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Witness Testimony of Robert L. Jesse, M.D., Ph.D., Principal Deputy Under Secretary for Health, Veterans Health Administration, U.S. Department of Veterans Affairs

Chairwoman Buerkle, Ranking Member Michaud, and distinguished Members of the Subcommittee:

Thank you for inviting me here today to present the Administration’s views on H.R. 198, the Veterans Dog Training Therapy Act; H.R. 1154, the Veterans Equal Treatment for Service Dogs Act (VETS Dogs Act); H.R. 1855, the Veterans’ Traumatic Brain Injury Rehabilitative Services’ Improvements Act of 2011; H.R. 2074, the Veterans Sexual Assault Prevention Act; and H.R. 2530, a bill to increase flexibility in establishing rates for reimbursement of State Homes.  Joining me today are Jim Sullivan, Director of the Office of Asset Enterprise Management; Jane Clare Joyner, Deputy Assistant General Counsel; and Charlma Quarles, Deputy Assistant General Counsel.   We have not had sufficient time to develop official views and estimates regarding the draft Honey Sue Newby Spina Bifida Attendant Care Act or section 9 of the draft Veterans Health Care Facilities Capital Improvement Act of 2011.  We will forward the views and estimated costs on these items to you as soon as they are available.

H.R. 198 ‘‘Veterans Dog Training Therapy Act’’

H.R. 198 would require the Secretary, within 120 days of enactment, to carry out a pilot program to assess the effectiveness of addressing post-deployment mental health and post-traumatic stress disorder (PTSD) symptoms of Veterans through a therapeutic medium of training service dogs for other Veterans with disabilities.  The bill would require the Secretary to conduct the pilot program at a minimum of three but not more than five Department of Veterans Affairs (VA) medical centers for a 5 year period.  Veterans diagnosed with PTSD or other post-deployment mental health conditions would be eligible to volunteer to participate. The bill requires that the VA medical centers selected as program sites have available the following resources:  a dedicated space suitable for grooming and training dogs indoors, classroom and office space, storage capacity, other areas for periodic use of training dogs with wheelchairs and for other exercises, outdoor exercise and toileting space for dogs, and the provision of weekly field trips to train dogs in other environments.  The pilot program must be administered under the direction of a certified recreational therapist, and the Secretary would be required to establish a Director of Service Dog Training with specific experience such as experience in teaching others to train service dogs in a vocational setting, to oversee the training of service dogs at selected VA medical facilities.  Each pilot site would also be required to have certified service dog training instructors. 

The bill also includes provisions concerning the service dogs themselves. The bill requires VA to ensure that each service dog in training is purpose-bred for this work with an adequate temperament and health clearance.  Dogs in animal shelters or foster homes are not to be overlooked as candidates, but only as determined appropriate by VA.  The Secretary must also ensure that each service dog in training is taught all essential commands required of service dogs, that the service dog in training lives at the pilot program site or at a volunteer foster home while receiving training, that the pilot programs include both lecture of service dog training methodologies and practical hands-on training and grooming of service dogs, and that the programs are designed to maximize the therapeutic benefit of the Veterans participating in the program and to produce well-trained service dogs for Veterans with disabilities.  The Secretary would be required to give hiring preference for service dog training instructor positions to Veterans who have successfully graduated from PTSD or other residential treatment programs and who have received adequate certification in service dog training.  

VA would be required to collect data on the pilot program and determine its effectiveness for the Veteran participants.  Specifically, under this bill, VA must consider whether the pilot program effectively reduces the stigma associated with PTSD or other post-deployment mental health conditions, improves emotional regulation or patience, instills or re-establishes a sense of purpose among participants, provides an opportunity to help fellow Veterans, facilitates community reintegration, exposes service dogs to new environments in order to help Veterans reduce social isolation and withdrawal, builds relationship skills, relaxes the hyper-vigilant survival state, improves sleep patterns, and enables Veterans to decrease the use of pain medication.  VA would be required to submit an annual report to Congress following the end of the first year of the pilot program and each year thereafter to inform Congress about the details of the program and its effectiveness in specific areas.

VA recognizes the therapeutic value to Veterans diagnosed with PTSD of training service dogs for persons with disabilities; however, VA cannot support H.R. 198. 

VA has used Animal Assisted Therapy, or Animal Facilitated Therapy, for many years as part of VA’s comprehensive approach to health care.  VA is currently utilizing therapy dogs as a component of treatment in a number of facilities and settings, including VA’s Community Living Centers, palliative care units, and most recently in recovery treatment programs.  In July 2008, a Service Dog Training Program was established as a therapy component at the Palo Alto Veterans Healthcare System (Menlo Park Division), in collaboration with Bergin University.  Patients who have been diagnosed with PTSD and assigned to the Men and Women’s Trauma Recovery Program have the option to participate in the training of service dogs as one of their activities in their comprehensive recovery program.  This training focuses on basic obedience (e.g., commands such as “sit,” “stay,” and “heel”) and public access skills (sensitizing dogs to different environments) to prepare the dogs to become service dogs for persons with mobility impairments.  Initial patient self-reports and informal observations by staff have been positive, and VA staff members have indicated that the training of dogs, in combination with established recovery therapies, is showing promise. 

H.R. 198 imposes specific requirements that focus on the training of service dogs.  The bill is very prescriptive as to the requirements of the proposed pilot program (e.g., staffing guidelines), and it would require evaluation of a large and very detailed list of factors, many of which cannot be measured with any degree of specificity or reliability.  We are available to work with the Committee to design a workable program and an appropriate mechanism to evaluate whether training service dogs is a clinically appropriate form of treatment.

VA estimates the total cost for this bill would be $2 million in the first year of the program and $10 million over 5 years.

H.R. 1154 “Veterans Equal Treatment for Service Dogs Act (VETS Dogs Act)”

H.R. 1154 would prohibit the Secretary from excluding service dogs from any VA facilities or property or any facilities or property that receive funding from VA.

VA acknowledges that trained service dogs can have a significant role in maintaining functionality and promoting maximum independence of Veterans with disabilities.  VA recognizes the need for persons with disabilities to be accompanied by their trained service dogs on VA properties consistent with the same terms and conditions, and subject to the same regulations as generally govern the admission of members of the public to the property.  However, H.R. 1154 is unnecessary.

Under existing statutory authority in 38 U.S.C. § 901, VA can implement national policy for all VA properties, and in fact did so for VHA facilities and property on March 10, 2011 (VHA Directive 2011-013), directing that both Veterans and members of the public with disabilities who require the assistance of a trained guide dog or trained service dog be authorized to enter VHA facilities and property accompanied by their trained guide dog or trained service dog consistent with the same terms and conditions, and subject to the same regulations that govern the admission of members of the public to the property. We would be glad to provide a copy of the Directive for the record. This Directive requires each Veterans Integrated Service Network (VISN) Director to ensure all VHA facilities have a written policy on access for guide and service dogs meeting the requirements of the national policy by June 30, 2011, and VA is reviewing these policies to ensure their compliance with national standards.  In addition, VA intends to initiate rulemaking that will establish criteria for service dog access to all VA facilities and property in a manner consistent with the same terms and conditions, and subject to the same regulations, as generally govern the admission of members of the public to the property while maintaining a safe environment for patients, employees, visitors, and service dogs.

H.R. 1154 would prohibit the Secretary from excluding service dogs from any facility or on any property that receives funding from the Secretary.  Such a prohibition is unnecessary because it duplicates other statutes discussed below.

Any non-VA facilities and properties with which H.R. 1154 is concerned that are also owned or controlled by the Federal government must under current law at 40 U.S.C.

§ 3103, admit on the same terms and conditions, and subject to the same regulations, as generally govern the admission of the public to the property, specially trained and educated guide dogs or other service animals accompanying individuals with disabilities.  Other non-VA properties not otherwise owned or controlled by the Federal government, including but not limited to professional offices of health care providers, hospitals, and other service establishments, will almost certainly meet the definition of a place of public accommodation or public entity under the Americans with Disabilities Act of 1990 as prescribed in regulations at 28 C.F.R. §§ 35.104 and 36.104, and therefore be required to modify their policies, practices, or procedures to permit the use of a service animal by an individual with a disability in accordance with 28 C.F.R. §§ 35.136 and 36.302.  We would note that VA facilities are not subject to the Americans with Disabilities Act of 1990, but are subject to the Rehabilitation Act.  The Rehabilitation Act does not specifically address the issue of service dogs in buildings or on property owned or controlled by the Federal government, but does prohibit discrimination against individuals with disabilities, including those who use service animals, in Federally- funded or -conducted programs and activities.  In addition, as explained above, there are other existing authorities that address the issue of bringing guide dogs and other service animals onto VA property.

VA estimates that there would be no costs associated with implementing this bill.

H.R. 1855 “Veterans’ Traumatic Brain Injury Rehabilitative Services’ Improvements Act of 2011”

In 2008, Congress established several programs targeted at the comprehensive rehabilitation of Veterans and members of the Armed Services receiving VA care and services for Traumatic Brain Injuries (TBI).  In general, H.R. 1855 seeks to improve those programs (established by 38 U.S.C. §§1710C-E) by requiring rehabilitative services, as defined by the bill and discussed below, to be an integral component of those ongoing programs.  With one exception, we have no objection to H.R. 1855.

Currently, the provisions of 38 U.S.C. § 1710C set forth the requirements for an individualized rehabilitation and reintegration plan that must be developed for each Veteran or member of the Armed Forces receiving VA inpatient or outpatient rehabilitative hospital care or medical services for a TBI.   VA Handbook 1172.04, Physical Medicine and Rehabilitation Individualized Rehabilitation and Community Reintegration Care Plan, implements section 1710C.   

Section 2(a) of H.R. 1855 would amend some of the mandated requirements in section 1710C.  Specifically, it would clarify that the goal of each individualized plan is to maximize the individual’s independence and quality of life.  It would also require, as part of a plan’s stated rehabilitative objectives, the sustaining of improvements made in the areas of physical, cognitive, and vocational functioning.  Section 2(a) of the bill would further require that each such plan include rehabilitation objectives for improving and sustaining improvements in the individual’s behavioral functioning as well as mental health. 

These amendments would not alter VA’s policy or operations in any significant way, as VA’s primary aim for Veterans with serious or severe injuries has always been, and continues to be, maximizing their independence, health, and quality of life.  It is out of these concerns that VA has developed robust rehabilitation therapy programs to help them learn or re-learn skills and develop resources for sustaining gains made in their rehabilitation.

Section 2(a) of the bill would require the individual plans to include access, as warranted, to all appropriate rehabilitative services of the TBI continuum of care.  The law now requires these plans to provide access, as warranted, to rehabilitative components of the TBI continuum of care (which includes, as appropriate, access to long-term care services).  

Current law also requires that each individualized plan include a description of the specific “rehabilitation treatments and other services” needed to achieve the patient’s rehabilitation and reintegration goals.  Section 2(a) of the bill would replace all references to “treatments” in the affected provision with “services.”   This would ostensibly broaden the scope of rehabilitative benefits available to these patients beyond what is deemed to be treatment per se

It would also add to each plan the specific objective of improving (and sustaining improvements in) the patient’s behavioral functioning. That addition, together with the existing rehabilitation objective to improve a patient’s cognitive functioning, would effectively encompass all relevant mental health issues related to TBI.  For that reason, we believe the bill’s other amendment to separately include a rehabilitation objective for improving “mental health” would create confusion or redundancy.  We thus recommend that language be deleted.

Most notably, Section 2(a) of H.R. 1855 would establish a new definition of the term “rehabilitative services,” for purposes of all of VA’s specially targeted, statutory programs for TBI patients (i.e., 38 U.S.C. §§ 1710C-E).  Such services would include not only those that fall under the current statutory definition found in 38 U.S.C. § 1701 but also “services (which may be of ongoing duration) to sustain, and prevent loss of, functional gains that have been achieved.”  In addition, they would include "any other services or supports that may contribute to maximizing an individual's independence and quality of life.”  This last definition is overly broad and could be read to include services or items well beyond the field of health care.  It is also unworkable. What maximizes an individual’s “quality of life” is highly subjective and, as such, the term defies consistent interpretation and application.  We believe enactment of that last provision of the proposed new definition would conflict with and exceed our primary statutory mission, which is to provide medical and hospital care.  It should therefore be deleted, leaving only the first two prongs of the definition. 

Next, as briefly alluded to above, the individualized rehabilitation and reintegration plans required by section 1710C must include access, where appropriate, to long-term care services.  The eligibility and other requirements of VA’s mandated comprehensive program of long-term care for the rehabilitation of post-acute TBI are found in 38 U.S.C. § 1710D.  Section 2(b) of H.R. 1855 would require the Secretary to include rehabilitative services (as that term would be defined by Section 2(a) of the bill) in the comprehensive program.  It would also eliminate the word “treatment” in the description of the interdisciplinary teams to be used in carrying out that program.  We have no objection to this proposed revision.   

Lastly, Congress authorized VA, under specified circumstances, to furnish hospital care and medical services required by an individualized rehabilitation and reintegration plan through a cooperative agreement.  (A cooperative agreement may be entered only with an appropriate public or private entity that has established long-term neurobehavioral rehabilitation and recovery programs.)  This authority is found at 38 U.S.C. § 1710E.   Section 2(c) of H.R. 1855 would add “rehabilitative services” (again as defined by Section 2(a) of the bill) to the types of services that may be provided under those agreements.  We have no objection to this proposed revision.   

Finally, we note as a technical matter that there is a typographical error in the spelling of “ophthalmologist” in Section 1710C(c)(2)(S) of title 38, U.S.C.  Additionally, current law permits inclusion of “educational therapists” among the TBI experts responsible for conducting comprehensive assessments of these patients.  (These assessments are then used to design the individualized plans discussed above.)  However, this categorization of professionals is no longer used in the field of medical rehabilitation. 

We do not otherwise object to H.R. 1855.  No new costs would be associated with its enactment.

H.R. 2074 “Veterans Sexual Assault Prevention Act”

H.R. 2074 would amend title 38, United States Code, by adding a new section 1709 known as the “Veterans Sexual Assault Prevention Act.” Section 1709 would require VA to “develop and implement a centralized and comprehensive policy on the reporting and tracking of sexual assault incidents and other safety incidents that occur” at VA medical facilities including incidents of sexual assault, criminal and purposeful unsafe acts, alcohol or substance abuse related acts, and acts involving abuse of a patient.  VA would need to develop and implement this policy by October 1, 2011.  In addition, Section 1709(d) would require VA to submit an annual report to Congress discussing implementation and effectiveness of the policy. 

VA considers the safety and security of our Veterans, employees and visitors to be among our highest priorities.  We take all allegations seriously and investigate them thoroughly.

In response to a recent Government Accountability Office (GAO) report (GAO-11-530) entitled “VA Health Care:  Actions Needed to Prevent Sexual Assaults and Other Safety Incidents,” VA has convened an interdisciplinary Safety/Security Workgroup including representatives from VHA and VA corporate offices, including the Office of Operations, Security and Preparedness (OSP) and the Office of General Counsel.  VA has charged the Safety/Security Workgroup to define steps necessary to ensure VA is taking every action required to respond effectively to reports of sexual victimization of Veterans, employees, and visitors.  The Workgroup is developing appropriate proactive interventions to reduce the risk of these events, testing a computerized reporting system  for ongoing data tracking and trending, and is currently establishing guidance for training of staff and providers.  Initial action plans from the Workgroup have been submitted, with a final written report to be completed by September 30, 2011.  The Workgroup’s Chairs provide weekly updates to VA’s Under Secretary for Health, ensuring that leadership is aware of the progress being made and can intervene to continue our efforts to improve facility safety.

We believe H.R. 2074 is unnecessary because our current efforts are fulfilling much of what it would require.  In addition to the Workgroup, VA is already undertaking other efforts to enhance the safety and security of our facilities.  For example, VA is evaluating its risk assessment tools and is developing enterprise-wide assessments that consider issues beyond the Veteran’s legal history and medical record.  VA is taking steps to consider universal risk for violence and design appropriate intervention actions.  These are important steps to improve evaluations of patient risk.  Mandatory training on security issues is also in development, and VA plans to provide educational materials for patients and visitors as well so they can help contribute to a safer VA environment for everyone.  VA’s Integrated Operations Center (IOC), established in 2009, provides oversight of VA facilities 24 hours a day, 7 days a week and is responsible for collecting any reports of serious incidents, including alleged criminal behavior at VA facilities.  VHA is already developing an oversight system like that described in the bill.  It will be in place later this summer, and will have clear and consistent guidance on the management and treatment of sexual assaults by the end of 2011.

While we agree with many of the aims of H.R. 2074, and are proceeding with similar initiatives, we do have several concerns with the bill as written.  First, the timeline for the implementation of this policy is not feasible.  VA is committed to enacting this policy, but needs time to complete work on reporting tools and processes and to pilot these initiatives before the policy will be fully implemented so that we can achieve the shared goal of increased safety.  Second, VA is concerned that the term “other safety incidents” is overly broad.  While the bill requires VA to define the term “safety incident” and provides the Secretary the authority to prescribe regulations to implement the legislation, “other safety incidents” could be read broadly to include any safety incident, including workplace issues (such as a slip and fall situation) and occupational safety concerns.  VA believes the intent of this provision is to focus on the security of patients, employees and visitors, and we will define this term accordingly. We are happy to work with the Committee to refine this language in the legislation.

VA also has serious concerns with the requirement that VA report “alcohol or substance abuse related acts” committed by Veterans.  VA is an integrated health care system that treats all of the health care needs of Veterans, including substance use disorders and alcoholism.  With our focus on universal precautions, we will assess all potential risks, not just those associated with substance use disorders.  Alcohol and drug misuse are associated with a host of medical, social, mental health, and employment problems.  Fortunately, these problems are treatable and with treatment, the lives of our patients and their loved ones can be enriched.  VA does not want to create a disincentive for Veterans to seek treatment for these conditions and recommends that this provision be deleted from the bill. 

Since VA is already making significant improvements in our tracking and reporting system that meet or exceed the requirements of the legislation, we estimate that this bill would result in no additional costs.  We appreciated the opportunity to discuss this issue and hear your recommendations on June 13.  We are happy to meet with the Committee to discuss this issue in more detail.

H.R. 2530 Increased Flexibility in Rates of Reimbursement for State Homes

H.R. 2530 would require State homes and VA to contract, or enter into a provider agreement under 38 U.S.C. § 1720(c)(1)(A), for the purpose of providing nursing home care in these homes to Veterans who need it for a service-connected condition or have a service-connected rating of 70 percent or greater.  This payment methodology would replace the current per diem grant payments for these Veterans which were implemented in 2009.  VA supports this provision in principle as subsection (a)(1) is consistent with section 104 of VA’s draft bill “Veterans Health Care Act of 2011,” which was transmitted to Congress on June 7, 2011.

We do have technical concerns with how the bill would treat provider agreements, as distinguished from arrangements with State Veterans Homes on a contract basis.  The requirement in subsection (a)(2) that payments under each provider agreement be based on a methodology developed by VA in consultation with the State home would prevent VA from using provider agreements with State homes.  The authority for using provider agreements in 38 U.S.C. § 1720(c)(1)(A) essentially authorizes VA to enter into agreements like the Centers for Medicare and Medicaid Services (CMS) does under the Medicare program without entering into contracts.  There are no procedures for negotiating rates of payments under the Medicare program.  This facilitates entering into these agreements. If H.R. 2530 were enacted and negotiations are required under this authority, VA would only be able to contract.  We are happy to work with the Committee to refine this language in the legislation.  

VA estimates that there would be no additional costs associated with H.R. 2530. 

H.R. _____    Veterans Health Care Facilities Capital Improvement Act of 2011”

H.R. _____, the “Veterans Health Care Facilities Capital Improvement Act of 2011”, would authorize certain Department of Veterans Affairs major medical facility projects and leases, extend certain expiring provisions of law, and modify certain other authorities.  Specifically, this bill would provide authorization for major medical facility construction projects and major medical facility leases, all of which are consistent with projects and leases requested in Department of Veterans Affairs’ draft construction authorization bill.

Section 2 would authorize construction of a project for seismic corrections for Building 100 in Seattle, Washington, in an amount not to exceed $51,800,000.  Also authorized is a project for construction of seismic corrections and renovation of various buildings, the initial phase of which is Building 209 for housing facilities for homeless Veterans in West Los Angeles, California, in an amount not to exceed $35,500,000.

Section 3 would modify the authorization of five major medical facility construction projects.  The authorization of the Veterans Affairs Medical Center in Fayetteville, Arkansas, would be modified to include a parking garage.  The total amount for this project is $90,600,000.  The previous extension of authorization for the project at the Veterans Affairs Medical Center in Orlando, Florida is modified to include a Simulation, Learning, Education and Research Network Center.  The amount of the previously authorized project for the project at the Veterans Affairs Medical Center in Palo Alto, California, is increased to $716,600,000.  The amount of the previously authorized project at the Veterans Affairs Medical Center in San Juan, Puerto Rico, is increased to $277,000,000.  The amount of the previously authorized project at the Veterans Affairs Medical Center in St. Louis, Missouri, is increased to $346,300,000.

Section 4 would authorize the Secretary to carry out eight major medical facility leases, all of which were included in VA’s draft construction bill.  Specifically, Section 4 would authorize the Secretary to carry out major medical facility leases for a community-based outpatient clinic in Columbus, Georgia, in an amount not to exceed $5,335,000; an outpatient clinic in Fort Wayne, Indiana, in an amount not to exceed $2,845,000; an outpatient clinic in Mobile, Alabama, in an amount not to exceed $6,565,000; an outpatient clinic in Rochester, New York, in an amount not to exceed $9,232,000; a community-based Outpatient Clinic in Salem, Oregon, in an amount not to exceed $2,549,000; an outpatient clinic in San Jose, California, in an amount not to exceed $9,546,000; an outpatient clinic in South Bend, Indiana, in an amount not to exceed $6,731,000; and, a community-based outpatient clinic in Springfield, Missouri, in an amount not to exceed $6,489,000.

Section 5 would authorize appropriations for the projects and leases listed in Sections 2, 3 and 4, subject to certain limitations.  With the exception of Section 5(b), this section is consistent with the Department of Veterans Affairs draft construction authorization bill.  Section 5(b) indicates that $850,070,000 is authorized to be appropriated for certain major medical facility projects that were previously authorized.  However, we believe the correct amount to be authorized for Section 5(b) is $914,507,000. 

Section 6 would make certain amendments to VA’s enhanced-use lease (EUL) authority, including granting a much-needed 10-year extension to the current legislation, before it expires at the end of this calendar year.  Section 6 of the draft bill would also allow the Secretary to consider proposed EUL business plans by other organizations within the Department, as opposed to just VA’s Veterans Health Administration.   Third, the draft bill would incorporate certain business parameters to ensure EUL compliance with the latest capital scoring rules and guidelines.  Fourth, it would allow the Department to deposit and use future EUL proceeds as part of the agency’s major and minor construction accounts.  And fifth, the draft bill would add clarifying language to emphasize that the Federal government’s underlying real property ownership, and leaseback of any lands through EULs are exempt from State and local taxes, fees, and assessments.  I would like to thank the Subcommittee for addressing VA’s EUL authority extension in the Veterans Health Care Facilities Capital Improvement Act of 2011.

The EUL authority was enacted in August 1991, and is codified in sections 8161 through 8169 of title 38 of the U.S. Code.  In 2001, the authority was renewed for an additional ten years through the end of 2011.  The Department’s authority to enter into additional EUL agreements will expire on December 31, 2011.  Without a reinstatement of the EUL authority, VA will no longer have the mechanism in place to acquire third-party investment for new facilities, space, services or revenue to serve Veterans. 

The EUL authority allows VA to outlease land and improvements under the department’s jurisdiction or control, to public or private sector entities for up to 75 years.  In return, VA receives negotiated monetary and/or in-kind consideration.  The outleased property is developed, used, and maintained for agreed-upon uses that directly or indirectly support VA’s mission. 

EULs have provided a variety of benefits such as enhanced services to Veterans, operations and maintenance cost savings, private investment, new long-term revenue for VA, job creation, and additional tax revenues for local, state and federal sectors.  In some instances, EULs have helped VA meet its environmental goals by creating on-site renewable energy facilities enabling VA to reduce its greenhouse gas emissions. 

Since the original EUL legislation passed in August 1991, more than 60 projects have been awarded–18 of these for housing providing 1,066 housing units benefiting Veterans.  From FY 2006 to 2010, EULs have generated approximately $266 in total consideration. 

In terms of Veterans housing, EUL provides multiple benefits:  helping to reduce homelessness among our Veterans while leveraging underutilized assets, reducing the inventory of underutilized real estate, and transferring the operation and maintenance costs to the developers – while maintaining VA control of the underlying assets. 

 Currently, VA has 19 EUL projects underway to provide nearly 2,200 units of housing for homeless Veterans and their families; and approximately 600 units of assisted living and senior housing, which will be curtailed if VA’s EUL authority is not extended. 

Additionally, if VA’s EUL authority is not extended, it will halt another 34 housing projects under VA’s Building Utilization Review & Reuse (BURR) Initiative, which involves approximately 1,700 units of housing for homeless Veterans, and 900 units of senior, non-senior independent living, and assisted living housing for Veterans.  

Congressional approval of VA’s EUL authority extension is critical for VA to continue the successful efforts to facilitate the provision of homeless housing for Veterans and their families through public/private ventures.  EUL is a valuable tool used by the Secretary in VA’s multi-faceted approach to eliminate Veteran homelessness.  If the EUL authority is not extended, a total of 5,500 housing units for homeless Veterans and Veterans at-risk-for homelessness will be affected.

Section 7 of the Act would modify the requirements relating to congressional approval of certain medical facility acquisitions.  Specifically, the Secretary would be required to submit additional information in the prospectus for each major construction facility.   We do not object to these modifications. 

Section 8 would designate the Department of Veterans Affairs telehealth clinic in Craig, Colorado as the “Major William Edward Adams Department of Veterans Affairs.” The Department has no objection to this proposal and defers to Congress in the naming of federal property.

Section 9 would extend certain expiring authorities.  Subsection (a) of section 9 would amend 38 U.S.C. § 1703 to extend the recovery audit program for fee basis and other medical service contracts until September 30, 2020.  This authority is currently set to expire on September 30, 2013.

Subsection (b) would amend 38 U.S.C. § 2031 to extend until December 31, 2018, VA's authority to provide certain services to seriously mentally ill Veterans.  Title 38 U.S.C. § 2031(a) authorizes VA to provide to seriously mentally ill Veterans, including homeless Veterans, (1) outreach services, (2) care, treatment, rehabilitation, and other services, and (3) therapeutic transitional housing assistance.  This authority is currently set to expire on December 31, 2011. 

Subsection (c) would amend 38 U.S.C. § 2033 to extend until December 31, 2018, VA's authority to expand and improve benefits to homeless Veterans. Title 38 U.S.C. § 2033 authorizes VA, subject to appropriations, to operate a program to expand and improve the provision of benefits and services to homeless Veterans. The program includes establishing sites under VA jurisdiction to be centers for the provision of comprehensive services to homeless Veterans in at least each of the 20 largest metropolitan statistical areas.  This authority is currently set to expire on December 31, 2011.

Subsection (d) would amend 38 U.S.C. § 2041(c) to extend, through December 31, 2018, the Secretary’s authority to enter into agreements with homeless providers for the purpose of selling, leasing, or donating homes acquired through the guaranteed loan program.  This authority is currently set to expire on December 31, 2011.

Subsection (e) would amend 38 U.S.C. § 2066 to extend Congressional authority to continue the Advisory Committee for Homeless Veterans until December 31, 2018.  This authority is currently set to expire on December 30, 2011.

Subsection (f) would amend 38 U.S.C. § 8118(a)(5) to extend until December 31, 2018, the Secretary of VA's authority to transfer real properties under his jurisdiction and control, to other Federal agencies, State agencies, public or private entities, or Indian tribes.  This authority is currently set to expire on December 31, 2011. 

While VA requested extensions of sections 2031, 2033, 2041 and 2066 of title 38, U.S.C. in our draft bills the “Veterans Health Care Act of 2011” and “Veterans Benefit Programs Improvement Act of 2011,” which were transmitted to Congress on June 7 and May 19, 2011, the draft “Veterans Health Care Facilities Capital Improvement Act of 2011” would extend these authorities for a considerably longer period of time.   VA requires additional time to evaluate these provisions and we will provide views and costs on this section for the record.

This concludes my prepared statement. Thank you for the opportunity to testify before the Subcommittee.  I would be pleased to respond to any questions you or Members of the Subcommittee may have.