H.R. 4063 would require the Department of Veterans Affairs (VA) to update safety measures for opioid therapy, expand the use of alternative medicine, and conduct audits of the VA health care system through a nongovernment entity. In total, CBO estimates that implementing the bill would cost $138 million over the 2017-2021 period, subject to appropriation of the necessary amounts.
Pay-as-you-go procedures do not apply because enacting the legislation would not affect direct spending or revenues. CBO estimates that enacting H.R. 4063 would not increase net direct spending or on-budget deficits in any of the four consecutive 10-year periods beginning in 2027.
H.R. 4063 would impose an intergovernmental mandate by requiring state medical boards to report to the VA information about medical violations in the past 20 years committed by licensed physicians whom the VA is considering for employment. Information from state medical boards indicates that many boards already provide information that is similar to what the bill requires. Consequently, CBO estimates that the incremental costs of the mandate would be small and would fall below the annual threshold established in the Unfunded Mandates Reform Act (UMRA) for intergovernmental mandates ($77 million, adjusted annually for inflation).