S. 2309, Veteran Burial Timeliness and Death Certificate Accountability Act

Bill Summary

S. 2309 would require a medical professional at the Department of Veterans Affairs (VA) to certify, within two business days, the death of certain veterans who receive care from the department. The bill also would require VA to report to the Congress annually about compliance with that requirement.

Estimated Federal Cost

The estimated budgetary effects of S. 2309 are shown in Table 1. The costs of the legislation fall within budget function 700 (veterans’ benefits and services).

Basis of Estimate

For this estimate, CBO assumes that the bill will be enacted in fiscal year 2026, that the estimated amounts will be appropriated each year, and that outlays will follow historical spending patterns for affected programs.

Background

The standard U.S. death certificate consists of a demographic section, which is usually completed by a funeral director, and a medical certification of death. The death certification is usually completed by the decedent’s physician when the cause of death is natural and by a medical examiner or coroner when the cause of death is not natural, such as suicide or homicide, or when the decedent did not recently receive medical treatment. Death certificates are required for a variety of legal and financial matters, including to obtain survivor benefits and life insurance payments.

Spending Subject to Appropriation

CBO estimates that implementing S. 2309 would cost $20 million over the 2026-2031 period. Such spending would be subject to the availability of appropriated funds.

Death Certifications. S. 2309 would require the VA medical professional who is the primary care provider of a veteran who dies of natural causes to certify the death of that veteran within two business days after learning of their death. The department’s current standard for signing a death certificate is within two business days of notification. However, CBO anticipates that setting a statutory standard would require VA to assign an alternative medical professional to certify a veteran’s death when their primary care provider is unavailable. CBO estimates that under S. 2309, VA would undertake additional work to timely certify the deaths of about 5,000 veterans per year.

According to VA, the department provides medical care to approximately 7.5 million veterans annually. On the basis of demographic data about those veterans, CBO estimates that about 200,000 veterans who receive health care from VA will die each year. For many of those veterans, a non-VA medical professional is responsible for certifying their death, such as when a veteran’s death is not of natural causes or occurs after a lengthy period without receiving medical treatment. Additionally, when a veteran dies in a non-VA medical facility, the treating medical professional or medical director of that facility is responsible for the certification. Research shows that most Americans—about two-thirds—die in a hospital or long-term care facility. For veterans, those facilities may be operated by VA or by another entity. Considering those factors, CBO estimates that VA will be responsible for certifying the deaths of about 100,000 health care recipients each year; about half (50,000) of those deaths occur in VA facilities, and the other half (50,000) occur elsewhere, such as at home.

For the veterans who die in VA facilities, the bill should impose no additional work on the department because a treating medical professional is always present and can often complete death certifications within a few minutes. For the 50,000 veterans who die outside of VA facilities, their primary care provider may be unavailable to complete the certification within the two business days following their death. Accounting for federal holidays and the leave available to federal employees, CBO estimates that primary care providers are unavailable about 10 percent of the time. Therefore, under S. 2309, VA would need to assign an alternative medical professional to certify about 5,000 veterans’ deaths annually.

When a veteran dies somewhere other than a medical facility, the medical professional who certifies their death often needs an hour or more to become familiar with the case, gather information from third parties, and complete the certification. CBO expects that a surrogate or supervising clinician would need an additional hour to complete those steps. Thus, CBO expects that each year medical professionals would spend about 5,000 additional hours completing death certifications when primary care providers are unavailable. On the basis of hourly salary and benefit costs, CBO estimates that implementing the requirement to certify veterans’ deaths within two business days would cost $1 million per year and total $5 million over the 2026-2031 period.

Reports. S. 2309 would require VA to report to the Congress within a year of enactment and annually thereafter for five years on VA’s compliance with the requirement to certify deaths within two business days and on the common causes for not satisfying that requirement.

To collect the data necessary to complete the reports, VA would need to enhance its existing information technology. On the basis of information about similar enhancements, CBO estimates that VA would spend $5 million each year in 2027 and in 2028 for development and $250,000 each year thereafter for maintenance.

CBO expects that medical professionals would spend one minute on data entry for each of the 100,000 death certifications for which VA is annually responsible. On the basis of hourly salary and benefit costs, CBO estimates that data entry would cost about $300,000 per year.

Using information about the cost of similar reporting requirements, CBO estimates that compiling the annual report would cost about $250,000 in each of the six years a report is required.

In total, CBO estimates that satisfying the reporting requirement would cost $15 million over the 2026-2031 period.

Uncertainty

Several factors of CBO’s estimate for S. 2309 are subject to uncertainty. If the number of deaths that VA is required to certify or the number that requires an alternative medical professional differs from CBO’s projections, costs could be greater or less than the amounts estimated.

Additionally, if collecting data to report on compliance with the bill requires more work than CBO anticipates, the cost of the technology enhancements could be greater than the amounts estimated.

Pay-As-You-Go Considerations

Enacting the bill would not affect direct spending or revenues; therefore, pay-as-you-go procedures do not apply.

Increase in Long-Term Net Direct Spending and Deficits

CBO estimates that enacting S. 2309 would not increase net direct spending or on-budget deficits in any of the four consecutive 10-year periods beginning in 2037.

Mandates

The bill contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act.

Estimate Prepared By

Federal Costs: David Rafferty

Mandates: Brandon Lever

Estimate Reviewed By

David Newman
Chief, Defense, International Affairs, and Veterans’ Affairs Cost Estimates Unit

Kathleen FitzGerald
Chief, Public and Private Mandates Unit

Christina Hawley Anthony
Deputy Director of Budget Analysis

Estimate Approved By