nurses; increase the limit on special pay for nurse executives from $25,000 to $100,000; sets guidelines for conducting wage surveys; and make part-time and full time nurses eligible for additional premium pay for any service between 6 pm and 6 am.


The bill would prohibit the VA from requiring nurses to work more than 40 hours/week or eight consecutive hours/day except on a voluntary basis, except under emergency circumstances; amend alternate work schedule to define six regularly scheduled 12-hour tours within a 14 day period as a full 80-hour pay period and remove from statute language that says nurses on approved leave be charged at a rate of five hours of leave for every three hours of absence.


S.1963 would reauthorize the Health Professionals Educational Assistance Scholarship Program (which expired on December 31, 1998) through December 31, 2014. The bill would direct the VA to fully employ program graduates as soon as possible upon graduation and require participants to perform clinical tours while enrolled in program and be provided a mentor in the same facility where he/she works. 


The bill authorizes the VA to consult with DHHS and utilize authorities available to repay the principal and interest of educational loans of appropriately qualified health professionals from disadvantaged backgrounds in order to employ such professionals in VHA to conduct clinical research.


TITLE VII - Homeless Veterans Matters


S. 1963 would allow the VA to make per diem payments to organizations assisting homeless veterans that meet some but not all of the criteria to participate in the Homeless Grant and Per Diem program.   


TITLE VIII - Nonprofit Research and Education Corporations

The bill would allow for the establishment of a multi-medical center research corporation, and would require that an official from each medical center concerned serve on the board of directors and be established in accordance with the non-profit corporation laws of the state of the applicable medical center location.  S. 1963 further clarifies the purpose of corporations defined in Sec. 801 as providing flexible funding for approved research and education at one or more VA medical facilities; ensures education includes education and training for patients and families; and repeals the role of corporations with respect to fellowships.  The bill strikes individuals with financials relationships from those with a conflict of interest, and clarifies the general powers of a corporation's authority to accept, administer, retain, and spend funds derived in various ways, enter into contracts and agreements with individuals as well as public/private entities, set fees for education and training, receive, retain, administer, and spend funds to further education and training, reimburse funds to the applicable appropriation account, and employ such employees as the corporation considers necessary.


S. 1963 would require corporations to submit an annual report to VA providing a summary of operations, activities, and accomplishments during the year; increase the threshold requirements for corporations to obtain independent audits for corporations with revenues in excess of $300,000 and an audit once every three years for corporations with revenues between $10,000 and $300,000; establish that each employee of a corporation is subject to a conflict of interest policy adopted by the corporation; and increase the salary threshold to $50,000 for staff reporting requirements. 



TITLE IX - Construction and Naming Matters

The bill authorizes the following Major Medical Projects for FY 2010 (totaling $189,410,000):

  • Realignment of services and closure projects at the VA Medical Center in Livermore, CA for $55,430,000.
  • New medical facility at the VA Medical Center in Louisville, KY for $75,000,000.
  • Expansion for Mental Health Facility at the VA Medical Center in Dallas, TX for $15,640,000.
  • Replacement bed tower and clinical expansion at the VA in St. Louis, MO for $43,340,000.


S.1963 extends authorization for the following Major Medical Facility Construction Projects previously authorized (totaling $994,400,000):

  • Replacement of the existing VA Medical Center in Denver, CO for $800,000,000.
  • Construction of Outpatient and Inpatient Improvements in Bay Pines, FL for $194,400,000.


The bill designates the VA outpatient clinic in Havre, Montana as the "Merril Lundman Department of Veterans Affairs Outpatient Clinic," the VA outpatient clinic in Knoxville, Tennessee as the "William C. Tallent Department of Veterans Affairs Outpatient Clinic," and the VA outpatient clinic in Alexandria, Minnesota as the "Max J. Beilke Department of Veterans Affairs Outpatient Clinic."


TITLE X - Other Matters

S. 1963 expands the authority of VA Police Officers to enforce traffic and motor vehicle laws of a state or local government, carry appropriate weapons while off VA property in an official capacity or while on official travel, conducting investigations on and off VA property for offenses that may have been committed on VA property.


The bill would also require determination of the budgetary effects of provisions contained in the Compromise Agreement to be based upon the statement jointly entered into the Congressional Record by the Chairmen of the Committees on the Budget of the Senate and the House of Representatives.



According to CBO's PAYGO scorecard, the legislation would not increase direct spending and would thus have no impact on spending in terms of PAYGO compliance.  However, CBO has not prepared a full score with an analysis of estimated outlays resulting from the new authorized spending in the bill.  However, the bill authorizes $1,284,310,000 for FY 2010 and $1,594,500,000 for FY 2011 - FY 2014.