[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4425 Reported in House (RH)]

                                                 Union Calendar No. 287

103d CONGRESS

  2d Session

                               H. R. 4425

                          [Report No. 103-518]

_______________________________________________________________________

                                 A BILL

   To authorize major medical facility construction projects for the 
  Department of Veterans Affairs for fiscal year 1995, to revise and 
       improve veterans' health programs, and for other purposes.

_______________________________________________________________________

                              May 19, 1994

Committed to the Committee of the Whole House on the State of the Union 
                       and ordered to be printed





                                                 Union Calendar No. 287
103d CONGRESS
  2d Session
                                H. R. 4425

                          [Report No. 103-518]

   To authorize major medical facility construction projects for the 
  Department of Veterans Affairs for fiscal year 1995, to revise and 
       improve veterans' health programs, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 16, 1994

 Mr. Rowland (for himself and Mr. Smith of New Jersey) introduced the 
   following bill; which was referred to the Committee on Veterans' 
                                Affairs

                              May 19, 1994

    Additional sponsors: Mr. Montgomery, Mr. Stump, Mr. Hefner, Mr. 
    Richardson, Mr. Stenholm, Mr. Payne of Virginia, and Mr. Parker

                              May 19, 1994

Committed to the Committee of the Whole House on the State of the Union 
                       and ordered to be printed

_______________________________________________________________________

                                 A BILL


 
   To authorize major medical facility construction projects for the 
  Department of Veterans Affairs for fiscal year 1995, to revise and 
       improve veterans' health programs, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

                  TITLE I--CONSTRUCTION AUTHORIZATION

SEC. 101. AUTHORIZATION OF MAJOR MEDICAL FACILITY PROJECTS AND MAJOR 
              MEDICAL FACILITY LEASES.

    (a) Projects in President's Budget.--(1) Except as provided in 
paragraph (2), the Secretary of Veterans Affairs may carry out the 
major medical facility projects for the Department of Veterans Affairs, 
and may carry out the major medical facility leases for that 
Department, for which funds are requested in the budget of the 
President for fiscal year 1995.
    (2) The Secretary is not authorized to carry out--
            (A) the project described in the budget of the President 
        for fiscal year 1995 for the construction of a research 
        addition at Huntington, West Virginia; or
            (B) the project described in the budget of the President 
        for fiscal year 1995 for the construction of a research 
        addition at Portland, Oregon.
    (b) Additional Projects.--In addition to the projects authorized in 
subsection (a), the Secretary may carry out the following major medical 
facility projects, in the amounts specified:
            (1) The projects for ambulatory care facilities that are 
        proposed in the budget for fiscal year 1995 to be financed with 
        funds from the Health Care Investment Fund.
            (2) Construction of a nursing home facility at the 
        Department of Veterans Affairs Medical Center in Charleston, 
        South Carolina, $7,300,000.
            (3) A lease/purchase of a nursing home facility near Ft. 
        Myers, Florida, $18,630,000.
            (4) Construction of an outpatient care addition at the 
        Department of Veterans Affairs medical center in Phoenix, 
        Arizona, in the amount of $50,000,000.
    (c) Projects for Which Funds Appropriated.--In addition to the 
projects authorized in subsections (a) and (b), the Secretary may carry 
out the following major medical facility projects for which funds were 
appropriated in the Emergency Supplemental Appropriations Act of 1994 
(Public Law 103-211) in the amounts specified:
            (1) Construction of an ambulatory care/support services 
        facility at the Department of Veterans Affairs Medical Center 
        in Sepulveda, California, $53,700,000.
            (2) Other major medical facility projects required to 
        repair, restore, or replace earthquake-damaged facilities at 
        the Department of Veterans Affairs Medical Center in Sepulveda, 
        California, $50,000,000.

SEC. 102. AUTHORIZATION OF APPROPRIATIONS.

    (a) In General.--There is hereby authorized to be appropriated to 
the Secretary of Veterans Affairs for fiscal year 1995--
            (1) $343,800,000 for the major medical facility projects 
        authorized in subsections (a) and (b) of section 101; and
            (2) $15,800,000 for the major medical facility leases 
        authorized in section 101(a).
    (b) Limitation.--The projects authorized in subsections (a) and (b) 
of section 101 may only be carried out using--
            (1) funds appropriated for fiscal year 1995 pursuant to the 
        authorization of appropriations in subsection (a);
            (2) funds appropriated for Construction, Major Projects for 
        a fiscal year before fiscal year 1995 that remain available for 
        obligation; and
            (3) funds appropriated for Construction, Major Projects for 
        fiscal year 1995 for a category of activity not specific to a 
        project.
    (c) Limitation on Certain Projects.--The projects authorized in 
subsection (c) of section 101 may only be carried out using--
            (1) funds appropriated, as well as funds transferred by the 
        President, to the Construction, Major Projects account pursuant 
        to the Emergency Supplemental Appropriations Act of 1994 
        (Public Law 103-211);
            (2) funds appropriated to the Medical Care account by the 
        Emergency Supplemental Appropriations Act of 1994 (Public Law 
        103-211) that are transferred by law to the Construction, Major 
        Projects account;
            (3) funds appropriated to the Construction, Major Projects 
        account for a fiscal year before fiscal year 1994 that remain 
        available for obligation; and
            (4) funds appropriated to the Construction, Major Projects 
        account for fiscal year 1994 for a category of activity not 
        specific to a project.

              TITLE II--HEALTH CARE PLANNING AND PROGRAMS

SEC. 201. HEALTH CARE FACILITIES MISSIONS.

    (a) In General.--The Secretary of Veterans Affairs shall prescribe 
a specific, detailed statement of the mission of, and the clinical 
programs to be operated at, each health care facility of the 
Department, determined based upon a requirement that each such facility 
operate within a network of Department facilities in the same 
geographic area which, taken together, provide a full range of services 
for veterans.
    (b) Purposes of Mission Statements.--The mission statements shall 
be designed so as to permit--
            (1) effective planning;
            (2) reduction in duplication of services and programs in 
        the same geographic area;
            (3) realignment of services among facilities within each 
        network;
            (4) improved means of resource distribution; and
            (5) more efficient delivery of needed services.
    (c) Review of Current Missions.--In preparing the mission 
statements under subsection (a), the Secretary shall review the 
existing missions and clinical programs at each health care facility of 
the Department.
    (d) Deadline and Report.--The Secretary, not later than nine months 
after the date of the enactment of this Act, shall--
            (1) prescribe the mission statements required by subsection 
        (a); and
            (2) submit to the Committees on Veterans' Affairs of the 
        Senate and House of Representatives a report on the 
        implementation of this section and on the timetable and 
        projected milestones for implementing actions to enable each 
        such facility to carry out fully its prescribed missions.

SEC. 202. PILOT PROGRAM FOR NONINSTITUTIONAL ALTERNATIVES TO NURSING 
              HOME CARE.

    (a) Extension of Program.--Subsection (a) of section 1720C of title 
38, United States Code, is amended by striking out ``During the four-
year period beginning on October 1, 1990,'' and inserting in lieu 
thereof ``During the period through September 30, 1997,''.
    (b) Veterans Eligible To Participate in Program.--Such subsection 
is further amended by striking out ``care and who--'' and inserting in 
lieu thereof ``care. The Secretary shall give priority for 
participation in such program to veterans who--''.
    (c) Report Deadlines.--Section 201(b) of the Department of Veterans 
Affairs Nurse Pay Act of 1990 (Public Law 101-366; 104 Stat. 438) is 
amended--
            (1) by striking out ``February 1, 1994,'' and inserting in 
        lieu thereof ``February 1, 1997,''; and
            (2) by striking out ``September 30, 1993,'' and inserting 
        in lieu thereof ``September 30, 1996,''.

               TITLE III--MEDICAL FACILITIES ACQUISITION

SEC. 301. REVISION TO PROSPECTUS REQUIREMENTS.

    (a) Additional Information.--Section 8104(b) of title 38, United 
States Code, is amended--
            (1) by striking out ``shall include--'' and inserting in 
        lieu thereof ``shall include:'';
            (2) in paragraph (1)--
                    (A) by striking out ``a detailed'' and inserting in 
                lieu thereof ``A detailed''; and
                    (B) by striking out the semicolon at the end and 
                inserting in lieu thereof a period;
            (3) in paragraph (2)--
                    (A) by striking out ``an estimate'' and inserting 
                in lieu thereof ``An estimate''; and
                    (B) by striking out ``; and'' and inserting in lieu 
                thereof a period;
            (4) in paragraph (3), by striking out ``an estimate'' and 
        inserting in lieu thereof ``An estimate''; and
            (5) by adding at the end the following new paragraphs:
            ``(4) Demographic data applicable to the project.
            ``(5) Current and projected workload and utilization data.
            ``(6) The relationship between the mission of the facility 
        and the missions and capabilities of other nearby Department 
        facilities and, as applicable, the availability or lack of 
        availability of alternative sources of service in the community 
        and the cost-effectiveness of using such alternative sources.
            ``(7) Current and projected operating costs of the 
        facility.
            ``(8) The raw score assigned to the proposal under the 
        Department's prioritization methodology and, if the project is 
        being proposed for funding ahead of a project with a higher 
        score, a comprehensive explanation of the specific factors on 
        the basis of which the project is being proposed for funding 
        ahead of each such higher-scored project.
            ``(9) A listing of each alternative to construction of the 
        facility that has been considered.''.
    (b) Applicability.--The amendments made by subsection (a) shall 
apply with respect to any prospectus submitted by the Secretary of 
Veterans Affairs after the date of the enactment of this Act.

SEC. 302. PRIORITIZATION METHODOLOGY.

    (a) Review of Methodology.--The Secretary of Veterans Affairs shall 
conduct a review of the methodology used by the Department for 
establishing the relative priority for major construction projects 
under consideration in the Department.
    (b) Revision.--Based upon the review under subsection (a), the 
Secretary shall revise the prioritization methodology so as to give 
additional weight, as determined appropriate by the Secretary taking 
into consideration particularly the needs of the aging veteran 
population, to projects intended to expand long-term care and 
ambulatory care programs.
    (c) Report.--Not later than 120 days 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 
on the actions of the Secretary in carrying out this section.

SEC. 303. SEMIANNUAL COMPILATION OF CONSTRUCTION PRIORITIES.

    Section 8107 of title 38, United States Code, is amended by adding 
at the end the following new subsection:
    ``(c)(1) The Secretary shall submit to each committee, not later 
than January 31 and July 31 of each year, a report showing the current 
priorities of the Department for proposed major medical construction 
projects. Each such report shall identify the 20 projects, from within 
all the projects in the Department's inventory of proposed projects, 
that have the highest priority and, for those 20 projects, the relative 
priority and rank scoring of each such project. The 20 projects shall 
be compiled, and their relative rankings shall be shown, by category of 
project (including the categories of ambulatory care projects, nursing 
home care projects, and such other categories as the Secretary 
determines).
    ``(2) The Secretary shall include in each report, for each project 
listed, a description of the specific factors that account for the 
relative ranking of that project in relation to other projects within 
the same category.
    ``(3) In a case in which the relative ranking of a proposed project 
has changed since the last report under this subsection was submitted, 
the Secretary shall also include in the report a description of the 
reasons for the change in the ranking, including an explanation of any 
change in the scoring of the project under the Department's scoring 
system for proposed major medical construction projects.

SEC. 304. DEFINITION OF MAJOR MEDICAL FACILITY PROJECT.

    Subparagraph (A) of section 8104(a)(3) of title 38, United States 
Code, is amended by inserting before the period at the end the 
following: ``, and, in the case of a project which is principally for 
the alteration of a medical facility to provide additional space for 
provision of ambulatory care, such term means a project involving a 
total expenditure of more than $5,000,000''.

                      TITLE IV--STATE HOME PROGRAM

SEC. 401. PER DIEM FOR ADULT DAY HEALTH CARE.

    (a) In General.--Subsection (a) of section 1741 of title 38, United 
States Code, is amended to read as follows:
    ``(a)(1) The Secretary shall pay to each State a per diem amount 
for each veteran receiving domiciliary care, nursing home care, 
hospital care, or adult day health care in a State home if the veteran 
is eligible to receive that care in a Department facility.
    ``(2) The per diem rate to be paid under this subsection is as 
follows:
            ``(A) For domiciliary care, $15.11 for each day.
            ``(B) For nursing home care and hospital care, $35.37 for 
        each day.
            ``(C) For adult day health care, $16.28 for each day.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply with respect to adult day health care provided in a State home 
after September 30, 1994.

SEC. 402. CONSTRUCTION ASSISTANCE PROGRAM.

    (a) In General.--Subchapter III of chapter 81 of title 38, United 
States Code, is amended as follows:
            (1) Section 8131(3) is amended by inserting ``or adult day 
        health care'' after ``hospital care''.
            (2) Section 8132 is amended by inserting ``adult day health 
        care'' after ``hospital care''.
            (3) Section 8135(a)(4) is amended by inserting ``and, in 
        the case of adult day health care, not more than 25 percent of 
        the number of patients participating in that program,'' after 
        ``occupancy''.
            (4) Section 8135(b) is amended--
                    (A) in paragraph (2)(C), by inserting ``or adult 
                day health care facilities'' after ``domiciliary 
                beds''; and
                    (B) in paragraph (3)(A), by inserting ``, or would 
                involve expansion, remodeling, or alteration of 
                existing buildings for the furnishing of adult day 
                health care'' after ``buildings''.
            (5) Section 8136 is amended by inserting ``adult day health 
        care'' after ``hospital care''.
            (6) The heading of such subchapter is amended to read as 
        follows:

  ``SUBCHAPTER III--STATE HOME FACILITIES FOR FURNISHING DOMICILIARY 
  CARE, NURSING HOME CARE, ADULT DAY HEALTH CARE, AND HOSPITAL CARE''.

    (b) Clerical Amendment.--The item relating to subchapter III in the 
table of sections at the beginning of such chapter is amended to read 
as follows:

  ``SUBCHAPTER III--STATE HOME FACILITIES FOR FURNISHING DOMICILIARY 
  CARE, NURSING HOME CARE, ADULT DAY HEALTH CARE, AND HOSPITAL CARE''.

    (c) Effective Date.--The amendments made by subsection (a) shall 
apply with respect to grants made to States using funds appropriated 
after the date of the enactment of this Act.

                         TITLE V--MISCELLANEOUS

SEC. 501. DEPARTMENT OF VETERANS AFFAIRS RESEARCH ADVISORY COMMITTEES.

    (a) Statutory Basis for Research Advisory Committees.--Chapter 5 of 
title 38, United States Code, is amended by adding at the end of 
subchapter III the following new section:
``Sec. 544. Veterans research advisory committees
    ``(a) Congress declares that each of the veterans research advisory 
committees specified in subsection (c) (previously established by the 
Secretary in carrying out the duties of the Secretary under section 
7303 of this title) has a continuing, ongoing function that is 
integrally related to the successful completion by the Department of 
its statutory duties. Each such committee shall, for all purposes, 
operate as though such committee had been established by, and chartered 
pursuant to, law. The objectives and scope of the activities of each 
such committee and the duties for which the committee is responsible, 
as specified by the Secretary as of March 1, 1993, shall be those in 
effect as of that date.
    ``(b) The Secretary may not terminate a veterans' research advisory 
committee specified in subsection (c) unless the Secretary finds that 
the committee is no longer needed. Not less than 120 days before 
terminating such a committee, the Secretary shall submit to the 
congressional veterans' affairs committees a report on the proposed 
termination. The report shall include an explanation of (1) the basis 
for the Secretary's determination that such committee is no longer 
needed, and (2) the manner in which the Secretary will carry out the 
Secretary's responsibilities under section 7303 of this title in the 
absence of the committee.
    ``(c) For purposes of this section, each of the following 
committees and boards, as established by the Secretary as of March 1, 
1993, shall be considered to be a veterans' research advisory 
committee:
            ``(1) The Career Development Committee.
            ``(2) The Department of Veterans Affairs Cooperative 
        Studies Evaluation Committee.
            ``(3) The Merit Review Board for Basic Sciences Programs.
            ``(4) The Merit Review Board for Cardiovascular Programs.
            ``(5) The Merit Review Board for Clinical Pharmacology, 
        Alcoholism, and Drug Dependence Programs.
            ``(6) The Merit Review Board for Endocrinology Programs.
            ``(7) The Merit Review Board for Gastroenterology Programs.
            ``(8) The Merit Review Board for Hematology Programs.
            ``(9) The Merit Review Board for Immunology Programs.
            ``(10) The Merit Review Board for Infectious Diseases 
        Programs.
            ``(11) The Merit Review Board for Mental Health and 
        Behavioral Sciences Programs.
            ``(12) The Merit Review Board for Nephrology Programs.
            ``(13) The Merit Review Board for Neurobiology Programs.
            ``(14) The Merit Review Board for Oncology Programs.
            ``(15) The Merit Review Board for Respiration Programs.
            ``(16) The Merit Review Board for Surgery Programs.
            ``(17) The Scientific Review Evaluation Board for Health 
        Services Research and Development.
            ``(18) The Scientific Review Evaluation Board for 
        Rehabilitation Research and Development.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item relating to section 
543 the following new item:

``544. Veterans research advisory committees.''.

SEC. 502. CHILD CARE SERVICES.

    (a) Revised Child Care Authority.--Chapter 81 of title 38, United 
States Code, is amended by inserting after section 8116 the following 
new section:
``Sec. 8117. Child care centers
    ``(a) The Secretary may provide for the operation of child care 
centers at Department facilities. The operation of such centers under 
this section shall be carried out to the extent that the Secretary 
determines, based on the demand of employees of the Department for the 
care involved, that such operation is in the best interest of the 
Department and that it is practicable to do so.
    ``(b)(1) In offering child care services under this section, the 
Secretary shall give priority (in the following order) to employees 
of--
            ``(A) the Department;
            ``(B) other departments and agencies of the Federal 
        Government, and
            ``(C) schools affiliated with the Department and 
        corporations created under section 7361 of this title.
    ``(2) To the extent that space is available, the Secretary may 
provide child care services to members of the public at a child care 
center operated under this section if the Secretary determines that to 
do so is necessary to assure the financial success of that center.
    ``(c)(1) The Secretary shall establish reasonable charges for child 
care services provided at each child care center operated under this 
section. Such charges may be established at different rates for 
different centers.
    ``(2) In establishing charges for child care services provided at a 
center, the Secretary--
            ``(A) shall (except as provided in paragraph (3)) establish 
        the charges so as to ensure that the sum of all charges for 
        child care services at that center is sufficient to meet the 
        staffing expenses of that center; and
            ``(B) may also consider the expenses of constructing or 
        acquiring space for the center, the expenses of converting 
        existing space into the center, and the expenses of equipment 
        and services furnished to the center under subsection (d)(2).
    ``(3) The Secretary may establish charges for child care services 
provided at a center at rates less than those necessary to ensure that 
the sum of all charges for child care services at that center is 
sufficient to meet the staffing expenses of that center if the 
Secretary determines (with respect to a particular facility of the 
Department) that--
            ``(A) the operation of a child care center at that facility 
        would help overcome serious recruitment or retention problems;
            ``(B) adherence to the requirement to establish charges for 
        child care services at that center at rates sufficient to meet 
        the staffing expenses of that center would make the operation 
        of a child care center at that facility unfeasible; and
            ``(C) there are no other practical alternatives to meeting 
        the needs of employees at that facility for child care 
        services.
    ``(4) Proceeds from charges for child care services shall be 
credited to the applicable Department of Veterans Affairs account and 
shall be allotted to the facility served by the child care center and 
shall remain available until expended.
    ``(d) In connection with the establishment and operation of a child 
care center under this section, the Secretary--
            ``(1) may construct or alter space in any Department 
        facility, and may lease space in a non-Department facility for 
        a term not to exceed 20 years, for use as a child care center;
            ``(2) may provide, out of operating funds, other items and 
        services necessary for the operation of the center, including 
        furniture, office machines and equipment, utility and custodial 
        services, and other necessary services and amenities;
            ``(3) shall provide for the participation (directly or 
        through a parent advisory committee) of parents of children 
        receiving care in the center in the establishment of policies 
        to govern the operation of the center and in the oversight of 
        the implementation of such policies;
            ``(4) shall require the development and use of a process 
        for determining the fitness and suitability of prospective 
        employees of or volunteers at the center; and
            ``(5) shall require in connection with the operation of the 
        center compliance with all State and local laws, ordinances, 
        and regulations relating to health and safety and the operation 
        of child care centers.
    ``(e) The Secretary shall prescribe guidelines to carry out this 
section.
    ``(f) For the purpose of this section, the term `parent advisory 
committee' means a committee comprised of, and selected by, the parents 
of children receiving care in a child care center operated under this 
section.''.
    (b) Conforming Repeal.--Section 7809 of such title is repealed.
    (c) Clerical Amendments.--(1) The table of sections at the 
beginning of chapter 81 of such title is amended by inserting after the 
item relating to section 8116 the following new item:

``8117. Child care centers.''.
    (2) The table of sections at the beginning of chapter 78 of such 
title is amended by striking out the item relating to section 7809.

SEC. 503. CONTRACTS FOR UTILITIES, AUDIE L. MURPHY MEMORIAL HOSPITAL.

    (a) Authority To Contract.--Subject to subsection (b), the 
Secretary of Veterans Affairs may enter into contracts for the 
provision of utilities (including steam and chilled water) to the Audie 
L. Murphy Memorial Hospital in San Antonio, Texas. Each such contract 
may--
            (1) be for a period not to exceed 35 years;
            (2) provide for the construction and operation of a 
        production facility on or near property under the jurisdiction 
        of the Secretary;
            (3) require capital contributions by the parties involved 
        for the construction of such a facility, such contribution to 
        be in the form of cash, equipment, or other in-kind 
        contribution; and
            (4) provide for a predetermined formula to compute the cost 
        of providing such utilities to the parties for the duration of 
        the contract.
    (b) Funds.--A contract may be entered into under subsection (a) 
only to the extent and in the amount provided in advance in 
appropriations Acts.
    (c) Additional Terms.--The Secretary may include in a contract 
under subsection (a) such additional provisions as the Secretary 
considers necessary to secure the provision of utilities and to protect 
the interests of the United States.

SEC. 504. FACILITIES IN REPUBLIC OF THE PHILIPPINES.

    Notwithstanding section 1724 of title 38, United States Code, the 
Secretary of Veterans Affairs, during the period from February 28, 
1994, through June 1, 1994, may contract with facilities in the 
Republic of the Philippines other than the Veterans Memorial Medical 
Center to furnish hospital care and medical services to veterans for 
nonservice-connected disabilities if such veterans are unable to defray 
the expenses of necessary hospital care. When the Secretary determines 
it to be most feasible, the Secretary may provide medical services to 
such veterans at the Department of Veterans Affairs Outpatient Clinic 
at Manila, Republic of the Philippines.

SEC. 505. WAIVER OF CONGRESSIONAL WAITING PERIOD REQUIREMENT FOR A 
              SPECIFIED ADMINISTRATIVE REORGANIZATION.

    (a) Waiver.--The Secretary of Veterans Affairs may undertake the 
administrative reorganization described in subsection (b) of this 
section without regard to the waiting period requirement of section 
510(b) of title 38, United States Code.
    (b) Covered Administrative Reorganization.--The administrative 
reorganization referred to in subsection (a) of this section is a 
reorganization at the Department of Veterans Affairs Medical Center in 
Sepulveda, California, necessitated by the January 1994 earthquake 
damage at that location, as described in the letters dated April 25, 
1994, and the accompanying detailed plan and justification, submitted 
by the Secretary of Veterans Affairs to the chairmen of the House and 
Senate Committees on Veterans' Affairs pursuant to section 510(b) of 
title 38, United States Code.

SEC. 506. TECHNICAL AMENDMENT.

    Section 7363(c) of title 38, United States Code, is amended by 
striking out ``section 501(c)(3) of''.
HR 4425 RH----2