Legislation News & Report (TM) 

TheWeekInCongress.com (TM)

Managing America: Military

TheWeekInCongress.com (TM)

Week Ending March 30, 2006

H.R.1538 To amend title 10, United States Code, to improve the management of medical care, personnel actions, and quality of life issues for members of the Armed Forces who are receiving medical care in an outpatient status, and for other purposes.

Wounded troops returning home to the military healthcare system are finding themselves slipping through the cracks in the process or at least find their paperwork doing so. This bill begins with assigning Medical Care Case Managers to each outpatient at a military medical treatment facility to help in understanding the patient’s medical status, assist in prescribing medical care and conduct a weekly, in person, review of the medical status of the patient. Each case manager will have no more than 17 cases but the number can be temporarily increased for up to 120 days. Physical Evaluation personnel will not be given more than 20 in their caseload.

The case managers might come from among the group of Army Medical Corps, Army Medical Service Corps, Army Nurse Corps, Navy Medical Corps, Navy Medical Service Corps, Navy Nurse Corps, or Air Force Medical Service who will have been trained in a new program for case managers.

The patient will also receive a Service Member Advocate who will communicate with the patient and family, assist with oversight of welfare and quality of life and assist in resolving financial, administrative, personnel, transitional and other matters. SMAs will be trained.

The Secretary must produce a report on patient care that includes patient assessment of medical care and the facility, timeliness of care, adequacy of living at facilities and quality of life programs, management support and the fairness and timeliness of physical disability evaluation systems.

A toll-free hotline is established to report deficiencies in medical-related support facilities “to collect, maintain, and update information regarding possible deficiencies in the adequacy, quality, and state of repair of medical-related support facilities”

A Medical Evaluation Board must offer the patient the right to access to a physician who is independent of the medical evaluation board to serve as a patient advocate and provide advice and counsel regarding the patients’ medical condition.

Members of Congress are to be notified when a patient is from their district of state if the patient agrees to the notification.

When it comes to evaluating a physical disability the bill looks to a standardized training program that educates the necessary officers in the use of the disability evaluation system and requires the standardized program to be in place 180 days after this bill is written into law.

90 days after enactment the Secretary of Defense must submit recommendations for modifying training for patient care specialists “to ensure that such health care professionals, medical care case managers, and service member advocates are able to detect early warning signs of post-traumatic stress disorder (PTSD), suicidal tendencies, and other mental health conditions among recovering service members, and make prompt notification to the appropriate health care professionals.” Progress will be reported to Congress within 180 days.

The Secretary of Army is required to establish a pilot program based on the Wounded Warrior Regiment program at the Marine Corps to track the course of outpatient treatment and the soldier’s transcription back to duty or private life.

The Secretary of Treasury must create a fund in the treasury to support programs and activities relating to medical treatment, rehab, recovery and support of wounded or injured troops. The Secretary is also authorized to transfer funds from that fund and use them for other more routine military spending projects including construction and other non-medical projects and programs. The bill adds $50 million to the fund. An oversight board is also ordered to be created to oversee efforts to improve patient care and fund spending through direct inspection of facilities.

OTHER REPORTS

The Secretary of Defense must report yearly to Congress on the efforts this bill requires.

A 90 day report on implementation is required.

A study is ordered to determine support services for families of recovering service members.

A report is due in 90 days to determine if traumatic brain injury patients are receiving a proper medical designation concomitant with their injury as opposed to the generic ‘organic psychiatric disorder classification. A final report is due in 180 days.

Flow from the Department of Defense aftercare system to the veterans system are to be studied and streamlined. Contractors are to be scrutinized to determine if contracts are cost saving.

Sponsor:  Rep. Ike Skelton (D-MO-4^th)

Vote: Passed House 426 to 0 March 28, 2007 (RC 208)

Cost to the taxpayers: “The bill also would require DoD and VA to establish a single medical information system between the two departments. CBO does not have sufficient information about how DoD and VA might implement this requirement to estimate the cost, but we expect that cost could amount to billions of dollars, subject to appropriation of the necessary funds. CBO estimates that implementing the remainder of H.R. 1538 would incur discretionary costs of $66 million in 2008 and about $300 million over the 2008-2012 period, assuming appropriation of the necessary amounts. Enacting the bill would not have a significant impact on direct spending or revenues”

Earmark Certification:   Not applicable to this bill.

## All Rights Reserved. © 2007 TheWeekInCongress.com(TM)

No reproduction, language translation or distribution without written permission from TheWeekInCongress.com.(TM)

MORE INFORMATION

AMENDMENTS

ITEM OF SPECIAL INTEREST

REPORT ON ARMY INFRASTRUCTURE REQUIREMENTS

The committee directs the Secretary of the Army to submit to the House Committee on Armed Services by January 31, 2008, a report of the infrastructure requirements for supporting wounded warriors at Army medical facilities and installations. The report shall include the following:

(1) A description of current and projected military facilities that support soldiers receiving medical treatment and rehabilitation services including medical facilities, dining facilities, barracks, family housing, and exercise and rehabilitation facilities.

(2) An analysis of the parking situation at all army medical centers to determine whether an adequate number of parking spaces exist, and the walking time and distance on average to and from the most remote parking spaces.

(3) An analysis of the infrastructure improvements to the facilities described in items (1) and (2) to determine if sufficient funds have been allocated for such improvements and such other recommendations the Secretary considers appropriate.

LEGISLATIVE PROVISIONS

Section 101--Improvements to medical and dental care for members of the armed forces assigned to hospitals in an outpatient status

This section would require the assignment of a medical care case manager and a service member advocate to each service member assigned to a military treatment facility in an outpatient status or another unit designated to manage service members receiving outpatient medical care. This section would specify the duties of medical care case managers and service member advocates, require standardized training curriculums be developed for each, and would limit the number of cases that may be assigned to each. This section would also require the secretary concerned to conduct semiannual surveys of members in an outpatient status to determine the quality of medical care, adequacy of facilities, and effectiveness of disability evaluation systems and to coordinate the results with installation medical commanders and authorities.

Section 102--Establishment of toll-free hot line for reporting deficiencies in medical-related support facilities and expedited response to reports of deficiencies

This section would require the Secretary of Defense to establish a toll-free hot line for reporting deficiencies in facilities supporting medical patients and family members. This section would require investigation and formulation of a plan to remediate substantiated complaints within 96 hours, to include relocation of occupants when health and safety standards are violated.

Section 103--Notification to Congress of hospitalization of combat wounded service members

This section would require the secretary of each military service, with the service member's consent, to notify Members of Congress of the hospitalization of a service member who has been evacuated from a theater of combat.

Section 104--Independent medical advocate for members before medical evaluation boards

This section would require assignment of independent health care professionals to serve as counselors and advocates for service members being considered by medical evaluation boards.

Section 105--Training and workload for physical evaluation board liaison officers

This section would establish 20 cases as the maximum number that may be assigned to a physical evaluation board liaison officer or an assistant physical evaluation board liaison officer. This section would also require the Secretary of Defense to establish a standard training curriculum for physical evaluation board liaison officers or assistant physical evaluation board liaison officers.

Section 106--Standardized training program and curriculum for department of defense disability evaluation system

This section would require the Secretary of Defense to establish a standardized training program and curriculum for persons involved in the disability evaluation system including, commanders, enlisted supervisors, health care professionals, and other persons with administrative, professional, or technical responsibilities in the disability evaluation system.

Section 107--Improved training for health care professionals, medical care case managers, and service member advocates on particular conditions of recovering service members

This section would require the Secretary of Defense to recommend annually, improvements to the training of health care professionals, medical care case managers, and service member advocates to increase their effectiveness in assisting recovering wounded warriors. This section would, at a minimum, require the Secretary to make recommendations about improving training in the identification of post-traumatic stress disorder, suicidal tendencies, and other mental conditions among recovering service members and the timely reporting of observations to appropriate health care professionals. This section would also require the Secretary of Defense to develop a system to track the number of notifications made by medical care case managers and service member advocates to health care professionals regarding the early warning signs of both suicide and post-traumatic stress disorder.

Section 108--Pilot program to establish an army wounded warrior battalion at an appropriate active duty base

This section would require the Secretary of the Army to establish an Army Wounded Warrior Battalion pilot program at an installation with a major medical facility modeled after the Wounded Warrior Regiment program operated by the United States Marine Corps.

The Secretary shall submit a report with the results of the pilot program within 90 days after completion of a one-year test.

Section 109--Criteria for removal of member from temporary disability retired list

This section would require that service member medical conditions must be permanent and stable before being removed from the temporary duty retired list.

Section 110--Improved transition of members of the armed forces to Department of Veterans Affairs upon retirement or separation

This section would require the Secretary of Defense to provide disabled service members being separated or retired from the armed forces with a written plan for transition of the service member to programs operated by the Department of Veterans Affairs and a formal process for the transmittal of records and other information to the Department of Veterans Affairs on or before the date of separation or retirement. This section would require the service member's identification and contact information to be provided to the applicable State agency responsible for veterans' affairs, with the consent of the service member. This section would also require the Secretary of Defense and the Secretary of Veterans Affairs to establish a joint separation and evaluation physical and a fully interoperable medical information system.

Section 111--Establishment of medical support fund for support of members of the armed forces returning to military service or civilian life

This section would authorize a Treasury fund to be used to support programs and activities relating to the medical treatment, care, rehabilitation, recovery, and support of wounded and injured members of the armed forces. This section would authorize $50.0 million to be appropriated from emergency supplemental appropriations for fiscal years 2007 and 2008, to remain available through September 30, 2008.

Section 112--Oversight board for wounded warriors

This section would require the establishment of an Oversight Board for Wounded Warriors to give oversight of medical care, quality of life, administrative processing, and family programs supporting wounded warriors and to provide advice and counsel to Congress and the Department of Defense about how the programs can be made more efficient and effective. The Board would be composed of twelve members with knowledge or experience of military health care, disability evaluation systems, or the challenges faced by recovering wounded warriors.

TITLE II--STUDIES AND REPORTS

LEGISLATIVE PROVISIONS

Section 201--Annual report on military medical facilities

This section would require the Secretary of Defense to submit an annual report beginning with the budget submission for fiscal year 2009 on the adequacy, suitability, and quality of military medical facilities and medical-related support facilities. This section would require that the report include any facility deficiencies and accompanying response plans identified through the toll-free hotline established in section 102 of this Act.

Section 202--Access of recovering service members to adequate outpatient residential facilities

This section would require the inspectors general of the regional medical commands to conduct semiannual inspections of facilities housing recovering service members for the first two years following the date of enactment of this Act and annually thereafter. This section would require the inspection results to be coordinated with local and service medical and civilian leadership, reported to Congress, and posted on the Internet website for the regional medical command.

Section 203--Evaluation and report on department of defense and department of veterans affairs disability evaluation systems

This section would require the Secretary of Defense and the Secretary of Veterans Affairs to conduct a joint evaluation of the disability evaluation systems operated by both secretaries for the purpose of improving the consistency of the two systems and evaluating the feasibility of, and potential for, consolidating the two systems. This section would require the secretaries to consider the findings and recommendations of the Veterans' Disability Benefits Commission.

Section 204--Study and report on support services for families of recovering service members

This section would require the Secretary of Defense to conduct a study of the support services provided to families of recovering service members including, a survey of the services currently provided; a determination of the services that may be provided with the associated costs; an estimate of the number of family members that would be eligible to receive the services; and a determination of any employment discrimination that the family members experience.

Section 205--Report on traumatic brain injury classifications

This section would require the Secretary of Defense to report on the changes being undertaken to ensure that traumatic brain injury victims receive a proper medical designation concomitant with their injury. The committee is aware that the Department of Defense recognizes that the current classification of organic psychiatric disorder used to classify traumatic brain injuries suffered by service members may require further definition.

Section 206--Evaluation of the polytrauma liaison officer/non-commissioned officer program

This section would require the Secretary of Defense to conduct an evaluation of the Polytrauma Liaison Officer/Non-commissioned Officer program operated by the military departments and the Department of Veterans Affairs to assist the transition of service members from the Department of Defense health care system to the Department of Veterans Affairs' system.

TITLE III--GENERAL PROVISIONS

LEGISLATIVE PROVISIONS

Section 301--Moratorium on conversion to contractor performance of Department of Defense functions at military medical facilities

This section would prohibit the initiation or announcement of a competition under Office of Management and Budget Circular A-76 relating to the possible conversion to performance of functions at a Department of Defense military medical facility by a contractor. The prohibition would be effective during a 12-month period beginning on the date of enactment of this Act.

Section 302--Prohibition on transfer of resources from medical care

This section would prohibit the transfer of funds or personnel from medical care functions to support the administrative requirements imposed by this Act.

Section 303--Increase in physicians at hospitals of the Department of Veterans Affairs

This section would require the Secretary of Veterans Affairs to increase the number of resident physicians at Department of Veterans Affairs' hospitals.

To Top

AMENDMENTS

Agreed to by voice vote March 28, 2007

To Top

## All Rights Reserved. © 2007 TheWeekInCongress.com.(TM)

No reproduction, language translation or distribution without written permission from TheWeekInCongress.com.(TM)