Statements on Introduced Bills and Joint Resolutions - S. 1847
STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS
By Mr. CORZINE:
S. 1847. A bill to amend title 38, United States Code, to establish a comprehensive program for testing and treatment of veterans for Hepatitis C virus; to the Committee on Veterans' Affairs.
Mr. CORZINE. Mr. President, I rise today on Veterans Day to introduce the Veterans Comprehensive Hepatitis C Health Care Act. This bill would fundamentally change the way the Department of Veterans Affairs is addressing the growing Hepatitis C epidemic, and would create a national standard for testing and treating veterans with the virus.
Hepatitis C is a disease of the liver caused by contact with the Hepatitis C virus. It is primarily spread by contact with infected blood. The CDC estimates that 1.8 percent of the population is infected with the Hepatitis C virus, and that number is much higher among veterans. Vietnam-era veterans are considered to be at greater risk because many were exposed to Hepatitis C-infected blood as a result of combat-related surgical care during the Vietnam War. In fact, data from the Veterans
Administration suggests that as many as 18 percent of all veterans and 64 percent of Vietnam veterans are infected with the
Hepatitis C Virus (HCV). For many of those infected, Hepatitis C can lead to liver failure, transplants, liver cancer, and death.
And yet, most veterans who have Hepatitis C don't even know it-and often do not get treatment until it's too late. Despite recent advances in treating Hepatitis C, the VA still lacks a comprehensive, consistent, uniform approach to testing and treating veterans for the virus. Only a fraction of the 3.5 million veterans enrolled nationally with the VA Health Care System have been tested to date. Part of the problem stems from a lack of qualified, full-time medical personnel to administer and analyze the tests. Most of the 172 VA hospitals in this country have only one doctor, working a half day a week, to conduct and analyze all the tests. At this rate, it will take years to test the entire enrolled population-years that many of these veterans may not have.
To address this growing problem, I am introducing the Veterans Comprehensive Hepatitis C Health Care Act. This legislation will improve access to Hepatitis C testing and treatment for all veterans, ensure that the VA spends all allocated Hepatitis C funds on testing and treatment, and sets new, national policies for Hepatitis C care. Congressman Rodney Frelinghuysen from New Jersey has introduced companion legislation in the House of Representatives.
The bill would improve testing and treatment for veterans by requiring annual screening tests for Vietnam-era veterans enrolled in the VA system, and providing annual tests, upon request, to other veterans enrolled in the VA system. Further, it would require the VA to treat any enrolled veteran who tests positive for the Hepatitis C virus, regardless of service-connected disability status or priority group categorization. The VA would be required to provide at least one dedicated health care professional-a doctor and a nurse-at each VA Hospital for testing and treatment of this disease.
This bill would also increase the amount of money dedicated to Hepatitis C testing and treatment, and would make sure these funds are spent where they are needed most. Beginning in FY04, Hepatitis C funding would be shifted to the Specific Purpose account under the Veterans Health Administration, and would be dedicated solely for the purpose of paying for the costs associated with treating veterans with the Hepatitis C virus. The bill would allocate these funds to the 22 Veterans Integrated Service Networks (VISN) based on each VISN's Hepatitis C incidence rate, or the number of veterans infected with the virus.
In addition, this bill will end the confusing patchwork of policies governing the care of veterans with Hepatitis C throughout the nation. This legislation directs the VA to develop and implement a standardized, national Hepatitis C policy for its testing protocol, treatment options and education and notification efforts. The bill further directs the VA to develop an outreach program to notify veterans who have not been tested for the Hepatitis C virus of the need for such testing and the availability of such testing through the VA. And finally, this legislation would establish Hepatitis C Centers of Excellence in geographic areas with high incidence of Hepatitis C infection.
As I've said, many veterans do not even realize that they may be infected with the Hepatitis C virus, and the VA is doing little to encourage them to get the critical testing they need. The VA currently lacks a comprehensive national strategy for combating this deadly disease. With the passage of the Veterans Comprehensive Hepatitis C Health Care Act, veterans will finally be provided with the access to testing and treatment that they have more than earned and deserve. Additionally, the Federal Government will actually save money in the long run by testing and treating this infection early on. The alternative is much more costly treatment of end-stage liver disease and the associated complications, or other disorders.
The VA has known about the problem of Hepatitis C among veterans since 1992, but they have not acted. We must address this critical issue for the brave men and women who have placed their lives in danger to protect the United States. I urge my colleagues to join me in supporting this crucial legislation.
There being no objection, the bill was ordered to be printed in the RECORD, as follows:
S. 1847
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the "Veterans Comprehensive Hepatitis C Health Care Act".
SEC. 2. COMPREHENSIVE HEPATITIS C HEALTH CARE TESTING AND TREATMENT PROGRAM FOR VETERANS.
(a) IN GENERAL.-Chapter 17 of title 38, United States Code, is amended by inserting after section 1720E the following new section:
"§ 1720F. Hepatitis C testing and treatment
"(a) INITIAL TESTING.-(1) During the one-year period beginning on the date of the enactment of the Veterans Comprehensive Hepatitis C Health Care Act, the Secretary shall provide a blood test for the Hepatitis C virus to-
"(A) each veteran who served in the active military, naval, or air service during the Vietnam era or who is considered to be 'at risk,' and is enrolled to receive care under section 1710 of this title who requests the test or is otherwise receiving a physical examination or any care or treatment from the Secretary; and
"(B) to any other veteran who requests the test.
"(2) After the end of the period referred to in paragraph (1), the Secretary shall provide a blood test for the Hepatitis C virus to any veteran who requests the test.
"(b) FOLLOWUP TESTING AND TREATMENT.-In the case of any veteran who tests positive for the Hepatitis C virus, the Secretary-
"(1) shall provide such followup tests as are considered medically appropriate; and
"(2) shall provide appropriate treatment for that veteran in accordance with the national protocol for the treatment of Hepatitis C.
"(c) STATUS OF CARE.-(1) Treatment shall be provided under subsection (b) without regard to whether the Hepatitis C virus is
determined to be service-connected and without regard to priority group categorization of the veteran. No copayment may be charged for treatment under subsection (b), and no third-party reimbursement may be sought or accepted, under section 1729 of this title or any other provision of law, for testing or treatment under subsection (a) or (b).
"(2) Paragraph (1) shall cease to be in effect upon the effective date of a determination by the Secretary or by Congress that the occurrence of the Hepatitis C virus in specified veterans shall be presumed to be service-connected.
"(d) STAFFING.-(1) The Secretary shall require that each Department medical center employ at least one full-time gastroenterologist, hepatologist, or other qualified physician to provide tests and treatment for the Hepatitis C virus under this section.
"(2) The Secretary shall, to the extent practicable, ensure that each Department medical center has at least one staff member assigned to work, in coordination with Hepatitis C medical personnel, to coordinate treatment options for Hepatitis C patients and provide information and counseling for those patients and their families. Such a staff member should preferably be trained in psychology or psychiatry or be a social worker.
"(3) In order to improve treatment provided to veterans with the Hepatitis C virus, the Secretary shall provide increased training options to Department health care personnel.".
(b) CLERICAL AMENDMENT.-The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 1720E the following new item:
"1720F. Hepatitis C testing and treatment.".
SEC. 3. FUNDING FOR HEPATITIS C PROGRAMS OF THE DEPARTMENT OF VETERANS AFFAIRS.
(a) PROGRAM ACCOUNT.-Beginning with fiscal year 2004, amounts appropriated for the Department of Veterans Affairs for Hepatitis C detection and treatment shall be provided, within the "Medical Care" account, through the "Specific Purpose" subaccount, rather than the "VERA" subaccount.
(b) ALLOCATION OF FUNDS TO VISNS.-In allocating funds appropriated for the Department of Veterans Affairs for the "Medical Care" account to the Veterans Integrated Service Networks, the Secretary of Veterans Affairs shall allocate funds for detection and treatment of the Hepatitis C virus based upon incidence rates of that virus among veterans (rather than based upon the overall population of veterans) in each such network.
(c) LIMITATION ON USE OF FUNDS.-Amounts appropriated for the Department of Veterans Affairs for Hepatitis C detection and treatment through the "Specific Purpose" subaccount may not be used for any other purpose.
SEC. 4. NATIONAL POLICY.
(a) STANDARDIZED NATIONWIDE POLICY.-The Secretary of Veterans Affairs shall develop and implement a standardized policy to be applied throughout the Department of Veterans Affairs health care system with respect to the Hepatitis C virus. The policy shall include the testing protocol for the Hepatitis C virus, treatment options, education and notification efforts, and establishment of a specific Hepatitis C diagnosis code for measurement and treatment purposes.
(b) OUTREACH.-The Secretary shall, on an annual basis, take appropriate actions to notify veterans who have not been tested for the Hepatitis C virus of the need for such testing and the availability of such testing from the Department of Veterans Affairs.
SEC. 5. HEPATITIS C CENTERS OF EXCELLENCE.
(a) ESTABLISHMENT.-The Secretary of Veterans Affairs shall establish at least one, and not more than three, additional Hepatitis C centers of excellence or additional sites at which activities of Hepatitis C centers of excellence are carried out. Each such additional center or site shall be established at a Department of Veterans Affairs medical center in one of the five geographic service areas (known as a Veterans Integrated Service Network) with the highest case rate of Hepatitis C in fiscal year 1999.
(b) FUNDING.-Funding for the centers or sites established under subsection (a) shall be provided from amounts available to the Central Office of the Department of Veterans Affairs and shall be in addition to amounts allocated for Hepatitis C pursuant to section 3.