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115th Congress } { Report
HOUSE OF REPRESENTATIVES
2d Session } { 115-869
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VA COST SAVINGS ENHANCEMENTS ACT
_______
July 24, 2018.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Roe of Tennessee, from the Committee on Veterans' Affairs,
submitted the following
R E P O R T
[To accompany H.R. 5974]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred
the bill (H.R. 5974) to direct the Secretary of Veterans
Affairs to use on-site regulated medical waste treatment
systems at certain Department of Veterans Affairs facilities,
and for other purposes, having considered the same, report
favorably thereon with an amendment and recommend that the bill
as amended do pass.
CONTENTS
Page
Purpose and Summary.............................................. 2
Background and Need for Legislation.............................. 2
Hearings......................................................... 3
Subcommittee Consideration....................................... 4
Committee Consideration.......................................... 4
Committee Votes.................................................. 4
Committee Oversight Findings..................................... 4
Statement of General Performance Goals and Objectives............ 4
New Budget Authority, Entitlement Authority, and Tax Expenditures 4
Earmarks and Tax and Tariff Benefits............................. 5
Committee Cost Estimate.......................................... 5
Congressional Budget Office Estimate............................. 5
Federal Mandates Statement....................................... 6
Advisory Committee Statement..................................... 6
Constitutional Authority Statement............................... 6
Applicability to Legislative Branch.............................. 6
Statement on Duplication of Federal Programs..................... 6
Disclosure of Directed Rulemaking................................ 7
Section-by-Section Analysis of the Legislation................... 7
Changes in Existing Law Made by the Bill as Reported............. 7
AMENDMENT
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Department of Veterans Affairs
Creation of On-Site Treatment Systems Affording Veterans Improvements
and Numerous General Safety Enhancements Act'' or the ``VA COST SAVINGS
Enhancements Act''.
SEC. 2. USE OF ON-SITE REGULATED MEDICAL WASTE TREATMENT SYSTEMS AT
DEPARTMENT OF VETERANS AFFAIRS FACILITIES.
(a) Identification of Facilities.--The Secretary of Veterans Affairs
shall identify Department of Veterans Affairs facilities that would
benefit from cost savings associated with the use of an on-site
regulated medical waste treatment system over a five-year period.
(b) Regulated Medical Waste Cost Analysis Model.--For purposes of
carrying out subsection (a), the Secretary shall develop a uniform
regulated medical waste cost analysis model to be used to determine the
cost savings associated with the use of an on-site regulated medical
waste treatment system at Department facilities. Such model shall be
designed to calculate savings based on--
(1) the cost of treating regulated medical waste at an off-
site location under a contract with a non-Department entity,
compared to
(2) the cost of treating regulated medical waste on-site,
based on the equipment specification of treatment system
manufacturers, with capital costs amortized over a ten-year
period.
(c) Installation.--At each Department facility identified under
subsection (a), the Secretary shall secure, install, and operate an on-
site regulated medical waste treatment system.
(d) Use of Blanket Purchase Agreement.--Any medical waste treatment
system purchased pursuant to this section shall be purchased under the
blanket purchase agreement known as the ``VHA Regulated Medical Waste
On-Site Treatment Equipment Systems Blanket Purchase Agreement'' or any
successor, contract, agreement, or other arrangement.
(e) Regulated Medical Waste Defined.--In this section, the term
``regulated medical waste'' has the meaning given such term under
section 173.134(a)(5) of title 49, Code of Federal Regulations,
concerning regulated medical waste and infectious substances, or any
successor regulation, except that, in the case of an applicable State
law that is more expansive, the definition in the State law shall
apply.
PURPOSE AND SUMMARY
H.R. 5974, as amended, the Department of Veterans Affairs
Creation of On-Site Treatment Systems Affording Veterans
Improvements and Numerous General Safety Enhancements (VA COST
SAVINGS) Act, would require VA to establish a uniform,
regulated medical waste cost analysis model to be used to
determine the cost savings associated with on-site medical
waste disposal and to install and operate on-site medical waste
treatment facilities at locations determined to benefit from
supplanting off-site disposal services. Representative Jeff
Dunham of California introduced H.R. 5974 on May 25, 2018.
BACKGROUND AND NEED FOR LEGISLATION
According to the World Health Organization, 15 percent of
all waste generated by healthcare activities is considered
infectious, toxic or radioactive waste--collectively referred
to as regulated medical waste.\1\ Proper containment and
removal of regulated medical waste prevents contamination and
the spread of infectious conditions. The management and
disposal of regulated medical waste is required at virtually
every clinical site operated by the Veterans Health
Administration (VHA)--with approximately 80 percent of VHA
facilities outsourcing to contractors who specialize in off-
site disposal.
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\1\http://www.who.int/news-room/fact-sheets/detail/health-care-
waste
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While off-site disposal is a relatively safe and effective
method, on-site disposal often provides a cheaper, safer, and
more environmentally-friendly means of disposal. The on-site
disposal of regulated medical waste is also beneficial in
emergency and contingency scenarios, where off-site disposal
services may be interrupted.
According to the bill sponsor, the World Health
Organization and the Centers for Disease Control and Prevention
(CDC) both consider on-site waste management to be a medical
best practice as well as a cost-effective alternate to off-site
waste management. VA has also acknowledged the cost, readiness,
and environmental benefits of on-site disposal of regulated
medical waste, and has issued a blanket purchase agreement for
on-site regulated medical waste treatment equipment; however,
only 20 percent of VHA facilities have installed on-site
sterilization equipment.\2\
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\2\https://www.voa.va.gov/DocumentView.aspx?DocumentID=3944
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H.R. 5974, as amended, would direct VA to establish a
standardized cost analysis model by which each VA medical
facility can be evaluated to determine if the use of on-site
sterilization and disposal equipment would be beneficial and to
identify those facilities which would benefit over a 5-year
baseline. The Committee believes that H.R. 5974, as amended,
would both improve VA's emergency preparedness and improve the
stewardship of taxpayer resources.
HEARINGS
On June 13, 2018, the Subcommittee on Health conducted a
legislative hearing on a number of bills including H.R. 5974,
as amended.
The following witnesses testified:
The Honorable Vicky Hartzler, U.S. House of
Representatives, 4th District, Missouri; The Honorable
Marcy Kaptur, U.S. House of Representatives, 9th
District, Ohio; The Honorable Matt Cartwright, U.S.
House of Representatives, 17th District, Pennsylvania;
The Honorable Clay Higgins, U.S. House of
Representatives, 3rd District, Louisiana; The Honorable
Mike Bost, U.S. House of Representatives, 12th
District, Illinois; The Honorable Jeff Denham, U.S.
House of Representatives, 10th District, California;
The Honorable Jenniffer Gonzalez-Colon, U.S. House of
Representatives, Puerto Rico; The Honorable Brad
Wenstrup, U.S. House of Representatives, 2nd District,
Ohio; Roscoe Butler, Deputy Director for Health Care,
The American Legion; Jeremy Villanueva, Associate
National Legislative Director, Disabled American
Veterans; Kayda Keleher, Associate Director, Veterans
of Foreign Wars of the United States; Jessica Bonjorni,
Acting Assistant Deputy Under Secretary for Health for
Workforce Services, U.S. Department of Veterans
Affairs, who was accompanied by Dayna Cooper, MSN, RN,
Director of Home and Community-Based Programs, Veterans
Health Administration, U.S. Department of Veterans
Affairs.
Statements for the record were submitted by:
American Orthotic and Prosthetic Association,
Paralyzed Veterans of America, and Military Officers
Association of America.
SUBCOMMITTEE CONSIDERATION
On June 27, 2018, the Subcommittee on Health met in open
markup session, a quorum being present and favorably forwarded
H.R. 5974, as amended, to the Full Committee. During
consideration of the bills, the following amendment was
considered and agreed to by voice vote:
An amendment offered by Representative Radewagen of
American Samoa, which would include a technical
correction to appropriately identify the nature of the
current blanket purchase agreement, and to include any
successor agreements.
COMMITTEE CONSIDERATION
On July 12, 2018, the full Committee met in open markup
session, a quorum being present, and ordered H.R. 5974, as
amended, to be reported favorably to the House of
Representatives by voice vote. No amendments were offered to
H.R. 5974, as amended.
COMMITTEE VOTES
In compliance with clause 3(b) of rule XIII of the Rules of
the House of Representatives, there were no recorded votes
taken on amendments or in connection with ordering H.R. 5974,
as amended, reported to the House. A motion by Representative
Walz of Minnesota to report H.R. 5974, as amended, favorably to
the House of Representatives was adopted by voice vote.
COMMITTEE OVERSIGHT FINDINGS
In compliance with clause 3(c)(1) of rule XIII and clause
(2)(b)(1) of rule X of the Rules of the House of
Representatives, the Committee's oversight findings and
recommendations are reflected in the descriptive portions of
this report.
STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES
In accordance with clause 3(c)(4) of rule XIII of the Rules
of the House of Representatives, the Committee's performance
goals and objectives are to improve VA's emergency preparedness
and stewardship of taxpayer resources.
NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX EXPENDITURES
In compliance with clause 3(c)(2) of rule XIII of the Rules
of the House of Representatives, the Committee adopts as its
own the estimate of new budget authority, entitlement
authority, or tax expenditures or revenues contained in the
cost estimate prepared by the Director of the Congressional
Budget Office pursuant to section 402 of the Congressional
Budget Act of 1974.
EARMARKS AND TAX AND TARIFF BENEFITS
H.R. 5974, as amended, does not contain any Congressional
earmarks, limited tax benefits, or limited tariff benefits as
defined in clause 9 of rule XXI of the Rules of the House of
Representatives.
COMMITTEE COST ESTIMATE
The Committee adopts as its own the cost estimate on H.R.
5974, as amended, prepared by the Director of the Congressional
Budget Office pursuant to section 402 of the Congressional
Budget Act of 1974.
CONGRESSIONAL BUDGET OFFICE COST ESTIMATE
Pursuant to clause 3(c)(3) of rule XIII of the Rules of the
House of Representatives, the following is the cost estimate
for H.R. 5974, as amended, provided by the Director of the
Congressional Budget Office pursuant to section 402 of the
Congressional Budget Act of 1974:
U.S. Congress,
Congressional Budget Office,
Washington, DC, July 19, 2018.
Hon. Phil Roe, M.D.,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 5974, the
Department of Veterans Affairs Creation of On-Site Treatment
Systems Affording Veterans Improvements and Numerous General
Safety Enhancements Act.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Ann E.
Futrell.
Sincerely,
Mark P. Hadley
(For Keith Hall, Director).
Enclosure.
H.R. 5974--Department of Veterans Affairs Creation of On-Site Treatment
Systems Affording Veterans Improvements and Numerous General
Safety Enhancements Act
H.R. 5974 would require the Department of Veterans Affairs
(VA) to identify medical facilities that could reduce costs by
using on-site equipment to dispose of medical waste and to
purchase such equipment for those facilities. Currently, VA
disposes of regulated medical waste (RMW) by the following
methods: contracts with off-site facilities, sharing agreements
with other federal agencies, and various forms of on-site
activities. In 2017, VA spent roughly $10 million to dispose of
RMW.
Under this bill, VA would be required to develop a cost
analysis model which would compare the costs of contracting
with nondepartment entities to treat medical waste at off-site
locations to the costs of treating medical waste at VA medical
facilities. The bill specifies that the model must amortize
capital costs over a 10-year period. For facilities where that
analysis showed savings over a 5-year period, VA would be
required to purchase, install, and operate on-site equipment to
dispose of medical waste.
Although the model would spread the initial costs of
procuring and installing a disposal system over ten years,
those capital costs would need to be obligated when the
purchase agreement is finalized. Thus, CBO expects that most
cases in which the model indicates a five-year savings would,
in fact, result in costs over the first five years. However,
because the costs of disposing of RMW vary based on state and
local laws and regulations, CBO cannot project the outcome of
VA's analysis. Thus, CBO is unable to estimate the magnitude of
the cost of implementing H.R. 5974 at this time.
Enacting H.R. 5974 would not affect direct spending or
revenues; therefore, pay-as-you-go procedures do not apply.
CBO estimates that enacting H.R. 5974 would not increase
net direct spending or on-budget deficits in any of the four
consecutive 10-year periods beginning in 2029.
H.R. 5974 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act.
The CBO staff contact for this estimate is Ann E. Futrell.
The estimate was reviewed by Leo Lex, Deputy Assistant Director
for Budget Analysis.
FEDERAL MANDATES STATEMENT
The Committee adopts as its own the estimate of Federal
mandates regarding H.R. 5974, as amended, prepared by the
Director of the Congressional Budget Office pursuant to section
423 of the Unfunded Mandates Reform Act.
ADVISORY COMMITTEE STATEMENT
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act would be created by H.R.
5974, as amended.
STATEMENT OF CONSTITUTIONAL AUTHORITY
Pursuant to Article I, section 8 of the United States
Constitution, H.R. ___, as amended, is authorized by Congress'
power to ``provide for the common Defense and general Welfare
of the United States.''
APPLICABILITY TO LEGISLATIVE BRANCH
The Committee finds that H.R. 5974, as amended, does not
relate to the terms and conditions of employment or access to
public services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act.
STATEMENT ON DUPLICATION OF FEDERAL PROGRAMS
Pursuant to clause 3(c)(5) of rule XIII of the Rules of the
House of Representatives, the Committee finds that no provision
of H.R. 5974, as amended, establishes or reauthorizes a program
of the Federal Government known to be duplicative of another
Federal program, a program that was included in any report from
the Government Accountability Office to Congress pursuant to
section 21 of Public Law 111-139, or a program related to a
program identified in the most recent Catalog of Federal
Domestic Assistance.
DISCLOSURE OF DIRECTED RULEMAKING
Pursuant to section 3(i) of H. Res. 5, 115th Cong. (2017),
the Committee estimates that H.R. 5974, as amended, contains no
directed rulemaking that would require the Secretary to
prescribe regulations.
SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION
Section 1. Short title
Section 1 of the bill would establish the short title of
the bill as the ``Department of Veterans Affairs Creation of
On-Site Treatment Systems Affording Veterans Improvements and
Numerous General Safety Enhancements (VA COST SAVINGS) Act.''
Section 2. Use of on-site regulated medical waste treatment systems at
Department of Veterans Affairs facilities
Section 2 of the bill would require the Department of
Veterans Affairs to establish a cost analysis model to evaluate
whether a facility would benefit from purchasing on-site waste
disposal equipment or if an off-site waste disposal contract is
more appropriate. Further, this section would require VA to
purchase and install on-site waste disposal equipment at those
facilities identified to benefit from it.
CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED
If enacted, this bill would make no changes in existing
law.
[all]