[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1463 Introduced in House (IH)]
103d CONGRESS
1st Session
H. R. 1463
To amend title 38, United States Code, to implement recommendations
made by the Commission on the Future Structure of Veterans Health Care.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 24, 1993
Mr. Montgomery (by request) introduced the following bill; which was
referred to the Committee on Veterans' Affairs
_______________________________________________________________________
A BILL
To amend title 38, United States Code, to implement recommendations
made by the Commission on the Future Structure of Veterans Health Care.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Veterans Health-Care Reform Act of
1993''.
SEC. 2. RESTRUCTURING OF VETERANS HEALTH CARE.
Chapter 17 of title 38, United States Code, is amended as follows:
(1) The heading for subchapter I is amended to read as
follows:
``SUBCHAPTER I--HEALTH CARE AND HEALTH-CARE RELATED BENEFITS'';
(2) The heading for subchapter II is repealed.
(3) Subchapters III, IV, V, and VI, are redesignated as
subchapters II, III, IV, and V, respectively.
(4) The heading of subchapter II, as so redesignated, is
amended to read as follows:
``SUBCHAPTER II--MISCELLANEOUS PROVISIONS RELATING TO HEALTH CARE AND
HEALTH-CARE RELATED BENEFITS''.
(5) Sections 1701, 1703, 1710, 1712, 1717, 1719, 1720,
1720B, 1720C, 1722, 1722A, and subchapter VII are repealed.
(6)(A) Section 1702 is transferred to subchapter II, as so
redesignated, inserted after section 1721, and redesignated as
section 1722.
(B) Sections 1711, 1712A, and 1712B are redesignated as
sections 1704, 1705, and 1706, respectively.
(C) Section 1720A is transferred to appear after section
1706, as so redesignated, and is redesignated as section 1707.
(D) Section 1720D is transferred to appear after 1707, as
so transferred and redesignated, and is redesignated as section
1708.
(E) Sections 1713, 1714, 1715, 1716, and 1718 are
redesignated as sections 1709, 1710, 1711, 1712, and 1713,
respectively.
(7) Subchapter I is further amended by inserting after the
subchapter heading (as amended by paragraph (1)) the following
new sections:
``Sec. 1701. Eligibility for health-care benefits
``(a) The Secretary shall provide such care as the Secretary
determines is needed for any disability of a veteran who meets any of
the following conditions:
``(1) The veteran has a service-connected disability.
``(2) The annual attributable income of the veteran does
not exceed the amount established under subsection (b).
``(3) The discharge or release of the veteran from the
active military, naval, or air service was for a disability
incurred or aggravated in line of duty.
``(4) The veteran is in receipt of, or but for a suspension
pursuant to section 1151 of this title (or both such suspension
and the receipt of retired pay), would be entitled to
disability compensation, but only to the extent that such
veteran's continuing eligibility for such care is provided for
in the judgment or settlement described in such section.
``(b)(1) For purposes of subsection (a)(2), attributable income for
the calendar year beginning on January 1, 1993, is--
``(A) $19,408, in the case of a veteran with no dependents;
and
``(B) $23,290, in the case of a veteran with one dependent,
plus $1,296 for each additional dependent.
``(2) Effective on January 1 of each calendar year after 1993, the
amounts in effect under paragraph (1) shall be increased by the
percentage by which the maximum rates of pension were increased under
section 1512(a) of this title during the preceding calendar year.
``(c)(1) Notwithstanding the attributable income of a veteran, the
Secretary may not furnish care under subsection (a)(2) to a veteran if
the corpus of the estate of the veteran is such that, under all the
circumstances, it is reasonable that some part of the corpus of the
estate be consumed for the veteran's maintenance.
``(2) For the purposes of paragraph (1), the corpus of the estate
of a veteran shall be determined in the same manner as the manner in
which determinations are made of the corpus of the estates of persons
under section 1522 of this title.
``(3) The term `corpus of the estate of the veteran' includes the
corpus of the estates of the veteran's spouse and dependent children,
if any.
``(d)(1) The term `attributable income' means the income of a
veteran for the previous calendar year determined in the same manner as
the manner in which a determination is made of the total amount of
income by which the rate of pension of such veteran under section 1521
of this title would be reduced if such veteran were eligible for
pension under that section.
``(2) Notwithstanding paragraph (1), the current projections of a
veteran's income for the current year shall be considered the
attributable income if the projected income is substantially below the
amount determined under paragraph (1).
``(e) The Secretary, under such regulations as the Secretary shall
prescribe, may provide such care and such health-related benefits under
section 1702 of this title, as the Secretary determines are needed for
any disability of any veteran who does not meet any of the conditions
listed in subsection (a). In prescribing regulations to carry out this
subsection, the Secretary may provide for payments at rates prescribed
by the Secretary.
``(f) The term `disability' means a disease, injury, or other
physical or mental defect.
``Sec. 1702. Eligibility for health-related benefits
``(a) The Secretary shall provide any veteran eligible for care
under section 1701 of this title with the following:
``(1) Such preventive health care services as the Secretary
determines are efficacious.
``(2) Social support services, including personal care and
homemaker services, if needed to enable the veteran to reside
in the home, or another noninstitutional setting, while
receiving care under section 1701 of this title.
``(3) The opportunity to receive hospital or nursing home
care of limited duration on an intermittent basis for the
purpose of helping a veteran who is suffering from a chronic
illness to continue residing primarily at home.
``(4) Hospice care services in such cases as the Secretary
determines to be clinically appropriate.
``(5) Wheelchairs, artificial limbs, and other prosthetic
devices, and such medical and rehabilitative devices,
equipment, and supplies as the Secretary determines to be
medically indicated.
``(6) Improvements and structural alterations to the
veteran's home if necessary to assure the continuation of care
under section 1701 of this title or to provide access to the
home or to essential lavatory and sanitary facilities.
``(b) The cost of improvements and structural alterations (or the
amount of reimbursement therefor) under subsection (a)(6) may not
exceed $4,100 in the case of veterans eligible for care under
paragraphs (1), (3), and (4) of section 1701(a) of this title, or
$1,200 in the case of veterans eligible for care under paragraph (2) of
section 1701(a) of this title.
``(c) The Secretary shall provide any person (including family
members of a veteran or others residing in the same household as the
veteran) with (1) counseling, training in the provision of care, or any
other service needed for the effective provision of care to the veteran
under section 1701 of this title, and (2) bereavement counseling in
connection with the death of a veteran who had been receiving care
under section 1701 or section 1702(a)(4) of this title at the time of
the death of such veteran.
``(d) The Secretary may contract for services authorized pursuant
to this section.
``Sec. 1703. Contracts for care
``(a) The Secretary shall contract for needed care for veterans
eligible for care under section 1701 of this title when Department
facilities are geographically inaccessible, lack sufficient capacity,
or are otherwise not capable of furnishing needed care.
``(b) No veteran may be transferred or admitted to any institution
for nursing home care under this chapter, unless such institution is
determined by the Secretary to meet such standards as the Secretary may
prescribe. The standards prescribed and any report of inspection of
institutions furnishing care to veterans under this section made by or
for the Secretary shall, to the extent possible, be made available to
all Federal, State, and local agencies charged with the responsibility
of licensing or otherwise regulating or inspecting such institutions.
``(c) In applying the provisions of section 2(b)(1) of the Service
Contract Act of 1965 (41 U.S.C. 351(b)(1)) with respect to any contract
entered into under this section to provide nursing home care of
veterans, the payment of wages not less than those specified in section
6(b) of the Fair Labor Standards Act of 1938 (29 U.S.C. 206(b)) shall
be deemed to constitute compliance with such provisions.
``(d) In arranging to provide adult day health care and other
health-related services in noninstitutional settings under section 1702
of this title, the Secretary may provide in-kind assistance (through
the services of Department employees and the sharing of other
Department resources) to a facility furnishing such services to
veterans under this chapter. Any such in-kind assistance shall be
provided under a contract between the Secretary and the facility
concerned. The Secretary may provide such assistance only for use
solely in the furnishing of adult day health care or other health-
related services and only if, under such contract, the Department
receives reimbursement for the full cost of such assistance, including
the cost of services and supplies and normal depreciation and
amortization of equipment. Such reimbursement may be made by reduction
in the charges to the United States or by payment to the United States.
Any funds received through such reimbursement shall be credited to
funds allotted to the Department facility that provided the
assistance.''.
(8) Section 1705 (as redesignated by paragraph (6)) is
amended--
(A) in subsection (b)--
(i) by striking out ``under the conditions
specified in section 1712(a)(5)(B) of this
title'' in paragraph (1) and inserting in lieu
thereof ``for a period not in excess of 12
months unless the Secretary determines that a
longer period is required by reason of the
disability being treated''; and
(ii) by striking out ``and expenses as are
described in section 1701(6)(B) of this title''
in paragraph (2) and inserting in lieu thereof
``and beneficiary travel expenses under section
111 of this title, for the members of the
immediate family or legal guardian of a
veteran, or the individual in whose household
such veteran certifies an intention to live'';
and
(B) in subsection (e)(1), by striking out
``sections 1712(a)(1)(B) and 1703(a)(2)'' and inserting
in lieu thereof ``section 1703''.
(9) Section 1707 (as transferred and redesignated by
paragraph (6)) is amended--
(A) by striking out subsections (e) and (g); and
(B) by redesignating subsection (f) as subsection
(e).
(10)(A) The heading of section 1709 (as redesignated by
paragraph (6)) is amended to read as follows:
``Sec. 1709. Use of prosthetic appliances; aids for the blind and
hearing-impaired''.
(B) Such section is amended by adding at the end the
following:
``(c) The Secretary may repair or replace any artificial limb,
truss, brace, hearing aid, spectacles, or similar appliance (not
including dental appliances) reasonably necessary to a veteran and
belonging to such veteran which was damaged or destroyed by a fall or
other accident.
``(d) The Secretary may furnish devices for assisting in overcoming
the handicap of deafness (including telecaptioning television decoders)
to any veteran who is profoundly deaf and is entitled to compensation
on account of hearing impairment.''.
(11) Section 1712 (as redesignated by paragraph (6)) is
amended by striking out subsection (e) and redesignating
subsection (f) as subsection (e).
(12) Section 1721 is amended--
(A) in the first sentence, by striking out
``hospital, nursing home, and domiciliary care and
medical services'' and inserting in lieu thereof
``care''; and
(B) in the second sentence, by striking out ``and
services''.
(13) Section 1724(d) is amended to read as follows:
``(d)(1) Subject to paragraph (2), the Secretary may contract for
nursing home care for any veteran who has been furnished hospital care
in the Philippines pursuant to this section, and who requires a
protracted period of nursing home care.
``(2) The Secretary may not furnish care under this subsection for
a period in excess of six months unless--
``(A) the care is for a service-connected disability;
``(B) the hospitalization of the veteran was for a service-
connected disability; or
``(C) the Secretary determines that a longer period of care
is warranted.
``(3) The cost of nursing home care under this subsection may not
exceed reasonable limits established by the Secretary. The Secretary
shall establish standards for nursing homes with which the Department
contracts.''.
SEC. 3. BENEFICIARY TRAVEL.
Section 111 of title 38, United States Code, is amended--
(1) by striking out subsections (b) and (c);
(2) by redesignating subsections (d), (e), (f), (g), and
(h) as subsections (b), (c), (d), (e), and (f), respectively;
and
(3) in paragraph (2) of subsection (e), as so redesignated,
by striking out subparagraph (A) and redesignating
subparagraphs (B) and (C) as subparagraphs (A) and (B),
respectively.
SEC. 4. RECOVERY OF COST OF PROVIDING CARE.
Section 1729 of title 38, United States Code, is amended as
follows:
(1) The heading of such section is amended by striking out
``by the United States''.
(2) Subsections (a) and (b) are amended by striking out
``United States'' each place it appears and inserting in lieu
thereof ``Secretary''.
(3) Subsection (a)(1) is amended--
(A) by striking out ``Subject'' and inserting in
lieu thereof ``Notwithstanding any other provision of
this title or any other law but subject'';
(B) by inserting ``such care or services, or
receive'' before ``payment''; and
(C) by striking out ``a department or agency of the
United States'' and inserting in lieu thereof ``the
Secretary''.
(4) Subsection (a)(2) is amended--
(A) by inserting ``or'' at the end of subparagraph
(A);
(B) by striking out ``, or'' at the end of
subparagraph (D)(ii) and inserting in lieu thereof a
period; and
(C) by striking out subparagraph (E).
(5) Subsection (b)(2) is amended--
(A) in subparagraph (A), by inserting ``other than
a Federal agency'' before the period; and
(B) in subparagraph (B), by striking out
``against'' and inserting in lieu thereof ``against a
non-Federal''.
(6)(A) Subsection (g)(3) is amended--
(i) by redesignating subparagraphs (A) and (B) as
subparagraphs (B) and (C), respectively; and
(ii) by inserting before subparagraph (B), as so
redesignated, the following new subparagraph:
``(A) Reimbursement for the cost of care or services
furnished under this chapter.''; and
(B) by striking out paragraph (4).
(7) Subsection (i)(1) is amended--
(A) in subparagraph (A), by striking out ``or
similar arrangement,'' and inserting in lieu thereof
``similar arrangement, or eligibility under a Federal
program or the Federal portion of a program of any
State or political subdivision of any State''; and
(B) in subparagraph (B), by striking out clauses
(i) and (ii) and redesignating clauses (iii) and (iv)
as clauses (i) and (ii), respectively.
(8) Subsection (i)(3) is amended--
(A) by redesignating subparagraphs (A), (B), (C),
and (D), as subparagraphs (B), (C), (D), and (E),
respectively; and
(B) by inserting before subparagraph (B), as so
redesignated, the following new subparagraph:
``(A) an agency or instrumentality of the United
States;''.
SEC. 5. STATE HOMES.
(a) Criteria for Payment.--(1) Subsection (c) of section 1741 of
title 38, United States Code, is amended by striking out ``sections
1710 and 1720'' and inserting in lieu thereof ``section 1701''.
(2) Subsection (d) of such section is amended to read as follows:
``(d) The Secretary shall periodically determine the cost of care
furnished in a general hospital under the direct jurisdiction of the
Secretary, and if that cost has increased, the Secretary may increase
the rates paid under subsection (a) by a percentage not greater than
the percentage of the increase in the cost of the care furnished in the
general hospital.''.
(b) Standards for State Homes.--Section 1742 of such title is
amended by striking out ``, which standards'' and all that follows
through ``of this title''.
SEC. 6. CONFORMING AMENDMENT.
The table of sections at the beginning of chapter 17 of title 38,
United States Code, is amended to read as follows:
``subchapter i--health care and health-care related benefits
``Sec.
``1701. Eligibility for health-care benefits.
``1702. Eligibility for health-related benefits.
``1703. Contracts for care.
``1704. Care during examinations and in emergencies.
``1705. Eligibility for readjustment counseling and related mental
health services.
``1706. Counseling for former prisoners of war.
``1707. Treatment and rehabilitation for alcohol or drug dependence or
abuse disabilities.
``1708. Counseling to women veterans for sexual trauma.
``1709. Medical care for survivors and dependents of certain veterans.
``1710. Use of prosthetic appliances; aids for the blind and hearing-
impaired.
``1711. Tobacco for hospitalized veterans.
``1712. Hospital care by other agencies of the United States.
```subchapter ii--miscellaneous provisions relating to health care and
health-care related benefits
``1721. Power to make rules and regulations.
``1722. Presumption relating to psychosis.
``1723. Furnishing of clothing.
``1724. Hospital care, medical services, and nursing home care abroad.
``1726. Reimbursement for loss of personal effects by natural disaster.
``1727. Persons eligible under prior law.
``1728. Reimbursement of certain medical expenses.
``1729. Recovery of the cost of certain care and services.
```subchapter iii--hospital care and medical treatment for veterans in
the republic of the philippines
``1731. Assistance to the Republic of the Philippines.
``1732. Contracts and grants to provide for the care and treatment of
United States veterans by the Veterans
Memorial Medical Center.
``1733. Supervision of program by the President.
``1734. Hospital and nursing home care and medical services in the
United States.
``1735. Definiti``subchapter iv--payments to state homes
``1741. Criteria for payment.
``1742. Inspections of such homes; restrictions on beneficiaries.
``1743. Applicatio``subchapter vi--sickle cell anemia
``1751. Screening, counseling, and medical treatment.
``1752. Research.
``1753. Voluntary participation; confidentiality.
``1754. Reports.''.
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HR 1463 IH----2