S. 2193 would increase the use o f community health care and long-term care by the Department of Veterans Affairs (VA) by broadening eligibility for such care and allowing VA to enter into agreements with health care providers in the private sector without complying with the Federal Acquisition Regulation (FAR) . The bill also would make changes to VA’s health car e programs and compensation of employees, including expanding the caregivers program, increasing pay for employees, and reimbursing medical staff for professional training. In total, CBO estimate s that implementing the bill would cost $43.3 billion over the 2018-2022 period, assuming appropriation of the necessary amounts.
In addition, S. 2193 would directly appropriate $4 billion for the Veterans Choice Program (VCP) and $1 billion to provide educational assistance for health professionals at VA. The bill also would expand VA’s authority to enter into leases for medical facilities. In total, CBO estimates that enacting the bill would increase direct spending by $5.6 billion over the 2 018-2027 period.
Pay-as-you-go procedures apply because enacting S. 2193 would affect direct spending. Enacting the bill would not affect revenues.
CBO estimates that enacting S. 2 193 would not increase net dire ct spending or on-budget deficits by more than $2.5 billion in any of the four consecutive 10-year periods beginning in 2028.
S. 2193 would impose an intergovernmental mandate as defined in the Unfunded Mandates Reform Act (UMRA) by preempting state laws that prohibit VA physicians from practicing telemedicine to treat veterans across state lines. Although it would limit the application of state regulations, the bill would impose no duty on state governments that would result in additional spending or any significant loss of revenues.
The bill contains no private-sect or mandates as defined in UMRA.