[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[S. 1030 Engrossed in Senate (ES)]

103d CONGRESS

  2d Session

                                S. 1030

_______________________________________________________________________

                                 AN ACT

  To amend title 38, United States Code, to improve the Department of 
  Veterans Affairs program of sexual trauma services for veterans, to 
   improve certain Department of Veterans Affairs programs for women 
  veterans, to extend the period of entitlement to inpatient care for 
veterans exposed to Agent Orange or ionizing radiation, to establish a 
 hospice care pilot program, to establish a rural health care clinics 
program, to authorize the Secretary of Veterans Affairs to provide per 
  diem payments and construction grants to State homes for adult day 
health care services, to establish an education debt reduction program, 
                        and for other purposes.
  
  
  
  
  
  
  
  
  
103d CONGRESS
  2d Session
                                S. 1030

_______________________________________________________________________

                                 AN ACT


 
  To amend title 38, United States Code, to improve the Department of 
  Veterans Affairs program of sexual trauma services for veterans, to 
   improve certain Department of Veterans Affairs programs for women 
  veterans, to extend the period of entitlement to inpatient care for 
veterans exposed to Agent Orange or ionizing radiation, to establish a 
 hospice care pilot program, to establish a rural health care clinics 
program, to authorize the Secretary of Veterans Affairs to provide per 
  diem payments and construction grants to State homes for adult day 
health care services, to establish an education debt reduction program, 
                        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; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Veterans Health 
Programs Improvement Act of 1994''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
                        TITLE I--WOMEN VETERANS

Sec. 101. Department of Veterans Affairs sexual trauma services 
                            program.
Sec. 102. Reports relating to determinations of service connection for 
                            sexual trauma.
Sec. 103. Coordinators of women's services.
Sec. 104. Women's health services.
Sec. 105. Expansion of research relating to women veterans.
Sec. 106. Mammography quality standards.
                 TITLE II--GENERAL HEALTH CARE SERVICES

Sec. 201. Extension of period of eligibility for medical care for 
                            exposure to dioxin or ionizing radiation.
Sec. 202. Extension of period of eligibility for priority health care 
                            for veterans of the Persian Gulf War.
Sec. 203. Programs for furnishing hospice care to veterans.
Sec. 204. Rural health-care clinic program.
Sec. 205. Payment to States of per diem for veterans receiving adult 
                            day health care.
Sec. 206. Revision of authority on use of tobacco products in 
                            department facilities.
                        TITLE III--MISCELLANEOUS

              Subtitle A--Education Debt Reduction Program

Sec. 301. Short title.
Sec. 302. Program of assistance in the payment of education debts 
                            incurred by certain Veterans Health 
                            Administration employees.
                      Subtitle B--Other Provisions

Sec. 311. Extension of authority of Advisory Committee on Education.
Sec. 312. Extension of authority to maintain regional office in the 
                            Philippines.

                        TITLE I--WOMEN VETERANS

SEC. 101. DEPARTMENT OF VETERANS AFFAIRS SEXUAL TRAUMA SERVICES 
              PROGRAM.

    (a) Authority To Provide Services for Sexual Trauma.--(1) 
Subsection (a)(1) of section 1720D of title 38, United States Code is 
amended--
            (A) by inserting ``(A)'' before ``During the period''; and
            (B) by adding at the end the following:
    ``(B) During the period referred to in subparagraph (A), the 
Secretary may provide appropriate care and services to a veteran for an 
injury, illness, or other psychological condition which the Secretary 
determines to be the result of a physical assault, battery, or 
harassment referred to in that subparagraph.''.
    (2) Subsection (c)(1) of such section is amended to read as 
follows:
    ``(1) The Secretary shall give priority to the establishment and 
operation of the program to provide counseling and care and services 
under subsection (a). In the case of a veteran eligible for counseling 
and care and services under subsection (a)(1), the Secretary shall 
ensure that the veteran is furnished counseling under this section in a 
way that is coordinated with the furnishing of such care and services 
under this chapter.''.
    (3) Subsection (d) of such section is amended by inserting ``and 
care and services'' after ``counseling'' each place it appears.
    (b) Authority To Provide Services by Contract.--Subsection (a)(3) 
of such section is amended--
            (1) by inserting ``(A)'' before ``In furnishing'';
            (2) in subparagraph (A), as so designated--
                    (i) by striking out ``(A)'' and inserting in lieu 
                thereof ``(i)''; and
                    (ii) by striking out ``(B)'' and inserting in lieu 
                thereof ``(ii)''; and
            (3) by adding at the end the following:
    ``(B) The Secretary may provide care and services to a veteran 
under paragraph (1)(B) pursuant to a contract with a qualified non-
Department health professional or facility if Department facilities are 
not capable of furnishing such care and services to that veteran 
economically because of geographic inaccessibility.''.
    (c) Extension of Authority To Provide Sexual Trauma Services.--
Subsection (a) of such section, as amended by subsections (a) and (b) 
of this section, is further amended--
            (1) by striking out ``December 31, 1995,'' in paragraph 
        (1)(A) 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,''.
    (d) Period of Eligibility To Seek Services.--(1) Such subsection, 
as amended by subsections (a), (b), and (c) of this section, is further 
amended--
            (A) by striking out paragraph (2); and
            (B) by redesignating paragraph (3) 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.
    (e) Repeal of Limitation on Period of Receipt of Services.--Section 
1720D of title 38, United States Code (as amended by subsections (a) 
through (d) of this section), 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.
    (f) 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 and care and services under section 1720D of 
                this title, for the purposes of such counseling and 
                care and services'' 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''.
    (g) Program Revision.--(1) Section 1720D of title 38, United States 
Code (as amended by subsections (a) through (e) of this section), is 
further amended--
            (A) by striking out ``woman'' in subsection (a)(1)(A);
            (B) by striking out ``women'' in subsection (b)(2)(C) and 
        in the first sentence of subsection (c); and
            (C) by striking out ``women'' in subsection (c)(2) and 
        inserting in lieu thereof ``individuals''.
    (2)(A) The heading of such section is amended to read as follows:
``Sec. 1720D. Counseling, care, and services 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, care, and services for sexual trauma.''.
    (h) Information on Counseling by Telephone.--(1) Paragraph (1) of 
section 1720D(c) of title 38, United States Code, as redesignated by 
subsection (d) of this section, is amended by striking out ``may'' and 
inserting in lieu thereof ``shall''.
    (2) In providing information on counseling available to veterans 
through the information system required under section 1720D(c)(1) of 
title 38, United States Code, as amended by this section, the Secretary 
of Veterans Affairs shall ensure--
            (A) that the telephone system described in such section is 
        operated by Department of Veterans Affairs personnel who are 
        trained in the provision to persons who have experienced sexual 
        trauma of information about the counseling and care and 
        services relating to sexual trauma that are available to 
        veterans in the communities in which such veterans reside, 
        including counseling and 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;
            (B) that such personnel are provided with information on 
        the counseling and care and services relating to sexual trauma 
        that are available to veterans and the locations in which such 
        care and services are available;
            (C) that such personnel refer veterans seeking such 
        counseling and care and services to appropriate providers of 
        such counseling and care and services (including counseling and 
        care and services that are available in the communities in 
        which such veterans reside);
            (D) that the telephone system is operated in a manner that 
        protects the confidentiality of persons who place telephone 
        calls to the system; and
            (E) that the telephone system operates at all times.
    (3) The Secretary shall ensure that information about the 
availability of the telephone system is visibly posted in Department 
medical facilities and is advertised through public service 
announcements, pamphlets, and other means.
    (4) 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 system 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 telephone calls placed to the system 
        during the period covered by the report, with a separate 
        display of (i) the number of calls placed to the system from 
        each State (as such term is defined in section 101(20) of title 
        38, United States Code) during that period, and (ii) the number 
        of persons who placed more than one call to the system during 
        that period.
            (B) The types of sexual trauma described to personnel 
        operating the system by persons placing calls to the system.
            (C) A description of the difficulties, if any, experienced 
        by persons placing calls to the system in obtaining counseling 
        and care and services for sexual trauma in the communities in 
        which such persons live, including counseling and care and 
        services available from the Department and from non-Department 
        agencies and organizations.
            (D) A description of the training provided to the personnel 
        operating the system.
            (E) The recommendations and plans of the Secretary for the 
        improvement of the system.
    (5) The Secretary shall commence operation of the telephone system 
required under section 1720D(c)(1) of title 38, United States Code (as 
so amended), not later than 180 days after the date of the enactment of 
this Act.

SEC. 102. REPORTS RELATING TO DETERMINATIONS OF SERVICE CONNECTION FOR 
              SEXUAL TRAUMA.

    (a) Report.--(1) The Secretary of Veterans Affairs shall submit to 
the Committees on Veterans' Affairs of the Senate and House of 
Representatives a report containing the Secretary's assessment of--
            (A) the difficulties that veterans encounter in obtaining 
        from the Department of Veterans Affairs determinations that 
        disabilities relating to sexual trauma resulting from events 
        that occurred during active duty are service-connected 
        disabilities; and
            (B) the extent to which Department personnel fail to make 
        determinations that such disabilities are service-connected 
        disabilities.
    (2) The Secretary shall include in the report the Secretary's 
recommendations for actions to be taken to respond in a fair manner to 
the difficulties described in the report and to eliminate failures to 
make determinations that such disabilities are service-connected 
disabilities.
    (3) The report required by this subsection shall be submitted not 
later than June 30, 1994.
    (b) Follow-Up Reports.--Not later than June 30 of each of 1995 and 
1996, the Secretary shall submit to the committees referred to in 
paragraph (1) of subsection (a) a report on the actions taken by the 
Secretary to implement the recommendations referred to in paragraph (2) 
of that subsection.
    (c) Definition.--In this section, the term ``sexual trauma'' means 
the immediate and long-term physical or psychological trauma resulting 
from rape, sexual assault, aggravated sexual abuse (as such term is 
described in section 2241 of title 18, United States Code), sexual 
harassment, or other act of sexual violence.

SEC. 103. COORDINATORS OF WOMEN'S SERVICES.

    (a) Requirement of Full-time Service.--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 so serve on a full-time 
basis.''.
    (b) Additional Responsibilities.--Subsection (a) of such section 
(as designated by subsection (a) of this section) is further amended--
            (1) by redesignating paragraph (5) as paragraph (6); and
            (2) by inserting after paragraph (4) the following new 
        paragraph (5):
            ``(5) Facilitating communication between women veterans 
        coordinators under the jurisdiction of such regional 
        coordinator and the Under Secretary for Health and the 
        Secretary.''.
    (c) Support for Women's Services Coordinators.--The Secretary of 
Veterans Affairs shall take appropriate actions to ensure that--
            (1) sufficient funding is provided to each Department of 
        Veterans Affairs facility in order to permit the coordinator of 
        women's services to carry out the responsibilities of the 
        coordinator at the facility;
            (2) sufficient clerical and communications support is 
        provided to each such coordinator for that purpose; and
            (3) each such coordinator has direct access to the Director 
        or Chief of Staff of the facility to which the coordinator is 
        assigned.

SEC. 104. 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 health care 
services provided to women, including counseling and services relating 
to the following:
            ``(A) Papanicolaou tests (pap smears).
            ``(B) Breast examinations and mammography.
            ``(C) Maternity care, including pre-natal care, delivery, 
        and post-natal care.
            ``(D) Menopause.''.
    (b) Contracts for Women's Health Services.--Section 1703(a) of such 
title is amended by adding at the end the following:
            ``(9) Women's health services for veterans on an ambulatory 
        or outpatient basis.''.
    (c) 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''.
    (d) Report on Health Care and Research.--Section 107(b) of such Act 
(38 U.S.C. 1710 note) is amended--
            (1) in paragraph (1), by inserting ``and women's health 
        services (as such term is defined in section 1701(10) of title 
        38, United States Code)'' after ``section 106 of this Act'';
            (2) in paragraph (2), by striking out ``and (B)'' and 
        inserting in lieu thereof ``(B) the type and amount of services 
        provided by such personnel, including information on the 
        numbers of inpatient stays and the number of outpatient visits 
        through which such services were provided, and (C)'';
            (3) by redesignating paragraph (4) as paragraph (7);
            (4) by adding after paragraph (3) the following new 
        paragraphs:
            ``(4) A description of the personnel of the Department who 
        provided such services to women veterans, including the number 
        of employees (including both the number of individual employees 
        and the number of full-time employee equivalents) and the 
        professional qualifications or specialty training of such 
        employees and the Department facilities to which such personnel 
        were assigned.
            ``(5) A description of any actions taken by the Secretary 
        to ensure the retention of the personnel described in paragraph 
        (4), and any actions undertaken to recruit additional such 
        personnel or personnel to replace such personnel.
            ``(6) An assessment by the Secretary of any difficulties 
        experienced by the Secretary in the furnishing of such services 
        and the actions taken by the Secretary to resolve such 
        difficulties.''; and
            (5) by adding after paragraph (7), as redesignated by 
        paragraph (3) of this subsection, the following:
            ``(8) A description of the actions taken by the Secretary 
        to foster and encourage the expansion of such research.''.

SEC. 105. EXPANSION OF RESEARCH RELATING TO WOMEN VETERANS.

    (a) Health Research.--Section 109(a) of the Veterans Health Care 
Act of 1992 (Public Law 102-585; 38 U.S.C. 7303 note) is amended--
            (1) by inserting ``(1)'' before ``The Secretary'';
            (2) in paragraph (1), as so designated, by striking out 
        ``veterans who are women'' and inserting in lieu thereof 
        ``women veterans''; and
            (3) by adding at the end the following:
    ``(2) In carrying out this section, the Secretary shall consult 
with the following:
            ``(A) The Director of the Nursing Service.
            ``(B) Officials of the Central Office assigned 
        responsibility for women's health programs and sexual trauma 
        services.
            ``(C) The members of the Advisory Committee on Women 
        Veterans established under section 542 of title 38, United 
        States Code.
            ``(D) Members of appropriate task forces and working groups 
        within the Department of Veterans Affairs (including the Women 
        Veterans Working Group and the Task Force on Treatment of Women 
        Who Suffer Sexual Abuse).
    ``(3) The Secretary shall foster and encourage research under this 
section on the following matters as they relate to women:
            ``(A) Breast cancer.
            ``(B) Gynecological and reproductive health, including 
        gynecological cancer, infertility, sexually-transmitted 
        diseases, and pregnancy.
            ``(C) Human Immunodeficiency Virus and Acquired Immune 
        Deficiency Syndrome.
            ``(D) Mental health, including post-traumatic stress 
        disorder and depression.
            ``(E) Diseases related to aging, including menopause, 
        osteoporosis, and Alzheimer's Disease.
            ``(F) Substance abuse.
            ``(G) Sexual violence and related trauma.
            ``(H) Exposure to toxic chemicals and other environmental 
        hazards.
    ``(4) The Secretary shall, to the maximum extent practicable, 
ensure that personnel of the Department of Veterans Affairs engaged in 
the research referred to in paragraph (1) include the following:
            ``(A) Personnel of the geriatric research, education, and 
        clinical centers designated pursuant to section 7314 of title 
        38, United States Code.
            ``(B) Personnel of the National Center for Post-Traumatic 
        Stress Disorder established pursuant to section 110(c) of the 
        Veterans Health Care Act of 1984 (Public Law 98-528; 98 Stat. 
        2692).
    ``(5) The Secretary shall, to the maximum extent practicable, 
ensure that personnel of the Department engaged in research relating to 
the health of women veterans are advised and informed of such research 
engaged in by other personnel of the Department.''.
    (b) Population Study.--Section 110(a) of such Act (38 U.S.C. 1710 
note) is amended--
            (1) in paragraph (1), by striking out the second sentence; 
        and
            (2) by amending paragraph (3) to read as follows:
    ``(3)(A) Subject to subparagraph (B), the study shall be based on--
            ``(i) an appropriate sample of veterans who are women and 
        of women who are serving on active military, naval, or air 
        service; and
            ``(ii) an examination of the medical and demographic 
        histories of the women comprising such sample.
    ``(B) The sample referred to in subparagraph (A) shall, to the 
maximum extent practicable, constitute 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 and women who are serving on 
such duty.
    ``(C) In carrying out the examination referred to in subparagraph 
(A)(ii), the Secretary shall determine the number of women of the 
sample who have used medical facilities of the Department, nursing home 
facilities of or under the jurisdiction of the Department, and 
outpatient care facilities of or under the jurisdiction of the 
Department.''.

SEC. 106. MAMMOGRAPHY QUALITY STANDARDS.

    (a) Performance of Mammograms.--Mammograms may not be performed at 
a Department of Veterans Affairs facility unless that facility is 
accredited for that purpose by a private nonprofit organization 
designated by the Secretary of Veterans Affairs. The organization 
designated by the Secretary under this subsection shall meet the 
standards for accrediting bodies established by the Secretary of Health 
and Human Services under section 354(e) of the Public Health Service 
Act (42 U.S.C. 263b(e)).
    (b) Quality Standards.--(1)(A) The Secretary of Veterans Affairs 
shall prescribe quality assurance and quality control standards 
relating to the performance and interpretation of mammograms and use of 
mammogram equipment and facilities by personnel of the Department of 
Veterans Affairs. 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.
    (B) In prescribing such standards, the Secretary of Veterans 
Affairs shall consult with the Secretary of Health and Human Services.
    (2) The Secretary of Veterans Affairs shall prescribe such 
standards not later than 120 days after the Secretary of Health and 
Human Services prescribes quality standards under such section 354(f).
    (c) Inspection of Department Equipment.--(1) The Secretary of 
Veterans Affairs shall, on an annual basis, inspect the equipment and 
facilities utilized by and in Department of Veterans Affairs health-
care facilities for the performance of mammograms in order to ensure 
the compliance of such equipment and facilities with the standards 
prescribed under subsection (b). Such inspection 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 Services Act.
    (2) The Secretary of Veterans Affairs may not delegate the 
responsibility of such secretary under paragraph (1) to a State agency.
    (d) Application of Standards to Contract Providers.--The Secretary 
of Veterans Affairs shall ensure that mammograms performed for the 
Department of Veterans Affairs 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) Report.--(1) The Secretary shall submit to the Committees on 
Veterans' Affairs of the Senate and House of Representatives a report 
on the quality standards prescribed by the Secretary under subsection 
(b)(1).
    (2) The Secretary shall submit the report not later than 180 days 
after the date on which the Secretary prescribes such regulations.
    (f) Definition.--In this section, the term ``mammogram'' shall have 
the meaning given such term in section 354(a)(5) of the Public Health 
Service Act (42 U.S.C. 263b(a)).

                 TITLE II--GENERAL HEALTH CARE SERVICES

SEC. 201. EXTENSION OF PERIOD OF ELIGIBILITY FOR MEDICAL CARE FOR 
              EXPOSURE TO DIOXIN OR IONIZING RADIATION.

    Section 1710(e)(3) of title 38, United States Code, is amended by 
striking out ``June 30, 1994'' and inserting in lieu thereof ``December 
31, 2003''.

SEC. 202. EXTENSION OF PERIOD OF ELIGIBILITY FOR PRIORITY HEALTH CARE 
              FOR VETERANS OF THE PERSIAN GULF WAR.

    (a) Inpatient Care.--Section 1710(e)(3) of title 38, United States 
Code, is amended by striking out ``after December 31, 1994'' and 
inserting in lieu thereof ``after September 30, 2003''.
    (b) Outpatient Care.--Section 1712(a)(1)(D) of such title is 
amended by striking out ``before December 31, 1994'' and inserting in 
lieu thereof ``before October 1, 2003''.

SEC. 203. PROGRAMS FOR FURNISHING HOSPICE CARE TO VETERANS.

    (a) Establishment of Programs.--Chapter 17 of title 38, United 
States Code, is amended by adding at the end the following:

  ``subchapter vii--hospice care pilot program; hospice care services

``Sec. 1761. Definitions
    ``For the purposes of this subchapter--
            ``(1) The term `terminally ill veteran' means any veteran--
                    ``(A) who is (i) entitled to receive hospital care 
                in a medical facility of the Department under section 
                1710(a)(1) of this title, (ii) eligible for hospital or 
                nursing home care in such a facility and receiving such 
                care, (iii) receiving care in a State home facility for 
                which care the Secretary is paying per diem under 
                section 1741 of this title, or (iv) transferred to a 
                non-Department nursing home for nursing home care under 
                section 1720 of this title and receiving such care; and
                    ``(B) who has a medical prognosis (as certified by 
                a Department physician) of a life expectancy of six 
                months or less.
            ``(2) The term `hospice care services' means (A) the care, 
        items, and services referred to in subparagraphs (A) through 
        (H) of section 1861(dd)(1) of the Social Security Act (42 
        U.S.C. 1395x(dd)(1)), and (B) personal care services.
            ``(3) The term `hospice program' means any program that 
        satisfies the requirements of section 1861(dd)(2) of the Social 
        Security Act (42 U.S.C. 1395x(dd)(2)).
            ``(4) The term `medical facility of the Department' means a 
        facility referred to in section 1701(4)(A) of this title.
            ``(5) The term `non-Department facility' means a facility 
        (other than a medical facility of the Department) at which care 
        to terminally ill veterans is furnished, regardless of whether 
        such care is furnished pursuant to a contract, agreement, or 
        other arrangement referred to in section 1762(b)(1)(D) of this 
        title.
            ``(6) The term `personal care services' means any care or 
        service furnished to a person that is necessary to maintain a 
        person's health and safety within the home or nursing home of 
        the person, including care or services related to dressing and 
        personal hygiene, feeding and nutrition, and environmental 
        support.
``Sec. 1762. Hospice care: pilot program requirements
    ``(a)(1) During the period beginning on October 1, 1993, and ending 
on December 31, 1998, the Secretary shall conduct a pilot program in 
order--
            ``(A) to assess the feasibility and desirability of 
        furnishing hospice care services to terminally ill veterans; 
        and
            ``(B) to determine the most efficient and effective means 
        of furnishing such services to such veterans.
    ``(2) The Secretary shall conduct the pilot program in accordance 
with this section.
    ``(b)(1) Under the pilot program, the Secretary shall--
            ``(A) designate not less than 15 nor more than 30 medical 
        facilities of the Department at or through which to conduct 
        hospice care services demonstration projects;
            ``(B) designate the means by which hospice care services 
        shall be provided to terminally ill veterans under each 
        demonstration project pursuant to subsection (c);
            ``(C) allocate such personnel and other resources of the 
        Department as the Secretary considers necessary to ensure that 
        services are provided to terminally ill veterans by the 
        designated means under each demonstration project; and
            ``(D) enter into any contract, agreement, or other 
        arrangement that the Secretary considers necessary to ensure 
        the provision of such services by the designated means under 
        each such project.
    ``(2) In carrying out the responsibilities referred to in paragraph 
(1) the Secretary shall take into account the need to provide for and 
conduct the demonstration projects so as to provide the Secretary with 
such information as is necessary for the Secretary to evaluate and 
assess the furnishing of hospice care services to terminally ill 
veterans by a variety of means and in a variety of circumstances.
    ``(3) In carrying out the requirement described in paragraph (2), 
the Secretary shall ensure, to the maximum extent feasible, that--
            ``(A) the medical facilities of the Department selected to 
        conduct demonstration projects under the pilot program include 
        facilities located in urban areas of the United States and 
        rural areas of the United States;
            ``(B) the full range of affiliations between medical 
        facilities of the Department and medical schools is represented 
        by the facilities selected to conduct demonstration projects 
        under the pilot program, including no affiliation, minimal 
        affiliation, and extensive affiliation;
            ``(C) such facilities vary in the number of beds that they 
        operate and maintain; and
            ``(D) the demonstration projects are located or conducted 
        in accordance with any other criteria or standards that the 
        Secretary considers relevant or necessary to furnish and to 
        evaluate and assess fully the furnishing of hospice care 
        services to terminally ill veterans.
    ``(c)(1) Subject to paragraph (2), hospice care to terminally ill 
veterans shall be furnished under a demonstration project by one or 
more of the following means designated by the Secretary:
            ``(A) By the personnel of a medical facility of the 
        Department providing hospice care services pursuant to a 
        hospice program established by the Secretary at that facility.
            ``(B) By a hospice program providing hospice care services 
        under a contract with that program and pursuant to which 
        contract any necessary inpatient services are provided at a 
        medical facility of the Department.
            ``(C) By a hospice program providing hospice care services 
        under a contract with that program and pursuant to which 
        contract any necessary inpatient services are provided at a 
        non-Department medical facility.
    ``(2)(A) The Secretary shall provide that--
            ``(i) care is furnished by the means described in paragraph 
        (1)(A) at not less than five medical facilities of the 
        Department; and
            ``(ii) care is furnished by the means described in 
        subparagraphs (B) and (C) of paragraph (1) in connection with 
        not less than five such facilities for each such means.
    ``(B) The Secretary shall provide in any contract under 
subparagraph (B) or (C) of paragraph (1) that inpatient care may be 
provided to terminally ill veterans at a medical facility other than 
that designated in the contract if the provision of such care at such 
other facility is necessary under the circumstances.
    ``(d)(1) Except as provided in paragraph (2), the amount paid to a 
hospice program for care furnished pursuant to subparagraph (B) or (C) 
of subsection (c)(1) may not exceed the amount that would be paid to 
that program for such care under section 1814(i) of the Social Security 
Act (42 U.S.C. 1395f(i)) if such care were hospice care for which 
payment would be made under part A of title XVIII of such Act.
    ``(2) The Secretary may pay an amount in excess of the amount 
referred to in paragraph (1) (or furnish services whose value, together 
with any payment by the Secretary, exceeds such amount) to a hospice 
program for furnishing care to a terminally ill veteran pursuant to 
subparagraph (B) or (C) of subsection (c)(1) if the Secretary 
determines, on a case-by-case basis, that--
            ``(A) the furnishing of such care to the veteran is 
        necessary and appropriate; and
            ``(B) the amount that would be paid to that program under 
        section 1814(i) of the Social Security Act would not compensate 
        the program for the cost of furnishing such care.
``Sec. 1763. Care for terminally ill veterans
    ``(a) During the period referred to in section 1762(a)(1) of this 
title, the Secretary shall designate not less than 10 medical 
facilities of the Department at which hospital care is being furnished 
to terminally ill veterans to furnish the care referred to in 
subsection (b)(1).
    ``(b)(1) Palliative care to terminally ill veterans shall be 
furnished at the facilities referred to in subsection (a) by one of the 
following means designated by the Secretary:
            ``(A) By personnel of the Department providing one or more 
        hospice care services to such veterans at or through medical 
        facilities of the Department.
            ``(B) By personnel of the Department monitoring the 
        furnishing of one or more of such services to such veterans at 
        or through non-Department facilities.
    ``(2) The Secretary shall furnish care by the means referred to in 
each of subparagraphs (A) and (B) of paragraph (1) at not less than 
five medical facilities designated under subsection (a).
``Sec. 1764. Information relating to hospice care services
    ``The Secretary shall ensure to the extent practicable that 
terminally ill veterans who have been informed of their medical 
prognosis receive information relating to the eligibility, if any, of 
such veterans for hospice care and services under title XVIII of the 
Social Security Act (42 U.S.C. 1395 et seq.).
``Sec. 1765. Evaluation and reports
    ``(a) Not later than September 30, 1994, and on an annual basis 
thereafter until October 1, 1999, the Secretary shall submit a written 
report to the Committees on Veterans' Affairs of the Senate and House 
of Representatives relating to the conduct of the pilot program under 
section 1762 of this title and the furnishing of hospice care services 
under section 1763 of this title. Each report shall include the 
following information:
            ``(1) The location of the sites of the demonstration 
        projects provided for under the pilot program.
            ``(2) The location of the medical facilities of the 
        Department at or through which hospice care services are being 
        furnished under section 1763 of this title.
            ``(3) The means by which care to terminally ill veterans is 
        being furnished under each such project and at or through each 
        such facility.
            ``(4) The number of veterans being furnished such care 
        under each such project and at or through each such facility.
            ``(5) An assessment by the Secretary of any difficulties in 
        furnishing such care and the actions taken to resolve such 
        difficulties.
    ``(b) Not later than August 1, 1997, the Secretary shall submit to 
the committees referred to in subsection (a) a report containing an 
evaluation and assessment by the Director of the Health Services 
Research and Development Service of the hospice care pilot program 
under section 1762 of this title and the furnishing of hospice care 
services under section 1763 of this title. The report shall contain 
such information (and shall be presented in such form) as will enable 
the committees to evaluate fully the feasibility and desirability of 
furnishing hospice care services to terminally ill veterans.
    ``(c) The report shall include the following:
            ``(1) A description and summary of the pilot program.
            ``(2) With respect to each demonstration project conducted 
        under the pilot program--
                    ``(A) a description and summary of the project;
                    ``(B) a description of the facility conducting the 
                demonstration project and a discussion of how such 
                facility was selected in accordance with the criteria 
                set out in, or prescribed by the Secretary pursuant to, 
                subparagraphs (A) through (D) of section 1762(b)(3) of 
                this title;
                    ``(C) the means by which hospice care services care 
                are being furnished to terminally ill veterans under 
                the demonstration project;
                    ``(D) the personnel used to furnish such services 
                under the demonstration project;
                    ``(E) a detailed factual analysis with respect to 
                the furnishing of such services, including (i) the 
                number of veterans being furnished such services, (ii) 
                the number, if any, of inpatient admissions for each 
                veteran being furnished such services and the length of 
                stay for each such admission, (iii) the number, if any, 
                of outpatient visits for each such veteran, and (iv) 
                the number, if any, of home-care visits provided to 
                each such veteran;
                    ``(F) the direct costs, if any, incurred by 
                terminally ill veterans, the members of the families of 
                such veterans, and other individuals in close 
                relationships with such veterans in connection with the 
                participation of veterans in the demonstration project;
                    ``(G) the costs incurred by the Department in 
                conducting the demonstration project, including an 
                analysis of the costs, if any, of the demonstration 
                project that are attributable to (i) furnishing such 
                services in facilities of the Department, (ii) 
                furnishing such services in non-Department facilities, 
                and (iii) administering the furnishing of such 
                services; and
                    ``(H) the unreimbursed costs, if any, incurred by 
                any other entity in furnishing services to terminally 
                ill veterans under the project pursuant to section 
                1762(c)(1)(C) of this title.
            ``(3) An analysis of the level of the following persons' 
        satisfaction with the services furnished to terminally ill 
        veterans under each demonstration project:
                    ``(A) Terminally ill veterans who receive such 
                services, members of the families of such veterans, and 
                other individuals in close relationships with such 
                veterans.
                    ``(B) Personnel of the Department responsible for 
                furnishing such services under the project.
                    ``(C) Personnel of non-Department facilities 
                responsible for furnishing such services under the 
                project.
            ``(4) A description and summary of the means of furnishing 
        hospice care services at or through each medical facility of 
        the Department designated under section 1763(a)(1) of this 
        title.
            ``(5) With respect to each such means, the information 
        referred to in paragraphs (2) and (3).
            ``(6) A comparative analysis by the Director of the 
        services furnished to terminally ill veterans under the various 
        demonstration projects referred to in section 1762 of this 
        title and at or through the designated facilities referred to 
        in section 1763 of this title, with an emphasis in such 
        analysis on a comparison relating to--
                    ``(A) the management of pain and health symptoms of 
                terminally ill veterans by such projects and 
                facilities;
                    ``(B) the number of inpatient admissions of such 
                veterans and the length of inpatient stays for such 
                admissions under such projects and facilities;
                    ``(C) the number and type of medical procedures 
                employed with respect to such veterans by such projects 
                and facilities; and
                    ``(D) the effectiveness of such projects and 
                facilities in providing care to such veterans at the 
                homes of such veterans or in nursing homes.
            ``(7) An assessment by the Director of the feasibility and 
        desirability of furnishing hospice care services by various 
        means to terminally ill veterans, including an assessment by 
        the Director of the optimal means of furnishing such services 
        to such veterans.
            ``(8) Any recommendations for additional legislation 
        regarding the furnishing of care to terminally ill veterans 
        that the Secretary considers appropriate.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by adding at the end the following:
  ``subchapter vii--hospice care pilot program; hospice care services
``1761. Definitions.
``1762. Hospice care: pilot program requirements.
``1763. Care for terminally ill veterans.
``1764. Information relating to hospice care services.
``1765. Evaluation and reports.''.
    (c) Authority To Carry Out Other Hospice Care Programs.--The 
amendments made by subsection (a) may not be construed as terminating 
the authority of the Secretary of Veterans Affairs to provide hospice 
care services to terminally ill veterans under any program in addition 
to the programs required under the provisions added by such amendments.
    (d) Authorization of Appropriations.--Funds are authorized to be 
appropriated for the Department of Veterans Affairs for the purposes of 
carrying out the evaluation of the hopice care pilot programs under 
section 1765 of title 38, United States Code (as added by subsection 
(a)), as follows:
            (1) For fiscal year 1994, $1,200,000.
            (2) For fiscal year 1995, $2,500,000.
            (3) For fiscal year 1996, $2,200,000.
            (4) For fiscal year 1997, $100,000.

SEC. 204. RURAL HEALTH-CARE CLINIC PROGRAM.

    (a) Program.--(1) Chapter 17 of title 38, United States Code, is 
amended by adding at the end of subchapter II the following:
``Sec. 1720E. Rural health-care clinics: pilot program
    ``(a) During the three-year period beginning on October 1, 1993, 
the Secretary shall conduct a rural health-care clinic program in 
States where significant numbers of veterans reside in areas 
geographically remote from existing health-care facilities (as 
determined by the Secretary). The Secretary shall conduct the program 
in accordance with this section.
    ``(b)(1) In carrying out the rural health-care clinic program, the 
Secretary shall furnish medical services to the veterans described in 
subsection (c) through use of--
            ``(A) mobile health-care clinics equipped, operated, and 
        maintained by personnel of the Department; and
            ``(B) other types of rural clinics, including part-time 
        stationary clinics for which the Secretary contracts and part-
        time stationary clinics operated by personnel of the 
        Department.
    ``(2) The Secretary shall furnish services under the rural health-
care clinic program in areas--
            ``(A) that are more than 100 miles from a Department 
        general health-care facility; and
            ``(B) that are less than 100 miles from such a facility, if 
        the Secretary determines that the furnishing of such services 
        in such areas is appropriate.
    ``(c) A veteran eligible to receive medical services through rural 
health-care clinics under the program is any veteran eligible for 
medical services under section 1712 of this title.
    ``(d) The Secretary shall commence operation of at least three 
rural health-care clinics (at least one of which shall be a mobile 
health-care clinic) in each fiscal year of the program. The Secretary 
may not operate more than one mobile health-care clinic under the 
authority of this section in any State in any such fiscal year.
    ``(e) Not later than 120 days after the date of the enactment of 
this Act, the Secretary shall submit to Congress a report on the 
Secretary's plans for the implementation of the pilot program required 
under this section.
    ``(f) Not later than December 31, 1997, the Secretary shall submit 
to Congress a report containing an evaluation of the program. The 
report shall include the following:
            ``(1) A description of the program, including information 
        with respect to--
                    ``(A) the number and type of rural health-care 
                clinics operated under the program;
                    ``(B) the States in which such clinics were 
                operated;
                    ``(C) the medical services furnished under the 
                program, including a detailed specification of the cost 
                of such services;
                    ``(D) the veterans who were furnished services 
                under the program, setting forth (i) the numbers and 
                percentages of the veterans who had service-connected 
                disabilities, (ii) of the veterans having such 
                disabilities, the numbers and percentages who were 
                furnished care for such disabilities, (iii) the ages of 
                the veterans, (iv) taking into account the veterans' 
                past use of Department health-care facilities, an 
                analysis of the extent to which the veterans would have 
                received medical services from the Department outside 
                the program and the types of services they would have 
                received, and (v) the financial circumstances of the 
                veterans; and
                    ``(E) the types of personnel who furnished services 
                to veterans under the program, including any 
                difficulties in the recruitment or retention of such 
                personnel.
            ``(2) An assessment by the Secretary of the cost-
        effectiveness and efficiency of furnishing medical services to 
        veterans through various types of rural clinics (including 
        mobile health-care clinics operated under the pilot program 
        conducted pursuant to section 113 of the Veterans' Benefits and 
        Services Act of 1988 (Public Law 100-322; 38 U.S.C. 1712 
        note)).
            ``(3) Any plans for administrative action, and any 
        recommendations for legislation, that the Secretary considers 
        appropriate.
    ``(g) For the purposes of this section, the term `Department 
general health-care facility' has the meaning given such term in 
section 1712A(i)(2) of this title.''.
    (2) The table of sections at the beginning of such chapter is 
amended by inserting after the item relating to section 1720D the 
following new item:

``1720E. Rural health-care clinics: pilot program.''.
    (b) Authorization of Appropriations.--(1) There is authorized to be 
appropriated for the Department of Veterans Affairs to carry out the 
rural health-care clinics program provided for in section 1720E of 
title 38, United States Code (as added by subsection (a)), the 
following:
            (A) For fiscal year 1994, $3,000,000.
            (B) For fiscal year 1995, $6,000,000.
            (C) For fiscal year 1996, $9,000,000.
    (2) Amounts appropriated pursuant to such authorization may not be 
used for any other purpose.
    (3) No funds may be expended to carry out the rural health-care 
clinics program provided for in such section 1720E unless expressly 
provided for in an appropriations Act.

SEC. 205. PAYMENT TO STATES OF PER DIEM FOR VETERANS RECEIVING ADULT 
              DAY HEALTH CARE.

    (a) Payment of Per Diem for Veterans Receiving Adult Day Care.--
Section 1741 of title 38, United States Code, is amended--
            (1) by inserting ``(1)'' after ``(a)'';
            (2) by redesignating paragraphs (1) and (2) as 
        subparagraphs (A) and (B), respectively; and
            (3) by adding at the end the following new paragraph (2):
    ``(2) The Secretary may pay each State per diem at a rate 
determined by the Secretary for each veteran receiving adult day health 
care in a State home, if such veteran is eligible for such care under 
laws administered by the Secretary.''.
    (b) Assistance to States for Construction of Adult Day Care 
Facilities.--(1) Section 8131(3) of title 38, United States Code, is 
amended by inserting ``adult day health,'' before ``or hospital care''.
    (2) Section 8132 of such title is amended by inserting ``adult day 
health,'' before ``or hospital care''.
    (3) Section 8135(b) of such title 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 construction 
        (other than new construction) of adult day health care 
        buildings'' before the semicolon.

SEC. 206. REVISION OF AUTHORITY ON USE OF TOBACCO PRODUCTS IN 
              DEPARTMENT FACILITIES.

    Section 526(a) of the Veterans Health Care Act of 1992 (Public Law 
102-585; 38 U.S.C. 1715 note) is amended--
            (1) in paragraph (1), by striking out ``establishes and 
        maintains--'' and inserting in lieu thereof ``may establish and 
        maintain--''; and
            (2) in paragraph (2), by striking out ``provides access'' 
        and all that follows through ``paragraph (1)'' and inserting in 
        lieu thereof ``if such an area is established, provides access 
        to the area''.

                        TITLE III--MISCELLANEOUS

              Subtitle A--Education Debt Reduction Program

SEC. 301. SHORT TITLE.

    This subtitle may be cited as the ``Department of Veterans Affairs 
Health Professionals Education Debt Reduction Act''.

SEC. 302. PROGRAM OF ASSISTANCE IN THE PAYMENT OF EDUCATION DEBTS 
              INCURRED BY CERTAIN VETERANS HEALTH ADMINISTRATION 
              EMPLOYEES.

    (a) Program.--(1) Chapter 76 of title 38, United States Code, is 
amended by adding at the end the following:

           ``SUBCHAPTER VI--EDUCATION DEBT REDUCTION PROGRAM

``Sec. 7661. Authority for program
    ``(a) The Secretary shall carry out an education debt reduction 
program under this subchapter. The program shall be known as the 
Department of Veterans Affairs Education Debt Reduction Program 
(hereafter in this chapter referred to as the `Education Debt Reduction 
Program'). The purpose of the program is to assist personnel serving in 
health-care positions in the Veterans Health Administration in reducing 
the amount of debt incurred by such personnel in completing educational 
programs that qualify such personnel for such service.
    ``(b)(1) Subject to paragraph (2), assistance under the Education 
Debt Reduction Program shall be in addition to the assistance available 
to individuals under the Educational Assistance Program established 
under this chapter.
    ``(2) An individual may not receive assistance under both the 
Education Debt Reduction Program and the Educational Assistance Program 
for the same period of service in the Department.
``Sec. 7662. Eligibility; application
    ``(a) An individual eligible to participate in the Education Debt 
Reduction Program is any individual (other than a physician or dentist) 
who--
            ``(1) serves in a position in the Veterans Health 
        Administration under an appointment under section 7402(b) of 
        this title;
            ``(2) serves in an occupation, specialty, or geographic 
        area for which the recruitment or retention of an adequate 
        supply of qualified health-care personnel is especially 
        difficult (as determined by the Secretary);
            ``(3) has pursued or is pursuing, as the case may be--
                    ``(A) a two-year or four-year course of education 
                or training at a qualifying undergraduate institution 
                which course qualified or will qualify, as the case may 
                be, the individual for appointment in a position 
                referred to in paragraph (1); or
                    ``(B) a course of education at a qualifying 
                graduate institution which course qualified or will 
                qualify, as the case may be, the individual for 
                appointment in such a position; and
            ``(4) owes any amount of principal or interest under a loan 
        or other obligation the proceeds of which were used or are 
        being used, as the case may be, by or on behalf of the 
        individual to pay tuition or other costs incurred by the 
        individual in the pursuit of a course of education or training 
        referred to in paragraph (3).
    ``(b) Any eligible individual seeking to participate in the 
Education Debt Reduction Program shall submit an application to the 
Secretary relating to such participation.
``Sec. 7663. Agreement
    ``(a) The Secretary shall enter into an agreement with each 
individual selected to participate in the Education Debt Reduction 
Program. The Secretary and the individual shall enter into such an 
agreement at the beginning of each year for which the individual is 
selected to so participate.
    ``(b) An agreement between the Secretary and an individual selected 
to participate in the Education Debt Reduction Program shall be in 
writing, shall be signed by the individual, and shall include the 
following provisions:
            ``(1) The Secretary's agreement to provide assistance on 
        behalf of the individual under the program upon the completion 
        by the individual of a one-year period of service in a position 
        referred to in section 7662(a) of this title which period 
        begins on the date of the signing of the agreement (or such 
        later date as is jointly agreed upon by the Secretary and the 
        individual).
            ``(2) The individual's agreement that the Secretary shall 
        pay any assistance provided under the program to the holder (as 
        designated by the individual) of any loan or other obligation 
        of the individual referred to in section 7662(a)(4) of this 
        title in order to reduce or satisfy the unpaid balance 
        (including principal and interest) due on such loan or other 
        obligation.
            ``(3) The individual's agreement that assistance shall not 
        be paid on behalf of the individual under the program for a 
        year unless and until the individual completes the one-year 
        period of service referred to in paragraph (1).
            ``(4) The individual's agreement that assistance shall not 
        be paid on behalf of the individual under the program for a 
        year unless the individual maintains (as determined by the 
        Secretary) an acceptable level of performance during the 
        service referred to in paragraph (3).
``Sec. 7664. Amount of assistance
    ``(a) Subject to subsection (b), the amount of assistance provided 
to an individual under the Education Debt Reduction Program for a year 
may not exceed $4,000 (adjusted in accordance with section 7631 of this 
title).
    ``(b) The total amount of assistance received by an individual 
under the Education Debt Reduction Program may not exceed $12,000 (as 
so adjusted).''.
    (2) The table of sections at the beginning of such chapter is 
amended by adding at the end the following:

           ``SUBCHAPTER VI--EDUCATION DEBT REDUCTION PROGRAM

``7661. Authority for program.
``7662. Eligibility; application.
``7663. Agreement.
``7664. Amount of assistance.''.
    (b) Conforming Amendments.--Section 7631 of title 38, United States 
Code, is amended--
            (1) in subsection (a), by striking out ``and the maximum 
        Selected Reserve member stipend amount'' and inserting in lieu 
        thereof ``the maximum Selected Reserve stipend amount, and the 
        education debt reduction amount and limitation''; and
            (2) in subsection (b)--
                    (A) by redesignating paragraph (4) as paragraph 
                (5); and
                    (B) by inserting after paragraph (3) the following 
                new paragraph (4):
            ``(4) The term `education debt reduction amount and 
        limitation' means the maximum amount of assistance, and the 
        limitation applicable to such assistance, for a person 
        receiving assistance under subchapter VI of this chapter, as 
        specified in section 7663 of this title and as previously 
        adjusted (if at all) in accordance with this subsection.''.
    (c) Regulations.--The Secretary of Veterans Affairs shall prescribe 
regulations necessary to carry out the Education Debt Reduction Program 
established under subchapter VI of chapter 76 of title 38, United 
States Code (as added by subsection (a)). The Secretary shall prescribe 
such regulations not later than 90 days after the date of the enactment 
of this Act.
    (d) Report.--Section 7632 of title 38, United States Code, is 
amended--
            (1) in the matter above paragraph (1), by inserting ``and 
        the Education Debt Reduction Program'' before the period at the 
        end;
            (2) in paragraph (1)--
                    (A) by inserting ``and the Education Debt Reduction 
                Program'' after ``Educational Assistance Program'';
                    (B) by striking out ``Program and'' and inserting 
                in lieu thereof ``Program,''; and
                    (C) by inserting ``, and the Education Debt 
                Reduction Program'' before ``separately'';
            (3) in paragraph (3), by striking out ``the Educational 
        Assistance Program (or predecessor program) has'' and inserting 
        in lieu thereof ``each of the Educational Assistance Program 
        (or predecessor program) and the Education Debt Reduction 
        Program have'';
            (4) in paragraph (4)--
                    (A) by striking out ``and per'' and inserting in 
                lieu thereof ``, per''; and
                    (B) by inserting ``, and per participant in the 
                Education Debt Reduction Program'' before the period at 
                the end.
    (e) Authorization of Appropriations.--(1) There is authorized to be 
appropriated for the Department of Veterans Affairs $10,000,000 for 
each of fiscal years 1994 through 1998 to carry out the Education Debt 
Reduction Program.
    (2) No funds may be used to provide assistance under the program 
unless expressly provided for in an appropriations Act.
    (f) Exemption From Limitation.--Section 523(b) of the Veterans 
Health Care Act of 1992 (Public Law 102-585; 38 U.S.C. 7601 note) shall 
not apply to the Education Debt Reduction Program.

                      Subtitle B--Other Provisions

SEC. 311. EXTENSION OF AUTHORITY OF ADVISORY COMMITTEE ON EDUCATION.

    Section 3692(c) of title 38, United States Code, is amended by 
striking out ``December 31, 1994'' and inserting in lieu thereof 
``December 31, 1997''.

SEC. 312. EXTENSION OF AUTHORITY TO MAINTAIN REGIONAL OFFICE IN THE 
              PHILIPPINES.

    Section 315(b) of title 38, United States Code, is amended by 
striking out ``December 31, 1994'' and inserting in lieu thereof 
``September 30, 1995''.

            Passed the Senate July 26 (legislative day, July 20), 1994.

            Attest:






                                                             Secretary.

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