[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3313 Reported in House (RH)]

                                                 Union Calendar No. 188

103d CONGRESS

  1st Session

                               H. R. 3313

                          [Report No. 103-349]

_______________________________________________________________________

                                 A BILL

To amend title 38, United States Code, to improve health care services 
 of the Department of Veterans Affairs relating to women veterans, to 
 extend and expand authority for the Secretary of Veterans Affairs to 
 provide priority health care to veterans who were exposed to ionizing 
radiation or to Agent Orange, to expand the scope of services that may 
  be provided to veterans through Vet Centers, and for other purposes.

_______________________________________________________________________

                           November 10, 1993

Reported with amendments, committed to the Committee of the Whole House 
          on the State of the Union, and ordered to be printed





                                                 Union Calendar No. 188
103d CONGRESS
  1st Session
                                H. R. 3313

                          [Report No. 103-349]

To amend title 38, United States Code, to improve health care services 
 of the Department of Veterans Affairs relating to women veterans, to 
 extend and expand authority for the Secretary of Veterans Affairs to 
 provide priority health care to veterans who were exposed to ionizing 
radiation or to Agent Orange, to expand the scope of services that may 
  be provided to veterans through Vet Centers, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            October 19, 1993

  Mr. Rowland (for himself, Mr. Montgomery, Mr. Stump, Mr. Edwards of 
Texas, Mr. Smith of New Jersey, Mr. Filner, Mr. Bilirakis, Mr. Bishop, 
 Mr. Hutchinson, Mr. Kreidler, Mr. Everett, Mr. Buyer, and Mr. Linder) 
 introduced the following bill; which was referred to the Committee on 
                           Veterans' Affairs

                           November 10, 1993

Additional sponsors: Mr. Stearns, Mr. Quinn, Mr. Spence, Mr. Ridge, Mr. 
King, Mr. Hefner, Mr. Richardson, Mr. Stenholm, Mr. Payne of Virginia, 
                      Mr. Parker, and Ms. Woolsey

                           November 10, 1993

Reported with amendments, committed to the Committee of the Whole House 
          on the State of the Union, and ordered to be printed
  [Omit the part struck through and insert the part printed in italic]

_______________________________________________________________________

                                 A BILL


 
To amend title 38, United States Code, to improve health care services 
 of the Department of Veterans Affairs relating to women veterans, to 
 extend and expand authority for the Secretary of Veterans Affairs to 
 provide priority health care to veterans who were exposed to ionizing 
radiation or to Agent Orange, to expand the scope of services that may 
  be provided to veterans through Vet Centers, and for other purposes.

    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 Improvements Act of 
1993''.

              TITLE I--WOMEN VETERANS HEALTH IMPROVEMENTS

SEC. 101. SHORT TITLE.

    This title may be cited as the ``Women Veterans Health Improvements 
Act of 1993''.

SEC. 102. HEALTH CARE SERVICES FOR WOMEN.

    (a) Ensured Provision of Services.--The Secretary of Veterans 
Affairs shall ensure that each health-care facility under the direct 
jurisdiction of the Secretary is able, through services made available 
either by individuals appointed to positions in the Veterans Health 
Administration or under contracts or other agreements made under 
section 7409, 8111, or 8153 of title 38, United States Code, or title 
II of Public Law 102-585, to provide in a timely and appropriate manner 
women's health services (as defined in section 1701(10) of title 38, 
United States Code (as added by section 3)) to any veteran described in 
section 1710(a)(1) of title 38, United States Code, who is eligible for 
such services.
    (b) Routine Health Care Services.--The Secretary shall ensure that 
each health-care facility under the direct jurisdiction of the 
Secretary that serves a catchment area in which the number of women 
veterans described in section 1710(a)(1) of title 38, United States 
Code, makes it cost effective to do so shall provide routine women's 
health services directly (rather than by contract or other agreement). 
The Secretary shall ensure that each such facility is provided 
appropriate equipment, facilities, and staff to carry out the preceding 
sentence and to ensure that the quality of care provided under the 
preceding sentence is in accordance with professional standards.
    (c) Conforming Repeal.--Section 302 of the Veterans' Health Care 
Amendments of 1983 (Public Law 98-160; 97 Stat. 1004; 38 U.S.C. 1701 
note) is repealed.

SEC. 103. WOMEN'S HEALTH SERVICES.

    (a) Women's Health Services.--Section 1701 of title 38, United 
States Code, is amended--
            (1) in paragraph (6)(A)(i), by inserting ``women's health 
        services,'' after ``preventive health services,''; and
            (2) by adding at the end the following:
    ``(10) The term `women's health services' means the following 
health care services provided to women:
            ``(A) Papanicolaou tests (pap smear).
            ``(B) Breast examinations and mammography.
            ``(C) General reproductive health care (including the 
        management of menopause), but not including infertility 
        services (other than infertility counseling), abortions, or 
        pregnancy care (including prenatal and delivery care), except 
        for such care relating to a pregnancy that is complicated or in 
        which the risks of complication are increased by a service-
        connected condition.
            ``(D) The management and prevention of sexually-transmitted 
        diseases.
            ``(E) The management and treatment of osteoporosis.
            ``(F) Counseling and treatment for physical or 
        psychological conditions arising out of acts of sexual 
        violence.-'-'-.
            ``(G) Early detection, management, and treatment for 
        cardiac disease, in the case of women who are determined to be 
        at risk of cardiac disease.''.
    (b) Repeal of Superseded Authority.--Section 106 of the Veterans 
Health Care Act of 1992 (Public Law 102-585; 38 U.S.C. 1710 note) is 
amended--
            (1) by striking out subsection (a); and
            (2) by striking out ``(b) Responsibilities of Directors of 
        Facilities.--'' before ``The Secretary''.
    (c) Extension of Annual Report Requirement.--Section 107(a) of such 
Act is amended by striking out ``Not later than January 1, 1993, 
January 1, 1994, and January 1, 1995'' and inserting in lieu thereof 
``Not later than January 1 of 1993 and each year thereafter through 
1998''.
    (d) Report on Health Care and Research.--Section 107(b) of such Act 
is amended--
            (1) in paragraph (1), by striking out ``services described 
        in section 106 of this Act'' and inserting in lieu thereof 
        ``women's health services (as such term is defined in section 
        1701(10) of title 38, United States Code)'';
            (2) in paragraph (2)(A), by inserting ``(including 
        information on the number of inpatient stays and the number of 
        outpatient visits through which such services were provided)'' 
        after ``facility''; and
            (3) by adding at the end the following new paragraph:
            ``(5) A description of the actions taken by the Secretary 
        to foster and encourage the expansion of such research.''.

SEC. 104. MAMMOGRAPHY QUALITY STANDARDS.

    (a) In General.--(1) Subchapter II of chapter 73 of title 38, 
United States Code, is amended by adding at the end the following new 
section:
``Sec. -7-3-1-8 7319. Mammography quality standards
    ``(a) A mammogram may not be performed at a Department facility 
unless that facility is accredited for that purpose by a private 
nonprofit organization designated by the Secretary. An organization 
designated by the Secretary under this subsection shall meet the 
standards for accrediting bodies established under section 354(e) of 
the Public Health Service Act (42 U.S.C. 263b(e)).
    ``(b) The Secretary, in consultation with the Secretary of Health 
and Human Services, shall prescribe quality assurance and quality 
control standards relating to the performance and interpretation of 
mammograms and use of mammogram equipment and facilities of the 
Department of Veterans Affairs consistent with the requirements of 
section 354(f)(1) of the Public Health Service Act. Such standards 
shall be no less stringent than the standards prescribed by the 
Secretary of Health and Human Services under section 354(f) of the 
Public Health Service Act and shall be prescribed during the 120-day 
period beginning on the date on which the Secretary of Health and Human 
Services prescribes quality standards under section 354(f) of the 
Public Health Service Act (42 U.S.C. 263b(f)).
    ``(c)(1) The Secretary, to ensure compliance with the standards 
prescribed under subsection (b), shall provide for an annual inspection 
of the equipment and facilities used by and in Department health care 
facilities for the performance of mammograms. Such inspections shall be 
carried out in a manner consistent with the inspection of certified 
facilities by the Secretary of Health and Human Services under section 
354(g) of the Public Health Service Act.
    ``(2) The Secretary may not provide for an inspection under 
paragraph (1) to be performed by a State agency.
    ``(d) The Secretary shall ensure that mammograms performed for the 
Department under contract with any non-Department facility or provider 
conform to the quality standards prescribed by the Secretary of Health 
and Human Services under section 354 of the Public Health Service Act.
    ``(e) For the purposes of this section, the term `mammogram' has 
the meaning given such term in section 354(a)(5) of the Public Health 
Service Act (42 U.S.C. 263b(a)).''.
    (2) The table of sections at the beginning of such chapter is 
amended by inserting after the item relating to section -7-3-1-7 7318 
the following new item:

``-7-3-1-8 7319. Mammography quality standards.''.
    (b) Transition.--(1) Subsection (a) of section -7-3-1-8 7319 of 
title 38, United States Code, as added by subsection (a), shall take 
effect on the date on which standards are prescribed by the Secretary 
of Veterans Affairs under subsection (b) of such section.
    (2) During the transition period, the Secretary may waive the 
requirement of subsection (a) of section -7-3-1-8 7319 of title 38, 
United States Code, as added by subsection (a), to any facility of the 
Department. The Secretary may provide such a waiver in the case of any 
facility only if the Secretary determines, based upon the 
recommendation of the Under Secretary for Health, that during the 
period such a waiver is in effect for such facility (including any 
extension of the waiver under paragraph (3)) the facility will be 
operated in accordance with standards prescribed by the Secretary under 
subsection (b) of such section to assure the safety and accuracy of 
mammography services provided.
    (3) The transition period for purposes of this section is the six-
month period beginning on the date specified in paragraph (1). The 
Secretary may extend such period for a period not to exceed 90 days in 
the case of any Department facility. Any such extension may be made 
only if the Under Secretary for Health determines that--
            (A) without the extension access of veterans to mammography 
        services in the geographic area served by the facility would be 
        significantly reduced; and
            (B) appropriate steps will be taken before the end of the 
        transition period (as extended) to obtain accreditation of the 
        facility as required by subsection (a) of section -7-3-1-8 7319 
        of title 38, United States Code, as added by subsection (a).
    (c) Implementation Report.--The Secretary of Veterans Affairs shall 
submit to the Committees on Veterans' Affairs of the Senate and House 
of Representatives a report on the Secretary's implementation of 
section -7-3-1-8 7319 of title 38, United States Code, as added by 
subsection (a). The report shall be submitted not later than 120 days 
after the date on which the Secretary prescribes the quality standards 
required under subsection (b) of that section.

SEC. 105. RESEARCH RELATING TO WOMEN VETERANS.

    (a) Inclusion of Women and Minorities in Clinical Research 
Projects.--(1) In conducting or supporting clinical research, the 
Secretary of Veterans Affairs shall ensure that, whenever possible and 
appropriate--
            (A) women who are veterans are included as subjects in each 
        project of such research; and
            (B) members of minority groups who are veterans are 
        included as subjects of such research.
    (2) In the case of a project of clinical research in which women or 
members of minority groups will under paragraph (1) be included as 
subjects of the research, the Secretary of Veterans Affairs shall 
ensure that the project is designed and carried out so as to provide 
for a valid analysis of whether the variables being tested in the 
research affect women or members of minority groups, as the case may 
be, differently than other persons who are subjects of the research.
    (b) Population Study.--Section 110(a) of the Veterans Health Care 
Act of 1992 (Public Law 102-585; 106 Stat. 4948) is amended by adding 
at the end of paragraph (3) the following: ``If it is feasible to do so 
within the amounts available for the conduct of the study, the 
Secretary shall ensure that the sample referred to in subsection (a) 
constitutes a representative sampling (as determined by the Secretary) 
of the ages, the ethnic, social and economic backgrounds, the enlisted 
and officer grades, and the branches of service of all veterans who are 
women.''.

SEC. 106. SEXUAL TRAUMA COUNSELING.

    (a) Extension of Period of Authority To Provide Sexual Trauma 
Counseling.--Subsection (a) of section 1720D of title 38, United States 
Code, is amended--
            (1) by striking out ``December 31, 1995,'' in paragraph (1) 
        and inserting in lieu thereof ``December 31, 1998,''; and
            (2) by striking out ``December 31, 1994,'' in paragraph (3) 
        and inserting in lieu thereof ``December 31, 1998,''.
    (b) Period of Eligibility To Seek Counseling.--(1) Such subsection 
is further amended--
            (A) by striking out paragraph (2); and
            (B) by redesignating paragraph (3) (as amended by 
        subsection (a)(2)) as paragraph (2).
    (2) Section 102(b) of the Veterans Health Care Act of 1992 (Public 
Law 102-585; 106 Stat. 4946; 38 U.S.C. 1720D note) is repealed.
    (c) Repeal of Limitation on Period of Receipt of Counseling.--
Section 1720D of title 38, United States Code, is further amended--
            (1) by striking out subsection (b); and
            (2) by redesignating subsections (c), (d), and (e) as 
        subsections (b), (c), and (d), respectively.
    (d) Increased Priority of Care.--Section 1712(i) of title 38, 
United States Code, is amended--
            (1) in paragraph (1)--
                    (A) by inserting ``(A)'' after ``To a veteran''; 
                and
                    (B) by inserting ``, or (B) who is eligible for 
                counseling under section 1720D of this title, for the 
                purposes of such counseling'' before the period at the 
                end; and
            (2) in paragraph (2)--
                    (A) by striking out ``, (B)'' and inserting in lieu 
                thereof ``or (B)''; and
                    (B) by striking out ``, or (C)'' and all that 
                follows through ``such counseling''.
    (e) Program Revision.--(1) Section 1720D of title 38, United States 
Code, is further amended--
            (A) by striking out ``woman'' in subsection (a)(1);
            (B) by striking out ``women'' in subsection (b)(2)(C) and 
        in the first sentence of subsection (c), as redesignated by 
        subsection (c); and
            (C) by striking out ``women'' in subsection (c)(2), as so 
        redesignated, and inserting in lieu thereof ``individuals''.
    (2)(A) The heading of such section is amended to read as follows:
``Sec. 1720D. Counseling for sexual trauma''.
    (B) The item relating to such section in the table of sections at 
the beginning of chapter 17 of such title is amended to read as 
follows:

``1720D. Counseling for sexual trauma.''.
    (f) Information by Telephone.--(1) Paragraph (1) of section 
1720D(c) of title 38, United States Code, as redesignated by subsection 
(c) of this section, is amended to read as follows:
            ``(1) shall include availability of a toll-free telephone 
        number (commonly referred to as an 800 number), and''.
    (2) In providing information on counseling available to veterans as 
required under section 1720D(c)(1) of title 38, United States Code (as 
amended by this section), the Secretary of Veterans Affairs shall 
ensure that the Department of Veterans Affairs personnel who provide 
assistance under such section are trained in the provision to persons 
who have experienced sexual trauma of information about the care and 
services relating to sexual trauma that are available to veterans in 
the communities in which such veterans reside, including care and 
services available under programs of the Department (including the care 
and services available under section 1720D of such title) and from non-
Department agencies or organizations.
    (3) Not later than 18 months after the date of the enactment of 
this Act, the Secretary shall submit to Congress a report on the 
operation of the telephone assistance service required under section 
1720D(c)(1) of title 38, United States Code (as so amended). The report 
shall set forth the following:
            (A) The number of persons who sought information during the 
        period covered by the report through a toll free telephone 
        number regarding services available to veterans relating to 
        sexual trauma, with a separate display of the number of such 
        persons arrayed by State (as such term is defined in section 
        101(20) of title 38, United States Code).
            (B) A description of the training provided to the personnel 
        who provide such assistance.
            (C) The recommendations and plans of the Secretary for the 
        improvement of the service.

SEC. 107. COORDINATORS OF WOMEN'S SERVICES.

    (a) Full-Time Status.--Section 108 of the Veterans Health Care Act 
of 1992 (Public Law 102-585; 106 Stat. 4948; 38 U.S.C. 1710 note) is 
amended--
            (1) by inserting ``(a)'' before ``The Secretary''; and
            (2) by adding at the end the following:
    ``(b) Each official who serves in the position of coordinator of 
women's services under subsection (a) shall serve in such position on a 
full-time basis.''.
    (b) Empowerment.--The Secretary of Veterans Affairs shall take 
appropriate actions to ensure that the coordinator of women's services 
at each facility of the Veterans Health Administration--
            (1) is able to carry out the responsibilities of a 
        coordinator in ensuring that women veterans receive quality 
        medical care and, to the extent practicable, have equal access 
        to Veterans Administration facilities; and
            (2) has direct access to the Director or Chief of Staff of 
        the facility to which the coordinator is assigned.

SEC. 108. PATIENT PRIVACY.

    (a) Identification of Deficiencies.--The Secretary of Veterans 
Affairs shall conduct a survey of each medical center under the 
jurisdiction of the Secretary to identify deficiencies relating to 
patient privacy afforded to women patients in the clinical areas at 
each such center which may interfere with appropriate treatment of such 
patients.
    (b) Correction of Deficiencies.--The Secretary shall ensure that 
plans and, where appropriate, interim steps, to correct the 
deficiencies identified in the survey conducted under subsection (a) 
are developed and are incorporated into the Department's construction 
planning processes and given a high priority.
    (c) Reports to Congress.--The Secretary shall compile an annual 
inventory, by medical center, of deficiencies identified under 
subsection (a) and of plans and, where appropriate, interim steps, to 
correct such deficiencies. The Secretary shall submit to the Committees 
on Veterans' Affairs of the Senate and the House of Representatives, 
not later than October 1, 1994, and not later than October 1 each year 
thereafter through 1996 a report on such deficiencies. The Secretary 
shall include in such report the inventory compiled by the Secretary, 
the proposed corrective plans, and the status of such plans.

        TITLE II--CARE FOR VETERANS EXPOSED TO TOXIC SUBSTANCES

SEC. 201. AUTHORITY TO PROVIDE HEALTH CARE.

    (a) Authorized Inpatient Care.--Section 1710(e) of title 38, United 
States Code, is amended to read as follows:
    ``(e)(1)(A) Subject to paragraph (2), a herbicide-exposed veteran 
is eligible for hospital care and nursing home care under subsection 
(a)(1)(G) for any disease specified in subparagraph (B).
    ``(B) The diseases referred to in subparagraph (A) are those for 
which the National Academy of Sciences, in a report issued in 
accordance with section 2 of the Agent Orange Act of 1991, has 
determined--
            ``(i) that there is sufficient evidence to conclude that 
        there is a positive association between occurrence of the 
        disease in humans and exposure to a herbicide agent;
            ``(ii) that there is evidence which is suggestive of an 
        association between occurrence of the disease in humans and 
        exposure to a herbicide agent, but such evidence is limited in 
        nature; or
            ``(iii) that available studies are insufficient to permit a 
        conclusion about the presence or absence of an association 
        between occurrence of the disease in humans and exposure to a 
        herbicide agent.
    ``(C) A radiation-exposed veteran is eligible for hospital care and 
nursing home care under subsection (a)(1)(G) for--
            ``(i) any disease listed in section 1112(c)(2) of this 
        title; and
            ``(ii) any other disease for which the Secretary, based on 
        the advice of the Advisory Committee on Environmental Hazards, 
        determines that there is credible evidence of a positive 
        association between occurrence of the disease in humans and 
        exposure to ionizing radiation.
    ``(2) Hospital and nursing home care may not be provided under or 
by virtue of paragraph (1)(A) after September 30, 1996.
    ``(3) For purposes of this subsection and section 1712 of this 
title--
            ``(A) the term `herbicide-exposed veteran' means a veteran 
        (i) who served on active duty in the Republic of Vietnam during 
        the Vietnam era, and (ii) who the Secretary finds may have been 
        exposed during such service to a herbicide agent;
            ``(B) the term `herbicide agent' has the meaning given that 
        term in section 1116(a)(4) of this title; and
            ``(C) the term `radiation-exposed veteran' has the meaning 
        given that term in section 1112(c)(4) of this title.''.
    (b) Authorized Outpatient Care.--Section 1712 of such title is 
amended--
            (1) in subsection (a)(1)--
                    (A) by striking out ``and'' at the end of 
                subparagraph (B);
                    (B) by striking out the period at the end of 
                subparagraph (C) and inserting in lieu thereof a 
                semicolon; and
                    (C) by adding at the end the following:
                    ``(D) during the period before October 1, 1996, to 
                any herbicide-exposed veteran for any disease listed in 
                section 1710(e)(1)(B) of this title; and
                    ``(E) to any radiation-exposed veteran for any 
                disease covered under section 1710(e)(1)(C) of this 
                title.''; and
            (2) in subsection (i)(3)--
                    (A) by striking out ``(A)''; and
                    (B) by striking out ``, or (B)'' and all that 
                follows through ``title''.

SEC. 202. SAVINGS PROVISION.

    The provisions of sections 1710(e) and 1712(a) of title 38, United 
States Code, as in effect on the day before the date of the enactment 
of this Act, shall apply with respect to hospital care, nursing home 
care, and medical services in the case of any veteran furnished care or 
services before such date of enactment on the basis of presumed 
exposure to a substance or radiation under the authority of those 
provisions.

                    TITLE III--READJUSTMENT SERVICES

SEC. 301. SCOPE OF SERVICES PROVIDED IN VET CENTERS.

    (a) Expansion of Services.--Section 1712A of title 38, United 
States Code, is amended--
            (1) in subsection (a)(1) by inserting ``and, to the extent 
        otherwise authorized by law, may furnish such additional needed 
        services as described in subsection (i)'' in the first sentence 
        after ``life''; -a-n-d
            -(-2-) -b-y -a-d-d-i-n-g -a-t -t-h-e -e-n-d -t-h-e 
        -f-o-l-l-o-w-i-n-g -n-e-w -s-u-b-s-e-c-t-i-o-n-s-:
            (2) by redesignating subsection (i) as subsection (j); and
            (3) by inserting after subsection (g) the following new 
        subsections:
    ``(h) The Secretary may, to the extent resources and facilities are 
available, furnish to any veteran who served in combat during World War 
II or the Korean conflict counseling in a center to assist such veteran 
in overcoming the effects of the veteran's combat experience.
    ``(i) In operating centers under this section, the Secretary may 
provide (1) preventive health care services, (2) medical services 
reasonably necessary in preparation for hospital admission, and (3) 
referral services to assist in obtaining specialized care. The 
Secretary shall provide such services through such health care 
personnel as the Secretary determines appropriate.''.
    (b) Report.--Not later than one year after the date of the 
enactment of this Act, the Secretary shall submit to the Committees on 
Veterans' Affairs of the Senate and House of Representatives a report 
relating to the implementation of the amendments made by subsection 
(a). The report shall include the following:
            (1) The number of veterans provided services described in 
        section 1712A(i) of title 38, United States Code, as added by 
        subsection (a).
            (2) The number of centers which provided services described 
        in that section.
            (3) An assessment of the effect providing such services has 
        had on access to and timeliness of service delivery.

SEC. 302. ADVISORY COMMITTEE ON THE READJUSTMENT OF VETERANS.

    (a) In General.--(1) Subchapter II of chapter 17 of title 38, 
United States Code, is amended by inserting after section 1712B the 
following new section:
``Sec. 1712C. Advisory Committee on Veterans Readjustment Counseling
    ``(a)(1) There is in the Department the Advisory Committee on 
Veterans Readjustment Counseling (hereinafter in this section referred 
to as the `Committee').
    ``(2) The Committee shall consist of 18 members. The members of the 
Committee shall be appointed by the Secretary and shall include 
individuals who are recognized authorities in fields pertinent to the 
social, psychological, economic, or educational readjustment of 
veterans. An officer or employee of the United States may not be 
appointed as a member of the Committee. At least 12 of the Committee 
shall be veterans of the Vietnam era or other period of war. 
Appointments of members of the Committee shall be made from among 
individuals who have experience with the provision of veterans benefits 
and services by the Department or who are otherwise familiar with 
programs of the Department.
    ``(3) The Secretary shall seek to ensure that members appointed to 
the Committee include persons from a wide variety of geographic areas 
and ethnic backgrounds, persons from veterans service organizations, 
minorities, and women.
    ``(4) The Secretary shall determine the terms of service and pay 
and allowances of the members of the Committee, except that a term of 
service may not exceed two years. The Secretary may reappoint any 
member for additional terms of service.
    ``(b)(1) The Secretary shall, on a regular basis, consult with and 
seek the advice of the Committee with respect to the provision by the 
Department of benefits and services to veterans in order to assist 
veterans in the readjustment to civilian life.
    ``(2) In providing advice to the Secretary under this subsection, 
the Committee shall--
            ``(A) assemble and review information relating to the needs 
        of veterans in readjusting to civilian life;
            ``(B) provide information relating to the nature and 
        character of psychological problems arising from military 
        service;
            ``(C) provide an on-going assessment of the effectiveness 
        of the policies, organizational structures, and services of the 
        Department in assisting veterans in readjusting to civilian 
        life; and
            ``(D) provide on-going advice on the most appropriate means 
        of responding to the readjustment needs of future veterans.
    ``(3) In carrying out its duties under paragraph (2), the Committee 
shall take into special account veterans of the Vietnam era and the 
readjustment needs of those veterans.
    ``(c)(1) Not later than March 31 of each year, the Committee shall 
submit to the Secretary a report on the programs and activities of the 
Department that relate to the readjustment of veterans to civilian 
life. Each such report shall include--
            ``(A) an assessment of the needs of veterans with respect 
        to readjustment to civilian life;
            ``(B) a review of the programs and activities of the 
        Department designed to meet such needs; and
            ``(C) such recommendations (including recommendations for 
        administrative and legislative action) as the Committee 
        considers appropriate.
    ``(2) Not later than 90 days after the receipt of each report under 
paragraph (1), the Secretary shall transmit to the Committees on 
Veterans' Affairs of the Senate and House of Representatives a copy of 
the report, together with any comments and recommendations concerning 
the report that the Secretary considers appropriate.
    ``(3) The Committee may also submit to the Secretary such other 
reports and recommendations as the Committee considers appropriate.
    ``(4) The Secretary shall submit with each annual report submitted 
to the Congress pursuant to section 529 of this title a summary of all 
reports and recommendations of the Committee submitted to the Secretary 
since the previous annual report of the Secretary submitted pursuant to 
that section.''.
    (2) The table of sections at the beginning of chapter 17 of such 
title is amended by inserting after the item relating to section 1712B 
the following:

``1712C. Advisory Committee on Veterans Readjustment Counseling.''.
    (b) Original Members.--(1) Notwithstanding subsection (a)(2) of 
section 1712C of title 38, United States Code (as added by subsection 
(a)), the members of the Advisory Committee on the Readjustment of 
Vietnam and Other War Veterans on the date of the enactment of this Act 
shall be the original members of the advisory committee established 
under that section.
    (2) The original members shall so serve until the Secretary of 
Veterans Affairs carries out appointments under such subsection (a)(2). 
The Secretary shall carry out such appointments as soon as is 
practicable. The Secretary may make such appointments from among such 
original members.

SEC. 303. PLAN FOR EXPANSION OF VIETNAM VETERAN RESOURCE CENTERS PILOT 
              PROGRAM.

    (a) Plan.--The Secretary of Veterans Affairs shall submit to the 
Committees on Veterans' Affairs of the Senate and House of 
Representatives a plan for expansion of the Vietnam Veteran Resource 
Centers program established by section 1712A(h) of title 38, United 
States Code. The plan submitted shall be a plan which the Secretary 
would implement if resources for such implementation were available.
    (b) Submission of Plan.--The plan, together with an analysis 
setting forth in detail the resources required for the implementation 
of the plan, shall be submitted under subsection (a) not later than 
four months after the date of the enactment of this Act.

              TITLE IV--SERVICES FOR MENTALLY ILL VETERANS

SEC. 401. AUTHORITY TO ESTABLISH NONPROFIT CORPORATIONS.

    (a) In General.--Chapter 17 of title 38, United States Code, is 
amended by inserting after section 1718 the following new section:
``Sec. 1718A. Nonprofit corporations
    ``(a) The Secretary may authorize the establishment at any Veterans 
Health Administration facility of a nonprofit corporation (1) to 
arrange for therapeutic work for patients of such facility or patients 
of other such Department facilities pursuant to section 1718(b) of this 
title, and (2) to provide a flexible funding mechanism to achieve the 
purposes of section 1718 of this title.
    ``(b) The Secretary shall provide for the appointment of a board of 
directors for any corporation established under this section and shall 
determine the number of directors and the composition of the board of 
directors. The board of directors shall include--
            ``(1) the director of the facility and other officials or 
        employees of the facility; and
            ``(2) members appointed from among individuals who are not 
        officers or employees of the Department of Veterans Affairs.
    ``(c) Each such corporation shall have an executive director who 
shall be appointed by the board of directors with concurrence of the 
Under Secretary for Health of the Department. The executive director of 
a corporation shall be responsible for the operations of the 
corporation and shall have such specific duties and responsibilities as 
the board may prescribe.
    ``(d) A corporation established under this section may--
            ``(1) arrange with the Department of Veterans Affairs under 
        section 1718(b)(2) of this title to provide for therapeutic 
        work for patients;
            ``(2) accept gifts and grants from, and enter into 
        contracts with, individuals and public and private entities 
        solely to carry out the purposes of this section; and
            ``(3) employ such employees as it considers necessary for 
        such purposes and fix the compensation of such employees.
    ``(e)(1) Except as provided in paragraph (2), any funds received by 
a corporation established under this section through arrangements 
authorized under subsection (d)(1) in excess of amounts reasonably 
required to carry out obligations of the corporation authorized under 
subsection (d)(3) shall be deposited in or credited to the Special 
Therapeutic and Rehabilitation Activities Fund established under 
section 1718(c) of this title.
    ``(2) The Secretary, in accordance with guidelines which the 
Secretary shall prescribe, may authorize a corporation established 
under this section to retain funds derived from arrangements authorized 
under subsection (d)(1).
    ``(3) Any funds received by a corporation established under this 
section through arrangements authorized under subsection (d)(2) may be 
transferred to the Special Therapeutics and Rehabilitation Activities 
Fund.
    ``(f) A corporation established under this section shall be 
established in accordance with the nonprofit corporation laws of the 
State in which the applicable medical facility is located and shall, to 
the extent not inconsistent with Federal law, be subject to the laws of 
such State.
    ``(g)(1)(A) The records of a corporation established under this 
section shall be available to the Secretary.
    ``(B) For the purposes of sections 4(a)(1) and 6(a)(1) of the 
Inspector General Act of 1978, the programs and operations of such a 
corporation shall be considered to be programs and operations of the 
Department with respect to which the Inspector General of the 
Department has responsibilities under such Act.
    ``(2) Such a corporation shall be considered an agency for the 
purposes of section 716 of title 31 (relating to availability of 
information and inspection of records by the Comptroller General).
    ``(3) Each such corporation shall submit to the Secretary an annual 
report providing a detailed statement of its operations, activities, 
and accomplishments during that year. The corporation shall obtain a 
report of independent auditors concerning the receipts and expenditures 
of funds by the corporation during that year and shall include that 
report in the corporation's report to the Secretary for that year.
    ``(4) Each member of the board of directors of a corporation 
established under this section, each employee of such corporation, and 
each employee of the Department who is involved in the functions of the 
corporation during any year shall--
            ``(A) be subject to Federal laws and regulations applicable 
        to Federal employees with respect to conflicts of interest in 
        the performance of official functions; and
            ``(B) submit to the Secretary an annual statement signed by 
        the director or employee certifying that the director or 
        employee is aware of, and has complied with, such laws and 
        regulations in the same manner as Federal employees are 
        required to.
    ``(h) The Secretary shall submit to the Committees on Veterans' 
Affairs of the Senate and House of Representatives an annual report on 
the number and location of corporations established and the amount of 
the contributions made to each such corporation.
    ``(i) No corporation may be established under this section after 
September 30, 1999.
    ``(j) If by the end of the four-year period beginning on the date 
of the establishment of a corporation under this section the 
corporation is not recognized as an entity the income of which is 
exempt from taxation under the Internal Revenue Code of 1986, the 
Secretary shall dissolve the corporation.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item relating to section 
1718 the following new item:

``1718A. Nonprofit corporations.''.

SEC. 402. EXTENSION OF DEMONSTRATION PROGRAM.

    Section 7 of Public Law 102-54 (105 Stat. 269; 38 U.S.C. -6-1-8 
1718 note) is amended--
            (1) in subsection (a), by striking out ``1994'' and 
        inserting in lieu thereof ``1998'';
            (2) in subsection (c)--
                    (A) by striking out ``no more than 50''; and
                    (B) by striking out ``-o-f under this subsection.'' 
                and inserting in lieu thereof ``-o-f under this 
                subsection--
            ``(1) at no more than 58 sites during fiscal year 1994;
            ``(2) at no more than 70 sites during fiscal year 1995;
            ``(3) at no more than 82 sites during fiscal year 1996;
            ``(4) at no more than 94 sites during fiscal year 1997; and
            ``(5) at no more than 106 sites during fiscal year 1998.''.

SEC. 403. SPECIAL COMMITTEE.

    (a) Establishment.--The Secretary of Veterans Administration, 
acting through the Under Secretary for Health of the Department of 
Veterans Affairs, shall establish in the Veterans Health Administration 
a Special Committee on Care of Severely Chronically Mentally Ill 
Veterans (hereinafter in this section referred to as the ``Special 
Committee''). The Under Secretary shall appoint employees of the 
Department with expertise in the care of the chronically mentally ill 
to serve on the Special Committee.
    (b) Functions.--The Special Committee may assess, and carry out a 
continuing assessment of, the capability of the Veterans Health 
Administration to meet effectively the treatment and rehabilitation 
needs of severely, chronically mentally ill veterans. In carrying out 
that responsibility, the Special Committee shall--
            (1) monitor the care provided to such veterans through the 
        Veterans Health Administration;
            (2) identify systemwide problems in caring for such 
        veterans in facilities of the Veterans Health Administration;
            (3) identify specific facilities within the Veterans Health 
        Administration at which program support is needed to improve 
        treatment and rehabilitation of such veterans; and
            (4) identify model programs which have had demonstrated 
        success in the treatment and rehabilitation of such veterans 
        and which should be implemented more widely in or through 
        facilities of the Veterans Health Administration.
    (c) Advice and Recommendations.--The Special Committee shall--
            (1) advise the Under Secretary regarding the development of 
        policies for the care and rehabilitation of the severely, 
        chronically mentally ill; and
            (2) make recommendations to the Under Secretary--
                    (A) for improving programs of care of such veterans 
                at specific facilities and throughout the Veterans 
                Health Administration;
                    (B) for establishing special programs of education 
                and training relevant to the care of such veterans for 
                employees of the Veterans Health Administration;
                    (C) regarding research needs and priorities 
                relevant to the care of such veterans; and
                    (D) regarding the appropriate allocation of 
                resources for all such activities.
    (d) Annual Reports.--(1) Not later than April 1, 1994, the 
Secretary of Veterans Affairs shall submit to the Committees on 
Veterans' Affairs of the Senate and House of Representatives a report 
on the implementation of this section. The report shall include the 
following:
            (A) A list of the members of the Special Committee.
            (B) The assessment of the Under Secretary for Health, after 
        review of the findings of the Special Committee, regarding the 
        capability of the Veterans Health Administration, on a 
        systemwide and facility-by-facility basis, to meet effectively 
        the treatment and rehabilitation needs of severely, chronically 
        mentally ill veterans.
            (C) The plans of the Special Committee for further 
        assessments.
            (D) The findings and recommendations made by the Special 
        Committee to the Under Secretary for Health and the views of 
        the Under Secretary on such findings and recommendations.
            (E) A description of the steps taken, plans made (and a 
        timetable for their execution), and resources to be applied 
        toward improving the capability of the Veterans Health 
        Administration to meet effectively the treatment and 
        rehabilitation needs of severely, chronically mentally ill 
        veterans.
    (2) Not later than February 1, 1995, and February 1 of each of the 
three following years, the Secretary shall submit to the Committees on 
Veterans' Affairs of the Senate and House of Representatives a report 
containing information updating the reports submitted under this 
subsection before the submission of such report.
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