Veterans Health Administration: Community-Based Outpatient Clinics

Sidath Viranga Panangala
Specialist in Veterans Policy

In the early 1990s, the Veterans Health Administration (VHA)—one of the three administrations of the Department of Veterans Affairs (VA)—began developing a strategy to expand its capacity to provide outpatient primary care, especially for veterans who had to travel long distances to receive care at VA facilities. To facilitate access to primary care closer to where veterans reside, VHA began implementing a system for approving and establishing Community-Based Outpatient Clinics (CBOCs). 

A CBOC is a fixed health care site that is geographically distinct or separate from its parent VA medical facility. A CBOC can be either VA-owned and VA-staffed or contracted to Healthcare Management Organizations (HMO). Regardless of how it is administered, a CBOC must have the necessary professional medical staff, access to diagnostic testing and treatment capability, and the referral arrangements needed to ensure continuity of health care for current or eligible veteran patients. VA policies require all CBOCs to be operated in a manner that provides veterans with consistent, safe, high-quality health care. 

CBOCs are managed at the Veterans Integrated Service Network (VISN) level, and planning and development of a new CBOC is based on the VA's need, available resources, local market circumstances, and veteran preference. 

In FY2010, VA expects to have a total of 833 operational CBOCs throughout the United States and its territories to serve over 2.8 million veteran patients. In addition to primary care, CBOCs provide mental health services, management of acute and chronic medical conditions, and pharmacy benefits, among other services. It should be noted that the type of medical services available at a CBOC can vary from clinic to clinic. 

This report provides an overview of VA's rationale in establishing CBOCs, describes how they are managed and administered, discusses medical services provided at CBOCs, and summarizes what is known about the quality and cost of providing care in CBOCs compared to primary care clinics at VA Medical Centers. Lastly, it describes the process for developing a new CBOC.


Date of Report: February 22, 2010
Number of Pages: 17
Order Number: R41044
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Security Assistance Reform: “Section 1206” Background and Issues for Congress

Nina M. Serafino
Specialist in International Security Affairs

Section 1206 of the National Defense Authorization Act (NDAA) for Fiscal Year 2006 provides the Secretary of Defense with authority to train and equip foreign military and foreign maritime security forces. The Department of Defense (DOD) values this authority as an important tool to train and equip military partners. Funds may be obligated only with the concurrence of the Secretary of State. Thus far, the Department of Defense (DOD) has used Section 1206 authority primarily to provide counterterrorism support. Because Section 1206 authority expires in FY2011, Congress may wish to examine the utility and suitability of this special DOD authority. In its FY2011 budget request, the Obama Administration indicates that it seeks about $490 million in Section 1206 funding for FY2011; this would require both an extension of Section 1206 authority and an increase in the current $350 million authorized level. 

As of October 13, 2009, Section 1206 allocations total a little under $1 billion for FY2006 through FY2009. Section 1206 allocations totaled some $100 million for FY2006, $274 million for FY2007, $272 million for FY2008, and $340 million for FY2009. (The amounts allocated are somewhat less than the amounts notified to Congress, which totaled over $1 billion for FY2006- FY2009.) For FY2010, Congress provided $345 million in the Department of Defense Appropriations Act, 2010, P.L. 111-118. (The amount is not specified in the act, but is included under the total appropriated to the Defense Security Cooperation Agency.) The FY2010 National Defense Authorization Act (NDAA) put in place a temporary limit of $75 million on the use of Section 1206 funds for each FY2010 and FY2011 to train military troops that would deploy to military or stability operations in which U.S. armed forces participate. The President signed the FY2010 NDAA into law on October 28, 2009 (P.L. 111-84). 

Through the use of FY2006 through FY2009 funds, Section 1206 has supported bilateral programs in 24 countries, 13 multilateral programs, and a global human rights program. Just over 40% of the FY2006-FY2009 Section 1206 funding has been obligated for three countries: Pakistan, Lebanon, and Yemen. Pakistan has been by far the largest recipient, receiving $203.4 million or over 20% of total. About 20% has been allocated to bilateral programs in four countries: Bahrain, Indonesia, the Philippines, and Malaysia. Most of the Section 1206 funding to the latter three focuses on controlling the Celebes Sea that sits among them, as well as adjoining waters. Smaller allocations (i.e., those ranging from $1 million to $32 million) comprise close to 40% of the total. 

Some Members are concerned with several issues related to Section 1206 authority, both narrow and broad. Specific current concerns include whether Section 1206 funds are being used appropriately and effectively, and whether the authority should be expanded to provide training not only military forces but also to a wide range of foreign security forces. (Currently, Section 1206 limits security force training to maritime security forces.) An overarching issue is whether Congress should place Section 1206 train and equip (T&E) authority under the State Department with other T&E authorities. (Members have thus far refrained from codifying Section 1206 in permanent law, as requested by DOD.) A related issue is whether Congress should grant the State Department its own security assistance contingency fund with purposes that overlap Section 1206, as provided in the House-passed FY2010-FY2011 Foreign Relations Authorization Act (H.R. 2410, Section 841). Finally, as the Obama Administration conducts an overall assessment of foreign assistance, including security assistance, some Members may wish to examine the status of Section 1206 in the context of broader security assistance reform.


Date of Report: February 18, 2010
Number of Pages: 37
Order Number: RS22855
Price: $29.95

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Peacekeeping/Stabilization and Conflict Transitions: Background and Congressional Action on the Civilian Response/Reserve Corps and other Civilian Stabilization and Reconstruction Capabilities

Nina M. Serafino
Specialist in International Security Affairs

The second session of the 111th Congress faces a number of issues regarding the development of civilian capabilities to carry out stabilization and reconstruction activities. In September 2008, Congress passed the Reconstruction and Stabilization Civilian Management Act, 2008, as Title XVI of the Duncan Hunter National Defense Authorization Act for Fiscal Year 2009 (S. 3001, P.L. 110-417, signed into law October 14, 2008). This legislation codified the existence and functions of the State Department Office of the Coordinator for Reconstruction and Stabilization (S/CRS) and authorized new operational capabilities within the State Department, a Civilian Response Corps (CRC) of government employees with an active and a standby component, and a reserve component. Although the establishment of active and standby units began under the Bush Administration, Congress has yet to fund the reserve component. The first session of the 111th Congress created a new fund to support Corps deployments, but the second session faces questions about the appropriate funding level for it. 

S/CRS was established in 2004 to address longstanding concerns, both within Congress and the broader foreign policy community, over the perceived lack of the appropriate capabilities and processes to deal with transitions from conflict to stability. These capabilities and procedures include adequate planning mechanisms for stabilization and reconstruction operations, efficient interagency coordination structures and procedures in carrying out such tasks, and appropriate civilian personnel for many of the non-military tasks required. Effectively distributing resources among the various executive branch actors, maintaining clear lines of authority and jurisdiction, and balancing short- and long-term objectives are major challenges for designing, planning, and conducting post-conflict operations, as is fielding the appropriate civilian personnel. 

Since July 2004, S/CRS has worked to establish the basic concepts, mechanisms, and capabilities necessary to carry out such operations. Working with a staff that has slowly grown from a few dozen to 175 individuals, S/CRS has taken steps to monitor and plan for potential conflicts, to develop a rapid-response crisis management "surge" capability, to improve interagency and international coordination, to develop interagency training exercises, and to help State Department regional bureaus develop concepts and proposals for preventive action. In 2008, Congress first provided funding to establish civilian response capabilities. Bush Administration plans at that point contemplated a CRC force of 4,250, including a sizable reserve component of private citizens similar in concept to the U.S. military reserve. 

In 2009, the Obama Administration requested $323.3 million in FY2010 funds for the Civilian Stabilization Initiative (CSI) to continue developing and to deploy a CRC active component and a CRC standby component, and to establish a 2,000-member civilian reserve component. The Administration also requested a $40 million Stabilization Bridge Fund under the Economic Support Fund (ESF) to support the activities of deployed CRC members and $76 million to establish a response fund under the USAID Transition Initiatives account. Through the FY2010 Consolidated Appropriations Act (P.L. 111-117), Congress provided $150 million for CRC development and support ($120 million for the State Department and $30 million for USAID) to support the recruitment, hiring, and training of the first two response corps components, the Active and Stand-by units of federal government employees. In addition, Congress established a new USAID Complex Crises Fund (CCF) to support programs and activities to respond to emerging or unforeseen complex crises abroad. 

For FY2011, the Obama Administration requests $184 million for the CSI and $100 million for the CCF, stating that the latter replaces funding provided under Department of Defense "Section 1207" authority in the past.


Date of Report: February 17, 2010
Number of Pages: 30
Order Number: RL32862
Price: $29.95

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Navy Littoral Combat Ship (LCS) Program: Background, Issues, and Options for Congress

Ronald O'Rourke
Specialist in Naval Affairs

The Littoral Combat Ship (LCS) is a relatively inexpensive Navy surface combatant equipped with modular "plug-and-fight" mission packages. The basic version of the LCS, without any mission packages, is referred to as the LCS sea frame. 

The Navy wants to field a force of 55 LCSs. The first two (LCS-1 and LCS-2) were procured in FY2005 and FY2006 and were commissioned into service on November 8, 2008, and January 16, 2010. Another two (LCS-3 and LCS-4) were procured in FY2009 and are under construction. Two more (LCS-5 and LCS-6) were procured in FY2010. 

The Navy's FY2011-FY2015 shipbuilding plan calls for procuring 17 more LCSs in annual quantities of 2, 3, 4, 4, and 4. The Navy's proposed FY2011 budget requests $1,231.0 million in procurement funding for the two LCSs that the Navy wants to procure in FY2011, and $278.4 million in FY2011 advance procurement funding for the 11 LCSs that the Navy wants to procure in FY2012-FY2014. The Navy's proposed FY2011 budget also requests procurement funding to procure LCS mission packages, and research and development funding for the LCS program. 

There are currently two very different LCS designs—one developed and produced by an industry team led by Lockheed, and another developed and produced by an industry team led by General Dynamics. LCS-1 and LCS-3 use the Lockheed design; LCS-2 and LCS-4 use the General Dynamics design. 

On September 16, 2009, the Navy announced a proposed new LCS acquisition strategy. Under the strategy, the Navy would hold a competition to pick a single design to which all LCSs procured in FY2010 and subsequent years would be built. (The process of selecting the single design for all future production is called a down select.) The winner of the down select would be awarded a contract to build 10 LCSs over the five-year period FY2010-FY2014, at a rate of two ships per year. The Navy would then hold a second competition—open to all bidders other than the shipyard building the 10 LCSs in FY2010-FY2014—to select a second shipyard to build up to five additional LCSs to the same design in FY2012-FY2014 (one ship in FY2012, and two ships per year in FY2013-FY2014). These two shipyards would then compete for contracts to build LCSs procured in FY2015 and subsequent years. 

Section 121(a) and (b) of the FY2010 defense authorization act (H.R. 2647/P.L. 111-84 of October 28, 2009) grant the Navy contracting and other authority needed to implement this new LCS acquisition strategy. The Navy reportedly plans to make the down select decision and award the contract to build the 10 LCSs in the second or third quarter of FY2010. 

The issue for Congress for FY2011 is whether to approve, reject, or modify the Navy's request for FY2011 procurement and advance procurement funding for the LCS program, and whether to provide any additional direction to the Navy regarding LCS acquisition strategy. .


Date of Report: February 18, 2010
Number of Pages: 23
Order Number: RL33741
Price: $29.95

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Chemical Facility Security: Reauthorization, Policy Issues, and Options for Congress

Dana A. Shea
Specialist in Science and Technology Policy

The Department of Homeland Security (DHS) has statutory authority to regulate chemical facilities for security purposes. This authority expires in October 2010. The 111th Congress is taking action to reauthorize this program, but the scope and details of its reauthorization remains an issue of congressional debate. Some Members of Congress support an extension, either shortor long-term, of the existing authority. Other Members call for revision and more extensive codification of chemical facility security regulatory provisions. The tension between continuing and changing the statutory authority is exacerbated by questions regarding its effectiveness in reducing chemical facility risk and the sufficiency of federal funding for chemical facility security. 

Key policy issues debated in previous Congresses have been considered during the reauthorization debate. These issues include the facilities that should be considered as chemical facilities; the appropriateness and scope of federal preemption of state chemical facility security activities; the availability of information for public comment, potential litigation, and congressional oversight; and the role of inherently safer technologies. 

Congress is faced with a variety of options. Congress might allow the statutory authority to expire. Congress might permanently or temporarily extend the expiring statutory authority in order to observe the impact of the current regulations and, if necessary, address any perceived weaknesses at a later date. Congress might codify the existing regulation in statute and reduce the discretion available to the Secretary of Homeland Security to change the current regulatory framework. Alternatively, Congress might change the current regulation's implementation, scope, or impact by amending the existing statute or creating a new one. 

The Department of Homeland Security Appropriations Act, 2010 (P.L. 111-83) extends the existing statutory authority through October 4, 2010, and provides DHS with additional chemical facility security funding relative to FY2009. The House of Representatives has passed H.R. 2868, which addresses chemical facility, water treatment facility, and wastewater treatment facility security. This legislation includes the provisions of H.R. 3258, as reported by the House Committee on Energy and Commerce. H.R. 2868 has been referred to the Senate Committee on Homeland Security and Governmental Affairs. 

Members have introduced other bills in the 111th Congress to address security at chemical facilities and other facilities that possess chemicals. S. 2996 would extended the existing authority until October 4, 2015, and establish chemical security training and exercise programs. H.R. 2477 would extend the existing statutory authority until October 1, 2012. H.R. 261 would alter the existing authority but has not been reported. H.R. 2883 would authorize EPA to establish certain risk-based security requirements for wastewater facilities.


Date of Report: February 16, 2010
Number of Pages: 23
Order Number: R40695
Price: $29.95

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