Changes in S. 1501 as introduced.—Prior to the Committee's July 31 meeting, there was an attempt to develop a compromise on the provisions relating to the Readjustment Counseling Program, as proposed in S. 1501 as introduced and amended by Amendment No. 610, that would be acceptable to most if not all of the members of the Committee. Although that compromise ultimately was not agreed to, most of the revisions developed during that effort were proposed by the Chairman and included in the Committee bill in order to narrow the differences and to demonstrate the good faith that had characterized the attempt to reach a consensus. These revisions are as follows:

-The provision in S. 1501 to make any action which resulted in the relocation of 25 personnel in the Readjustment Counseling Program an administrative reorganization that could only proceed with at least 8 months advance notice, was modified to raise the threshold for such a "notify and wait" requirement to any action after FY 1988 involving the movement or closure of 18 vet centers-9 in FY 1988-thereby providing significantly more flexibility for the VA to take actions to move or close up to this many centers without such a long waiting period while still retaining protection in the case of major reorganizations affecting the program.

or

-The provision in S. 1501 that would have protected the budget and staff of any vet center moved to a VA medical center for 3 full fiscal years was modified so as to provide protection for 2 full fiscal years, with authority given to the Chief Medical Director to reduce funding or staffing or both after the first such year based on a real decline in the center's potential workload. -The S. 1501 provision requiring the conversion, on the date of enactment, from time-limited appointments to career career-conditional appointments of any employees who had been serving on a time-limited basis for 2 or more years has been modified so as to provide for a delay of 90 days after the enactment date before the conversion would be required. -The provision in S. 1501 providing an entitlement for readjustment counseling for active-duty personnel who served either during the Vietnam era or since then in combat conditions has been modified so as to make such individuals eligible forrather than being entitled to such counseling.

-Authority was added for the Chief Medical Director to establish criteria other than those specified in the bill to be considered before any individual vet center is moved or closed so long as the factor chosen relates to the effective provision of readjustment counseling services.

COST ESTIMATE

In compliance with paragraph 11(a) of rule XXVI of the Standing Rules of the Senate, the Committee, based on information supplied by the Congressional Budget Office (CBO), estimates that the costs resulting from the enactment of the Committee bill during the first 5 years following enactment would be $35 million in budget authority and outlays in fiscal year 1988; $37 million in budget authority and outlays in fiscal year 1989; $39 million in budget authority and

The Congressional Budget Office has prepared the attached cost estimate for S. 1464, the Veterans' Administration Beneficiary Travel, Quality Assurance, and Readjustment Counseling Amendments of 1987, as ordered reported by the Senate Committee on Veterans' Affairs, July 31, 1987.

Should you so desire, we would be pleased to provide further details on the attached cost estimate. The staff contact is Nina Shepherd (226-2820).

With best wishes,

CC:

Honorable Frank H. Murkowski

Ranking Minority Member

Sincerely,

Schad Ischich

Edward M. Gramlich
Acting Director

Veterans Administration Beneficiary Travel, Quality Assurance, and Readjustment Counseling Amendments of 1987.

3. BILL STATUS:

As ordered reported by the Senate Committee on Veterans'
Affairs, July 31, 1987.

4. BILL PURPOSE:

To provide eligibility to certain individuals for beneficiary travel benefits when traveling to Veterans Administration (VA) medical facilities, and for other purposes.

The cost of this bill would fall in budget function 700.

Basis of Estimate

Title I. This title would require the Veterans Administration (VA) to reimburse four categories of veterans for the cost of their travel to and from VA facilities for medical care. The four categories of veterans who would be eligible for benefits are: veterans receiving benefits for a service-connected disability; veterans receiving VA pension benefits; veterans whose income is below the income standard for VA pension; and veterans seeking compensation or pension examinations. Veterans requiring special modes of transportation (ambulance, wheelchair van, etc.) would only be eligible for reimbursement if they fell into one of the above categories. The reimbursements would be reduced by a deductible of $3.75 for each one-way trip. Veterans requiring frequent visits to VA medical facilities would not be required to pay total deductibles of more than $22.50 in any calendar month.

The Administrator would retain the authority to eliminate beneficiary travel benefits altogether, but if any benefits were paid, the payments described above would be required.

Prior to April 1987, the categories of veterans listed above were eligible for beneficiary travel reimbursements without a copayment. In April new regulations took effect which limited travel benefits to veterans seeking compensation or pension eligibility examinations, those requiring special modes of transportation, and any others within the eligibility categories who live more than 100 miles from the nearest VA facility. While experience under the new regulations is quite limited, it is estimated that the cost of the program was reduced by between $74 and $95 million a year during the projection period. On the other hand, it is estimated that S.1464 would reduce costs from the pre-April level of operations by only $41 to $55 million over the period, resulting in the net increase over current law cost that is shown above.

The estimate was based on data from three studies: Administration of and Veterans' Participation in the VA Beneficiary Travel Program, U.S. General Accounting Office (GAO/HRD-85-28), February 7, 1985; The Veterans Administration Beneficiary Travel Program, prepared for the U.S. Veterans Administration by Maximus, Inc., March 13, 1985; Study of Health-Care Services to Veterans Living in Geographically Remote Areas, Department of Medicine and Surgery, U.S. Veterans Administration, December, 1985.

Title II. This title would require the VA to establish three new offices to conduct a medical quality assurance program.

This provision would establish the position of Medical Inspector General and would require that the position be supported with a staff of not less than five Assistant Medical Inspectors General and not less than five full-time support