[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            (2) The heading for subchapter II is repealed.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        1720B, 1720C, 1722, 1722A, and subchapter VII are repealed.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