8 1 "(4) The Associate Director shall conduct special educa2 tion and training programs on posttraumatic stress disorder 3 for appropriate employees of the Department of Medicine and 4 Surgery, including programs on diagnostic criteria and meth5 odologies, referrals, and the formulation and implementation 6 of treatment plans and followup care. 7 "(5) The Chief Medical Director shall establish a task 8 force on the care and treatment of posttraumatic stress disor9 der. The task force shall include health care employees of the 10 Veterans' Administration who are involved in the treatment 11 or care of veterans suffering from posttraumatic stress disor12 der. The task force shall advise the Chief Medical Director on 13 policies regarding "(A) the use of appropriate treatment modalities and the development of standards governing lengths of stay of veterans in Veterans' Administration health care facilities for care and treatment for problems related to posttraumatic stress disorder; "(B) the coordination of treatment of posttraumatic stress disorder patients after discharge from inpa tient care; "(C) the monitoring and evaluation of treatment programs for posttraumatic stress disorder patients; "(D) the conduct of health-services research making comparisons among various treatment modal 8.2514 IS 1 2 3 4 5 6 7 8 9 10 11 9 ities for posttraumatic stress disorder to determine proper treatment methods and length of stay; "(E) ensuring proper diagnosis of posttraumatic stress disorder at all medical facilities including those which do not have programs dedicated specifically to the care and treatment of posttraumatic stress disorder; and "(F) the necessity of, and appropriate standards governing referral of patients, including those receiving vocational rehabilitation in domiciliaries.". (b) Not later than nine months after the date of enact12 ment of this Act, the Administrator shall submit to the Com13 mittees on Veterans' Affairs of the Senate and the House of 14 Representatives a report evaluating the results of the imple15 mentation of this subsection. 16 REPORT ON VETERANS' ADMINISTRATION PROGRAMS FOR 17 18 TERMINALLY ILL AND CERTAIN OTHER VETERANS SEC. 6. (a) Not later than September 30, 1985, the Ad19 ministrator of Veterans' Affairs shall submit to the Commit20 tees on Veterans' Affairs of the Senate and the House of 21 Representatives a report regarding programs of the Veter22 ans' Administration (1) to furnish palliative and supportive 23 care to terminally ill veterans and supportive care to mem24 bers of such veterans' families, and (2) to furnish care to ter25 minally and chronically ill veterans for brief periods in part 10 1 for the purpose of providing a respite for members of the 2 veterans' families in order to encourage them to maintain the 3 veterans in their homes (in order to obviate the need for insti 4 tutional care) to the maximum extent practicable. 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 (b) The report required by subsection (a) shall include(1) a review of Veterans' Administration policies and guidelines on the provision of care described in subsection (a); (2) a review of the care furnished to the veterans described in paragraph (a) and any treatment modalities used to furnish such care, including a description of the services furnished in connection with such care; (3) a comparison of the care provided to terminally ill veterans in hospice and nonhospice treatment programs, including a comparison of the routine and ancillary services furnished as hospice care and the routine and ancillary services furnished to terminally ill pa tients in nonhospice treatment programs; (4) an analysis of the lengths of stay of, and cost of care provided to, chronically and terminally ill veterans in programs described in subsection (a); (5) an evaluation of whether and how the provision of care to terminally and chronically ill veterans described in subsection (a)(2) helps to obviate or delay 8 2514 IS 11 1 2 3 4 5 6 7 8 9 10 11 12 13 14 the need for institutionalizing such veterans for a prolonged period; (6) an explanation of how the care described in subsection (a) is or will be included in the overall plans of the Veterans' Administration for providing health care to elderly veterans in the future and the extent to which plans to furnish hospice and respite care are included in such plans; (7) a review of the steps taken to coordinate the provision of the care described in subsection (a) with community providers of similar care; and (8) proposals for such administrative or legislative action as the Administrator may deem appropriate in light of the findings and conclusions of such report. [From the Congressional Record, Vol. 130, No. 40, pp. S3533-S3536--Senate, March 30, 1984] VETERANS' ADMINISTRATION HEALTH CARE AMENDMENTS OF 1984 Mr. SIMPSON. Mr, President, as Chairman of the Committee on Veterans' Affairs, I am today introducing S. 2514, the proposed Veterans' Admintstration Health Care Amendments of 1984. This legislation is designed to chartfy and improve certain health care programs and services currently provided and administered by the Veterans Administration. The central purpose of this initiative is to continne to obtain maximum use of VA health bare resources and to improve the quality of health care services by pubviding the most appropriate kinds and levels of care to certain specific veteran populations which are already recelving VA health care services. Our measure promotes a more concentrat ed effort to coordinate complex types of care and a more efficient use of resources by targeting appropriate kinds of services to match veterans' specific needs. Specific veterans populations who would benefit from the legislation would be those service-connected vet erans, elderly veterans, Vietnam veterans with post traumatic stress disorder (PTSD), veterans who are totally deaf, and veterans with alcohol-related disorders. SUMMARY OF PROVISIONS Mr. President, the five substantive provisions of my bill would: First, authorize the Veterans' Administration to arrange for certain health and health-related services in local communities at no expense to the VA but which would allow the VA to further manage a veteran's care. Second, provide that the Administra tor of Veterans' Affairs shall coordinate care for veterans suffering from alcohol dependence. Third, provide the Administrator with specific authority to provide for the hearing-impaired, including telecaptioning television decoders, to veterans who are totally deaf. Fourth, direct the Administrator to establish the position of Associate Di rector for Post Traumatic Stress Disorder (PTSD) in order to clarify VA policy, provide guidance, and coordinate care for Vietnam veterans suffering from PTSD. Fifth, direct the administrator to submit a report to Congress regarding VA hospice and respite programs for terminally ill and chronically ill veter VA/COMMUNITY COORDINATION PROGRAMS' Mr. President, a major problem in caring for geriatric veterans is to coordinate the delivery of the various health care services which are often needed. Not all veterans are eligible for all types of care and not all VAMC's provide all types of care, therefore some reliance on community resources may be necessary. There is presently considerable interest within the VA to cooperate with other public and private institutions in order to improve the delivery of health care services. Under current law, the VA is authorized to partici pate in the cooperative health manpower education program (CHMEP), with public institutions, nonprofit corporations, and others by establishing cooperative health care personnel education programs in areas geographically remote from major academic health centers. The purpose of these programs is to improve the competencies end performance of practicing health care personnel in areas underserved by the health care system. The purpose of this provision would be to provide the VA with enhanced authority to manage a veteran's program of treatment under varying circumstances including such times when a certain service is not offered by the VA, or times when a veteran may not be eligible for a certain service or times when due to a great distance between the veteran's home and the VA medical center close monitoring of a chronic condition is impractical. This legislation would establish a VA/community office within each medical center that would provide as part of discharge planning and ongoing care management, referral services to and help for veterans to negotiate the system in order to take advantage of certain health services currently avail. able in local communities that would certainly enhance a veteran's treatment. Section 3 of the measure I am introducing today, would particularly benefit elderly veterans who reside in rural areas and who receive VA health care services, and who could benefit from supplemental services that exist in the community. CLARIFY ALCOHOL TREATMENT AND REHABILITATION Mr. President, according to the National Institute of Medicine, alcohol abuse and alcoholism cost America $60 billion a year. Twenty percent of our total national expenditure for hospital care is alcohol related. The VA treats approximately 100,000 veterans each year for alcohol-related disorders in its 102 alcohol treatment units and other programs out of a total of about 3 million veterans treated. The VA's most recent report on alcoholism and VA patients "1980 Supplement to Alcoholism and Problem Drinking 1970-1975," notes that alcoholism-related disorders are the second largest category of di agnoses of patients discharged from VA hospitals, next to heart disease. When "problem drinkers"-those whose current treatment or prognosis are complicated by drinking-are added to those defined as "alcoholics," the percentage in VA hospitals was 26 percent in 1980. And the percent of alcoholics or problem drinkers among hospitalized Vietnam-era veterans was 38 percent. The VA's specialized alcohol dependence treatment programs emphasize short-term inpatient hospitalizations during which time a comprehensive evaluation is made including blomedical, social, and vocational skills assessments. An individualized treatment plan is formulated, including treatment for other significant medical, surgical, or mental health problems. According to the VA, the trend in VA care is for shorter inpatient stays and proportionately more of the needed treatment to be provided in an outpa tient or ambulatory setting. Mr. President, I very seriously considered including in section 4 of the bill I am introducing today a provision which would unify alcohol treatment goals within the VA by mirroring the VA's current policy of emphasizing short-term inpatient stay and making maximum use of outpatient and other forms of ambulatory care for alcohol treatment and rehabilitation. That provision would have provided the VA with specific authority to provide up to 7 days detoxification, 28 days inpa tient treatment, 15 weeks for rehabili tation (If necessary) and followup outpatient or half-way house care for alcohol treatment and rehabilitation. The VA would have been directed to provide a minimum of 1 year of followup to all veterans who had completed the inpatient treatment program. The purpose of this provision was to require the VA to put into practice what is reflected in its program guide and by other Government and privatesector alcohol treatment programs generally and to address three specific goals: First, to move the veteran through the treatment phases in a timely manner, second, to take into ac count other possible medical complications when formulating the veteran's treatment plan; and third, to provide the essential coordination of rehabilitative services and reintegration into the veteran's local community. I be lieve these goals are especially critical to the veteran's chances of recovery. In an attempt to be responsive to the Veterans' Administration and others concerned about the VA's efforts to treat veterans with alcohol dependence and abuse disabilities, I have decided not to specify the limitations in the bill but instead to include in section 4 of the bill I am introducing today a requirement that the Administrator prescribe regulations to estab lish maximum periods of treatment and rehabilitation for alcohol or drug dependence or abuse disabilities consistent with the average period of such treatment and rehabilitation experienced in programs not administered by the VA. These regulations are to include maximum periods for detoxification, acute inpatient care, additional extended care for cases involving mul tiple and complex diagnoses, and outpatient care. Regulations on the use of Individualized treatment plans, their development and implementation, and including at least 1 year of followup monitoring would also be prescribed. Rather than specifying the limits of each treatment phase in the legislation, the requirement that the VA prescribe regulations would provide the VA with the flexibility to exercise their own medical Judgment in setting forth the parameters of the program. It is my expectation and hope that the VA will proceed expeditiously to prescribe these regulations and that further legislation will not be necessary. MEDICAL AND REHABILITATION DEVICES FOR TRE HEARING IMPAIRED Mr. President, the VA Issues over 1 million prosthetic and sensory aids to eligible veterans each year, including |